Iodine 131 thyroid Therapy. Sara G. Johnson, MBA, CNMT, NCT President SNMMI-TS VA Healthcare System San Diego
|
|
- Reginald Burns
- 5 years ago
- Views:
Transcription
1 Iodine 131 thyroid Therapy Sara G. Johnson, MBA, CNMT, NCT President SNMMI-TS VA Healthcare System San Diego
2 OBJECTIVES Describe the basics of thyroid gland anatomy and physiology Outline the disease process of hyperthyroidism and thyroid cancer Describe the use of Iodine-131 in the treatment of thyroid conditions Dr. Ryan Niederkohr will discuss the 2015 American Thyroid Association Guidelines
3 RADIONUCLIDES IODINE I-131 Physical half-life: 8 days Principle gamma photon: 364 kev Beta particle emission: MeV High radiation absorbed dose (50 rads/50 uci) Therapeutic agent; minimal diagnostic utility
4 Development of Thyroid Gland 7 weeks of gestation thyroid develops Starts at base of tongue Migrates caudally down to neck Week 12 fetal thyroid hormones
5 Lingual Thyroid 1 month old serum labs Reveal hypothyroidism slide courtesy of e.v.belezzuoli, M.D.
6 Development of Thyroid Gland 7 weeks of gestation thyroid develops Starts at base of tongue Migrates caudally down to neck Week 12 fetal thyroid hormones Remnant of midline tissue arising from the isthmus the pyramidal lobe.
7 Pyramidal lobe Normal variant Seen in % of population Thyroglossal duct Yousem, David M. Nerurology imaging1996 Vol 6:2;453
8 Thyroid Anatomy Butterfly shaped organ located in the front of the neck just above the collar bone. Left and right lobes are connected by an isthmus. The normal thyroid gland weighs about 20 grams.
9 Thyroid Anatomy cont. The lobes contain most the functioning thyroid cells Functional units are epithelial cells arranged in follicles Cells trap iodide from blood stream organify and couple to form T3 & T4
10 Thyroid Endocrine Function Synthesis of thyroid hormone Thyroxine (T4) 80% T4 Triodothyronine (T3) 20% T3 T3 posses about 4x the hormone strength of T4
11 Thyroid homone Secretion TRH Hypothalamus TSH Pituitary Thyroid Gland - Thyroid hormones High blood conc. Of hormones inhibit TSH & TRF
12 Factors affecting uptake Size of the body s iodine pool Competitive inhibition counteracts active process of radioiodine accumilation Functional status of the gland Hypo decreased uptake Hyper increased uptake Time post administration
13 FACTORS AFFECTING UPTAKE DECREASED UPTAKE Thyroid Hormones Thyroxine (T4) Triiodothyronine (T3) Excess Iodine (Expanded Iodine Pool) Saturated solution of potassium iodide Some mineral supplements, cough medicines, and vitamin preparations Iodine Food supplements Iodinated drugs (e.g., amiodarone) Iodinated skin ointments Congestive heart failure Renal failure DURATION OF EFFECT 4-6 weeks 2 weeks 2-4 weeks 2-4 weeks Weeks to months 2-4 weeks
14 FACTORS AFFECTING RADIOIODINE UPTAKE DECREASED UPTAKE Radiographic Contrast Media Water-soluble intravascular media Oral cholecystographic agents Fat-soluble media (lymphography) Noniodine-Containing Drugs Adrenocorticotropic hormone, adrenal steroids Monovalent anions (perchlorate) Penicillin Antithyroid drugs Propylthiouracil (PTU) Methimazole (Tapazole) Bromides DURATION OF EFFECT 2-4 weeks 4 weeks to indefinite Months to years Variable 3-5 days 5-7 days
