Hypothyroidism in Women
|
|
- Madison Walsh
- 6 years ago
- Views:
Transcription
1 Illustration istock Collection / thinkstockphotos.com T Hypothyroidism in Women Donna Dunn Thyroid disease is a major health issue in the United States. Approximately 20 million Americans have been diagnosed or are being treated for thyroid disease (American Thyroid Association, 2015). Hypothyroidism is the second most common type of endocrine disorder affecting women of reproductive age, but it can affect women across the lifespan. The thyroid maintains metabolism and vital body functions. It is located in the anterior neck just below the larynx and is composed of two lobes that straddle the trachea. Hypothyroidism occurs when the thyroid gland does not make enough thyroid hormone. Carla Turner About Hypothyroidism In women, the risk of developing hypothyroidism increases with age and during pregnancy, the postpartum period, and menopause (Garber et al., 2012). Iodine deficiency is the most common cause of hypothyroidism worldwide (Vanderpump, 2011). The most common cause of hypothyroidism in the United States, Hashimoto s thyroiditis, results from damage to the thyroid gland caused by chronic inflammation initiated and sustained by one s own immune system (Zaletel & Gaberšček, 2011). This autoimmune Abstract Hypothyroidism, a disease in which the thyroid gland does not make enough thyroid hormone, is the second most common endocrine disorder among women. Symptoms of hypothyroidism include fatigue, weight gain, alteration in cognition, infertility, and menstrual abnormalities. The most common cause of hypothyroidism in the United States is Hashimoto s thyroiditis. The American Thyroid Association recommends an initial screening for thyroid disease at age 35 years and every 5 years thereafter. Thyroid-stimulating hormone is highly sensitive to thyroid dysfunction and is used to evaluate thyroid disorders. Monotherapy with levothyroxine is the standard for treating hypothyroidism. Diagnosing hypothyroidism requires appropriate diagnostic tests to facilitate prompt diagnosis and treatment. Keywords hypothyroidism levothyroxine pregnancy T3 T4 TSH nwhjournal.com 2016, AWHONN 93
2 reaction results in the underproduction of thyroid hormone and is 5 to 10 times more likely to occur in women than men (Garber et al., 2012). Medical treatments can also cause hypothyroidism. The treatment of certain thyroid conditions, such as thyroid cancer, goiter, and Graves disease, may require surgical removal of a portion of the thyroid gland or a thyroidectomy. If enough of the gland is removed, the thyroid is unable to produce adequate thyroid In women, the risk of developing hypothyroidism increases with age and during pregnancy, the postpartum period, and menopause hormone, resulting in hypothyroidism. Additionally, some other thyroid conditions and cancers may require treatment with radioactive iodine or external radiation, which can damage the thyroid, usually resulting in overt hypothyroidism. Some medications can cause hypothyroidism by affecting the thyroid gland s production or release of hormones. Medications such as amiodarone, interferon, and lithium have been identified as a cause of hypothyroidism (Barbesino, 2010). Pathophysiology It is important to understand the function of the thyroid and the thyroid hormones thyroidstimulating hormone (TSH), triiodothyronine (T3), and thyroxine (T4). A normally functioning thyroid uses iodine from the diet to produce T4 and T3. The pituitary gland, about the size of a peanut and located at the base of the brain, produces TSH, which stimulates the thyroid gland to produce and release T3 and T4. Through a negative feedback loop, the pituitary produces TSH if T3 and T4 levels are low. The pituitary gland is regulated by the hypothalamus. The hypothalamus detects low levels of thyroid hormones and then responds by releasing thyrotropin-releasing hormone, which stimulates the pituitary gland to produce and release TSH to facilitate the thyroid gland to produce and release T3 and T4. This interaction continues in an effort to normalize blood levels of thyroid hormones. However, during primary hypothyroidism, disruption in the feedback loop is caused by the thyroid gland s diminished secretion of hormones. Secondary hypothyroidism produces Box 1. Symptoms, Assessment, and Diagnostic Findings Donna Dunn, PhD, CNM, FNP-BC, is an assistant professor; Carla Turner, DNP, ACNP-BC, is an instructor; both authors are at the School of Nursing, University of Alabama at Birmingham in Birmingham, AL. The authors report no conflicts of interest or relevant financial relationships. Address correspondence to: DonnaDunn@uab.edu. Symptoms Depression Fatigue Weight gain Constipation Muscle cramps, arthralgias Menorrhagia Infertility Sexual dysfunction Cold intolerance Carpal tunnel syndrome Sleep disorders Assessment Findings Dry, coarse skin Reduced body and scalp hair Dull facial expression Bradycardia Goiter Macroglossia Ascites Galactorrhea Slow relaxation of tendon reflexes Nonpitting edema of lower extremities Hoarseness Diagnostic Findings Hyponatremia Macrocytic anemia Decreased memory Hyperprolactinemia Elevated creatine kinase level Pituitary gland enlargement Delayed bone age Hypercholesterolemia Sources: Gaitonde, Rowley, and Sweeney (2012); Orlander (2015). 94 Nursing for Women s Health Volume 20 Issue 1
