Thyroid: Dr. Dany Zayour

Thyroid: Bringing Life Back into Balance Dany Zayour, MD Endocrinologist Via Christi Medical Associates

Why talk about the Thyroid?
An estimated 27 million Americans have thyroid disease
More than half are undiagnosed
Women are at the greatest risk, developing thyroid problems seven times more often than men
A woman faces as high as a one in five chance of developing thyroid problems during her lifetime
Risk increases with age and family history of thyroid problems

Where is the Thyroid and What Does it Do?
Your thyroid is a small bowtie or butterfly-shaped gland located in the neck
Wrapped around the windpipe
Below the Adam's Apple area.
The thyroid produces several hormones: triiodothyronine (T3) and thyroxine (T4)
These hormones help oxygen get into cells, and make your thyroid the master gland of metabolism.

You have a higher risk of developing thyroid disease if
You're female
You have a family member with a thyroid problem
You or a family member have an autoimmune disease
You've been diagnosed with Chronic Fatigue Syndrome
You've been diagnosed with Fibromyalgia
You've just had a baby
You're a smoker
You've been exposed to radiation
You've been treated with lithium

What Diseases and Conditions Affect the Thyroid?
Hypothyroidism -- An underactive thyroid
Hyperthyroidism -- An overactive thyroid
Goiter -- An enlarged thyroid
Thyroid Nodules -- Lumps in the thyroid gland
Thyroid Cancer -- Malignant thyroid nodules or tissue
Thyroiditis -- Inflammation of the thyroid

Hypothyroidism: Underactive Thyroid
Improperly formed at birth
surgically removed all or in part
Autoimmune disease called Hashimoto's disease, in which antibodies gradually target the thyroid and destroy its ability to produce thyroid hormone

Risk factors for hypothyroidism
____ I have a family history of thyroid disease
____ I have had my thyroid "monitored" in the past to watch for changes
____ I had a previous diagnosis of goiters/nodules
____ I currently have a goiter
____ I was treated for hypothyroidism in the past
____ I had post-partum thyroiditis in the past
____ I had a temporary thyroiditis in the past
____ I have another autoimmune disease
____ I have had a baby in the past nine months

Risk factors for hypothyroidism
____ I have a history of miscarriage
____ I have had part/all of my thyroid removed due to cancer
____ I have had part/all of my thyroid removed due to nodules
____ I have had part/all of my thyroid removed due to hyperthyroidism
____ I have had radioactive iodine due to hyperthyroidism
____ I have had anti-thyroid drugs due to hyperthyroidism

Symptoms of hypothyroidism
____ I am gaining weight inappropriately
____ I'm unable to lose weight with diet/exercise
____ I am constipated, sometimes severely
____ I have hypothermia/low body temperature
(I feel cold when others feel hot, I need extra sweaters,
etc.)
____ I feel fatigued, exhausted
____ Feeling run down, sluggish, lethargic
____ My hair is coarse and dry, breaking, brittle, falling out

____ My skin is coarse, dry, scaly, and thick
____ I have a hoarse or gravely voice
____ I have puffiness and swelling around the eyes and face
____ I have pains, aches in joints, hands and feet
____ I have developed carpal-tunnel syndrome, or it's getting worse
____ I am having irregular menstrual cycles (longer, or heavier, or more frequent)
____ I am having trouble conceiving a baby

____ I feel depressed
____ I feel restless
____ My moods change easily
____ I have feelings of worthlessness
____ I have difficulty concentrating
____ I have more feelings of sadness
____ I seem to be losing interest in normal daily activities
____ I'm more forgetful lately

Hyperthyroidism
When the thyroid gland becomes overactive and produces too much thyroid hormone
The most common cause of hyperthyroidism is the autoimmune condition known as Graves' disease, where antibodies target the gland and cause it to speed up hormone production.

