Management of Common Thyroid Disorders

Size: px
Start display at page:

Download "Management of Common Thyroid Disorders"

Transcription

1 Management of Common Thyroid Disorders Douglas C. Bauer, MD UCSF Division of General Internal Medicine No Disclosures

2 Cases 68 yr old woman with new atrial fibrillation and no other findings except TSH=0.04, normal free T4 79 yr old woman with 1 yr of fatigue and lassitude and no findings except TSH=9.0, anti-tpo positive 45 yr old woman, enlarged thyroid with dominant nodule since 1999, FNA benign. On T4 suppression ever since, TSH=0.1

3 Topics Covered Rational use of thyroid tests Subclinical thyroid disease What can to wrong? Too much Too little Too big Screening for dysfunction

4

5 Thyroid Tests: stsh Very sensitive to circulating thyroid hormone levels Excellent correlation with TRH stimulation (stsh( < 0.1) Requires intact pituitary-hypothalamic axis; 4-66 weeks to equilibrate Falsely low: severe illness, corticosteriods,, dopamine Normal range mu/l; $58

6 TSH: What Is the Upper Limit of Normal Over Age 80? miu/l miu/l miu/l miu/l 25% 25% 25% 25% miu/l 6.0 miu/l 7.5 miu/l 8.5 miu/l

7 Normal TSH in NHANEs TSH values skewed upwards in elderly: Normal or disease? NHANEs: >13,000 people 12 to 80+ years Exclude anyone with known thyroid disease or drugs that could effect TSH Median TSH 1.39 miu/l 97.5 th Percentile: < 60 around 4.0 miu/l up to 4.3 miu/l up to 5.9 miu/l 80+ up to 7.5 miu/l Surks et al, Arch Int Med, 2007

8 Thyroid Tests: Free Thyroxine Measures unbound hormone Replacing index assays Gold standard: Equilibrium dialysis Other immunoassays: Improving Normal range, pmol/l; $64

9 Are Both stsh and Free T4 Necessary? American Thyroid Association says Yes Others recommend stsh first Simultaneous ordering common in clinical practice UCSF outpatient data Results when both tests ordered on the same specimen (N=3143) Each test classified as low, normal or high Bauer et al, Amer J Med, 1998

10 Diagnostic Redundancy of stsh and Free T4 Free T4 (pmol/l) stsh (miu/l) < > 5.5 < >

11 Subclinical Thyroid Disease Subclinical hypothyroidism Abnormally high sensitive TSH and normal thyroid hormone levels Subclinical hyperthyroidism Abnormally low sensitive TSH and normal thyroid hormone levels

12 Suggested Testing Strategy If stsh is normal, STOP If stsh is low, measure T4, consider T3 If stsh is high, measure T4, consider TPO antibodies

13 Thyroid Antibodies Anti-thyroperoxidase thyroperoxidase,, TPO (titer<100, $78) Similar to anti-microsomal Most sensitive thyroid autoantibody Specificity a problem TSH receptor antibody (absent, $112) Causes Grave s s disease Rarely found in normal individuals

14 Thyroid Scans Technetium 99 ($450) Low radiation, quick Useful for nodules in some circumstances Useful to determine cause of hyperthyroidism High uptake: Grave s, toxic nodule Low uptake: thyroiditis, thyroxine use

15 Hyperthyroidism: Epidemiology Etiology: Iatrogenic Over replacement (30-50% given rx) Suppression of CA, goiters, and nodules Autoimmune (Grave s s disease): thyroid stimulating autoantibodies Autonomous nodule(s). Occasionally T3 TSH secreting tumors

16 Hyperthyroidism: Prevalence Population based prevalence of suppressed TSH: Author age men women Bagchi (1990) >55 1.8% 2.7% Falkenberg (1991) >60 1.9% Parle (1991) > % Bauer (1993) >55 5.8%

17

18 Crook s Index* Symptom/Sign Present Absent Palpitation +2 0 Cold prefer Hyperkinetic +4-2 Weight loss +3 0 Lid lag +1 0 *hyperthyroid if 10 or more

19 Overt Hyperthyroidism in the Elderly Weight loss, palpitations, and nervousness less common Tachycardia, exophthalmos, tremor less common Atrial fibrillation more common 8-10% are completely asymptomatic

20 Subclinical Hyperthyroidism Does NOT Cause Which of the Following? 1. Reduced exercise tolerance 2. Fractures 3. Anxiety 4. Atrial fibrillation 25% 25% 25% 25% Reduced exercise toler... Fractures Anxiety Atrial fibrillation 10