3 Photo rob original / thinkstockphotos.com disruption in the feedback loop because of problems at the level of the pituitary gland. Diagnosis Diagnosing hypothyroidism can be challenging; clinical manifestations are not a reliable method for diagnosing hypothyroidism. Women often present with myriad symptoms that are easily attributable to other disorders or simply to normal aging (see Box 1). It is important to obtain appropriate diagnostic tests to facilitate prompt diagnosis and treatment. A health history is useful to evaluate for symptoms of hypothyroidism, past treatment for hyperthyroidism, use of drugs that influence thyroid hormones, or a history of iodine deficiency. A focused physical examination would include assessing for coarse skin, delayed ankle reflex, and bradycardia, which, in one study, showed only a modest specificity in diagnosing hypothyroidism (Indra, Patel, Joshi, Pai, & Kalantri, 2004). Therefore, clinicians must rely on diagnostic work-up, assessment, and a woman s symptoms to facilitate accurate diagnosis of hypothyroidism. Because hypothyroidism is the result of inadequate levels of thyroid hormones T3 and T4 Women often present with myriad symptoms that are easily attributable to other disorders or simply to normal aging and because the pituitary gland regulates the release of these hormones by TSH, an objective diagnosis of hypothyroidism can be confirmed with laboratory evaluation of TSH and T4 levels. The primary screening test to evaluate thyroid function measures TSH level because, if T3 and T4 levels are low, the pituitary gland produces more TSH (Garber et al., 2012). If the TSH level is elevated, the next step is to measure free T4 or the free T4 index. The T3 level is not as useful in diagnosing hypothyroidism because it is usually the last thyroid hormone to become abnormally low (Garber et al., 2012). The T3 level can also be low without thyroid abnormalities, such as during acute illness. After diagnostic laboratory data are available, it is important to determine the type and possible cause of hypothyroidism. Hypothyroidism can be characterized as primary, subclinical, February March 2016 Nursing for Women s Health 95
4 The goal of treatment is symptom relief and prevention of complications of untreated hypothyroidism and central; these types are differentiated by TSH and T4 levels (Ross, 2015). Primary hypothyroidism is defined by an elevated TSH level and a low free T4 level; this type accounts for most cases of hypothyroidism (Ross, 2015). Subclinical hypothyroidism is characterized by a normal free T4 level with an elevated TSH level. Central hypothyroidism is defined as either secondary or tertiary and is usually associated with disorders involving the pituitary (secondary) or hypothalamus (tertiary). Central hypothyroidism is defined by a low T4 level, and TSH level may be low, normal, or elevated. Primary hypothyroidism accounts for most cases. Other tests exist in addition to a thyroid function test. A specialist can evaluate for anti thyroid microsomal antibodies, such as anti thyroid peroxidase, to further determine the cause of hypothyroidism. The presence of these antibodies indicates thyroid damage has occurred that may lead to hypothyroidism. This test might be indicated in a woman with a goiter or a symptomatic woman with a normal TSH level. Symptoms associated with hypothyroidism may mimic anemia and hypoglycemia. When other diagnoses aside from hypothyroidism are suspected, clinicians should consider measuring a complete blood cell count, TSH level, and fasting blood glucose level. Differential diagnoses of hypothyroidism may include disorders such as chronic fatigue syndrome, anovulation, dysmenorrhea, hypopituitarism, chronic inflammatory diseases, or other disorders of the thyroid gland. Furthermore, clinicians should evaluate for depression, dementia, or sleep disorders because of similarity of symptomatology. Treatment Indications Women with primary hypothyroidism should be treated. Additionally, women with subclinical hypothyroidism with a TSH level greater than 10 miu/l should be treated. Treatment of women with a TSH level less than 10 miu/l should be done on a case-by-case basis (Garber et al., 2012). Subclinical hypothyroidism is likely to progress to overt hypothyroidism if left untreated. Treatment is also suggested for pregnant women with hypothyroidism and for adults younger than 70 years who have a goiter, anti thyroid peroxidase antibodies, or symptoms of hypothyroidism (Almandoz & Gharib, 2012). Photo monkeybusinessimages / thinkstockphotos.com 96 Nursing for Women s Health Volume 20 Issue 1
5 The goal of treatment is symptom relief and prevention of complications of untreated hypothyroidism. Treatment is not advised for women with symptoms of hypothyroidism without laboratory confirmation (Garber et al., 2012). Monotherapy with levothyroxine is the standard for treating hypothyroidism (Garber et al., 2012). Women with hypothyroidism should be referred to an endocrinologist for the following: (a) difficulty maintaining a euthyroid state, (b) during pregnancy, (c) when planning to become pregnant, (d) cardiac disease, (e) presence of a nodule or other abnormal thyroid structural changes, (f) presence of other endocrine abnormalities such as pituitary and adrenal disorders, and (g) unusual causes of hypothyroidism related to malabsorption of levothyroxine (Garber et al., 2012). Dosage The initial dose of levothyroxine depends on a woman s age, body mass index, and presence of illnesses such as cardiac disease. Higher levothyroxine dosages may intensify angina and should be started at a lower dosage with close monitoring to avoid overreplacement. Overreplacement of thyroid hormones increases risk for osteoporosis and atrial fibrillation. However, young healthy adults and those undergoing a full thyroidectomy usually require a full replacement dose. Special dosage considerations for women over 60 years of age and those with ischemic heart disease should start at one fourth to one half of the expected dosage (Orlander, 2015). Pregnancy increases the requirements of thyroid hormones. Higher doses of levothyroxine during pregnancy are usually necessary, and clinicians should include levothyroxine with consideration to the trimester-specific reference range (Garber et al., 2012). Additionally, because some prenatal vitamins may affect absorption of levothyroxine, it is important to counsel women to take levothyroxine 2 to 3 hours before or after taking a prenatal vitamin (Almandoz & Gharib, 2012). It is important to measure the thyroid levels in pregnant women every 6 to 8 weeks or 4 weeks after a dosing change has been