Risk factors for development of hyperthyroidism
Gender : affects women 8 times more often than men.
History : Having any past history of thyroid problems, autoimmune disease, or endocrine disease yourself or in your family
Age : between 20 and 40.
Pregnancy: Pregnancy and the year after childbirth
Smoking
Excessive Intake of Thyroid Hormone : Over-the-counter energy, diet and glandular supplements also may contain some active thyroid hormone,

Risk factors for development of hyperthyroidism
Exposure to or Excess of Iodine/Iodine Drugs -- through medical tests, topical exposure, or ingesting of iodine or supplements containing iodine (i.e., kelp, bladderwrack)
Certain Medical Treatments and Drugs -- Interferon Beta-1b and Interleukin-4, immunosuppressant therapy, antiretroviral treatment for AIDS, and lithium. A third of patients receiving monoclonal antibody (Campath-1H) therapy for multiple sclerosis (MS) develop Graves' disease within six months, and receiving a donated organ or bone marrow transplant from someone with Graves' disease
Trauma to the Thyroid -- vigorous manipulation or palpation of the thyroid; surgery to the thyroid, parathyroids, or the area surrounding the thyroid; injection to the thyroid; biopsy of the thyroid; and neck injury, i.e., whiplash, or from an automobile seat belt after a crash.
Major Stress -- death of a spouse, divorce or separation, loss of a job, death of close family member, major accident/personal injury, moving, marriage

Symptoms of Graves' Disease/Hyperthyroidism
Goiter: Visibly larger neck, a feeling of fullness in the neck or throat, discomfort with ties or scarves, a feeling like the thyroid is vibrating or buzzing, a choking sensation, pain or tenderness in the neck or hoarseness.
Weight Changes: Weight loss or weight gain
Pregnancy Problems
Temperature Problems: warm or hot when others are cold, or feel warm all the time, low grade fever, sweat more, or feel thirsty.

Heart and Blood Pressure Changes -- racing, fast heartbeat, sensation of a "loud" or pounding heartbeat, skipped beats, palpitations, or abnormal heart rhythms.
Gastrointestinal Problems -- frequent bowel movements, loose bowel movements, diarrhea, more frequent urination, or nausea.
Energy / Muscles / Joints -- extreme fatigue, muscle and joint fatigue, especially in leg and arm muscles, difficulty climbing stairs, exercise intolerance
Skin Changes -- smoother, younger-looking or velvety skin, worsening acne, bruising, spider veins on the face and neck, blister-like bumps on the forehead and face, flushing in the face, hives, itching, vitiligo.
Graves' Dermopathy/ Pretibial Myxedema -- waxy, reddish-brown lesions on the shins and lower legs skin (and less often the extremities, face or trunk) that are itchy and inflamed. These lesions heal into rough patches.

Changes to Hair / Nails / Hands -- Excessive hair loss from the head and body, nails that easily break
Eye Problems -- bulging of the eyeballs, dry eyes, achiness or pain behind the eyes, redness in the eyes, puffiness, and a wide-eyed look.
Thinking/Cognition Problems -- difficulty concentrating or making decisions, memory problems, and racing thoughts.
Mood Problems --depression, mood swings, uncontrollable anger, and irrational anger.
Panic and Anxiety – Anxiety, restlessness, nervousness, and even panic attacks. In rare cases, mania, psychosis, or delirium
Reflex/Movement Issues --fast reflexes, startle easily, and jumpy, and have tremors. They may be always moving, jiggling, tapping a foot, etc.
Sleep Problems -- Insomnia, or difficulty going back to sleep after waking

Especially in Men -- Men can experience a low sex drive, fertility problems, and gynecomastia, an enlargement or tenderness in the breasts.
Especially in Women -- In women, infertility, miscarriage, changes to sex drive, worsening premenstrual syndrome, erratic or even nonexistent menstrual periods.
Especially in Teenagers -- dramatic increase in appetite, or unusual weight loss, sports performance problems, and delayed puberty.
Especially in the Elderly / Seniors -- frequent falls, tremors, atrial fibrillation, or dementia, "apathetic hyperthyroidism" --appearing depressed, lacking in energy, confused, forgetful, and constipated -- without weight loss.

Thyroid Storm
Life-threatening condition known as thyroid storm. During a thyroid storm, the heart rate, blood pressure and body temperature can become uncontrollably high
chest pain, shortness of breath, high blood pressure, confusion, delirium, psychosis, stupor, fatigue
fatal complications such as stroke or heart attack.