21 Subclinical Hyperthyroidism: Cardiac Effects Systolic time intervals shortened Clinical significance uncertain Reduced exercise tolerance Increased incidence of atrial fibrillation Prospective cohort, N = 2000 RR = 3.1 (1.7, 5.5) if stsh < 0.1 Swain et al, Jama, 1994

22 Subclinical Hyperthyroidism: Skeletal Effects Florid hyperthyroidism causes fractures Effect on BMD, bone loss controversial Increased fracture risk - Prospective study, 9407 older women - TSH < 0.1 vs. normal - Hip fracture: RR = 3.6 (1.0, 12. 9) - Vertebral fracture: RR = 4.5 (1.3, 15.6) Effect of accelerated bone turnover? Bauer et al, Ann Int Med, 2001

23 Subclinical Hyperthyroidism: Natural History Exogenous (iatrogenic): Persists unless dose reduced Endogenous: 2024 untreated adults, two TSH<0.4 Most persist at 2 (82%) and 5 yr. (67%) Lower TSH at baseline persists Few progress to overt (<1%) Valdiveloo et al, JCEM, 2011

24 Who Should Be Treated? Exogenous (iatrogenic) Dose reduction unless contraindicated Endogenous (subclinical) Repeat and follow if uncomplicated Consider treatment as if overt when TSH<0.1 and atrial fibrillation or osteoporosis present Endogenous (overt) Rule out thyroiditis. They get beta blocker Everyone else gets beta blocker and... Endocrine Society Guidelines, JCEM, 2011

25 Hyperthyroidism: Treatment Anti-thyroid thyroid drugs (PTU and methimazole) Remission: 30-50% after mo Side effects: rash, fever, arthritis, agranulocytosis (all rare) Radioiodine Best treatment for hot nodules Remission: everyone Side effects: transient thyroiditis (rare), hypothyroid (50%), worsening exophthalmous Endocrine Society Guidelines, JCEM, 2011

26

27 Radioiodine and Mortality? Administrative database in the UK hyperthyroid pts, 15 yr follow-up - All cause mortality: 13% higher than age and sex matched populations - CV deaths increased, but not cancer Mechanism unknown, but clear dose- response Unable to adjust for other potential confounders Franklyn et al, 1998

28 Hypothyroidism: Epidemiology Etiology Autoimmune (Hashimoto s) s) Iodine deficiency Iatrogenic A. Radioiodine/ surgery B. Drugs (lithium, amiodarone) Pituitary/ hypothalamic disease

29 Hypothyroidism: Prevalence Population based prevalence of elevated TSH: Author Age Men Women Tunbridge(1977) >65 6.0% 10.9% Bagchi(1990) >55 1.8% 2.7% Parle(1991) >60 2.9% 11.6% Bauer(1993) >55 5.4%

30

31 Billewicz Index* Symptom/Sign Present Absent Bradykinesia Cold interance +4-5 Coarse skin +7-7 Pulse < Delayed AJ *hypothyroid if > 30

32 Overt Hypothyroidism in the Elderly Classic features often missing Neuropsychiatric complaints common: depression, weakness, memory loss Other clues: hypercholesterolemia, elevated CK, pleural effusion

33 Subclinical Hypothyroidism: CV Outcomes Observational studies: total cholesterol unchanged, but higher LDL and lower HDL? What about atherosclerosis? Rotterdam population-based study (Hak( Hak,, 2000) Aortic atherosclerosis RR = 1.7 (1.1, 2.6) CHD RR = 2.5 (0.7, 9.5) Cardiovascular Health Study (Cappola( Cappola,, 2003) CHD RR = 1.1 (0.9, 1.3) Australian population-based study (Walsh, 2005) CHR RR = 1.8 (1.2, 2.7)

34 Meta Analysis of Subclinical Hypothyroidism and CHD 11 prospective cohort studies Subject-level pooling of 42,000 adults Primary outcomes: CHD event or CHD death Overall results: CHD RH=1.23 (0.98, 1.56) CHD Event CHD Death TSH (0.9, 1.2) 1.1 (0.9, 1.3) TSH (1.0, 1.4) 1.4 (1.0, 2.0) TSH (1.3, 2.8) 1.6 (1.1, 2.3) Rodondi, Jama, 2010

35 Subclinical Hypothyroidism and CHF Events Among 2730 Adults Aged in Health ABC Rodondi et al, Arch Intern Med, 2005

36 Subclinical Hypothyroidism: Other Outcomes Observational studies of neuropsychiatric symptoms Not reliably related to subclinical hypothyroidism Four small double blinded trials, stsh > 5-75 Randomized to thyroxine or placebo No significant change in weight, lipids, other laboratory values (too small for CV outcomes) Psychometric testing: Inconsistent improvement in symptoms and memory scores

