Understanding Thyroid Labs
|
|
- Ashlie Parks
- 5 years ago
- Views:
Transcription
1 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 Pharmaceuticals None related to this topic Learning Objectives Participants in this session will learn : To choose appropriate labs for the diagnosis of common thyroid conditions To interpret laboratory values to identify the most likely diagnosis To recognize when additional diagnostic test (lab or imaging) are needed to clarify the diagnosis. To recognize when referral to a specialist is warranted
2 Question 1 Current labs: TSH: 0.25 ( ) Free T4: 1.4 ( ) Total T3: 165 (80-180) What is the most appropriate diagnosis based on these labs? A. Hypothyroidism B. Subclinical Hypothyroidism C. Hyperthyroidism D. Subclinical Hyperthyroidism E. I don t know, ask me again later A patient was started on methimazole 4 weeks ago for Graves dz. Current labs: TSH: ( ) Free T4: 0.30 ( ) Total T3: 55 (80-180) What is the most appropriate medication adjustment? A. Increase Methimazole B. Decrease Methimazole C. Keep current dose D. Ask the patient what they prefer Question 2 Prevalence of Thyroid Disorders Million in US with thyroid dz over half undiagnosed >360,000 new cases each year Increases with age 40% of patients on thyroid meds have an abnormal TSH Post-partum-thyroiditis on the rise
3 What Does Thyroid Hormone Do? The great SYNERGIZER Increases fetal development (synergy with GH) Increases MVO2, CO, HR Stimulate B-adrenergic Beta receptor in heart Stimulates gut motility and protein catabolism Major impact on menses and fertility Important in thermogenesis Lipid metabolism (T3 mostly) Suspicion/risk of thyroid issues High LFTs CHF, Afib, CAD Dyslipidemia Anemia, hypercalcemia, incr. Prolactin Infertility, menstural issues Autoimmune diseases Amiodarone, lithium, New psychosis, mental instability Newborn and pregnancy Thyroid Disorders & Autoimmune Associations Type 1 DM Vitiligo Addisons Pernicious anemia Celiac RA Psoriasis Sjogrens
4 TSH?? Free T4 TPO Abs T3 TRAb Hypothyroidism Hyperthyroidism Thyroid nodules/cancer What Can Go Wrong? The problem can be Intrinsic (PRIMARY): thyroid Extrinsic (SECONDARY): H-P disorders Or dietary/ medication/ acute illness problems
5 T4 Hypothalamic-Pituitary-Thyroid Axis Physiology Hypothalamus TRH Pituitary T3 TSH Thyroid Gland Target Tissues Heart Liver T4 T3 TR Bone Bind to proteins T4 T3 Liver CNS Adapted from Merck Manual of Medical Information. ed. R Berkow. 704:1997. Production of T4 and T3 T4 is the primary hormone released by the thyroid gland, ~9-10x more T4 than T3 T4 is highly protein bound (99%) 75% bound to thyroid binding globulin (TBG) The rest bound to: thyroid binding prealbumin, albumin, and HDL Carrier proteins can be affected by physiologic changes, drugs, and disease T3 released in very small amounts but it is the most potent physiologically (4x > T4) About 80% of circulating T3 comes from deinodination of T4 in peripheral tissues (20% from direct thyroid secretion) Obesity causes decreased T4 to T3 conversion Tests of Thyroid Function TSH Free T4 Total T3 or Free T3 Thyroid scanning
6 TSH THE screening test cant make dx on this alone New normal range ( for those without antibodies) to 3 decimal points ( highly-, super-, ultra-sensitive, etc.) Inverse relationship to FT4 (a 2 fold change in FT4 produces 100 fold change in TSH) Everyone has a genetically set point; a normal value may hide subclinical disease Changes slowly in response to Rx; (6-8 weeks, may take up to 12 weeks in elderly) Possible Causes of Low TSH Hyperthyroidism Graves Toxic adenomas or autonomously functioning thyroid nodules Toxic Multinodular goiter (TMNG) Thyroiditis (post-partum, subacute, silent) Pregnancy, Hyperemesis gravidarum Central Hypothyroidism Euthyroid Sick Syndrome Medications (steroids, sympathomimetics, Amiodarone) Ingestion of excess exogenous thyroid hormone (most common) Hypothalamic-Pituitary-Thyroid Axis Physiology Hypothalamus TRH Pituitary T4 T3 TSH Thyroid Gland Target Tissues Heart Liver T4 T3 TR Bone Bind to proteins T4 T3 Liver CNS Adapted from Merck Manual of Medical Information. ed. R Berkow. 704:1997.
