Common Thyroid Disorders
|
|
- Amie Garrett
- 5 years ago
- Views:
Transcription
1 8/29/16 Anatomy of the Thyroid Gland Common Thyroid Disorders Heather Cuevas PhD, RN, ACNS- BC Texas Diabetes and Endocrinology The University of Texas at Austin School of Nursing Hypothalamic- Pituitary- Thyroid Axis Physiology Hypothalamus Production of T4 and T3 TRH Pituitary TSH reflects tissue thyroid hormone actions T4 is the primary secretory product of the thyroid TSH as an index of therapeutic success and potential toxicity The thyroid secretes approximately µg of T4 TSH T4 Target Tissues T3 Heart Thyroid Gland Liver T3 T4 è T3 Liver per day T3 is derived from 2 processes The total daily production rate of T3 is about µg About 80% of circulating T3 comes from deiodination of T4 in peripheral tissues Largely liver and kidneys TR T4 gland, which is the only source of T4 Bone About 20% comes from direct thyroid secretion CNS Free Hormone Concept Only unbound (free) hormone has metabolic activity and physiologic effects Total hormone concentration Normally is kept proportional to the concentration of carrier proteins Is kept appropriate to maintain a constant free hormone level 1
2 8/29/16 Drugs and Conditions That Increase Serum T4 and T3 Levels by Increasing TBG Drugs that increase TBG Oral contraceptives and other sources of estrogen Methadone Conditions that increase TBG Pregnancy Infectious/chronic active hepatitis Clofibrate HIV infection 5- Fluorouracil Biliary cirrhosis Heroin Acute intermittent porphyria Tamoxifen Genetic factors Evaluate for thyroid disease All >35 years of age, every 5 years Patients >60 Women >50 with incidental finding suggestive of thyroid disease USPSTF: insufficient evidence for screening Symptoms Hypothyroidism Exam Hyperthyroidism Fatigue Fatigue Depression Insomnia Weight gain Weight loss or gain Loss of body hair Heat intolerance Dry skin Light periods Elevated lipids Visual changes Slower heartbeat Diarrhea Constipation Tremor Muscle weakness Tachycardia Heavy periods Irritability TSH Look Palpate Imaging? Thyroid- Stimulating Hormone (TSH) Assays Key test for diagnosis of hypothyroidism and hyperthyroidism TSH assay sensitivity has improved with subsequent test generations First generation: RIA Sensitivity: 1.0 µiu/ml Second generation: IRMA Sensitivity: 0.1 µiu/ml Third generation: ELISA Sensitivity: 0.03 µiu/ml Ladenson PW, et al. Arch Intern Med. 2000;160: Braverman LE, et al. Werner & Ingbar s The Thyroid. A Fundamental and Clinical Text. 8th ed Zophel K, et al. Nuklearmedizin. 1999;38:
3 8/29/16 Interpretation Influencing Medications FT4 FT3 TSH Hypothyroid Low Low High Subclinical Hypothyroid Normal Normal High Hyperthyroid High or high- normal High Low Non- compliance with LT4 High Low Comments TSHRAb- sensitive and specific for Graves High Hyperthyroid Mr. Smith is a 49 year- old, smoker, hx of HTN. C/O insomnia. Wife says she thinks he s lost weight. Labs show: TSH <0.1, FT4 2.3; CMP and CBC wnl. Exam: Lid lag, HR 110, tremor, warm/sweaty, thyroid = diffusely enlarged FT4 FT3 TSH Glucocorticoids Dopamine Normal Normal Low Lithium, iodine Low Low High Amiodarone Normal to high Low High or low Phenobarbitol Carbamezapine Phenytoin Rifampicin Low Low Normal Graves Disease (Toxic Diffuse Goiter) The most common cause of hyperthyroidism Accounts for 60% to 90% of cases Incidence in the United States estimated at 0.02% to 0.4% of the population Affects more females than males, especially in the reproductive age range Imaging Graves disease is an autoimmune disorder possibly related to a defect in immune tolerance Treatment of Hyperthyroidism Antithyroid drugs Inhibit the synthesis of T4 and T3 Surgical resection Remove hyperplastic and adenomatous tissues Restore normal thyroid function and, consequently, pituitary function Radioactive iodine therapy Iodine 131 taken up by functioning thyroid tissue can decrease thyroid hormone production Anti- thyroid Drugs Methimazole Inhibits organification of iodide Decreases production of T4 and T3 Dose is 10-20mg/day Side effects Rash Agranulocytosis Aplasia Cutis Hepatotoxicity Braverman LE, et al. Werner & Ingbar s The Thyroid. A Fundamental and Clinical Text. 8th ed
