Canadian Endocrine Review Course 2014

Size: px
Start display at page:

Download "Canadian Endocrine Review Course 2014"

Transcription

1 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 Canada

2 Canadian Endocrine Review Course Ally Prebtani has no potential for conflict of interest with this presentation

3 Faculty/Presenter Disclosure Faculty: Dr Ally Prebtani Rela3onships with commercial interests:* Grants/Research Support: NONE Speakers Bureau/Honoraria: NONE Consul3ng Fees: NONE Other: NONE

4 Disclosure of Commercial Support This program has received financial support from Eli Lilly/ Boehringer Ingelheim, Novo Nordisk, Pfizer, Sanofi, Astra/BMS, Merck, NovarHs, Serono/EMD, Janssen in the form of an Unrestricted EducaHonal Grant This program has not received in- kind support from any commercial organizahon

5 Amiodarone & Iodine Class III Anti-arrhythmic Similar structure to thyroid hormone 37% Iodine by weight 75mg Iodine in 200mg tablet Releases 10% free Iodine = 7.5mg od Normal intake = mg od Lipophilic Fat, Heart, Skeletal Muscle, Thyroid t 1/2 = days

6 Prevalence

7 Amiodarone Physiology Inhibits intrapituitary & peripheral 5 DI Dec T4 --> T3 conversion Inhibits Peripheral T4 & T3 uptake Desethylamiodarone (DES) Metabolite T3 antagonist Iodine Inhibits 5 DI Transient (10-14d) Wolf-Chaikoff effect

8 Effects on TFT s Euthyroid Patients Test Up to 3 mos > 3 mos T4 Inc Inc T3 Dec Dec TSH Transient inc N < 20 rt3 Inc Inc

9 Pathophysiology Amiodarone Direct Cytotoxic effect (Type II) Inflammation --> thyroiditis Autoimmune (Type I) Iodine Very controversial Jod-Basedow effect (Type I) Increased hormone production Cytotoxic (Type II)?? Autoimmune (Type I)

10 Risk Factors Hx Thyroid Dysfunction Iodine deficiency Family History Autoimmune Goitre/MNG Thyroid Antibodies

11 Clinical Apathetic/Subtle Older, Beta-blocked, decreased T3 Cardiac Arrhythmias, Ischemia, CHF Neuro Weakness, Mental status, Depression Weight loss, Fatigue Thyroid Gland Goitre, Nodule(s), Bruit Orbitopathy, Skin

12 DDx Type I Increased thyroid hormone production Jod-Basedow effect due to excess Iodine Pre-existing thyroid dysfunction Type II Grave s & MNG Preformed T4/T3 release due to destruction Normal thyroid gland More abrupt, 1-3 month duration, Self-limited Mixed Hypothyroid phase

13 Clues to DDx 80% Dx Tc-99m Scan ok on Tx Duration Thyroid Bx?? JCEM, Daniels GH, 86(1), 3-8, 2001

14 Other Clues Spontaneous remissions common Monitor for Hypothyroidism Repeat TFT testing in 6 weeks

15 Management Can be difficult No large RCT s Sick patients High Intrathyroidal Iodine content < Effective Antithyroid Drugs (ATD) Long t 1/2 Can t usually d/c Amiodarone Therapy depends on Type I vs Type II Often can t differentiate Mixed

16 Amiodarone Discontinuation Effects long-lasting, several months Potential Paradoxical danger esp CVS Beta-blockade T3 DES as T3 antagonist Loss of Iodine effect on release of T4 Continue ATD & taper 24hr urine Iodide normal Over 3-6 months

17 Antithyroid Drugs Type I, Mixed, Uncertain & Sick Higher doses needed since ++ Intrathyroidal Iodine Methimazole (MMZ) 30-60mg daily Propylthiouracil(PTU) mg qid

18 Glucocorticoids Type II, Mixed, Uncertain & Sick Prednisone 40-60mg X 7-14 days Taper over 2-3 months Esp if ++ CVS Sx Rapid effect in days Normal in 1 week if Type II Anti-inflammatory decreased thyroglobulin proteolysis Dec T4 --> T3

19 Potassium Perchlorate (KClO4) Type I, Mixed, Uncertain & Sick po 250 mg q6h (use < 1 month) Discharges Iodine from thyroid gland Decreases Iodide uptake Increases ATD efficacy Concerns Aplastic anemia Nephrotic syndrome Not big issue if < 1 month & monitoring