15 Factors increasing uptake Iodine deficiency Pregnancy Rebound phase after discontnuance of thyroid hormones & antithyroid drugs, recovery from thyroiditis Choriocancinoma (uterine tumor) Hydatid-form mole Renal failure
16 Diseases of the Thyroid Hypothyroidism Hyperthyoidism Thyroid cancer
17 Iodine 131 treatment Hypothyroidism not indicated Hyperthyroidism Graves disease (diffuse toxic goiter) Plummer s disease (toxic nodular goiter)
18 Graves Disease anxiety, Irritability, Fatigue, difficulty sleeping, weight loss, rapid or Irregular heart beat, brittle hair, exophalmus
19 % uptake % uptake = net counts in thyroid X 100 Net counts in phantom Normal 6 hour uptake % = appox 12% Normal 24 hour uptake % = appox. 7 30% Normal varies by institution
20 GRAVES DISEASE Most common etiology of thyrotoxicosis Diffuse/homogeneous uptake on scintigraphy Markedly elevated %RAIU Excellent response to therapy with I-131 slide courtesy of e.v.belezzuoli, M.D
21 MULTINODULAR TOXIC GOITER Symptoms mild compared with Graves Inhomogenous uptake on scintigraphy %RAIU my be normal or low Generally more resistant to RAI therapy Yousem, David M. Nerurology imaging1996 Vol 6:2;453
22 TOXIC ADENOMA Occurs in 5% of patients with solitary palpable nodule Toxic nodule suppresses uptake in extranodular gland %RAIU mildly elevated or normal Suppressed tissue receives minimal I-131 radiation slide courtesy of e.v.belezzuoli, M.D
23 SUBACUTE THYROIDITIS Includes de Quervain s, silent thyroiditis, and post-partum thyroiditis Minimal visualized activity on scan %RAIU markedly depressed RAI therapy not indicated slide courtesy of e.v.belezzuoli, M.D
24 HYPERTHYROIDISM THERAPY OPTIONS Surgery Antithyroid medication
25 ANTITHYROID MEDICATION Propylthiouracil (PTU), methimazole Block organification/synthesis of thyroid hormone Frequent adverse effects (50% of patients) Permanent remission more frequent with younger patients, mild disease, small goiters Used to cool down patient prior -131 to I Tx Biggest drawback once removed return to hyperthyroid state.
26 HYPERTHYROIDISM THERAPY OPTIONS Surgery Antithyroid medication RAI Therapy
27 GRAVES DISEASE I-131 THERAPY DOSING Standard dose (10-15 mci) Arbitrary high dose (20-30 mci) Calculated dose ( uci/g thyroid tissue)
28 Thyroid radioiodine uptake 100 Graves Uptake (%) 50 Normal 0 Graves rapid iodine turnover Time (hours) Adapted from The Requisites, Nuclear Medicine: 3rd edition: 2006 slide courtesy of e.v.belezzuoli, M.D.
29 GRAVES DISEASE I-131 DOSE CALCULATION I-131 dose (uci) = uci/g desired x gland wt (g) %RAIU (24 hr)
30 Graves Disease 45 y/o female Hyperthyroid Large Gland (100 g) RAIU 48%/79% 120uCi/g x 100g = 15.2 mci.79 slide courtesy of e.v.belezzuoli, M.D.
31 Thyroid radioiodine uptake 100 Graves Uptake (%) 50 Normal 0 Graves rapid iodine turnover Time (hours) Adapted from The Requisites, Nuclear Medicine: 3rd edition: 2006 slide courtesy of e.v.belezzuoli, M.D.
32 GRAVES DISEASE RAPID IODINE TURNOVER 55 y.o. female; hyperthyroid, diffuse goiter (60 g) RAIU 50% / 28% 120uCi/g x 60g 0.28 = 25.7 mci slide courtesy of e.v.belezzuoli, M.D
33 Thyroid radioiodine uptake 100 Graves Uptake (%) 50 Normal 0 Graves rapid iodine turnover Time (hours) Adapted from The Requisites, Nuclear Medicine: 3rd edition: 2006 slide courtesy of e.v.belezzuoli, M.D.