made. After a woman gives birth, she typically goes back to her prepregnancy dosage of levothyroxine. Follow-up Women whose symptoms have resolved and who have a therapeutic TSH level on the prescribed dosage of levothyroxine should undergo TSH level evaluation at least every 12 months. The TSH levels should also be re-evaluated 4 to 8 weeks after initiation or alteration of the dosage of levothyroxine. Serum TSH levels should be evaluated every 4 weeks during the first half Box 2. Risk Factors for Hypothyroidism Female Age >60 years Type 1 diabetes mellitus or other autoimmune disorders Graves disease Postpartum thyroiditis Turner syndrome and Down syndrome Primary pulmonary hypertension Lithium use Family history Amiodarone use Iodine deficiency Radiologic therapy, especially to the neck area Multiple sclerosis of pregnancy and less often during the second half. Women who were being treated for hypothyroidism before pregnancy usually require two additional doses weekly of their prepregnancy dose (Orlander, 2015). Once a diagnosis of hypothyroidism is confirmed, clinicians should provide education on the potential complications if the condition is left untreated Women should receive education on the signs and symptoms of hyperthyroidism that could occur from overtreatment. These include tachycardia, palpitations, and irregular heart rate, usually caused by atrial fibrillation. If hypothyroidism is overtreated, women may experience nervousness, insomnia, tremors, and chest pain. Clinicians should provide education on the importance of medication compliance and managing missed doses. Women should not double a dose for missed doses. Once a diagnosis of hypothyroidism is confirmed, clinicians should provide Sources: American Thyroid Association (2015); Garber et al. (2012). February March 2016 Nursing for Women s Health 97
6 education on the potential complications if the condition is left untreated. Hypothyroidism can result in physical and mental abnormalities. The severity is primarily attributable to the degree of thyroid hormone deficiency. A life-threatening but rare complication of untreated hypothyroidism is myxedema coma associated with severe hypothermia, bradycardia, seizures, and decreased cardiac output eventually resulting in coma (Citkowitz, 2014). Untreated hypothyroidism during pregnancy has been associated with a higher incidence of physical and mental birth defects (Berber, 2014). Untreated hypothyroidism can cause hyperlipidemia, which can contribute to the development of coronary Nurses are in an ideal position to identify women at risk and to educate them about hypothyroidism artery disease. Some studies have suggested a higher mortality with hypothyroidism and severe heart failure (Mitchell et al., 2013). Conclusion Hypothyroidism is an endocrine disorder that disproportionately affects women. The signs and symptoms of hypothyroidism are subtle and are usually attributed to other conditions, such as depression and natural aging. There is controversy among professional organizations concerning recommendations for screening. Given the lack of data supporting population-based screening, delegates from the Endocrine Society, American Thyroid Association, and American Association of Clinical Endocrinologists arrived at a consensus. They recommended screening for groups at risk for hypothyroidism (see Box 2), including pregnant women, women older than 60 years, and those with a family history of thyroid disorders (Almandoz & Gharib, 2012). Nurses are in an ideal position to identify women at risk and to educate them about hypothyroidism. NWH References Almandoz, J., & Gharib, H. (2012). Hypothyroidism: Etiology, diagnosis, and management. The Medical Clinics of North America, 96(2), doi: /j.mcna American Thyroid Association. (2015). About hypothyroidism. Falls Church, VA: Author. Retrieved from media-main/about-hypothyroidism Barbesino, G. (2010). Drugs affecting thyroid function. Thyroid, 20(7), doi: / thy Berber, E. (2014). Complications of hypothyroidism: What may happen if the disorder is untreated. Retrieved from complications-hypothyroidism Citkowitz, E. (2014). Myxedema coma or crisis. Retrieved from article/ overview#a5 Gaitonde, D. Y., Rowley, K. D., & Sweeney, L. B. (2012). Hypothyroidism: An update. South African Family Practice, 54(5), Garber, J. R., Cobin, R. H, Gharib, H., Hennessey, J. V., Klein, I., Mechanick, J. I.,... American Association of Clinical Endocrinologists & American Thyroid Association Taskforce on Hypothyroidism in Adults. (2012). Clinical practice guidelines for hypothyroidism in adults: Cosponsored by the American Association of Clinical Endocrinologists and the American Thyroid Association. Endocrine Practice, 18(6), Indra, R., Patil, S. S., Joshi, R., Pai, M., Kalantri, S. P. (2004). Accuracy of physical examination in the diagnosis of hypothyroidism: A cross-sectional, double-blind study. Journal of Postgraduate Medicine, 50(1), Mitchell, J. E., Hellkamp, A. S., Mark, D. B., Anderson, J., Johnson, G. W., Poole, J. E.,... Bardy, G. H. (2013). Thyroid function in heart failure and impact on mortality. Journal of the American College of Cardiology, 1(1), Orlander, P. R. (2015). Hypothyroidism: Practice essentials. Retrieved from Ross, D. (2015). Diagnosis of and screening for hypothyroidism in nonpregnant adults. Retrieved from: diagnosis-of-and-screening-for-hypothyroidism -in-nonpregnant-adults?source=see_link Vanderpump, M. P. (2011). The epidemiology of thyroid disease. British Medical Bulletin, 99, doi: /bmb/ldr030 Zaletel, K., & Gaberšček, S. (2011). Hashimoto s thyroiditis: From genes to the disease. Current Genomics, 12(8), doi: / Nursing for Women s Health Volume 20 Issue 1
Thyroid Disorders. January 2019
Thyroid Disorders January 2019 What is the Thyroid? The thyroid is a small butterfly-shaped gland inside the neck, located in front of the trachea (windpipe) and below the larynx (voicebox). It produces
More informationOUTLINE. Regulation of Thyroid Hormone Production Common Tests to Evaluate the Thyroid Hyperthyroidism - Graves disease, toxic nodules, thyroiditis
