Hyperthyroidism (overactive thyroid) occurs when your thyroid gland produces too much of the hormone thyroxine. Hyperthyroidism can accelerate your body's metabolism, causing unintentional weight loss and a rapid or irregular heartbeat
Hypothyroidism (underactive thyroid) is a condition in which your thyroid gland doesn't produce enough of certain crucial hormones.
lecture class for 4th year MBBS students. this lecture is based on the book 'Robbins' Pathologic basis of disease'. This is delivered by Dr. Umme Kulsum Munmun, Assistant professor (pathology) to the 4th year MBBS students of Chandpur Meducal College, Bangladesh
During this webinar Kyla discusses the potential causes of thyroid issues and the signs and symptoms to look out for in order to determine whether thyroid dysfunction may be a factor in your clients’ conditions. The negative health effects of thyroid dysfunction, including alterations in metabolism, skin health, digestive issues and fertility, will be covered. Kyla then goes on to discuss the tests available to better understand the extent and type of thyroid dysfunction and the nutritional and lifestyle approach to support thyroid health.
Thyroid Hormone Disorders lecture :-
-Thyroid gland & Thyroid hormones.
-How does Thyroid hormone is formed ?
-Regulation of secretion.
-Hypothyroidism.
-Treatment of hypothyroidism .
-Administration of Levothyroxin.
-Levothyroxin interactions.
-Levothyroxin cautions.
-Hyperthyroidism .
-Symptoms & treatment of Hyperthyroidism.
-Removal of part or all of the thyroid.
-Blockade of hormone release .
-Inhibition of thyroid hormone synthesis.
-Mechanism of action of antithyroid.
-Administration of antithyroid drugs.
-Antithyroid drugs interactions.
-Antithyroid drugs cautions.
-General notes.
-Practical notes on levothyroxin.
-Practical notes on antithroid drugs.
-Rapid review.
-Test yourself.
Hyperthyroidism (overactive thyroid) occurs when your thyroid gland produces too much of the hormone thyroxine. Hyperthyroidism can accelerate your body's metabolism, causing unintentional weight loss and a rapid or irregular heartbeat
Hypothyroidism (underactive thyroid) is a condition in which your thyroid gland doesn't produce enough of certain crucial hormones.
lecture class for 4th year MBBS students. this lecture is based on the book 'Robbins' Pathologic basis of disease'. This is delivered by Dr. Umme Kulsum Munmun, Assistant professor (pathology) to the 4th year MBBS students of Chandpur Meducal College, Bangladesh
During this webinar Kyla discusses the potential causes of thyroid issues and the signs and symptoms to look out for in order to determine whether thyroid dysfunction may be a factor in your clients’ conditions. The negative health effects of thyroid dysfunction, including alterations in metabolism, skin health, digestive issues and fertility, will be covered. Kyla then goes on to discuss the tests available to better understand the extent and type of thyroid dysfunction and the nutritional and lifestyle approach to support thyroid health.
Thyroid Hormone Disorders lecture :-
-Thyroid gland & Thyroid hormones.
-How does Thyroid hormone is formed ?
-Regulation of secretion.
-Hypothyroidism.
-Treatment of hypothyroidism .
-Administration of Levothyroxin.
-Levothyroxin interactions.
-Levothyroxin cautions.
-Hyperthyroidism .
-Symptoms & treatment of Hyperthyroidism.
-Removal of part or all of the thyroid.
-Blockade of hormone release .
-Inhibition of thyroid hormone synthesis.
-Mechanism of action of antithyroid.
-Administration of antithyroid drugs.
-Antithyroid drugs interactions.
-Antithyroid drugs cautions.
-General notes.
-Practical notes on levothyroxin.
-Practical notes on antithroid drugs.
-Rapid review.
-Test yourself.
Tom Selleck Health: A Comprehensive Look at the Iconic Actor’s Wellness Journeygreendigital
Tom Selleck, an enduring figure in Hollywood. has captivated audiences for decades with his rugged charm, iconic moustache. and memorable roles in television and film. From his breakout role as Thomas Magnum in Magnum P.I. to his current portrayal of Frank Reagan in Blue Bloods. Selleck's career has spanned over 50 years. But beyond his professional achievements. fans have often been curious about Tom Selleck Health. especially as he has aged in the public eye.