34 I-131 HYPERTHYROID TX COMPLICATIONS Exacerbation of hyperthyroid symptoms Hypothyroidism
35 TOXIC NODULAR GOITER I-131 THERAPY DOSING More resistant to RAI therapy Higher/maximal outpatient I-131 doses utilized Usual dose mci I-131 Low risk of hypothyroidism due to extranodular suppressed thyroid tissue slide courtesy of e.v.belezzuoli, M.D
36 slide courtesy of e.v.belezzuoli, M.D. HYPERTHYROIDISM Graves Thyroiditis TMNG Labs TSH, FT4, +TSI TSH, FT4, TSH, FT4, T3 Scan Diffuse homogeneo us activity Minimal visualizd activity Inhomogene ous hot / cold nodules %RAIU / RAI TX Yes No Yes
37 I-131 treatment for Cancer Functioning Thyroid Cancer Papillary (>70%) Follicular (appox 15%) Medullary (appox. 5-8 %) Hurthle Cell (Appox. 3%) Anaplastic (appox. 2%) Non Funcitioning thyroid Cancer Does not trap or organify iodine
38 Thyroid Cancer Cold Nodules % of nodules are Cold on scan. FNA needed to diagnosis
39 I-131 Therapy Patient preparation Stop antithyroid medication for 1 week prior (Hyperthryroid Tx) Stop Thyroid replacement weeks months (Ca Tx except for rtsh) Low iodine diet Pregnancy test as necessary Correlation with lab work Informed Consent
40 I-131 Treatment Post Therapy restrictions Avoid close contact with small Children & Pregnant Women 1 week Avoid close/intimate contact with other adults 3 4 days. Strict personal hygiene for 3-4 days Avoid pregnancy for 6-12 months
41 RAI Therapy Goals for Thyroid Cancer Post surgical ablation of thyroid remnant Disease Surveillance Therapy for recurrent/metastatic disease
42 slide courtesy of e.v.belezzuoli, M.D.
43 slide courtesy of e.v.belezzuoli, M.D.
44 RAI REMNANT ABLATION PROTOCOL Total/near-total thyroidectomy Withdraw thyroid hormone; verify TSH > 30 Low dose (1-3 mci) I-131 for pre-tx scan I-131 whole body scan at hours Admit for High dose - Discharge Pt exposure levels < 7mr/hr mrem exposure to others Whole Body I-131 Scan 7-10 days post Therapy
45 SURVEILLANCE WITHDRAWAL PROTOCOL Withdraw thyroid hormone; verify TSH > 30 Obtain thyroglobulin (Tg) level I-131 scanning dose (5-10 mci) I-131 whole body scan at hours High dose I-131 Tx if scan positive
46 SURVEILLANCE THYROGEN (rtsh) PROTOCOL Thyroid hormone withdrawal not required Day 1: Thyrogen injection #1 Day 2: Thyrogen injection #2 Day 3: Dose I-131 (3-5 mci) TSH blood test Day 5: Whole body I-131 scan Tg blood Test
47
48 SURVEILLANCE I-131 SCAN/Tg DISCORDANCE Tg level relatively low (<10) Repeat I-131 scan/tg level in 6-12 months Tg level high RAI Tx PET scan if post Tx I-131 scan is negative
49 Pet scan for Thyroid Cancer When? Use selectively Thyroglobulin positive, but iodine-negative Negative Pet cancer is slow growing Positive pet aggressive cancer usually stage iv Wan, Q. SNM Meeting Abstract 552. June 2003
50 Conclusion We have over 60 years of experience with Iodine 131. Iodine 131 is an excellent therapy for hyperthyodism. Most Thyroid Cancers respond very favorably to Iodine 131 therapy Dr. Ryan Niederkohr will discuss the 2015 American Thyroid Association Guidelines
Imaging in Pediatric Thyroid disorders: US and Radionuclide imaging. Deepa R Biyyam, MD Attending Pediatric Radiologist
Imaging in Pediatric Thyroid disorders: US and Radionuclide imaging Deepa R Biyyam, MD Attending Pediatric Radiologist Imaging in Pediatric Thyroid disorders: Imaging modalities Outline ACR-SNM-SPR guidelines
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 information2. RADIOPHARMACEUTICALS UTILIZED
1. OVERVIEW AND INDICATIONS (adapted from Society of Nuclear Medicine Procedure Guideline for Thyroid Uptake Measurement, Version 3.0; reprinted from http://snmmi.files.cmsplus.com/docs/thyroid%20uptake%20measure%20v3%200.pdf,
More informationAustin Radiological Association Nuclear Medicine Procedure THERAPY FOR THYROID CANCER (I-131 as Sodium Iodide)
Austin Radiological Association Nuclear Medicine Procedure THERAPY FOR THYROID CANCER (I-131 as Sodium Iodide) Overview Indications I-131 therapy for Thyroid Cancer, of the papillo-follicular type, is
More information42 yr old male with h/o Graves disease and prior I 131 treatment presents with hyperthyroidism and undetectable TSH. 2 hr uptake 20%, 24 hr uptake 50%
Pinhole images of the neck are acquired in multiple projections, 24hrs after the oral administration of approximately 200 µci of I123. Usually, 24hr uptake value if also calculated (normal 24 hr uptake
More informationAN INTRODUCTION TO NUCLEAR MEDICINE
AN INTRODUCTION TO NUCLEAR MEDICINE WITH RESPECT TO THYROID DISORDERS By: B.Shafiei MD Nuclear Physician Taleghani Medical Center Radioactive: An element with Unstable Nucleus (Excess Energy), can achieve
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 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 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 informationAlvin 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 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 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 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 informationTHYROID FUNCTION TEST and RADIONUCLIDE THERAPY
THYROID FUNCTION TEST and RADIONUCLIDE THERAPY Ajalaya Teyateeti, M.D. Division of Nuclear Medicine Department of Radiology I. Thyroid function test OUTLINE Application and interpretation of in vitro TFT