4 8/29/16 Anti- thyroid Drugs Thyroid Storm Propylthiouracil Inhibits organification of iodide Decreases production of T4 and T3 and conversion of T4 to T3 Dose is mg/day Side ffects Rash Agranulocytosis Hepatotoxicity Boxed Warning Which ATD? Monitoring in ATD Methimazole CBC All except first trimester Start 10-20mg qd; maintenance 5-10mg PTU TFTs: FT4 & TSH 4 weeks after starting med Liver Start tid; maintenance 50mg tid Allergy Relapse Pregnancy Hypothyroid Hypothyroidism: Types Ms. Smith is a 49 year- old, smoker, hx of HTN. Seeing Primary hypothyroidism Labs show: TSH 26, FT4 0.2; CMP and CBC wnl. Central or secondary hypothyroidism you for weight gain, fatigue, and cold intolerance. Exam: thyroid diffusely enlarged, HR 62, +1 pedal edema. From thyroid destruction From deficient TSH secretion, generally due to sellar lesions such as pituitary tumor or craniopharyngioma Infrequently is congenital Central or tertiary hypothyroidism From deficient TSH stimulation above level of pituitary ie, lesions of pituitary stalk or hypothalamus Is much less common than secondary hypothyroidism Bravernan LE, Utiger RE, eds. Werner & Ingbar's The Thyroid. 8th ed. Philadelphia, Pa: Lippincott Williams & Wilkins Persani L, et al. J Clin Endocrinol Metab. 2000; 85:
5 8/29/16 Chronic Autoimmune Thyroiditis (Hashimoto s Thyroiditis) Occurs when there is a severe defect in thyroid hormone synthesis Patients present with hypothyroidism, painless goiter, and other overt signs Persons with autoimmune thyroid disease may have other concomitant autoimmune disorders Treatment of Hypothyroidism Thyroid Hormone Replacement Treatment of choice: levothyroxine (synthetic levothyroxine, LT4) ½ life of 1 week Chemically stable T4 converted to T3 in periphery Other therapies (T3 or T3 and T4 mixtures) Thyroid USP, liothyronine, liotrix, thyroglobulin Some disadvantages Singer PA, et al. JAMA. 1995;273: Endocr Pract. 2002;8: Braverman LE, et al. Werner & Ingbar s The Thyroid. A Fundamental and Clinical Text. 8th ed Hypothyroidism Treatment Primary Hypothyroidism Treatment Algorithm Initial Levothyroxine Dose Levothyroxine sodium is the treatment of choice for the routine management of hypothyroidism Adults: about 1.7 µg/kg of body weight/day Children up to 4.0 µg/kg of body weight/day 6-8 Weeks TSH >4 µiu/ml Elderly <1.0 µg/kg of body weight/day until the serum TSH concentration is normalized levothyroxine therapy, it is preferable to maintain the patient on the same brand throughout treatment Increase Levothyroxine Dose by 12.5 to 25 µg/d Singer PA, et al. JAMA. 1995;273: Endocr Pract. 2002;8: Percentage of Euthyroid, Subclinical and Hypothyroid Patients Reporting Symptoms 60% euthyroid have 1 symptom 15% 4 symptoms TSH <0.3 µiu/ml TSH µiu/ml Symptoms Resolved Clinical and biochemical evaluations at 6- to 8- week intervals Given the narrow and precise treatment range for Repeat TSH Test Continue Dose Measure TSH at 6 Months, Then Annually or When Symptomatic Decrease Levothyroxine Dose by 12.5 to 25 µg/d Singer PA, et al. JAMA. 1995;273: Demers LM, Spencer CA, eds. The National Academy of Clinical Biochemistry Web site. Available at: Accessed Aug Thyroid hormone impact on weight in euthyroid patients Not effective weight loss drug May increase metabolism but increases appetite Canaris et al. Kaptein JCEM 2009 Fig 2b 5
6 8/29/16 Hazards of Overtreatment Heart, Bone, Psychiatric High risk subclinical hyperthyroid in patients on Factors That May Reduce Levothyroxine Effectiveness Malabsorption Syndromes Postjejunoileal bypass thyroid medication surgery Short bowel syndrome Celiac disease Colorado Prevalence Study, % (316) of patients on thyroid medication had subclinical hyperthyroidism 0.9% (13) Overt hyperthyroidism Reduced Absorption More adverse effects with poor monitoring Only 56% received standard monitoring Atrial fibrillation, unstable angina with poor monitoring Colestipol hydrochloride Sucralfate Ferrous sulfate Food (e.g. soybean formula) Aluminum hydroxide Cholestyramine Calcium carbonate Drugs That Increase Clearance Rifampin Carbamazepine Phenytoin Factors That Reduced T4 to T3 Clearance Amiodarone Selenium deficiency Other Mechanisms Lovastatin Sertraline Braverman LE, Utiger RD, eds. The Thyroid: A Fundamental and Clinical Text. 8th ed Synthroid [package insert]. Abbott Laboratories; When is T3 given? Not recommended by American Thyroid Association Experimental use ok by European Thyroid Association Genetic condition Has a Role in the Treatment of Hypothyroidism Been Demonstrated with T3? 10 15% of patients feel unwell on LT4 monotherapy, as they still have complaints in spite of TSH normalization. The thyroid gland secretes both T4 and T3, suggesting a physiological role for the amount of T3 directly secreted by the thyroid, and not originated by peripheral conversion of T4. Endpoints have been mostly affective ones Trials have been relatively short Studies to date mixed and meta- analyses negative, but not completely Combination therapy still not yet completely understood in the setting of patient preferences Counsel Patients Taking Alternative Therapies About Potential Side Effects and Hazards Liothyroinine Supraphysiologic amounts LT3 or Cytomel of iodine may alter thyroid status, particularly in those with disease Many thyroid- enhancing products have sympathomimetic amines and iodine Many thyroid support products have significant amount of thyroid hormone Short- acting About 4 times as potent Watch for hyperthyroid symptoms Take bid, avoid evening dosing May need to reduce LT4 6