37 Subclinical Hypothyroidism: Natural History and When to Treat If persists >6 mo spontaneous resolution infrequent Antibodies predict overt hypothyroidism If TPO positive, 5%/yr If TPO negative, 2%/yr When to treat? Little data Goiter or considering pregnancy Many treat if symptoms, TPO positive or TSH>10

38 Hypothyroidism: Treatment Replace with thyroxine (T4) T3 + T4 benefit unproven Typical replacement dose 1.6 mcg/kg Elderly or CAD: start low ( mg/d), gradually increase dose Maintain TSH within the normal range Wait 6 weeks after dose change Monitor yearly (noncompliance, reduced T4 clearance in elderly)

39 What About Treatment of Symptomatic but Euthyroid Patients? Forget It. Symptoms of hypothyroidism common Real but not detected by usual tests? Double blind RCT (Pollock, 2001) Euthyroid subjects, 25 symptomatic 18 not symptomtic 33 mo. of T4 (0.1/d) or placebo, cross- over TSH fell with T4, but no difference in cognitive or psychological function

40 Thyroid Nodules: Epidemiology and Evaluation Nodules are common (and cancer is rare) 90% women over age 60 have one or more thyroid nodules at autopsy Risk factors for cancer: neck irritation, FH Evaluation: FNA first 75% benign, 20% suspicious, 5% malignant Best centers: false negative 2% false positive 1%

41 Thyroid Nodules: Treatment Cancer - Histology is important (papillary best) - Surgery +/- 131 I ablation - Suppression with T4? TSH = Benign nodules - Many shrink spontaneously - Meta analysis of T4 suppression Smaller: 26% vs. 12% (NNT=7) Larger: 8% vs. 17% (NNT=11) - T4 doesn t t prevent new nodules

42 Screening for Thyroid Dysfunction US Preventive Task Force, 1996 routine screening is not recommended ACP, 1998 reasonable to screen women older than 50 years of age for unsuspected but symptomatic thyroid disease US Preventive Task Force, 2004 evidence is insufficient to recommend for or against routine screening. Fair evidence that the the TSH test can detect subclinical thyroid disease, but poor evidence that treatment improves clinically important outcomes

43 Screening Cost-effectiveness Danese and Sawin, 1995 Cost-utility analysis, stsh-based screening Modeled progression, symptoms and CAD Screening every 5 year from 35-65: $9,223 per QALY in women $22,595 per QALY in men Sensitivity analysis: cost of TSH key ($25)

44 Screening Cost-effectiveness Effects on HDL, fractures not included. Cost of testing overestimated ($3/TSH) Published analyses underestimate cost-effectiveness Other unresolved issues: Age to start screening? Not before 50 Optimal frequency? Every 5 years

45 Summary Take Home Points stsh is best test. T4 often unnecessary Subclinical thyroid disease is common, associated with morbidity, and treatable Low threshold to treat subclinical hypo until large trials available Treatment threshold for subclinical hyper less certain. Screening with stsh is cost-effective and should be considered in women >50

46 Cases 68 yr old woman with new atrial fibrillation and no other findings except TSH=0.04, normal free T4 79 yr old woman with 1 yr of fatigue and lassitude and no findings except TSH=9.0, anti-tpo positive 45 yr old woman, enlarged thyroid with dominant nodule since 1999, FNA benign. On T4 suppression ever since, TSH=0.1

Management of Common Thyroid Disorders

Management 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

Mastering 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 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 information

Page 1. Understanding Common Thyroid Disorders. Cases. Topics Covered

Page 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 information

Disorders of Thyroid Function

Disorders 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 information

Thyroid in the elderly. Akbar Soltani M.D. Endocrinology and Metabolism Research Center (EMRC) Shariati Hospital

Thyroid in the elderly. Akbar Soltani M.D. Endocrinology and Metabolism Research Center (EMRC) Shariati Hospital Thyroid in the elderly Akbar Soltani M.D. Endocrinology and Metabolism Research Center (EMRC) Shariati Hospital soltania@tuma.ac.ir Case 1 A 79 year old female is seen because of a 6 month history of fatigue,

More information

Thyroid Disease in Cardiovascular Patients

Thyroid 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 information

Hyperthyroidism Diagnosis and Treatment. April Janet A. Schlechte, M.D.