More informationRadionuclide Therapy. Prof. Dr. Çetin Önsel. Cerrahpaşa Medical School Department of Nuclear Medicine. Radionuclide Therapy
Prof. Dr. Çetin Önsel Cerrahpaşa Medical School Department of Nuclear Medicine Principles of radionuclide therapy (1) The radionuclide has to be concentrated at the site of the abnormality (tumor) with
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 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 informationJohn 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 information1. OVERVIEW AND INDICATIONS
1. OVERVIEW AND INDICATIONS (adapted from Society of Nuclear Medicine Procedure Guideline for Thyroid Scintigraphy and other sources) a) Evaluation of the general structure of the thyroid gland (e.g. nodular
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 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 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 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 informationToxic 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 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 informationThe 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 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 informationI-123 Thyroid Scintigraphy
APPROVED BY: Director of Radiology Page 1 of 6 I-123 Thyroid Scintigraphy Primary Indications: Thyroid scintigraphy with I-123 is indicated to evaluate thyroid morphology and global and/or regional function
More informationDisclosures. 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 informationNuclear Medicine Head and Neck Region. Bán Zsuzsanna, MD University of Pécs, Department of Nuclear Medicine
Nuclear Medicine Head and Neck Region Bán Zsuzsanna, MD University of Pécs, Department of Nuclear Medicine Thyroid scintigraphy Parathyroid scintigraphy F18-FDG PET examinations in head and neck cancer
More informationWomen 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 informationApproach to Thyroid Nodules
Approach to Thyroid Nodules 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 transmitted
More informationIndex. radiologic.theclinics.com. Note: Page numbers of article titles are in boldface type.
Index Note: Page numbers of article titles are in boldface type. A ACC. See Adrenal cortical carcinoma. Acromegaly and the pituitary gland, 551 Acute suppurative thyroiditis, 405, 406 Addison, Thomas and
More informationNuclear medicine in endocrinology
Nuclear medicine in endocrinology Thyroid gland: anatomy, function, inflammation, Nuclear medicine in endocrinology tumor dignitiy Parathyroid gland: localisation Adrenal cortex: function Adrenal medulla:
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 informationThyroid 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 informationUnderstanding 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 informationAustin Radiological Association Nuclear Medicine Procedure THYROID UPTAKE MEASUREMENT (I-123 or I-131 as Sodium Iodide)
Austin Radiological Association Nuclear Medicine Procedure THYROID UPTAKE MEASUREMENT (I-123 or I-131 as Sodium Iodide) Overview Indications The Thyroid Uptake Measurement measures the metabolic activity
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 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 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 informationHyperthyroidism, 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 informationEvaluation and Management of Thyroid Nodules. Nick Vernetti, MD, FACE Palm Medical Group Las Vegas, Nevada
Evaluation and Management of Thyroid Nodules Nick Vernetti, MD, FACE Palm Medical Group Las Vegas, Nevada Disclosure Consulting Amgen Speaking Amgen Objectives Understand the significance of incidental
More informationHypothalamo-Pituitary-Thyroid Axis
SMGr up Hypothalamo-Pituitary-Thyroid Axis Orluwene Chituru Godwill 1 * and Ohiri John U 1 1 Chemical Pathology Department, University of Port Harcourt Teaching Hospital, Nigeria *Corresponding author:
More informationLABORATORY 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 informationLaura 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 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 information19th 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 informationA rare case of solitary toxic nodule in a 3yr old female child a case report
Volume 3 Issue 1 2013 ISSN: 2250-0359 A rare case of solitary toxic nodule in a 3yr old female child a case report *Chandrasekaran Maharajan * Poongkodi Karunakaran *Madras Medical College ABSTRACT A three
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 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 informationUpdate 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 informationEANM Procedure Guideline For Therapy with Iodine-131
EANM Procedure Guideline For Therapy with Iodine-131 I. PURPOSE The purpose of this guideline is to assist nuclear medicine practitioners in 1. evaluating patients who might be candidates for therapy with
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 informationThyroid Nodule. Disclosure. Learning Objectives P A P A P A 3/18/2014. Nothing to disclose.