7 10-20% women have reduced TSH with HCG peak 28 yo female at 10 weeks gestation has a suppressed TSH of 0.24 ( ) She is asymptomatic for hyperthyroidism. You should: A. Refer to Endocrinology B. Check Free T4 C. Reassure, repeat TSH in 2 nd Trimest D. Order thyroid scan 10 Possible Causes of High TSH Hypothyroidism Thyroiditis Central Hyperthyroidism
8 T4 Hypothalamic-Pituitary-Thyroid Axis Physiology Hypothalamus TRH Pituitary T3 TSH Thyroid Gland Target Tissues Heart Liver T4 T3 TR Bone Bind to proteins T4 T3 Liver CNS Adapted from Merck Manual of Medical Information. ed. R Berkow. 704:1997. Free T4 THE test to monitor the acute response to therapy; changes rapidly To confirm meaning of a low or high TSH Everyone has a genetically set point; a normal value may hide subclinical disease Avoid FTI (Total T4/T3 Resin Uptake) Not a direct measurement of T4 but a calculation and prone to interference Why FT4 and not Total T4 (factors increasing total T4) High estrogen states Hyperemesis gravidarum Lab error Autoimmunity Acute illness Acute psychiatric problems Familial thyroid binding abnormalities Generalized resistance to thyroid hormone Drugs
9 When FT4 and TSH Seem Discordant Usually means early or subclinical disease Often occurs after initiating a therapy that changes thyroid function (e.g. starting L-thyroxine or starting anti-thyroid meds); FT4 will change before TSH Sign of Pituitary or Hypothalamic dysfunction (central hypo or hyperthyroidism) -Refer
10 Total or Free T3 Assess for T3 toxicosis To clarify subclinical thyroid conditions Assess response to therapy when using T3 in your replacement dose Assessing response to anti-thyroid medication when T3 was elevated prior to Rx Most accurate when elevated, poor performance in normal and low ranges (Total T3 more reliable assay) Adjunctive Tests Antibodies: (Tg, TPO): thyroiditis, goiter, nodules, Hashimoto s dz Thyroid Receptor Antibodies (TRAb): TSI- Thyrotropin stimulating immunoglobulin TBII- Thyrotropin binding inhibitory immunoglobulin Reverse T3: confirms euthyroid sick syndrome when elevated only order in hospitalized pts. Thyroglobulin: cancer marker post thyroidectomy Thyroid Scanning: labeled iodine travels to functioning parts of thyroid Thyroid Uptake: How rapidly the iodine gets in Adjunctive Tests (TRAB s) Free T4 Total T3, T3 toxicosis, euthyroid sick TSH Receptor Auto Antibodies (TRAb) TBII (thyrotropin binding inhibitory immunoglobulin) TSI (thyroid stimulating immunoglobulin) ENDOCRINE PRACTICE Vol 17 No. 3 May/June 2011
11 Thyroid Uptake/Scan Thyroiditis (low uptake) Graves (increased uptake, when other signs lacking) Looking for hot/cold nodules Percent uptake to prepare for I-131 Normal/Cold Nodule Toxic MNG
12 Toxic Hot Nodule Thyroiditis Thyroid Uptake Associated With Elevated Radioiodine Uptake Graves disease Toxic Adenoma/Nodule Toxic MNG Associated With Depressed Radioiodine Uptake Thyroiditis acute subacute Painless Post-partum Hashitoxicosis Iodine ingestion Fisher, J South Med J 2002
13 CASE 1 70 yo male with fatigue, (pulse 95 bpm) TSH: ( ) What do you do next? More Labs? I-123 Uptake and Scan? Ultrasound? CASE 1 What do you do next? It depends Any clues from physical exam? Free thyroid hormone levels Thyroid antibody tests? Imaging (US, Uptake, Scan) Diagnosis of Hypo/Hyperthyroidism Weight and blood pressure Thyroid palpation and auscultation (to determine size, tenderness, nodularity and vascularity) Cardiovascular (pulse rate, rhythm) Neuromuscular exam (muscle weakness, hyperreflexia, tremor, delayed ankle DTR) Eye exam (exophthalmos, stare, edema) Dermatologic (nails, diaphoresis, dry skin, myxedema)
14 CASE 1 Exam is normal except for high normal pulse of 95 bpm. When would you order an Ultrasound of the Thyroid? Asymmetrical gland or palpable nodule If cold area(s) on Scan suggestive of nodule(s) Note: Thyroid cancer and Graves disease although rare, are not mutually exclusive Toxic Nodule
15 CASE 1 Free T4: 1.58 ( ) Total T3: 166 (60-180) Uptake/Scan: slightly elevated uptake at 6 and 24 hrs, with even distribution of tracer TSI: 150% (<130%) What s the diagnosis? CASE 1 1) Graves disease 2) Subclinical Hyperthyroidism CASE 2 37 yo female with type 1 diabetes, h/o hypothyroidism since age 12. Currently on 100 mcg of levothyroxine, normal TFT s for many years on this dose. She is asymptomatic with normal exam. Routine labs reveal: TSH: ( ) Free T4: 1.54 ( )
16 Case 2 Her dose is decreased every 6-8 weeks but her TSH remains suppressed until the dose is down to 25 mcg TSH: 1.15 ( ) Free T4: 1.08 ( ) Case 2 10 months later on 25 mcg daily TSH: ( ) FT4: 1.43 ( ) Plan: D/C levothyroxine 25 mcg 2 months later TSH: FT4: 1.13 What would you do next? A.Check TRAB s B.Order thyroid uptake C.Thyroid Ultrasound D.Check Free T3 level Correct answer is A or B. 10
17 Case 2 Labs TRAB 5.18 (0-1.75) TPO Ab 330 (<40) TG Ab 103 (<40) Thyroid Uptake: 46% 24 hour uptake (normal 10-30%) Case 2 DX: Graves Disease/Subclinical Hyperthyroidism Plan: Begin Methimazole 5 mg daily 6 weeks later TSH: ( ) FT4: 0.72 ( ) Case 2 Conclusion: Pt. was weaned off methimazole over the next 2 months and then D/C d. Patient has remained with normal TFT s off of all thyroid medication for 2 years