Hyperthyroidism 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 information

None. Thyroid Potpourri for the Primary Care Physician. Evaluating Thyroid Function. Disclosures. Learning Objectives

None. 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 information

Update In Hyperthyroidism

Update In Hyperthyroidism Update In Hyperthyroidism CME Away India & Sri Lanka March 23 - April 7, 2018 Richard A. Bebb MD, ABIM, FRCPC Consultant Endocrinologist Medical Subspecialty Institute Cleveland Clinic Abu Dhabi Copyright

More information

Common Issues in Management of Hypothyroidism

Common 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 information

Thyroid Disease. I have no disclosures. Overview TSH. Matthew Kim, M.D. July, 2012

Thyroid Disease. I have no disclosures. Overview TSH. Matthew Kim, M.D. July, 2012 Thyroid Disease I have no disclosures Matthew Kim, M.D. July, 2012 Overview Thyroid Function Tests Hyperthyroidism Hypothyroidism Subclinical Thyroid Disease Thyroid Nodules Questions TSH Best single screening

More information

Hyperthyroidism. Objectives. Clinical Manifestations. Slide 1. Slide 2. Slide 3. Implications for Primary Care. hyperthyroidism

Hyperthyroidism. 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 information

Women s Health in General Practice Symposium 2015 Thyroid & Parathyroid Cases

Women s Health in General Practice Symposium 2015 Thyroid & Parathyroid Cases Women s Health in General Practice Symposium 2015 Thyroid & Parathyroid Cases Bill Fleming Epworth Freemasons Hospital 1 Common Endocrine Presentations anatomical problems thyroid nodule / goitre embryological

More information

Lecture title. Name Family name Country

Lecture 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 information

OUTLINE. Regulation of Thyroid Hormone Production Common Tests to Evaluate the Thyroid Hyperthyroidism - Graves disease, toxic nodules, thyroiditis

OUTLINE. 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 information

Subclinical thyroid disorders. Mario Skugor M.D. FACE Associate Professor of Medicine CCLCM of CWRU Cleveland Clinic

Subclinical thyroid disorders. Mario Skugor M.D. FACE Associate Professor of Medicine CCLCM of CWRU Cleveland Clinic Subclinical thyroid disorders Mario Skugor M.D. FACE Associate Professor of Medicine CCLCM of CWRU Cleveland Clinic Definitions: Individuals with elevation of TSH but normal thyroid hormone levels have

More information

Some Issues in the Management of Hypothyroidism

Some 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 information

Understanding thyroid function tests. Dr. Colette George

Understanding thyroid function tests. Dr. Colette George Understanding thyroid function tests Dr. Colette George Disclosures No financial disclosure I will present fictitious cases and thyroid function tests (TFTs) that are based on scenarios I commonly encounter.

More information

university sciences of Isfahan university Com

university 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 information

Effect of thyroid hormones of metabolism Thyroid Diseases

Effect 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 information

GOITER and Shortness of Breath. Case A: GOITER. Learning Objectives. Common Thyroid Disorders for

GOITER 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 information

Update on Gestational Thyroid Disease. Aidan McElduff The Discipline of Medicine, The University of Sydney

Update on Gestational Thyroid Disease. Aidan McElduff The Discipline of Medicine, The University of Sydney IADPSG 2016 Update on Gestational Thyroid Disease Aidan McElduff The Discipline of Medicine, The University of Sydney IADPSG 2016 DISCLOSURES and AIM Nil to disclose Aim: to provide an overview 2017 Guidelines

More information

Disclosures. Learning objectives. Case 1A. Autoimmune Thyroid Disease: Medical and Surgical Issues. I have nothing to disclose.

Disclosures. Learning objectives. Case 1A. Autoimmune Thyroid Disease: Medical and Surgical Issues. I have nothing to disclose. Disclosures Autoimmune Thyroid Disease: Medical and Surgical Issues I have nothing to disclose. Chrysoula Dosiou, MD, MS Clinical Assistant Professor Division of Endocrinology Stanford University School

More information

Chapter I.A.1: Thyroid Evaluation Laboratory Testing

Chapter I.A.1: Thyroid Evaluation Laboratory Testing Chapter I.A.1: Thyroid Evaluation Laboratory Testing Jennifer L. Poehls, MD and Rebecca S. Sippel, MD, FACS THYROID FUNCTION TESTS Overview Thyroid-stimulating hormone (TSH) is produced by the anterior

More information

Alvin C. Powers, M.D. 1/27/06

Alvin C. Powers, M.D. 1/27/06 Thyroid Histology Follicular Cells ECF side Apical lumen Thyroid Follicles -200-400 um Parafollicular or C-cells Colloid Photos from University of Manchester and tutorial created by Dr. James Crimando,

More information

Virginia 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 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 information

Screening for Thyroid Disease

Screening for Thyroid Disease DRAFT FOR CONSULTATION Screening for Thyroid Disease A draft report for the UK National Screening Committee February 2013 This report has been compiled by Dr Gail Pittam, Senior Researcher Dr Martin Allaby,

More information

The Thyroid: No mystery. Just need all the pieces to the puzzle.