20 Lithium Type I, Not 1st line Tx Similar mechanism as Iodine Dickstein G et al. Am J Med 1997 May;102(5): n = 21, not randomized 5 Amio withdrawal & 7 PTU mg 11 week recovery 9 PTU 300 mg & Li daily (sicker) 4 week recovery w/o ADR (p < 0.01)

21 I-131 Type I Definitive Tx If RAIU >> 1%, Repeat prn? rtsh stimulation Once stable Radiation thyroiditis Eye disease Contact precautions Hypothyroidism

22 Thyroidectomy Definitive Tx Refractory to medical Tx Thyroid storm Cardiac instability When immediate euthyroid state required Low morbidity & mortality despite thinking Possible under local anesthesia depends on surgeon & centre

23 Plasmapheresis Severe Transient effect Variable success Case reports only

24 Other Iopanoic Acid Type I & II? If Prednisone contraindicated Pre-op Decreases T4/T3 release T4 --> T3 Vascularity Cholestyramine Binds thyroid hormone Dialysis

25 Suggested Approach Thyrotoxicosis (confirmed on repeat testing in 6 weeks) Hx & Physical d/c Amiodarone if possible Beta-Blockade TPO, Tg Ab, TRAB RAIU CFDS/Ultrasound IL-6? Type I Type II Uncertain Mixed/Sick ATD KClO4 prn? Lithium Glucocorticoids? Iopanoic Acid ATD Glucorticoids prn KClO4 prn? Lithium ATD Glucocorticoids KClO4 prn? Lithium Iopanoic Acid Cholestyramine I-131 Thyroidectomy I-131 Thyroidectomy I-131 Thyroidectomy Plasmapheresis Dialysis

26 Bottom Line Not uncommon but limited EBM Presentation Apathetic, CV Sx Types Clues I & II, Mixed Not always easy to DDx Hx & PE Labs Imaging Tx Response Management Depends on Type Often empirical Ongoing Monitoring important

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

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

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

Amiodarone Induced Thyrotoxicosis Treatment? (AIT)

Amiodarone Induced Thyrotoxicosis Treatment? (AIT) Amiodarone Induced Thyrotoxicosis Treatment? (AIT) Presentation of a Case Report Annelies Tonnelier Brigitte Velkeniers 14-12-2013 1 1. Background 1. Case report 2. Investigations 3. Diagnosis 4. Treatment

More 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

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

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

35 yo F with Graves Disease. Endorama March 10, 2016 Mizuho Mimoto

35 yo F with Graves Disease. Endorama March 10, 2016 Mizuho Mimoto 35 yo F with Graves Disease Endorama March 10, 2016 Mizuho Mimoto PHONE CALL: 35 F with recently diagnosed Graves Vomiting Persistent diarrhea with incontinence x 2 days Tremor Heart racing Subjective

More information

THYROTOXICOSIS DR.J.BALA KUMAR 2 ND YR SURGERY PG

THYROTOXICOSIS 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 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

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

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

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

Review Article. Abstract. Introduction

Review Article. Abstract. Introduction Review Article Amiodarone therapy: don t forget thyroid Maseeh-uz-Zaman, Nosheen Fatima, Zafar Sajjad Department of Radiology, The Agha Khan University Hospital (AKUH), Karachi Institute of Radiotherapy

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

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. 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

DRUGS. 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

DRUGS. 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 information

NEWBORN 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 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 information

Dharma Lindarto Div. Endokrin-Metabolisme dan Diabetes. Dep Ilmu Penyakit Dalam FK USU / RSUP HAM Medan

Dharma 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 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

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

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

Pregnancy & Thyroid. Zohreh Moosavi Associate professor of Endocriology Imam Reza General Hospital Mashad University. Imam Reza weeky Conferance

Pregnancy & Thyroid. Zohreh Moosavi Associate professor of Endocriology Imam Reza General Hospital Mashad University. Imam Reza weeky Conferance Pregnancy & Thyroid Zohreh Moosavi Associate professor of Endocriology Imam Reza General Hospital Mashad University Imam Reza weeky Conferance Objectives Thyroid Disorders & Pregnancy Normal thyroid phsyiology