18 Summary TSH still the best initial screening test for thyroid dysfunction Clinical exam findings can help guide the diagnostic work-up Adjunctive labs including Free T4, T3, Thyroid Abs help to clarify diagnosis of hyperthyroidism Thyroid uptake/scan helpful when clinical picture is not clear Free T4 and T3 more accurately reflect acute changes in thyroid hormone status Current labs: TSH: 0.25 ( ) Free T4: 1.4 ( ) Total T3: 165 (80-180) What is the most appropriate diagnosis based on these labs? A. Hypothyroidism B. Subclinical Hypothyroidism C. Hyperthyroidism D. Subclinical Hyperthyroidism Correct answer is D. 10 A patient was started on methimazole 4 weeks ago for Graves dz. Current labs: TSH: ( ) Free T4: 0.30 ( ) Total T3: 55 (80-180) What is the most appropriate medication adjustment? A. Increase Methimazole B. Decrease Methimazole C. Keep current dose D. Change to PTU Correct answer is B. 10
19 Q&A Resources - physician/patient information source American Association of Clinical Endocrinologists American Thyroid Association - The Endocrine Society
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 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 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 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 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 informationAn 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 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 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 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 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 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 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 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 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 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 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 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 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 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 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 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 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 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 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 informationEndocrine part two. Presented by Dr. Mohammad Saadeh The requirements for the Clinical Chemistry Philadelphia University Faculty of pharmacy
Endocrine part two Presented by Dr. Mohammad Saadeh The requirements for the Clinical Chemistry Philadelphia University Faculty of pharmacy Cushing's disease: increased secretion of adrenocorticotropic
More informationPearls 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 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 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 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 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 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 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 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 informationPregnancy & 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 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 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 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 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 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 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 informationObjectives. 1)To recall thyroid nodule ultrasound characteristics that increase the risk of malignancy
Evaluation and Management of Thyroid Nodules in Primary Care Chris Sadler, MA, PA C, CDE, DFAAPA Medical Science Outcomes Liaison Intarcia Diabetes and Endocrine Associates La Jolla, CA Past President
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 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 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 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 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 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 DISEASE IN PREGNANCY
THYROID DISEASE IN PREGNANCY https://www.wddty.com/magazine/2016/june/depression-its-not-your-brain-its-your-thyroid.html Grand Rounds December 5, 2018 Maria Kolojeski, DO (PGY3) REVIEW OF THYROID HORMONES
More 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 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 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 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 informationIndex. Graves disease, 111 thyroid autoantigens, 110 Autoimmune thyroiditis, 11, 58, 180, 181. B Bamforth Lazarus syndrome, 27
Index A Adrenergic activation, 77 Allan Herndon Dudley syndrome, 31 Ambulatory practice choice of test, 156, 157 screening general population, thyroid dysfunction, 163, 164 targeted population, 164 167
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 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 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 informationGrave s disease (1 0 )
THYROID DYSFUNCTION Grave s disease (1 0 ) Autoimmune - activating AB s to TSH receptor High concentrations of circulating thyroid hormones Weight loss, tachycardia, tiredness Diffuse goitre - TSH stimulating