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Introduction
Many have been interested in Tom Selleck health. not only because of his enduring presence on screen but also because of the challenges. and lifestyle choices he has faced and made over the years. This article delves into the various aspects of Tom Selleck health. exploring his fitness regimen, diet, mental health. and the challenges he has encountered as he ages. We'll look at how he maintains his well-being. the health issues he has faced, and his approach to ageing .
Early Life and Career
Childhood and Athletic Beginnings
Tom Selleck was born on January 29, 1945, in Detroit, Michigan, and grew up in Sherman Oaks, California. From an early age, he was involved in sports, particularly basketball. which played a significant role in his physical development. His athletic pursuits continued into college. where he attended the University of Southern California (USC) on a basketball scholarship. This early involvement in sports laid a strong foundation for his physical health and disciplined lifestyle.
Transition to Acting
Selleck's transition from an athlete to an actor came with its physical demands. His first significant role in "Magnum P.I." required him to perform various stunts and maintain a fit appearance. This role, which he played from 1980 to 1988. necessitated a rigorous fitness routine to meet the show's demands. setting the stage for his long-term commitment to health and wellness.
Fitness Regimen
Workout Routine
Tom Selleck health and fitness regimen has evolved. adapting to his changing roles and age. During his "Magnum, P.I." days. Selleck's workouts were intense and focused on building and maintaining muscle mass. His routine included weightlifting, cardiovascular exercises. and specific training for the stunts he performed on the show.
Selleck adjusted his fitness routine as he aged to suit his body's needs. Today, his workouts focus on maintaining flexibility, strength, and cardiovascular health. He incorporates low-impact exercises such as swimming, walking, and light weightlifting. This balanced approach helps him stay fit without putting undue strain on his joints and muscles.
Importance of Flexibility and Mobility
In recent years, Selleck has emphasized the importance of flexibility and mobility in his fitness regimen. Understanding the natural decline in muscle mass and joint flexibility with age. he includes stretching and yoga in his routine. These practices help prevent injuries, improve posture, and maintain mobilit
Anti ulcer drugs and their Advance pharmacology ||
Anti-ulcer drugs are medications used to prevent and treat ulcers in the stomach and upper part of the small intestine (duodenal ulcers). These ulcers are often caused by an imbalance between stomach acid and the mucosal lining, which protects the stomach lining.
||Scope: Overview of various classes of anti-ulcer drugs, their mechanisms of action, indications, side effects, and clinical considerations.
- Video recording of this lecture in English language: https://youtu.be/lK81BzxMqdo
- Video recording of this lecture in Arabic language: https://youtu.be/Ve4P0COk9OI
- Link to download the book free: https://nephrotube.blogspot.com/p/nephrotube-nephrology-books.html
- Link to NephroTube website: www.NephroTube.com
- Link to NephroTube social media accounts: https://nephrotube.blogspot.com/p/join-nephrotube-on-social-media.html
Couples presenting to the infertility clinic- Do they really have infertility...Sujoy Dasgupta
Dr Sujoy Dasgupta presented the study on "Couples presenting to the infertility clinic- Do they really have infertility? – The unexplored stories of non-consummation" in the 13th Congress of the Asia Pacific Initiative on Reproduction (ASPIRE 2024) at Manila on 24 May, 2024.
New Directions in Targeted Therapeutic Approaches for Older Adults With Mantl...i3 Health
i3 Health is pleased to make the speaker slides from this activity available for use as a non-accredited self-study or teaching resource.
This slide deck presented by Dr. Kami Maddocks, Professor-Clinical in the Division of Hematology and
Associate Division Director for Ambulatory Operations
The Ohio State University Comprehensive Cancer Center, will provide insight into new directions in targeted therapeutic approaches for older adults with mantle cell lymphoma.