THYROID DISEASE OUTLINE Regulation of Thyroid Hormone Production Common Tests to Evaluate the Thyroid Hyperthyroidism - Graves disease, toxic nodules, thyroiditis OUTLINE Hypothyroidism - Hashimoto s thyroiditis,
More informationTANJA KEMP INTERNAL MEDICINE: ENDOCRINOLOGY
ENDOCRINE DISORDERS IN THE ELDERLY (part 2) TANJA KEMP INTERNAL MEDICINE: ENDOCRINOLOGY Pituitary axis Target organs of the pituitary gland Negative feedback Hypothalamus-Pituitary-Thyroid axis Thyroid
More informationTHYROID AWARENESS. By: Karen Carbone. January is thyroid awareness month. At least 30 million Americans
THYROID AWARENESS By: Karen Carbone January is thyroid awareness month. At least 30 million Americans have a thyroid disorder and half-15 million-are silent sufferers who are undiagnosed, according to
More informationHypothyroidism. Causes. Diagnosis. Christopher Theberge
Hypothyroidism Pronunciations: (Hypothyroidism) Hypothyroidism (under active thyroid) is a condition where the thyroid gland fails to secrete enough of the thyroid hormones thyroxine (T4) and triiodothyronine
More information4) Thyroid Gland Defects - Dr. Tara
4) Thyroid Gland Defects - Dr. Tara Thyroid Pituitary Axis TRH secreted in the hypothalamus stimulates production and Secretion of TSH TSH stimulates secretion of T3, T4 T4 has negative feedback on secretion
More informationHypothyroidism. Definition:
Definition: Hypothyroidism Primary hypothyroidism is characterized biochemically by a high serum thyroidstimulating hormone (TSH) concentration and a low serum free thyroxine (T4) concentration. Subclinical
More informationBELIEVE MIDWIFERY SERVICES
TITLE: THYROID DISEASE IN PREGNANCY EFFECTIVE DATE: July, 2013 POLICY STATEMENT: Pregnancy changes significantly the values influenced by the serum thyroid binding hormone level (i.e., total thyroxine,
More informationThyroid gland defects. Dr. Tara Husain
Thyroid gland defects Dr. Tara Husain Thyroid Pituitary Axis TRH secreted in the hypothalamus stimulates production and Secretion of TSH TSH stimulates secretion of T3,T4 T4 has negative feed back on secretion
More informationHypothyroidism. National Endocrine and Metabolic Diseases Information Service
Hypothyroidism National Endocrine and Metabolic Diseases Information Service U.S. Department of Health and Human Services NATIONAL INSTITUTES OF HEALTH What is hypothyroidism? Hypothyroidism occurs when
More informationDISORDERS OF THE THYROID GLAND SIGNS, SYMPTOMS, & TREATMENT ENDOCRINE SYSTEM AT A GLANCE OBJECTIVES ANATOMY OF THE THYROID
OBJECTIVES DISORDERS OF THE THYROID GLAND SIGNS, SYMPTOMS, & TREATMENT Stephanie Blackburn, MHS, MLS(ASCP) CM LSU Health Shreveport Clinical Laboratory Science Program Discuss the synthesis and action
More informationSanjay B. Dixit, M.D. BHS Endocrinology Associates November 11, 2017
Sanjay B. Dixit, M.D. BHS Endocrinology Associates November 11, 2017 I will not be discussing this Outline of discussion Laboratory tests for thyroid function Diagnosis of hypothyroidism Treatment of
More informationDisorders of the Thyroid Gland
Disorders of the Thyroid Gland István Takács MD., PhD, 1st Department of Medicine, Semmelweis University Connection to the dentistry: close to each other higher operation risk radiating pain macroglossia
More informationBarns Medical Practice Service Specification Outline: Hypothyroidism
Barns Medical Practice Service Specification Outline: Hypothyroidism DEVELOPED March 2015 REVIEW August 2019 Introduction The thyroid is a gland in the neck which makes two thyroid hormones, thyroxine
More informationB-Resistance to the action of hormones, Hormone resistance characterized by receptor mediated, postreceptor.
Disorders of the endocrine system 38 Disorders of endocrine system mainly are caused by: A-Deficiency or an excess of a single hormone or several hormones: - deficiency :can be congenital or acquired.
More informationuniversity sciences of Isfahan university Com
Introduce R. Gholamnezhad Lecturer of school of nursing & midwifery of Iran university Ph.D student tof Immunology, Sh School of medical sciences of Isfahan university E-Mail: Gholami278@gmail. Com Interpreting
More informationHYPOTHYROIDISM AND HYPERTHYROIDISM
HYPOTHYROIDISM AND HYPERTHYROIDISM SHAHIDA PERVEEN, AMBREEN Post RN BSCN Semester II FACULTY SIR RAJA April 13, 016 Objectives: State the functions of thyroid hormone. Understand the pathologic mechanism
More informationTHE THYROID GLAND AND YOUR HEALTH
THE THYROID GLAND AND YOUR HEALTH Your Thyroid is a gland located at the base of your neck, just below your Adam s apple. It is shaped like a butterfly each wing or lobe, of your thyroid lies on either
More informationCommon Issues in Management of Hypothyroidism
Common Issues in Management of Hypothyroidism Family Medicine Refresher Course April 5, 2018 Janet A. Schlechte, M.D. Disclosure of Financial Relationships Janet A. Schlechte, M.D. has no relationships
More informationHYPERTHYROIDISM. Hypothalamus. Thyrotropin-releasing hormone (TRH) Anterior pituitary gland. Thyroid-stimulating hormone (TSH) Thyroid gland T4, T3
HYPERTHYROIDISM Hypothalamus Thyrotropin-releasing hormone (TRH) Anterior pituitary gland Thyroid-stimulating hormone (TSH) Thyroid gland T4, T3 In hyperthyroidism, there is an increased production of
More informationNone. Thyroid Potpourri for the Primary Care Physician. Evaluating Thyroid Function. Disclosures. Learning Objectives
Thyroid Potpourri for the Primary Care Physician Ramya Vedula DO, MPH, ECNU Endocrinology, Diabetes and Metabolism Princeton Medical Group Assistant Professor of Clinical Medicine Rutgers Robert Wood Johnson
More informationVirginia ACP Clinical Update Thyroid Clinical Pearls. University of Virginia. Richard J. Santen MD
Virginia ACP Clinical Update Thyroid Clinical Pearls University of Virginia Richard J. Santen MD Goal Provide a guide to frequently encountered problems in thyroid disease Follow my approach to recently
More informationThyroid disorders. Dr Enas Abusalim