The 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 information

BELIEVE MIDWIFERY SERVICES

BELIEVE 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 information

SUBCLINICAL THYR ROID DYSFUNCTION

SUBCLINICAL THYR ROID DYSFUNCTION SUBCLINICAL THYR ROID DYSFUNCTION Wilmar M. Wiersinga Department of Endocrinology & Metabolism Academic Medical lcenter, University i of famsterdam The Neth herlands SUBCLINICAL THYROID DYSFUNCTION 1.

More information

B-Resistance to the action of hormones, Hormone resistance characterized by receptor mediated, postreceptor.

B-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 information

Hyperthyroidism and hypothyroidism are common

Hyperthyroidism and hypothyroidism are common Screening for Subclinical Thyroid Dysfunction in Nonpregnant Adults: A Summary of the Evidence for the U.S. Preventive Services Task Force Mark Helfand, MD, MPH Background: Subclinical thyroid dysfunction

More information

Approach to thyroid dysfunction

Approach 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 information

Project Title: Effectiveness of Screening and Treatment of

Project 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 information

SUBCLINICAL OR MILD THYROID

SUBCLINICAL OR MILD THYROID SCIENTIFIC REVIEW AND CLINICAL APPLICATIONS CLINICIAN S CORNER Subclinical Thyroid Disease Scientific Review and Guidelines for Diagnosis and Management Martin I. Surks, MD Eduardo Ortiz, MD, MPH Gilbert

More information

Reference intervals are derived from the statistical distribution of values in the general healthy population.

Reference 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 information

Toxic MNG Thyroiditis 5-15

Toxic MNG Thyroiditis 5-15 Hyperthyroidism Facts Prevalence 0.5-1.0%, more common in women Thyrotoxicosis is excess thyroid hormones from endogenous or exogenous sources Hyperthyroidism is excess thyroid hormones from thyroid gland

More information

Graves Disease in Pediatrics

Graves 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 information

Understanding Thyroid Labs

Understanding Thyroid Labs Understanding Thyroid Labs Chris Sadler, MA, PA-C, CDE, DFAAPA Senior Medical Science Liaison CVM Janssen Scientific Affairs Diabetes and Endocrine Associates La Jolla, CA Disclosures Employee of Janssen

More information

The Thyroid and Pregnancy OUTLINE OF DISCUSSION 3/19/10. Francis S. Greenspan March 19, Normal Physiology. 2.

The Thyroid and Pregnancy OUTLINE OF DISCUSSION 3/19/10. Francis S. Greenspan March 19, Normal Physiology. 2. The Thyroid and Pregnancy Francis S. Greenspan March 19, 2010 OUTLINE OF DISCUSSION 1. Normal Physiology 2. Hypothyroidism 3. Hyperthyroidism 4. Thyroid Nodules and Cancer NORMAL PHYSIOLOGY Iodine Requirements:

More information

HYPERTHYROIDISM. 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 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 information

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

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 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 information

Evaluation and Management of Thyroid Nodules. Overview of Thyroid Nodules and Their Management. Thyroid Nodule detection: U/S versus Exam

Evaluation and Management of Thyroid Nodules. Overview of Thyroid Nodules and Their Management. Thyroid Nodule detection: U/S versus Exam Overview of Thyroid Nodules and Their Management Matthew D. Ringel, M.D. Professor of Medicine Divisions of Endocrinology and Oncology, The Ohio State University Co-Director, Thyroid Cancer Unit Arthur

More information

Requesting and Management of abnormal TFTs.