More information

MTP: Thyroid Nodules

MTP: Thyroid Nodules Canadian Endocrine Update MTP: Thyroid Nodules Deric Morrison MD, FRCP, ECNU Assistant Professor, Division of Endocrinology and Metabolism, Western University April 2014 Faculty/Presenter Disclosure Faculty:

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

61 yo M w/heart disease presenting in decompensated HF. 1/24/13 Jess Hwang

61 yo M w/heart disease presenting in decompensated HF. 1/24/13 Jess Hwang 61 yo M w/heart disease presenting in decompensated HF 1/24/13 Jess Hwang HPI 3 weeks worsening orthopnea, PND, DOE Referred to UCMC for transplant evaluation Found to have 100% afib burden 1 month prior

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

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

THYROID FUNCTION TEST and RADIONUCLIDE THERAPY

THYROID 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 information

Systemic Management of Graves Disease. Robert James Graves, M.D., FRCS ( ) Graves Disease: Endocrinopathy or Ophthalmopathy?

Systemic Management of Graves Disease. Robert James Graves, M.D., FRCS ( ) Graves Disease: Endocrinopathy or Ophthalmopathy? Systemic Management of Graves Disease Rona Z. Silkiss, M.D., FACS Associate Clinical Professor, UCSF Chief, Division of Ophthalmic Plastic and Orbital Surgery California Pacific Medical Center No financial

More information

A 64 year old man with abnormal thyroid function testing

A 64 year old man with abnormal thyroid function testing A 64 year old man with abnormal thyroid function testing Dr. Dickens does not have any relevant financial relationships with any commercial interests. ENDORAMA: Case 1 A 64 year old man with abnormal thyroid

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

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

supraventricular (ectopic atrial) tachycardia: case report and review of the literature

supraventricular (ectopic atrial) tachycardia: case report and review of the literature Letter to the Editor Amiodarone-induced thyrotoxicosis with paroxysmal supraventricular (ectopic atrial) tachycardia: case report and review of the literature Zofia Kolesińska 1#, Katarzyna Siuda 1##,

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

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

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

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

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

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

Thyroid hormone. Functional anatomy of thyroid gland

Thyroid 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

Management of Common Thyroid Disorders

Management 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 information

Non Thyroid Surgery. In patients with Thyroid disorders

Non Thyroid Surgery. In patients with Thyroid disorders Non Thyroid Surgery In patients with Thyroid disorders The Thyroid disease problem. Is Thyroid disease a problem with anaesthetic? Why worry? The Physiology The evidence. A pragmatic approach From: The

More information

Austin 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) 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 information

Iodine 131 thyroid Therapy. Sara G. Johnson, MBA, CNMT, NCT President SNMMI-TS VA Healthcare System San Diego

Iodine 131 thyroid Therapy. Sara G. Johnson, MBA, CNMT, NCT President SNMMI-TS VA Healthcare System San Diego Iodine 131 thyroid Therapy Sara G. Johnson, MBA, CNMT, NCT President SNMMI-TS VA Healthcare System San Diego OBJECTIVES Describe the basics of thyroid gland anatomy and physiology Outline the disease process

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

Optimal 131 I Therapy of Thyrotoxicosis SNMMI Annual Meeting, 6/26/2018

Optimal 131 I Therapy of Thyrotoxicosis SNMMI Annual Meeting, 6/26/2018 RADIOACTIVE IODINE THERAPY FOR HYERTHYROIDISM Mark Tulchinsky, MD, FACNM, CCD Professor of Radiology and Medicine Division of Nuclear Medicine Penn State University Hospital I Love What I do, i.e. Nuclear

More information

Surgical Treatment of Graves Hyperthyroidism. Bertil Hamberger Karolinska Institutet Stockholm, Sweden

Surgical Treatment of Graves Hyperthyroidism. Bertil Hamberger Karolinska Institutet Stockholm, Sweden Surgical Treatment of Graves Hyperthyroidism Bertil Hamberger Karolinska Institutet Stockholm, Sweden In addition there are several uncommon forms of hyperthyroidism: Factitial hyperthyroidism, treatment