Thyroid disorders Dr Enas Abusalim Thyroid physiology The hypothalamic pituitary thyroid axis And peripheral conversion of T4 to T3, WHERE, AND BY WHAT ENZYME?? Only relatively small concentrations of
More information03-Dec-17. Thyroid Disorders GOITRE. Grossly enlarged thyroid - in hypothyroidism in hyperthyroidism - production of anatomical symptoms
Thyroid Disorders GOITRE Grossly enlarged thyroid - in hypothyroidism in hyperthyroidism - production of anatomical symptoms 1 Physiological Goiter load on thyroid supply of I - limited stress due to:
More informationEffect of thyroid hormones of metabolism Thyroid Diseases
Effect of thyroid hormones of metabolism Thyroid Diseases Medical Perspective Aspects That Will Be Addressed Regulation of thyroid hormone secretion Basic physiology Hyperthyroidism Hypothyroidism Thyroiditis
More informationSouthern Derbyshire Shared Care Pathology Guidelines. Hypothyroidism
Southern Derbyshire Shared Care Pathology Guidelines Hypothyroidism Purpose of Guideline The management and referral criteria of patients with newly diagnosed hypothyroidism in adults. Background Hypothyroidism
More informationThe Number Games and Thyroid Function Arshia Panahloo Consultant Endocrinologist St George s Hospital
The Number Games and Thyroid Function Arshia Panahloo Consultant Endocrinologist St George s Hospital Presentation Today: Common thyroid problems and treatments Pregnancy related thyroid problems The suppressed
More informationProject Title: Effectiveness of Screening and Treatment of
Project Title: Effectiveness of Screening and Treatment of Subclinical Hypo- or Hyperthyroidism Prepared for: Agency for Healthcare Research and Quality U.S. Department of Health and Human Services 0 Gaither
More informationApproach to thyroid dysfunction
Approach to thyroid dysfunction Alice Y.Y. Cheng, MD, FRCPC Twitter: @AliceYYCheng Copyright 2017 by Sea Courses Inc. All rights reserved. No part of this document may be reproduced, copied, stored, or
More informationThyroid Disorders Towards a Healthy Endocrine System
Thyroid Disorders Towards a Healthy Endocrine System What are Thyroid Disorders? The thyroid is a butterfly-shaped gland in the middle of the lower neck. Through the release of hormones, the thyroid regulates
More informationThyroid Gland. Patient Information
Thyroid Gland Patient Information Contact details for Endocrine and Thyroid Clinics Hawke s Bay Fallen Soldiers Memorial Hospital Villa 16 Phone: 06 8788109 ext 5891 Text: 0274 102 559 Email: endoclinic@hbdhb.govt.nz
More informationUnderactive Thyroid. Diagnosis, Treatment & Controversies
Underactive Thyroid Diagnosis, Treatment & Controversies Dr. Asif Malik Humayun Consultant Endocrinologist Milton Keynes University Hospital NHS Foundation Trust Thyroid Hormone Control of metabolism
More informationGraves Disease in Pediatrics
Graves Disease in Pediatrics Graves disease is a common cause of an overactive thyroid. It occurs in about 1 in 5000 children and teens. It occurs more often in females than males. This booklet is designed
More informationThyroid Disorders. Hypothyroidism. Low Total T4 Antiseizure meds Glucocorticoids. Free T4. Howard J. Sachs, MD.
Thyroid Disorders Free T4 Low Total T4 Antiseizure meds Glucocorticoids Hypothyroidism Howard J. Sachs, MD www.12daysinmarch.com Primary Hypothyroidism High TSH Low free T4 Primary = End organ failure
More informationRequesting and Management of abnormal TFTs.
Requesting and Management of abnormal TFTs. At the request of a number of GPs I have produced summary guidelines surrounding thyroid testing. These have been agreed with our Endocrinology leads Dr Bell
More informationYour Thyroid By Lawrence C. F Wood M.D., Chester Ridgway READ ONLINE
Your Thyroid By Lawrence C. F Wood M.D., Chester Ridgway READ ONLINE The thyroid is a gland located below the larynx (voice box), and its function is to regulate metabolism. Metabolism is the chemical
More informationThyroid Disorders: Patient Education on Hypothyroidism and Hyperthyroidism
Thyroid Disorders: Patient Education on Hypothyroidism and Hyperthyroidism Nisreen Mourad, PharmD, MSc Clinical Assistant Professor School of Pharmacy Lebanese International University Disclosure Nisreen
More informationCommon Causes of Hypothyroidism
Common Causes of Hypothyroidism Autoimmune thyroidi4s Surgical removal of thyroid gland Medica4on Therapy Iodine and iodine containing medica4ons Neck radia4on Post Partum thyroidi4s Prevalence of Hypothyroidism
More informationStudy of signs and symptoms of cardiovascular involvement in thyroid diseases.
Original article: Study of signs and symptoms of cardiovascular involvement in thyroid diseases. 1Dr.P.K.Satpathy, 2 Dr.Anil Katdare, 3 Dr.Sridevi, 4 Dr.Ranjeet Patil 1MD Medicine Professor, Department
More informationLecture title. Name Family name Country
Lecture title Name Family name Country Nguyen Thy Khue, MD, PhD Department of Endocrinology HCMC University of Medicine and Pharmacy, MEDIC Clinic Hochiminh City, Viet Nam Provided no information regarding
More informationSummary of Treatment Benefits Page 72 of 111. Page 72
1.8.2 Page 72 of 111 Page 72 need surgery to remove part or all of the thyroid gland. This procedure is known as a thyroidectomy (removal of thyroid gland), and is followed by life-long intake of levothyroxine.
More informationTHE THYROID BOOK. Medical and Surgical Treatment of Thyroid Problems
THE THYROID BOOK Medical and Surgical Treatment of Thyroid Problems Trouble with Your Thyroid Gland The thyroid is a small gland in your neck that plays a big role in how your body functions. It impacts
More informationTargeted Issues in Endocrinology Joshua S. Coren, DO, MBA, FACOFP
Targeted Issues in Endocrinology Joshua S. Coren, DO, MBA, FACOFP Endocrine in 25 Minutes Joshua S. Coren, D.O., MBA, FACOFP Vice Chair and Associate Professor, Family Medicine Rowan University School
More informationGoiter. This reference summary explains goiters. It covers symptoms and causes of the condition, as well as treatment options.