7 8/29/16 Desiccated thyroid Thyroid hormone conversions Combination of T4/T3 1 grain = about 100mcg Synthroid No RTCs of desiccated thyroid until Case #1 Case #1 Ms. A has been hypothyroid since age 35. Soy milk She takes Synthroid 0.088mg qd and an MVI Calcium supplements TSH 7.5 Iron She is now 52 and in menopause Coffee Complains of hot flashes and trying to treat with soy products What could be happening? Separate food, supplements, other medications by at least 2 hours Coffee by 1 hour Case #2 Again Mr. B has had hypothyroidism for 5 years. Take LT4 at the same time of day He takes Armour 1gr qd. TSH was 0.3 at lov. No food, no coffee, no milk Recently started on Lithium to treat bipolar ½ hour prior to eating or 2 hours after eating He complains of weight gain, increased fatigue and is worried Make sure to ask about any new medications the psych regimen is not working. TSH is now 28 May not be able to change the other meds MONITOR 7
8 8/29/16 Case #3 Ê Mr. B takes Synthroid 0.1mg qd. Ê TSH <0.1, FT4 4.7 Ê Complains of fatigue and says he takes an extra Synthroid when tired. Ê Remind patients of the problems with over- replacement. Ê AF, bone loss Ê Can t asses dose properly Incidence of Atrial Fibrillation (%) Consequences of Mild Thyrotoxicosis Atrial Fibrillation TSH 0.1 mu/l TSH > mu/l Years N=2007 pts > 60 Normal TSH (> mu/l) Adapted from: Sawin CT, et al. N Engl J Med. 1994;331: Case #4 Case #4 Ê TSH is 12, FT4 is 5 Ê Pt presents with these labs. Exam is normal. Pt states she was on a cruise and gained about 5 pounds. Otherwise feels well, energetic, and attributes the weight gain to overeating. Ê She forgot her meds on vacation Ê Tried to catch up by taking mg Levothyroxine qd for the past week when she returned home. Ê What can explain the labs? Questions? 8
Common Thyroid Disorders
Common Thyroid Disorders Louie Riesch MSN, MPH, RN, ACNS-BC, CDE Texas Diabetes and Endocrinology Anatomy of the Thyroid Gland Hypothalamic-Pituitary-Thyroid Axis Physiology Hypothalamus TRH Pituitary
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 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 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 informationJoshua Klopper, MD Assistant Professor of Medicine and Radiology Division of Endocrinology, Metabolism and Diabetes
Joshua Klopper, MD Assistant Professor of Medicine and Radiology Division of Endocrinology, Metabolism and Diabetes joshua.klopper@ucdenver.edu None Topliss and Eastman. MJA Vol 180 16 February 2004 A
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 informationNSC 830: Drugs Affecting the Thyroid BROOKE BENTLEY, PHD, APRN
NSC 830: Drugs Affecting the Thyroid BROOKE BENTLEY, PHD, APRN Hypothalamus-Pituitary-Thyroid Hormone Axis TSH: Normal = 0.5-5 mu/l Free T4: 1.3-3.8 ng/dl 1 Hypothyroidism: Thyroid Agents Natural Health
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 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 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 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 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 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 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 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 informationThyroid Hormones (T 4 & T 3 )
1 Thyroid Hormones (T 4 & T 3 ) Normalize growth and development, body temperature, and energy levels. Used as thyroid replacement therapy in hypothyroidism. Thyroxine (T 4 ) is peripherally metabolized
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 and Antithyroid Drugs
Thyroid and Antithyroid Drugs Dr. Yunita Sari Pane, MSi Department of Pharmacology HYPOTHALAMIC PITUITARY THYROID AXIS T3 and T4 are synthesized in the thyroid gland. Inorganic iodine is trapped with great
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 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 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 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 informationPitfalls of TFTs Interpretation