More information

Current Management And Changing Trends Of Treatment For Thyrotoxicosis

Current Management And Changing Trends Of Treatment For Thyrotoxicosis Session 5: Breast & Endocrine Current Management And Changing Trends Of Treatment For Thyrotoxicosis Win Meyer-Rochow Waikato DHB, Hamilton Management And Changing Trends Of Treatment For Thyrotoxicosis

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

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

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

Thyroid Disease Part 2

Thyroid Disease Part 2 Thyroid Disease Part 2 by H. David Bergman, Ph.D. Dean, College of Pharmacy, Southwestern Oklahoma State University Goals and Objectives Goals: To provide the pharmacist with information regarding the

More information

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: US and Radionuclide imaging Deepa R Biyyam, MD Attending Pediatric Radiologist Imaging in Pediatric Thyroid disorders: Imaging modalities Outline ACR-SNM-SPR guidelines

More information

Learning Objectives. The role of the laboratory in thyroid disease. Thyroid hormones 7/4/2014

Learning Objectives. The role of the laboratory in thyroid disease. Thyroid hormones 7/4/2014 Learning Objectives The role of the laboratory in thyroid disease Eleanor Burchell Describe the structure and function of the thyroid gland Explain the function of thyroid hormones Outline the action of

More information

Wit JM, Ranke MB, Kelnar CJH (eds): ESPE classification of paediatric endocrine diagnosis. 7. Thyroid disorders. Horm Res 2007;68(suppl 2):44 47

Wit JM, Ranke MB, Kelnar CJH (eds): ESPE classification of paediatric endocrine diagnosis. 7. Thyroid disorders. Horm Res 2007;68(suppl 2):44 47 Wit JM, Ranke MB, Kelnar CJH (eds): ESPE classification of paediatric endocrine diagnosis. 7. Thyroid disorders. Horm Res 2007;68(suppl 2):44 47 ESPE Code Diagnosis OMIM ICD10 7 THYROID DISORDERS 7A HYPOTHYROIDISM

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

The Effects of Amiodarone on the Thyroid*

The Effects of Amiodarone on the Thyroid* 0163-769X/01/$03.00/0 Endocrine Reviews 22(2): 240 254 Copyright 2001 by The Endocrine Society Printed in U.S.A. The Effects of Amiodarone on the Thyroid* ENIO MARTINO, LUIGI BARTALENA, FAUSTO BOGAZZI,

More information

Hyperthyroidism: Guidelines and Beyond. Douglas S Ross MD May Copyrighted slides omitted

Hyperthyroidism: Guidelines and Beyond. Douglas S Ross MD May Copyrighted slides omitted Hyperthyroidism: Guidelines and Beyond Douglas S Ross MD May 19 2018 Copyrighted slides omitted Abbott Laboratories Quest Diagnostics Disclosures Diagnosis Biochemical Assessment Biotin Interference Biotinylated

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

Thyroid Hormones (T 4 & T 3 )

Thyroid 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 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

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

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

NSC 830: Drugs Affecting the Thyroid BROOKE BENTLEY, PHD, APRN

NSC 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 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

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

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

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

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

Clinical Guideline MANAGEMENT OF INFANTS BORN TO MOTHERS WITH GRAVES DISEASE AND AT RISK OF THYROTOXICOSIS

Clinical Guideline MANAGEMENT OF INFANTS BORN TO MOTHERS WITH GRAVES DISEASE AND AT RISK OF THYROTOXICOSIS Clinical Guideline MANAGEMENT OF INFANTS BORN TO MOTHERS WITH GRAVES DISEASE AND AT RISK OF THYROTOXICOSIS Date of First Issue 18/07/2016 Approved 28/09/2017 Current Issue Date 16/06/2017 Review Date 01/09/2019

More information

SUBACUTE THYROIDITIS. Ibrahim Elebrashy

SUBACUTE THYROIDITIS. Ibrahim Elebrashy SUBACUTE THYROIDITIS Ibrahim Elebrashy Prof. Internal Medicine Head of the Internal Medicine Department Head of the Diabetes & Endocrinology Center Faculty Of Medicine-Cairo University DeQuervain s thyroiditis,

More information

HYPOTHYROIDISM AND HYPERTHYROIDISM

HYPOTHYROIDISM 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 information

1 day PTA: vaginal spotting, LE edema LMP 6 weeks ago. OSH Clinic: distended abdomen, (+) urine pregnancy; sent home with iron