STATEMENT OF NEED
Mantle cell lymphoma (MCL) is a rare, aggressive B-cell non-Hodgkin lymphoma (NHL) accounting for 5% to 7% of all lymphomas. Its prognosis ranges from indolent disease that does not require treatment for years to very aggressive disease, which is associated with poor survival (Silkenstedt et al, 2021). Typically, MCL is diagnosed at advanced stage and in older patients who cannot tolerate intensive therapy (NCCN, 2022). Although recent advances have slightly increased remission rates, recurrence and relapse remain very common, leading to a median overall survival between 3 and 6 years (LLS, 2021). Though there are several effective options, progress is still needed towards establishing an accepted frontline approach for MCL (Castellino et al, 2022). Treatment selection and management of MCL are complicated by the heterogeneity of prognosis, advanced age and comorbidities of patients, and lack of an established standard approach for treatment, making it vital that clinicians be familiar with the latest research and advances in this area. In this activity chaired by Michael Wang, MD, Professor in the Department of Lymphoma & Myeloma at MD Anderson Cancer Center, expert faculty will discuss prognostic factors informing treatment, the promising results of recent trials in new therapeutic approaches, and the implications of treatment resistance in therapeutic selection for MCL.
Target Audience
Hematology/oncology fellows, attending faculty, and other health care professionals involved in the treatment of patients with mantle cell lymphoma (MCL).
Learning Objectives
1.) Identify clinical and biological prognostic factors that can guide treatment decision making for older adults with MCL
2.) Evaluate emerging data on targeted therapeutic approaches for treatment-naive and relapsed/refractory MCL and their applicability to older adults
3.) Assess mechanisms of resistance to targeted therapies for MCL and their implications for treatment selection
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micro teaching on communication m.sc nursing.pdfAnurag Sharma
Microteaching is a unique model of practice teaching. It is a viable instrument for the. desired change in the teaching behavior or the behavior potential which, in specified types of real. classroom situations, tends to facilitate the achievement of specified types of objectives.
Pulmonary Thromboembolism - etilogy, types, medical- Surgical and nursing man...VarunMahajani
Disruption of blood supply to lung alveoli due to blockage of one or more pulmonary blood vessels is called as Pulmonary thromboembolism. In this presentation we will discuss its causes, types and its management in depth.
2. Learning objectives
By the end of this lecture, students should be able
to:
- Describe different classes of drugs used in
hyperthyroidism and their mechanism of action
- Understand their pharmacological effects, clinical
uses and adverse effects.
- Recognize treatment of special cases such as
hyperthyroidism during pregnancy, Graves' disease
and thyroid storm
2
4. • normal amount of thyroid hormones are
essential for normal growth and development
by maintaining the level of energy metabolism
in the tissue.
• Either too little or too much thyroid hormones
will bring disorders to the body.
Thyroid function
5. Thyroid function
Important functions are :
Growth & development, especially in the embryo &
brain
Thermoregulation: increase basal metabolic rate
(BMR)
Helps maintain metabolic energy balance
CVS : increase HR & cardiac output which
increase oxygen demand
6. Thyroid function
Iodine Importance :
• Thyroid hormones are unique biological
molecules in that they incorporate iodine in their
structure.
• Adequate iodine intake (diet, water) is required
for normal thyroid hormone production.
• Major sources of iodine:
- iodized salt
- iodated bread
- dairy products
- shellfish
• Minimum requirement: 75 micrograms/day
7. Iodine Metabolism
• Dietary iodine is absorbed in the GI tract, then
taken up by the thyroid gland (or removed from
the body by the kidneys).
• Iodide taken up by the thyroid gland is oxidized by
peroxide in the lumen of the follicle:
H2O2
I2 I-
• Oxidized iodine can then be used in production
of thyroid hormones.
9. Thyroid Regulation
• TSH release is influenced by hypothalamic TRH, and by
thyroid hormones themselves.
• Thyroid hormones exert negative feedback on TSH
release at the level of the anterior pituitary.