Goiter/Thyroid Nodules
When the thyroid become enlarged, this is known as a goiter
Solid or liquid filled cysts, lumps, bumps and tumors -- both benign and cancerous

Thyroid Cancer Statistics and Facts
The American Cancer Society estimates 37,340 new cases of thyroid cancer will be diagnosed each year in the United States, most of them in women
An estimated 1,590 people will die of thyroid cancer each year
Thyroid cancer is considered one of the least deadly and most survivable cancers, and 5-year survival rates for thyroid cancer is almost 97%.
Thyroid cancer is more common in younger people, and nearly two-thirds of those diagnosed with thyroid cancer are between the ages of 20 and 55.
Thyroid cancer is one of the few cancers on the rise in recent years, with a growth rate of about 6% a year since 1997.
Having one or more thyroid cancer risk factors does not mean that you will definitely develop the disease
Even if you have no risk factors, you can still develop thyroid cancer

Thyroid Cancer
Too Little Iodine in the Diet
Exposure to Radiation
Heredity/Genetics/Family History
Gender: women are two to three times more likely than men to develop thyroid cancer.
Age: nearly two-thirds of those diagnosed with thyroid cancer are between the ages of 20 and 55.
May not cause any symptoms at all.

Symptoms of thyroid cancer
A lump, or nodule in the neck Enlargement of the neck
Enlarged lymph nodes in the neck
Hoarseness, difficulty speaking normally, voice changes
Difficulty swallowing, or a choking feeling
Difficulty breathing
Pain in the neck or throat, including pain from the neck to the ears
Sensitivity in the neck -- discomfort with neckties, turtlenecks, scarves, necklaces
Persistent or chronic cough not due to allergies or illness
Asymmetry in the thyroid (big nodule on one side, nothing on the other)

Treatment of Hypothyroidism
When the thyroid is underactive (hypothyroidism) the key medical treatment is thyroid hormone replacement with a prescription medication.

Levothyroxine (Synthetic Thyroxine/T4)
Among conventional physicians, the most popular and commonly prescribed thyroid hormone replacement drug is levothyroxine, a synthetic form of thyroxine (the thyroid hormone abbreviated as T4). Levothyroxine is also referred to as l-thyroxine.
In the United States, levothyroxine is available as generic levothyroxine, as well as Synthroid and Levoxyl brand name tablets of levothyroxine. Tirosint is a brand name gel-cap liquid form of levothyroxine.Many doctors do not recommend generic levothyroxine
Brand names are preferred, and each is generally considered equally effective.

Liothyronine (Synthetic Triiodothyronine/T3)
The thyroid gland manufacturers both thyroxine and triiodothyronine (T3)
Liothyronine is a synthetic form of T3, and it is available in a manufactured form as the brand Cytomel, and also as generic liothyronine
T3 can also be compounded.
In recent years, some practitioners have been prescribing T3 in addition to T4. One 2009 study showed that the majority of patients preferred levothyroxine plus T3 compared to levothyroxine-only treatment.
A prominent study published in the New England Journal of Medicine found that patients benefited from T4/T3 combination treatment
Some other studies have failed to demonstrate a benefit and the use of T4/T3 combination treatments remains controversial

Liotrix (Synthetic Thyroxine/Triiodothyronine T4/T3 Combination)
Liotrix is a synthetic combination of thyroxine and triiodothyronine (T4 and T3)
Liotrix is available in a manufactured form, known by the brand name Thyrolar
Thyrolar has been in back-order and short supply for a number of years, and is rarely used in the United States .

Desiccated Natural Thyroid
Desiccated thyroid is a drug prepared from dried porcine (pig) thyroid
Desiccated thyroid was the only thyroid drug available in the early 1900s, until levothyroxine was introduced in the 1950s
Natural thyroid fell out of favor as the synthetic product was touted as more modern and stable
Since the 1990s, desiccated thyroid has enjoyed a resurgence, primarily with older doctors and holistically-oriented physicians who claim that it resolves symptoms better than synthetics in some patients
Several brands of desiccated thyroid are available by prescription, including Nature-Throid and Armour Thyroid

The T4/T3 Thyroid Drug Controversy
The use of T4 and T3 together as a treatment for hypothyroidism is controversial
The standard treatment is levothyroxine (T4) alone
The addition of T3 to the levothyroxine/T4-only treatment is, however, a topic of ongoing research and discussion

The Armour Thyroid / Desiccated Thyroid Controversy
Desiccated thyroid drugs, including Armour Thyroid, have been in use for more than 100 years
Remain popular with holistic, alternative and integrative physicians as a thyroid treatment and for thyroid hormone replacement in hypothyroid patients
These drugs are controversial, however; it can be a challenge to find doctors who will prescribe them.

Treatment of hyperthyroidism
Antithyroid medications: Methimazole, PTU
Radioactive iodine ablation
Surgery

Treatment of Thyroid Cancer
Surgery

THANK YOU

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Thyroid: Dr. Dany Zayour

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