Goiter Introduction The thyroid gland is located at the base of your neck. If the gland becomes abnormally enlarged, it is called a goiter. Goiters usually do not cause pain. But a large goiter could cause
More informationThyroid and Antithyroid Drugs. Munir Gharaibeh, MD, PhD, MHPE Faculty of Medicine April 2014
Thyroid and Antithyroid Drugs Munir Gharaibeh, MD, PhD, MHPE Faculty of Medicine April 2014 Anatomy and histology of the thyroid gland Located in neck adjacent to the 5 th cervical vertebra (C5). Composed
More informationHow to manage hypothyroid disease in pregnancy
For mass reproduction, content licensing and permissions contact Dowden Health Media. FIRST OF 2 PARTS How to manage hypothyroid disease in pregnancy Pregnancy complicated by hypothyroidism puts mother
More informationDisorders of Thyroid Function
Disorders of Thyroid Function Michael T. McDermott MD Director, Endocrinology and Diabetes Practice University of Colorado Hospital Michael.mcdermott@ucdenver.edu Thyroid Hormone Axis Hypothalamus TRH
More informationGraves Disease. What is Graves disease?
Graves Disease What is Graves disease? The thyroid gland s production of thyroid hormones (T 3 and T 4 ) is triggered by thyroidstimulating hormone (TSH), which is made by the pituitary gland. Graves disease,
More informationCHAPTER-II Thyroid Diseases. by: j. jayasutha lecturer department of Pharmacy practice Srm college of pharmacy srm university
CHAPTER-II Thyroid Diseases by: j. jayasutha lecturer department of Pharmacy practice Srm college of pharmacy srm university Aspects That Will Be Addressed Hyperthyroidism Hypothyroidism Thyroiditis Hyperthyroidism
More informationThyroid Function TSH Analyte Information
Thyroid Function TSH Analyte Information 1 2013-05-01 Thyroid-stimulating hormone (TSH) Introduction Thyroid-stimulating hormone (thyrotropin, TSH) is a glycoprotein with molecular weight of approximately
More informationSCREENING FOR THYROID DYSFUNCTION U S P S T F R E C O M M E N D A T I O N S T A T E M E N T M A R I A S T U R L A 8 M A Y 2015
SCREENING FOR THYROID DYSFUNCTION U S P S T F R E C O M M E N D A T I O N S T A T E M E N T M A R I A S T U R L A 8 M A Y 2015 BACKGROUND Thyroid dysfunction represents a continuum from asymptomatic biochemical
More informationGOITER and Shortness of Breath. Case A: GOITER. Learning Objectives. Common Thyroid Disorders for
2:25 3:05pm Diagnosing and Treating Thyroid Disorders SPEAKER John Tayek, MD Presenter Disclosure Information The following relationships exist related to this presentation: John Tayek, MD, serves on the
More informationThe Thyroid: No mystery. Just need all the pieces to the puzzle.
The Thyroid: No mystery. Just need all the pieces to the puzzle. Todd Chennell, MS, RN ANP-C Endocrine surgery University of Rochester 2018 1 According to the American Thyroid Association, 12 percent of
More informationThyroid Gland 甲状腺. Huiping Wang ( 王会平 ), PhD Department of Physiology Rm C541, Block C, Research Building, School of Medicine Tel:
Thyroid Gland 甲状腺 Huiping Wang ( 王会平 ), PhD Department of Physiology Rm C541, Block C, Research Building, School of Medicine Tel: 88208292 Outline Thyroid Hormones Types Biosynthesis Storage and Release
More informationSome Issues in the Management of Hypothyroidism
Some Issues in the Management of Hypothyroidism Family Medicine Refresher Course April 6, 2016 Janet A. Schlechte, M.D. Disclosure of Financial Relationships Janet A. Schlechte, M.D. has no relationships
More informationThe Presence of Thyroid Autoantibodies in Pregnancy
The Presence of Thyroid Autoantibodies in Pregnancy Dr. O Sullivan does not have any financial relationships with any commercial interests. KATIE O SULLIVAN, MD FELLOW, ADULT/PEDIATRIC ENDOCRINOLOGY ENDORAMA
More informationTHYROID DISEASE IN PREGNANCY
THYROID DISEASE IN PREGNANCY https://www.wddty.com/magazine/2016/june/depression-its-not-your-brain-its-your-thyroid.html Grand Rounds December 5, 2018 Maria Kolojeski, DO (PGY3) REVIEW OF THYROID HORMONES
More informationEndocrine part two. Presented by Dr. Mohammad Saadeh The requirements for the Clinical Chemistry Philadelphia University Faculty of pharmacy
Endocrine part two Presented by Dr. Mohammad Saadeh The requirements for the Clinical Chemistry Philadelphia University Faculty of pharmacy Cushing's disease: increased secretion of adrenocorticotropic
More informationPathophysiology of Thyroid Disorders. PHCL 415 Hadeel Alkofide April 2010
Pathophysiology of Thyroid Disorders PHCL 415 Hadeel Alkofide April 2010 1 Learning Objectives Understand the pathophysiology of hyperthyroidism & hypothyroidism Describe the signs & symptoms of hyperthyroidism
More information2014 NATIONAL COVERAGE DETERMINATION (NCD) CPT CODE(S): 84436, 84439, 84443, THYROID TESTING DESCRIPTION
017.50-017.56 Tuberculosis of the thyroid gland 183.0 Malignant neoplasm of ovary 193 Malignant neoplasm of thyroid gland 194.8 Malignant neoplasm of other endocrine glands and related structures 198.89
More informationSample Type - Serum Result Reference Range Units. Central Thyroid Regulation Surrey & Activity KT3 4Q. Peripheral Thyroid D Function mark
Thyroid Plus Sample Type - Serum Result Reference Range Units Central Thyroid Regulation Surrey & Activity KT3 4Q Total Thyroxine (T4)
More informationHORMONES OF THE POSTERIOR PITUITARY
HORMONES OF THE POSTERIOR PITUITARY HORMONES OF THE POSTERIOR PITUITARY In contrast to the hormones of the anterior lobe of the pituitary, those of the posterior lobe, vasopressin and oxytocin, are not
More informationThyroid Problems after Cancer Treatment
Thyroid Problems after Cancer Treatment Some people who were treated for cancer during childhood may develop endocrine (hormone) problems as a result of changes in the function of a complex system of glands
More informationHyperthyroidism. Objectives. Clinical Manifestations. Slide 1. Slide 2. Slide 3. Implications for Primary Care. hyperthyroidism
1 Hyperthyroidism Implications for Primary Care Laura A. Ruby, DNP, CRNP Wellspan Endocrinology 2 Objectives! Discuss the clinical manifestations of hyperthyroidism! Review the use of the diagnostic studies!