Mohammad Reza Bakhtiari DCLS, PhD Pitfalls of TFTs Interpretation CME July 2006 Vol.24 No.7, http://keck.usc.edu HPT axis physiology Log-linear relationship between TSH and FT4 Patient Specific Set Point
More informationThyroid Diseases. Q1: The most common thyroid function disorder is? Q2: The most sensitive test for thyroid function is?
Thyroid Diseases Scott Urquhart, PA-C Clinical Instruct., George Washington Univ. PA Program Adjunct Clinical Prof., James Madison Univ. PA Program Diabetes and Thyroid Associates. Fredericksburg, Virginia
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 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 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 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 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 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 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 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 informationThyroid Disease. Scott D. Isaacs, MD, FACP, FACE HRT Symposium Savannah GA July 14 16, All Rights Reserved. 1
Thyroid Disease Scott D. Isaacs, MD, FACP, FACE HRT Symposium Savannah GA July 14 16, 2016 2016. All Rights Reserved. 1 Disclosure Scott D. Isaacs, MD, FACP, FACE, is the Medical Director at Atlanta Center
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 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 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 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 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 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 informationThe interpretation and management of thyroid disorders
Journal of Endocrinology, Metabolism and Diabetes of South Africa 2015 ; 20(2) http://dx.doi.org/10.1080/16089677.2015.1056468 Open Access article distributed under the terms of the Creative Commons License
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 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 informationChapter 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 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 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 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 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 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 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 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 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, antithyroid, parathyroid & Calcium metabolism. Suharti K Suherman Dept. of Pharmacology & Therapeutic Medical Faculty, Univ.
Thyroid, antithyroid, parathyroid & Calcium metabolism Suharti K Suherman Dept. of Pharmacology & Therapeutic Medical Faculty, Univ. of Indonesia Thyroid secreted by thyroid gland source of 2 different
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 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 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 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 informationManagement of Common Thyroid Disorders
Management of Common Thyroid Disorders Douglas C. Bauer, MD UCSF Division of General Internal Medicine No Disclosures Cases 68 yr old woman with new atrial fibrillation and no other findings except TSH=0.04,
More informationThyroid Disease in Pregnancy. Justin Moore, MD
Thyroid Disease in Pregnancy Justin Moore, MD Case 1 22 yr old G1P0 female at 14 2/7 weeks presents with tremor Weight stable since first positive pregnancy test Some nausea, rare vomiting TSH 0.02 miu/l,
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 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 informationThyroid 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 informationMANAGING HYPOTHYROIDISM: A REVIEW OF THYROID HORMONES ETIOLOGY
Volume 26, Issue 6 March 2011 MANAGING HYPO- THYROIDISM: A REVIEW OF THYROID HORMONES Annie Moynihan, Pharm.D. candidate H ypothyroidism is a heterogenous disorder defined by biochemical markers and clinical
More informationThyroid Hot Topics. AACE Atlanta, GA January 26-27, 2018
Thyroid Hot Topics AACE Atlanta, GA January 26-27, 2018 Michael T. McDermott MD Director, Endocrinology and Diabetes Practice University of Colorado Hospital Disclosure Michael McDermott MD Financial Relationships
More informationTips For Taming Thyroid Disorders in Primary Care
Tips For Taming Thyroid Disorders in Primary Care Christine Kessler MN, ANP-BC, CNS, BC-ADM, CDTC, FAANP Metabolic Medicine Associates King George, Virginia Co-chair: Metabolic & Endocrine Disease Summit