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 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 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 informationIodine 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 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 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. 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 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 informationThyroid 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 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 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 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 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 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 informationObjectives. How to Investigate Thyroid Nodules like A Pro
How to Investigate Thyroid Nodules like A Pro Chris Sadler, MA, PA C, CDE, DFAAPA Medical Science Outcomes Liaison Intarcia Diabetes and Endocrine Associates La Jolla, CA Past President ASEPA Disclosures
More informationTHYROID DISEASE AND TESTING. Jack L. Snitzer, D.O., FACOI, FACE, CCD
THYROID DISEASE AND TESTING Jack L. Snitzer, D.O., FACOI, FACE, CCD MAPA MEETING 2018 JACK L. SNITZER, D.O. 410-572-8848 JACK.SNITZER@PENINSULA.ORG NO CONFLICTS OF INTEREST THYROID THYROID Goiter Hyperthyroidism
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 informationLothian Guidance for Diagnosis and Management of Thyroid Dysfunction in Pregnancy
Lothian Guidance for Diagnosis and Management of Thyroid Dysfunction in Pregnancy Early diagnosis and good management of maternal thyroid dysfunction are essential to ensure minimal adverse effects on
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 informationChecking 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 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 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 informationPathology. Hyperthyroidism (Overactive Thyroid), Graves Disease (Basedow Disease) and more. Definitions. See online here
Pathology Hyperthyroidism (Overactive Thyroid), Graves Disease (Basedow Disease) and more See online here Hyperthyroidism is caused by the excess of thyroid hormones T3 and T4. Graves disease is the most
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 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 informationDianne S Cheung, MD FACE Assistant Clinical Professor UCLA Health David Geffen School of Medicine CA-AACE Chapter Secretary
Dianne S Cheung, MD FACE Assistant Clinical Professor UCLA Health David Geffen School of Medicine CA-AACE Chapter Secretary No Financial Disclosures Objectives Which thyroid labs to order and interpret?
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 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 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 informationHypothyroidism and Hyperthyroidism. Paul V. Tomasic, MD, MS, FACP, FACE Nevada AACE EFNE & Annual Meeting October 6, 2018
Hypothyroidism and Hyperthyroidism Paul V. Tomasic, MD, MS, FACP, FACE Nevada AACE EFNE & Annual Meeting October 6, 2018 Disclosures: None related to this program or presentation Objectives: Hypothyroidism
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 informationBack to the Basics: Thyroid Gland Structure, Function and Pathology
Back to the Basics: Thyroid Gland Structure, Function and Pathology JANELLE M. CHIASERA LEARNING OBJECTIVES 1. Explain the HPT feedback system involving the thyroid gland. Include the hormone produced
More informationLimits of Liability/Disclaimer of Warranty
Page 0 of 8 Limits of Liability/Disclaimer of Warranty The author, Brad Shook has made their best effort to produce a high quality and informative reference. The author makes no representation or warranties
More informationPart I Initial Office Visit. Questions NATIONAL CENTER FOR CASE STUDY TEACHING IN SCIENCE
Thyroid Troubles: A Case Study in Negative Feedback Regulation by Breanna N. Harris Department of Biological Sciences Texas Tech University, Lubbock, TX Part I Initial Office Visit You are six months into
More informationHypothyroidism. National Endocrine and Metabolic Diseases Information Service
Hypothyroidism National Endocrine and Metabolic Diseases Information Service U.S. Department of Health and Human Services NATIONAL INSTITUTES OF HEALTH What is hypothyroidism? Hypothyroidism occurs when
More informationTimothy Bilash MD MS OBG Northern Inyo Hospital, Bishop, CA October 20, :30 PM
Thyroxine Deficiency in Pregnancy Timothy Bilash MD MS OBG Northern Inyo Hospital, Bishop, CA October 20, 2006 1:30 PM WHI Estrogen recap In http://courses.washington.edu/bonephys/opestrogen.html. from:
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 informationDr David Kim. Endocrinologist and General Physician Waitemata DHB and Apollo Specialist Clinic Albany Auckland
Dr David Kim Endocrinologist and General Physician Waitemata DHB and Apollo Specialist Clinic Albany Auckland 14:00-14:55 WS #40: Endocrine Case Studies 15:05-16:00 WS #52: Endocrine Case Studies (Repeated)
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 information1 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 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 information