Thyroid Nodule Evaluating the patient with a thyroid nodule and some management options. Miguel V. Valdez PA C Disclosure Nothing to disclose. Learning Objectives Examination of thyroid gland Options for
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 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 informationAdjuvant therapy for thyroid cancer
Carcinoma of the thyroid Adjuvant therapy for thyroid cancer John Hay Department of Radiation Oncology Vancouver Cancer Centre Department of Surgery UBC 1% of all new malignancies 0.5% in men 1.5% in women
More informationThyroid Cancer & rhtsh: When and How?
Thyroid Cancer & rhtsh: When and How? 8 th Postgraduate Course in Endocrine Surgery Capsis Beach, Crete, September 21, 2006 Quan-Yang Duh, Professor of Surgery, UCSF Increasing Incidence of Thyroid Cancer
More informationThyroid Ectopia in Hyperthyroidism
IJNM, 21(3): 50-55, 2006 Original Article Thyroid Ectopia in Hyperthyroidism Aban M. Samuel Nuclear Medicine, Mandakini Nuclear Imaging Centre, Mumbai Aims: Analyse the frequency and sites of ectopic thyroid
More informationUpdate 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 informationThe Thyroid Gland. Chaitan K. Narsule, M.D.
The Thyroid Gland Chaitan K. Narsule, M.D. The Thyroid Gland Thyreoides = shield shaped Goiter well-described in literature in 19th century Seaweed was medical treatment (iodine rich) The Thyroid Gland
More informationWhat you need to know about Thyroid Cancer
What you need to know about Thyroid Cancer This booklet has been designed to help you to learn more about your thyroid cancer. It covers the most important areas and answers some of the frequently asked
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 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 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 informationPatient Guide to Radioiodine Treatment For Thyrotoxicosis (Overactive Thyroid Gland or Hyperthyroidism)
Patient Guide to Radioiodine Treatment For Thyrotoxicosis (Overactive Thyroid Gland or Hyperthyroidism) Your doctor has referred you to Nuclear Medicine for treatment of your overactive thyroid gland.
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 informationSlide 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- RET/PTC rearrangement: 20% papillary thyroid cancer - RET: medullary thyroid cancer
Thyroid Cancer UpToDate: Introduction: Risk Factors: Biology: Symptoms: Diagnosis: 1. Lenvina is the first line therapy with powerful durable response and superior PFS in pts with RAI-refractory disease.
More informationCase 4: Disseminated bone metastases from differentiated follicular thyroid cancer
Case 4: Disseminated bone metastases from differentiated follicular thyroid cancer Giuliano Mariani Regional Center of Nuclear Medicine, University of Pisa Medical School, Pisa (Italy) Disseminated bone
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 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 informationEndocrine System Physiology
M53_MARI0000_00_SE_EX04.qxd 7/15/11 4:32 PM Page 369 4 E X E R C I S E Endocrine System Physiology Advance Preparation/Comments Consider covering the following topics to prepare students for the simulation:
More informationThyroid Ultrasonography: clinical and radiological correlations
Thyroid Ultrasonography: clinical and radiological correlations Dr.M.Thijs Radiology Anatomy Inflammatory Thyroid Disease Benign lesions Thyroid tumors Thyroglossal duct cyst Anatomy Transverse Longitudinal
More informationThyrotoxicosis 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 information4/22/2010. Hakan Korkmaz, MD Assoc. Prof. of Otolaryngology Ankara Dıșkapı Training Hospital-Turkey.