More informationHolistic Medicine for the 21 st Century
Holistic Medicine for the 21 st Century David Brownstein, M.D. Center for Holistic Medicine 5821 W. Maple Rd. Ste. 192 West Bloomfield, MI 48322 248.851.1600 www.drbrownstein.com Overcoming Thyroid Disorders
More informationHyperthyroidism Diagnosis and Treatment. April Janet A. Schlechte, M.D.
Hyperthyroidism Diagnosis and Treatment Family Practice Refresher Course April 2015 Janet A. Schlechte, M.D. Disclosure of Financial Relationships Janet A. Schlechte, M.D. has no relationships with any
More informationDecoding Your Thyroid Tests and Results
Decoding Your Thyroid Tests and Results Wondering about your thyroid test results? Learn about each test and what low, optimal, and high results may mean so you can work with your doctor to choose appropriate
More informationHypothyroidism in pregnancy. Nor Shaffinaz Yusoff Azmi Jabatan Perubatan Hospital Sultanah Bahiyah Kedah
Hypothyroidism in pregnancy Nor Shaffinaz Yusoff Azmi Jabatan Perubatan Hospital Sultanah Bahiyah Kedah Agenda 1. Epidemiology and clinical characteristics of maternal hypothyroidism 2. Prevention and
More informationReference intervals are derived from the statistical distribution of values in the general healthy population.
Position Statement Subject: Thyroid Function Testing for Adult Diagnosis and Monitoring Approval Date: July 2017 Review Date: July 2019 Review By: Chemical AC, Board of Directors Number: 1/2017 Introduction:
More informationEndocrine system pathology
Endocrine system pathology Central endocrine system peripheral endocrine system: thyroid gland parathyroid gland pancreas adrenal glands Thyroid gland. the weight of normal thyroid gland is about 15 grams.
More informationUpdates in Thyroid Disease. Thyroid Outline. Thyroid 10/5/2015. Leila Wing, MD. Endocrinology, Diabetes, and Metabolism
Updates in Thyroid Disease Leila Wing, MD Endocrinology, Diabetes, and Metabolism Background Hypothyroidism Hyperthyroidism Thyroid nodules Thyroid Cancer Conclusions Resources/References Thyroid Outline
More informationHYPOTHYROIDISM IN CHILDREN. IAP UG Teaching slides
HYPOTHYROIDISM IN CHILDREN 1 OBJECTIVES Introduction Congenital hypothyroidism Etiology, clinical features, diagnosis, approach, treatment and prognosis Acquired hypothyroidism Etiology, clinical features,
More informationVOLUME - XIII ISSUE - LXXVI JUL/AUG 2016
VOLUME - XIII ISSUE - LXXVI JUL/AUG 2016 1 2 9 11 12 15 Editorial Disease Diagnosis Interpretation Bouquet Trouble Shooting Tulip News Hypothyroidism, also called underactive thyroid or low thyroid, is
More informationDiseases of thyroid & parathyroid glands (1 of 2)
Diseases of thyroid & parathyroid glands (1 of 2) Thyroid diseases Thyrotoxicosis Hypothyroidism Thyroiditis Graves disease Goiters Neoplasms Chronic Lymphocytic (Hashimoto) Thyroiditis Subacute Granulomatous
More informationAnaesthesia In Thyroid Disorder. Dr. Umme Salma Ayesha Hoque MBBS, DA Medical Officer Department of Anaesthesiology and SICU BIRDEM General Hospital
Anaesthesia In Thyroid Disorder Dr. Umme Salma Ayesha Hoque MBBS, DA Medical Officer Department of Anaesthesiology and SICU BIRDEM General Hospital Anatomy Endocrine gland : Consist of two lobe Located
More informationHypothyroidism (Low Levels of Thyroid Hormone) Basics
Glendale Animal Hospital 623-934-7243 www.familyvet.com Hypothyroidism (Low Levels of Thyroid Hormone) Basics OVERVIEW Clinical condition that results from inadequate production and release of thyroid
More informationChapter 43. Endocrine System. Negative Feedback. Hypothalamus and Pituitary Glands
Chapter 43 Drugs for Pituitary, Thyroid, and Adrenal Disorders Endocrine System Consists of glands that secrete hormones Maintains homeostasis using hormones as chemical messengers Secreted in response
More informationThyroid Plus. Central Thyroid Regulation & Activity. Peripheral Thyroid Function. Thyroid Auto Immunity. Key Guide. Patient: DOB: Sex: F MRN:
Thyroid Plus Patient: DOB: Sex: F MRN: Order Number: Completed: Received: Collected: Sample Type - Serum Result Reference Range Units Central Thyroid Regulation & Activity Total Thyroxine (T4) 127 127
More informationNon Thyroid Surgery. In patients with Thyroid disorders
Non Thyroid Surgery In patients with Thyroid disorders The Thyroid disease problem. Is Thyroid disease a problem with anaesthetic? Why worry? The Physiology The evidence. A pragmatic approach From: The
More informationThyroid Disease in Cardiovascular Patients
Thyroid Disease in Cardiovascular Patients Stuart R. Chipkin, MD Research Professor, School of Public Health and Health Sciences University of Massachusetts Disclosure Stuart R. Chipkin, MD Nothing to
More informationPart I Initial Office Visit. Questions NATIONAL CENTER FOR CASE STUDY TEACHING IN SCIENCE
Thyroid Troubles: A Case Study in Negative Feedback Regulation by Breanna N. Harris Department of Biological Sciences Texas Tech University, Lubbock, TX Part I Initial Office Visit You are six months into
More informationCHECK YOUR BODY S CONTROL PANEL A USER MANUAL TO HELP YOU UNDERSTAND AND LOOK AFTER YOUR THYROID GLAND
CHECK YOUR BODY S CONTROL PANEL A USER MANUAL TO HELP YOU UNDERSTAND AND LOOK AFTER YOUR THYROID GLAND THE THYROID GLAND YOUR BODY S CONTROL PANEL When the body s control panel is working too hard or too
More informationWho is this leaflet for? What is hyperthyroidism? What is the thyroid gland? What causes hyperthyroidism? How is hyperthyroidism diagnosed?