Requesting 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 information

TANJA KEMP INTERNAL MEDICINE: ENDOCRINOLOGY

TANJA 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 information

Update In Hypothyroidism

Update In Hypothyroidism Update In Hypothyroidism CME Away India & Sri Lanka March 23 - April 7, 2018 Richard A. Bebb MD, ABIM, FRCPC Consultant Endocrinologist Medical Subspecialty Institute Cleveland Clinic Abu Dhabi Copyright

More information

Thyroid Plus. Central Thyroid Regulation & Activity. Peripheral Thyroid Function. Thyroid Auto Immunity. Key Guide. Patient: DOB: Sex: F MRN:

Thyroid 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 information

Laura Trask, MD FACP Central Maine Endocrinology Lewiston, ME

Laura Trask, MD FACP Central Maine Endocrinology Lewiston, ME Laura Trask, MD FACP Central Maine Endocrinology Lewiston, ME 795-7520 traskla@cmhc.org No disclosures Objectives To have an understanding of hyperthyroidism To have an understanding of the management

More information

Subclinical Hypothyroidism Something or Nothing? E. Chester Ridgway University of Colorado SOM August 1-2, 2008

Subclinical Hypothyroidism Something or Nothing? E. Chester Ridgway University of Colorado SOM August 1-2, 2008 Subclinical Hypothyroidism Something or Nothing? E. Chester Ridgway University of Colorado SOM August 1-2, 2008 Case: A 78 y/o female who is cold with fatigue, dry skin, and poor memory. Free T4 = 1.2

More information

LABORATORY TESTS FOR EVALUATION OF THYROID DISORDERS

LABORATORY TESTS FOR EVALUATION OF THYROID DISORDERS LABORATORY TESTS FOR EVALUATION OF THYROID DISORDERS Maryam Tohidi Anatomical & clinical pathologist Research Institute for Endocrine Sciences THYROID GLAND (15-25 gr), (12-20 gr), 2 lobes connected by

More information

Sanjay B. Dixit, M.D. BHS Endocrinology Associates November 11, 2017

Sanjay 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 information

Common Causes of Hypothyroidism

Common 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 information

Thyroid 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 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 information

Approach to Thyroid Dysfunction in the Elderly

Approach to Thyroid Dysfunction in the Elderly Approach to Thyroid Dysfunction in the Elderly Fernando Melaragno Endocrinology Objective The objective of this lecture is to review the epidemiology, clinical presentation, risks and complications, and

More information

THYROID DISEASE IN CHILDREN

THYROID DISEASE IN CHILDREN THYROID DISEASE IN CHILDREN Michelle Schweiger, D.O. Center for Pediatric and Adolescent Endocrinology Cleveland Clinic Foundation Neither I nor any immediate family members have any financial interests

More information

DISORDERS OF THE THYROID GLAND SIGNS, SYMPTOMS, & TREATMENT ENDOCRINE SYSTEM AT A GLANCE OBJECTIVES ANATOMY OF THE THYROID

DISORDERS 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 information

4) Thyroid Gland Defects - Dr. Tara

4) 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 information

CHAPTER-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 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 information

Updates in Thyroid Disease. Thyroid Outline. Thyroid 10/5/2015. Leila Wing, MD. Endocrinology, Diabetes, and Metabolism

Updates 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 information

Thyroid Screen (Serum)

Thyroid Screen (Serum) Thyroid Screen (Serum) Patient: DOB: Sex: F MRN: Order Number: Completed: Received: Collected: Sample Type - Serum Result Reference Range Units Central Thyroid Regulation & Activity Total Thyroxine (T4)

More information

Sample Type - Serum Result Reference Range Units. Central Thyroid Regulation Surrey & Activity KT3 4Q. Peripheral Thyroid D Function mark

Sample 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 information

Thyroid Gland. Patient Information

Thyroid 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 information

Diseases of thyroid & parathyroid glands (1 of 2)

Diseases 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 information

Disorders of the Thyroid Gland

Disorders 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 information

An Approach to: Thyroid Function Tests. Rinkoo Dalan Consultant Department of Endocrinology Tan Tock Seng Hospital

An Approach to: Thyroid Function Tests. Rinkoo Dalan Consultant Department of Endocrinology Tan Tock Seng Hospital An Approach to: Thyroid Function Tests Rinkoo Dalan Consultant Department of Endocrinology Tan Tock Seng Hospital Regulation of Thyroid axis Hypothalamus TRH T3,T4 ---- TRH Median Eminence (base of brain)

More information

Thyroid gland defects. Dr. Tara Husain

Thyroid 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 information

Pathophysiology of Thyroid Disorders. PHCL 415 Hadeel Alkofide April 2010

Pathophysiology 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 information

Thyroid and Antithyroid Drugs. Dr. Alia Shatanawi Feb,

Thyroid 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 information

The 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 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 information

Canadian Endocrine Review Course 2014

Canadian Endocrine Review Course 2014 Canadian Endocrine Review Course 2014 Amiodarone & Thyrotoxicosis Iodine, A Catch 22 Ally P.H. Prebtani Associate Professor of Medicine Internal Medicine, Endocrinology & Metabolism McMaster University