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 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 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 informationPediatric Thyroid Conundrums
Learning Objectives Pediatric Thyroid Conundrums Harvey Chiu, MD Associate Clinical Professor of Pediatrics UCLA Mattel Children s Hospital Division of Pediatric Endocrinology Understand the urgency of
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 informationTHYROID HORMONES: An Overview
1 SCHOOL OF MEDICINE AND HEALTH SCIENCES DIVISION OF BASIC MEDICAL SCIENCES DISCIPLINE OF BIOCHEMISTRY AND MOLECULAR BIOLOGY PBL SEMINAR MBBS III; BMLS & BDS Year 3 What are the Thyroid Hormones? THYROID
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 informationTHYROID DISEASES. CASE BASED WORKSHOP Z. Henry He, MD, PhD. Endocrinology, Diabetes, & Metabolism Cambridge Health Alliance Harvard Medical School
THYROID DISEASES CASE BASED WORKSHOP Z. Henry He, MD, PhD Endocrinology, Diabetes, & Metabolism Cambridge Health Alliance Harvard Medical School DISCLOSURE I have no relevant financial disclosure OBJECTIVES
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 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 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 informationNEWBORN FEMALE WITH GOITER PAYAL PATEL, M.D. PEDIATRIC ENDOCRINOLOGY FELLOW FEBRUARY 12, 2015
NEWBORN FEMALE WITH GOITER PAYAL PATEL, M.D. PEDIATRIC ENDOCRINOLOGY FELLOW FEBRUARY 12, 2015 CHIEF COMPLAINT 35 6/7 week F with goiter, born to a mother with Graves disease (GD) HPI 35 6/7 week F born
More informationPatient Diary: Treatment Tracker
Patient Diary: Treatment Tracker A tool to help you log your experience with LEVOXYL and communicate with your doctor When you are taking LEVOXYL, your doctor will monitor your symptoms and check your
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 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 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 informationUnder and Over: Update on Thyroid Disorders, Allen S. Burris, MD FACP 2004 AANP National Conference Monday, 13 June 2004 COURSE OBJECTIVES
Under and Over: Update on Thyroid Disorders, 2004 Allen S. Burris, MD FACP 2004 AANP National Conference Monday, 13 June 2004 COURSE OBJECTIVES 1. Review the pathophysiology of thyroid disorders and contemporary
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 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 informationTHYROID HORMONES & THYROID FUNCTION TESTS
THYROID HORMONES & THYROID FUNCTION TESTS SCHOOL OF MEDICINE AND HEALTH SCIENCES DIVISION OF BASIC MEDICAL SCIENCES DISCIPLINE OF BIOCHEMISTRY AND MOLECULAR BIOLOGY CLINICAL BIOCHEMISTRY LECTURE BMLS III
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 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 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 informationGuidance for Thyroid Function Testing in Primary Care in Lothian
Guidance for Thyroid Function Testing in Primary Care in Lothian In July 2006 following a lengthy consultation process, a joint working group comprising representatives from the Association of Clinical
More informationImportant Facts about LEVOXYL (Lev-OX-il) (levothyroxine sodium tablets)
Important Facts about LEVOXYL (Lev-OX-il) (levothyroxine sodium tablets) The risk information provided herein is not comprehensive. To learn more about LEVOXYL, talk to your healthcare provider or pharmacist.
More informationThyroid disorder for Resident
Thyroid disorder for Resident Chaicharn Deerochanawong M.D. Diabetes and Endocrinology Unit Department of Medicine Rajavithi Hospital, Ministry of Public Health Topics Abnormal thyroid function test Euthyroid
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 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 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 informationTable 1: Thyroid panel. Result (reference interval) TSH 89.5 miu/l ( ) Total T4 5.2 µg/dl ( ) T3 uptake 39% (22-35)
Introduction Thyroid disease is the second most common endocrine disorder (behind diabetes), and its prevalence increases with increasing age. The incidence of newly diagnosed thyroid cancer is increasing
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 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 informationSubclinical 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 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 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 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 information