Hyperthyroidism Who is this leaflet for? This leaflet is for patients who have been diagnosed with hyperthyroidism. It aims to give you some background information about the condition, its causes and the
More informationPathophysiology of the th E d n ocr i ne S S t ys em B. Marinov, MD, PhD Endocrine system Central: Hypothalamus
Pathophysiology of the Endocrine System B. Marinov, MD, PhD Pathophysiology Department Medical University of Plovdiv Endocrine system Central: Hypothalamus Pituitary Pineal Peripheral Thymus Thyroid Parathyroid
More informationAn overview of the disease epidemiology of the four indications of levothyroxine is provided in this section.
Page 85 VI.2 VI.2.1 Elements for a Public Summary Overview of Disease Epidemiology An overview of the disease epidemiology of the four indications of levothyroxine is provided in this section. Levothyroxine
More informationThyroid Hormones Exophthalmos GOITRE / GOITER Hyperthyroidism GOITRE / GOITER Endemic Goiter, a Hypertrophy of the Thyroid Gland Resulting from Iodine Deficiency ENDEMIC GOITRES: were common in Central
More informationInstructor s Manual Chapter 28 Endocrine Alterations. 1. Which of the following is an example of a negative feedback system?
1 Instructor s Manual Chapter 28 Endocrine Alterations Answers to Study Questions 1. Which of the following is an example of a negative feedback system? a. Hypothalamus secretes ACTH, stimulating the anterior
More informationAmiodarone Induced Thyrotoxicosis Treatment? (AIT)
Amiodarone Induced Thyrotoxicosis Treatment? (AIT) Presentation of a Case Report Annelies Tonnelier Brigitte Velkeniers 14-12-2013 1 1. Background 1. Case report 2. Investigations 3. Diagnosis 4. Treatment
More informationHormones by location
Endocrine System Hormones by location Pineal Gland: Melatonin Feeling of sleepiness Hypothalamus: Hormones that stimulate or inhibit pituitary Temp., hunger, parenting attachment, thirst Pituitary Gland:
More informationSouthern Derbyshire Shared Care Pathology Guidelines. Hyperthyroidism
Southern Derbyshire Shared Care Pathology Guidelines Hyperthyroidism Purpose of Guideline The management and referral criteria of patients with newly diagnosed hyperthyroidism. Background Hyperthyroidism
More informationPage 1. Understanding Common Thyroid Disorders. Cases. Topics Covered
Cases Understanding Common Thyroid Disorders Douglas C. Bauer, MD UCSF Division of General Internal Medicine No Disclosures 66 yr old female with 1 yr of fatigue and lassitude and no findings except TSH=8.2,
More informationKYAMC Journal Vol. 7, No.-1, July Hypothyroidism - A New View On An Old Disease
Review Article Hypothyroidism - A New View On An Old Disease Islam MI 1, Ali MZ 2, Islam MS 3, Solayman M 4, Hoque S 5 Abstract Hypothyroidism is a common disorder of the endocrine system in which the
More informationTHE THYROID. Your thyroid evaluation may include the following:
An endocrinologist is a doctor specially trained to diagnose and treat diseases affecting your glands. Glands are small organs that produce hormones, which are substances that help control various activities
More informationLESSON ASSIGNMENT. Thyroid, Antithyroid, and Parathyroid Preparations. After completing this lesson, you should be able to:
LESSON ASSIGNMENT LESSON 7 Thyroid, Antithyroid, and Parathyroid Preparations. LESSON ASSIGNMENT Paragraphs 7-1 through 7-12. LESSON OBJECTIVES After completing this lesson, you should be able to: 7-1.
More informationThyroid and Antithyroid Drugs. Dr. Alia Shatanawi Feb,
Thyroid and Antithyroid Drugs Dr. Alia Shatanawi Feb, 24 2014 Anatomy and histology of the thyroid gland Located in neck adjacent to the 5 th cervical vertebra (C5). Composed of epithelial cells which
More informationBalancing Hormone Function in Women By Meghna Thacker, NMD
Balancing Hormone Function in Women By Meghna Thacker, NMD Hormone function is central to health and well being in both men as well as women. A problem encountered with any one endocrine gland can lead
More informationThe Endocrine System
The Endocrine System Endocrine Glands Glands that secrete their products (HORMONES) into extracellular spaces around cells. The hormones then enter into the bloodstream by diffusing into the capillaries
More informationMastering Thyroid Disorders. Douglas C. Bauer, MD UCSF Division of General Internal Medicine
Mastering Thyroid Disorders Douglas C. Bauer, MD UCSF Division of General Internal Medicine Cases 68 yr old female with new atrial fibrillation and no other findings except TSH=0.04, normal free T4 79
More informationCase Vignette Tatiana Ramage, MD PGY2. 3/24/18 Northern California Psychiatric Society Annual Meeting
Case Vignette Tatiana Ramage, MD PGY2 3/24/18 Northern California Psychiatric Society Annual Meeting HPI 70 yo woman with history of wellcontrolled schizophrenia Erratic behavior, confused Previously stable
More informationManagement of Common Thyroid Disorders
Cases Management of Common Thyroid Disorders Douglas C. Bauer, MD UCSF Division of General Internal Medicine No Disclosures 68 yr old female with new atrial fibrillation and no other findings except TSH=0.04,
More information