More information

AUGUST 25-27, 2017 UPDATE & BOARD REVIEW. acofp INTENSIVE. Evolving Issues in Endocrinology. Chris Pitsch, DO INNOVATIVE COMPREHENSIVE HANDS-ON

AUGUST 25-27, 2017 UPDATE & BOARD REVIEW. acofp INTENSIVE. Evolving Issues in Endocrinology. Chris Pitsch, DO INNOVATIVE COMPREHENSIVE HANDS-ON acofp INTENSIVE UPDATE & BOARD REVIEW AUGUST 25-27, 2017 Loews Chicago O'Hare Hotel Rosemont, IL INNOVATIVE COMPREHENSIVE HANDS-ON Evolving Issues in Endocrinology Chris Pitsch, DO acofp Am eric an College

More information

Screening for thyroid dysfunction in adults

Screening for thyroid dysfunction in adults Screening for thyroid dysfunction in adults External review against programme appraisal criteria for the UK National Screening Committee (UK NSC) Version: Draft 2 Solutions for Public Health June 2017

More information

Cardiovascular complications of thyroid dysfunction

Cardiovascular complications of thyroid dysfunction Cardiovascular complications of thyroid dysfunction Brigitte Velkeniers Department of Internal Medicine-Endocrinology UZ-Brussel Free University of Brussels (VUB) 2 titel Klein I, Circulation, 2007 Direct

More information

Endocrine 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 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 information

Decoding Your Thyroid Tests and Results

Decoding 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 information

Southern Derbyshire Shared Care Pathology Guidelines. Hyperthyroidism

Southern 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 information

Disclosures. Clinical Dilemmas in Thyroid Disease 10/11/ yo healthy active man with abnormal thyroid tests CASE 1. None. Case Based Discussion

Disclosures. Clinical Dilemmas in Thyroid Disease 10/11/ yo healthy active man with abnormal thyroid tests CASE 1. None. Case Based Discussion Disclosures None Clinical Dilemmas in Thyroid Disease Case Based Discussion Chienying Liu MD CASE 1 69 yo healthy active man with abnormal thyroid tests PMH BPH, anxiety, mild hypertension, GERD FH Sister

More information

SUBCLINICAL HYPOTHYROIDISM

SUBCLINICAL HYPOTHYROIDISM SCIENTIFIC REVIEW AND CLINICAL APPLICATIONS CLINICIAN S CORNER Subclinical Thyroid Disease Clinical Applications Nananda F. Col, MD, MPP, MPH Martin I. Surks, MD Gilbert H. Daniels, MD SUBCLINICAL HYPOTHYROIDISM

More information

Thyroid. Dr Jessica Triay November 2018

Thyroid. Dr Jessica Triay November 2018 Thyroid Dr Jessica Triay November 2018 Hypothyroidism in Pregnancy Clinical update: Hypothyroidism in Pregnancy Take home messages Additional evidence supportive for more relaxed TSH targets for those

More information

John Sutton, DO, FACOI, FACE, CCD. Carson Tahoe Endocrinology Carson City, NV KCOM Class of 1989

John Sutton, DO, FACOI, FACE, CCD. Carson Tahoe Endocrinology Carson City, NV KCOM Class of 1989 John Sutton, DO, FACOI, FACE, CCD Carson Tahoe Endocrinology Carson City, NV KCOM Class of 1989 No Disclosures Disease Of the Thyroid Iodide Metabolism/Synthesis of Thyroid Hormone Trap Oxidation Organification(catalyzed

More information

Subclinical Hypothyroidism In Women: Will Screening And Early Detection Reduce Hyperlipidemia?

Subclinical Hypothyroidism In Women: Will Screening And Early Detection Reduce Hyperlipidemia? ISPUB.COM The Internet Journal of Advanced Nursing Practice Volume 5 Number 1 Subclinical Hypothyroidism In Women: Will Screening And Early Detection Reduce Hyperlipidemia? A Olson Citation A Olson. Subclinical

More information

Thyrotoxicosis in Pregnancy: Diagnose and Management

Thyrotoxicosis in Pregnancy: Diagnose and Management Thyrotoxicosis in Pregnancy: Diagnose and Management Yuanita Asri Langi email: meralday@yahoo.co.id Endocrinology & Metabolic Division, Internal Medicine Department, Prof.dr.R.D. Kandou Hospital/ Sam Ratulangi

More information

THYROID 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 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 information