Management of Differentiated Thyroid Cancer: Head Neck Surgeon Perspective Hakan Korkmaz, MD Assoc. Prof. of Otolaryngology Ankara Dıșkapı Training Hospital-Turkey Thyroid gland Small endocrine gland:
More informationDharma Lindarto Div. Endokrin-Metabolisme dan Diabetes. Dep Ilmu Penyakit Dalam FK USU / RSUP HAM Medan
HYPERTHYROIDISM Dharma Lindarto Div. Endokrin-Metabolisme dan Diabetes. Dep Ilmu Penyakit Dalam FK USU / RSUP HAM Medan Anatomy of the Thyroid Gland Tiroid Disease Multi N Aspect fungtion morphology eutiroid,
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 22 THYROID UPTAKE TEST. R.D. Ganatra
XA9847619 Chapter 22 THYROID UPTAKE TEST R.D. Ganatra Measurement of the uptake of the radioiodine by the thyroid gland was one of the earliest applications of the radioisotopes in medicine but in advanced
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 informationCanadian 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 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 informationAACE 2018 Advanced Endocrine Neck Ultrasound and UGFNA Course
AACE 2018 Advanced Endocrine Neck Ultrasound and UGFNA Course Describe the sonographic appearance of diffuse thyroid diseases: autoimmune thyroid disease Review non thyroidal findings that can be encountered
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 informationThyroid 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 information25/10/56. Hypothyroidism Myxedema in adults Cretinism congenital deficiency of thyroid hormone Hashimoto thyroiditis. Simple goiter (nontoxic goiter)
THERAPEUTIC USES OF THYROID HORMONE Supeecha Wittayalertpunya Wannarasmi Ketchart Nov 2013 Hyperthyroidism (Thyrotoxicosis) Grave s disease (diffuse toxic goiter) Toxic uninodular & Toxic multinodular
More informationPancreas. Endocrine pancreas - Islets of Langerhans A or alpha cells glucagon B or beta cells insulin Delta cells somatostatin
Endocrine System Pancreas Endocrine pancreas - Islets of Langerhans A or alpha cells glucagon B or beta cells insulin Delta cells somatostatin Glucagon & Metabolism Produced by beta cells of Islets Primary
More informationThyroid 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 informationTHYROTOXICOSIS DR.J.BALA KUMAR 2 ND YR SURGERY PG
THYROTOXICOSIS DR.J.BALA KUMAR 2 ND YR SURGERY PG What is the difference between thyrotoxicosis and hyperthyroidism Thyrotoxicosis Thyrotoxicosis is defined as the state of thyroid hormone excess and is
More informationApproach 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 informationUnderstanding 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 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 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 informationAnalysis of Lag Behind Thyrotropin State After Radioiodine Therapy in Hyperthyroid Patients
Analysis of Lag Behind Thyrotropin State After Radioiodine Therapy in Hyperthyroid Patients ORIGINAL ARTICLE Mohshi Um Mokaddema, Fatima Begum, Simoon Salekin, Tanzina Naushin, Sharmin Quddus, Nabeel Fahmi
More informationAUGUST 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 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 informationDRUGS. 4- Two molecules of DIT combine within the thyroglobulinto form L-thyroxine (T4)' One molecule of MIT & one molecule of DIT combine to form T3
THYROID HORMONEs & ANTITHYROID The thyroid secretes 2 types of hormones: DRUGS 1- Iodine containing amino acids (are important for growth, development and metabolism) and these are: triodothyronine, tetraiodothyronine,(
More informationGrave s autoimmune Graves and Hashimotos: antithyroglobulin and antimicrosomal antibodies T3 X 10d should decrease TSH 50%
Vesalius SCALpel : Thyroid (see also: head and neck folios) Anatomic lingual thyroid most common ectopic location normal thyroid tissue patients may have no thyroid in neck manifest as teenager, may enlarge
More informationThyroid hormone. Functional anatomy of thyroid gland
Thyroid hormone ส ว ฒณ ค ปต ว ฒ ต กจ ฑาธ ช ห อง 101 Aims Functional anatomy of thyroid gland Synthesis, secretion and metabolism of the thyroid hormones The mechanism of thyroid hormone action Role of
More information