1 day PTA: vaginal spotting, LE edema LMP 6 weeks ago. OSH Clinic: distended abdomen, (+) urine pregnancy; sent home with iron Anila Bindal, MD 1 day PTA: vaginal spotting, LE edema LMP 6 weeks ago OSH Clinic: distended abdomen, (+) urine pregnancy; sent home with iron UCMC ER: abdomen doubled overnight, significant vaginal bleeding,

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

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

A case of amiodarone-induced hypothyroidism in a mild to moderate iodine deficiency area

A case of amiodarone-induced hypothyroidism in a mild to moderate iodine deficiency area Clinical Case Seminar A6(1-5) A case of amiodarone-induced hypothyroidism in a mild to moderate iodine deficiency area Roberto Vita 1, Salvatore Benvenga 1,2,3 1 Department of Clinical and Experimental

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

TREATMENT OF AMIODARONE-INDUCED THYROTOXICOSIS RESISTANT TO CONVENTIONAL THERAPY

TREATMENT OF AMIODARONE-INDUCED THYROTOXICOSIS RESISTANT TO CONVENTIONAL THERAPY Tanja Nišić 1, Marija Barać, Velimir Srejić, 1 Marija Polovina 2, Miloš Stojanović, Biljana Nedeljković-Beleslin, Mirjana Stojković, Slavica Savić, Jasmina Ćirić, Ivan Paunović 3, Miloš Žarković TREATMENT

More information

Thyroid disease for R2

Thyroid disease for R2 Thyroid disease for R2 Rungnapa Laortanakul, MD. 5 February 2013 Thyroid Thyrotoxicosis/Thyroiditis Amiodarone and thyroid dysfunction Thyroid storm Hypothyroidism Thyroid nodule Thyrotoxicosis Refers

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

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

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

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

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

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

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

Case 1: 24 yo pregnant female presenting with abnormal TFTs and tachycardia RAJESH JAIN ENDORAMA 3/16/2017

Case 1: 24 yo pregnant female presenting with abnormal TFTs and tachycardia RAJESH JAIN ENDORAMA 3/16/2017 Case 1: 24 yo pregnant female presenting with abnormal TFTs and tachycardia RAJESH JAIN ENDORAMA 3/16/2017 Chief Complaint The ER calls about a 24 year old, 12 weeks pregnant. She presented with tachycardia

More information

A retrospective cohort study: do patients with graves disease need to be euthyroid prior to surgery?

A retrospective cohort study: do patients with graves disease need to be euthyroid prior to surgery? Al Jassim et al. Journal of Otolaryngology - Head and Neck Surgery (2018) 47:37 https://doi.org/10.1186/s40463-018-0281-z ORIGINAL RESEARCH ARTICLE Open Access A retrospective cohort study: do patients

More information

Managing thyrotoxicosis in the acute medical setting

Managing thyrotoxicosis in the acute medical setting 44 Review Article Managing thyrotoxicosis in the acute medical setting C Napier MBBS MRCP (UK) Endocrine Unit, Royal Victoria Infirmary, Queen Victoria Road, Newcastle Upon Tyne, NE1 4LP UK Email: c.napier2@newcastle.

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

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

Current and Future Treatments for Graves Disease and Graves Ophthalmopathy

Current and Future Treatments for Graves Disease and Graves Ophthalmopathy Kotwal Anupam, Stan Marius. Current and Future Treat- ments Horm Metab Res 2018; 00: 00 00 Current and Future Treatments for Graves Disease and Graves Ophthalmopathy Authors Anupam Kotwal, Marius Stan

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

Thyroid Nodules: What to do next?

Thyroid Nodules: What to do next? Thyroid Nodules: What to do next? Ally P. H. Prebtani Professor of Medicine Internal Medicine, Endocrinology & Metabolism McMaster University Canada Copyright 2017 by Sea Courses Inc. All rights reserved.

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 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

Checking the Right Box at the Right Age: the Art of Pediatric Endocrine Testing

Checking the Right Box at the Right Age: the Art of Pediatric Endocrine Testing Checking the Right Box at the Right Age: the Art of Pediatric Endocrine Testing Jean-Pierre Chanoine, MD Endocrinology and Diabetes Unit British Columbia s Children s Hospital Objectives 1. Interpret the

More information