Targeted Issues in Endocrinology Joshua S. Coren, DO, MBA, FACOFP

Targeted 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 information

Thyroid Nodules. Hossein Gharib, MD, MACP, MACE

Thyroid Nodules. Hossein Gharib, MD, MACP, MACE Thyroid Nodules Hossein Gharib, MD, MACP, MACE Professor of Medicine Mayo Clinic College of Medicine President Elect, American College of Endocrinology University Course January 2008 CP1294362-1 Thyroid

More information

Thyroid Disorders Towards a Healthy Endocrine System

Thyroid 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 information

Slide notes: This presentation provides information on Graves disease, a systemic autoimmune disease. Epidemiology, pathology, complications,

Slide notes: This presentation provides information on Graves disease, a systemic autoimmune disease. Epidemiology, pathology, complications, 1 This presentation provides information on Graves disease, a systemic autoimmune disease. Epidemiology, pathology, complications, including ophthalmic complications, treatments (both permanent solutions

More information

19th Century Thyroidology

19th Century Thyroidology 1 19th Century Thyroidology Dr. Kinnicutt s patient (1893) A cold, tired, constipated middle aged woman Slow pulse rate Low body temperature From physiology it was likely patient needed thyroid replacement

More information

The Presence of Thyroid Autoantibodies in Pregnancy

The 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 information

Pearls and Pitfalls of Thyroid Diagnosis. Todd W. Frieze, MD, FACP, FACE, ECNU, CCD Endocrine Care, Hattiesburg Clinic Biloxi MS

Pearls and Pitfalls of Thyroid Diagnosis. Todd W. Frieze, MD, FACP, FACE, ECNU, CCD Endocrine Care, Hattiesburg Clinic Biloxi MS Pearls and Pitfalls of Thyroid Diagnosis Todd W. Frieze, MD, FACP, FACE, ECNU, CCD Endocrine Care, Hattiesburg Clinic Biloxi MS Thyroid Anatomy Isthmus of gland located 1 fingerbreadth below cricoid cartilage

More information

Thyroid Disorders. January 2019

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 information

Thyroid Disease in Pregnancy: The Essentials. Elizabeth N. Pearce, MD, MSc

Thyroid Disease in Pregnancy: The Essentials. Elizabeth N. Pearce, MD, MSc Thyroid Disease in Pregnancy: The Essentials Elizabeth N. Pearce, MD, MSc None Disclosures Case 1 A 31-year-old woman from Massachusetts is practicing a vegan diet. She is currently planning a pregnancy.

More information

Part I Initial Office Visit. Questions NATIONAL CENTER FOR CASE STUDY TEACHING IN SCIENCE

Part 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 information

Hyperthyroidism, Inflammatory Disorders

Hyperthyroidism, Inflammatory Disorders Hyperthyroidism, Inflammatory Disorders free T4 Howard J. Sachs, MD www.12daysinmarch.com Hyperthyroidism, Inflammatory Disorders The total T4 may be elevated in pregnancy and with OCP use Graves I 123

More information

Thyroid nodules. Most thyroid nodules are benign

Thyroid nodules. Most thyroid nodules are benign Thyroid nodules Postgraduate Course in General Surgery Jessica E. Gosnell MD Assistant Professor March 22, 2011 Most thyroid nodules are benign thyroid nodules occur in 77% of the world s population palpable

More information

5/3/2017. Ahn et al N Engl J Med 2014; 371

5/3/2017. Ahn et al N Engl J Med 2014; 371 Alan Failor, M.D. Clinical Professor of Medicine Division of Metabolism, Endocrinology and Nutrition University of Washington April 20, 2017 No disclosures to report 1. Appropriately evaluate s in adult

More information

"Thyroid nodular disease: how to treat?" Take-home messages

Thyroid nodular disease: how to treat? Take-home messages "Thyroid nodular disease: how to treat?" Take-home messages Andrea Frasoldati, PhD MD Endocrinology Unit Arcispedale S. Maria Nuova IRCCS Reggio Emilia I declare that neither I nor any member of my immediate

More information

Thyroid disorders. Dr Enas Abusalim

Thyroid 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 information

Thyroiditis Diagnosis and Management issues. Prof. Md. Enamul Karim Professor of Medicine Dhaka Medical College

Thyroiditis Diagnosis and Management issues. Prof. Md. Enamul Karim Professor of Medicine Dhaka Medical College Thyroiditis Diagnosis and Management issues Prof. Md. Enamul Karim Professor of Medicine Dhaka Medical College Definition Thyroiditis is a general term that refers to inflammation of the thyroid gland.

More information

Thyroid Function TSH Analyte Information

Thyroid 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 information