- inhibition of TSH synthesis
- decrease in pituitary receptors for TRH
* TRH (thyrotropin releasing hormone)
* TSH (thyroid stimulating hormone or thyrotropin)
13. 13
Thyroid Hormones Synthesis
1. iodine trapping :uptake of iodine by the thyroid gland
2. oxidation of iodine: (to its active form)
thyroid peroxidase (key enzyme of the synthesis)
3. iodide organification : the iodination of tyrosyl groups
of thyroglobulin
produces : MIT and DIT
4. formation of T4 and T3 from MIT and DIT :
thyroid peroxidase
14. Thyroid Hormones Disorders
THYROTOXICOSIS :
Is the term for all disorders with increased levels of
circulating thyroid hormones
HYPERTHYROIDISM :
Refers to disorders in which the thyroid gland
secretes increased amounts of hormones
HYPOTHYROIDISM:
Refers to disorders in which the thyroid gland
secretes decreased amounts of hormones
Thyroid neoplasia
Benign enlargement or malignancies of the gland
15. THYROTOXICOSIS is :
Hypermetabolic state caused by thyroid
hormone excess at the tissue level
While HYPERTHYROIDISM is :
Increased thyroid hormones synthesis and
secretion
- All patients with hyperthyroidism have thyreotoxicosis
- Not all patients with thyrotoxicosis have hyperthyroidism
16. 16
Causes of thyrotoxicosis
With high RAIU
- Graves diseases (60-80%)
- Multinodular goitre (14%)
- Adenomas / carcinomas
With low RAIU
- Thyroiditis
- Iodine-induced thyrotoxicosis
drugs (e.g. amiodarone)
radiografic contrast media
----------------------------------------------------------------
RAIU: radioactive iodine uptake
17. Features of Graves' Disease
(Diffuse Toxic Goiter)
- Caused by thyroid stimulating immunoglobulins that
stimulate TSH receptor , resulting in sustained
thyroid over activity
- Mainly in young adults aged 20 to 50
- 5 times more frequent in women
- Swelling and soft tissues of hands and feet
- Clubbing of fingers and toes
- Half of cases have Exophthalmos (not seen with
other causes of hyperthyroidism)
- 5% have pretibial myxedema (thyroid dermopathy)
21. Features of Toxic Multi-nodular
Goiter
- Second most common cause of hyperthyroidism
- Most cases in women in 5th to 7th decades
- Often have long standing goiter
- Symptoms usually develop slowly
25. 25
Mechanism of Action
- Inhibit synthesis of thyroid hormones by
inhibiting the peroxidase enzyme that catalyzes
the iodination of tyrosine residues
- Propylthiouracil ( but not methimazole )
blocks the conversion of T4 to T3 in
peripheral tissues
26. 26
Mechanism of Action
- Inhibit synthesis of thyroid hormones by
inhibiting the peroxidase enzyme that catalyzes
the iodination of tyrosine residues
- Propylthiouracil ( but not methimazole )
blocks the conversion of T4 to T3 in
peripheral tissues
27. Pharmacokinetic comparison between Propylthiouracil
and Methimazole
Propylthiouracil Methimazole
Absorption Rapidly absorbed Rapidly absorbed
Protein binding 80-90% Most of the drug is free
accumulation in thyroid in thyroid
Excretion Kidneys as inactive
metabolite within
24 hrs
Excretion slow, 60-70%
of drug is recovered in
urine in 48 hrs
27
28. Pharmacokinetic comparison between Propylthiouracil
and Methimazole
Propylthiouracil Methimazole
Half life 1.5 hrs ( short ) 6 hrs ( long )
Administration Every 6-8 hours Every 8 hours
Pregnancy crosses placenta
Recommended in pregnancy
( crossing placenta is less
readily as it is highly protein
bound )
Concentrated in
Thyroid & crosses
placenta
Not recommended in
pregnancy
Breast feeding Less secreted in breast milk
Recommended
secreted
Not recommended
28
29. Adverse Effects
Adverse Effect Frequency comments
Skin reactions 4–6% Urticarial or macular rash
Arthralgia 1–5%
Polyarthritis 1–2% So-called anti-thyroid
arthritis
GIT effects 1–5% gastric distress and
nausea
29
32. Adverse Effects
Adverse Effect Frequency comments
Immunoallergic
hepatitis
0.1–0.5% Almost exclusively in
patients taking
propylthiouracil
Agranulocytosis 0.1–0.5% Seen in patients with
Graves’ disease; occurs
within 90 days of treatment
ANCA-positive vasculitis
(Anti-neutrophil
cytoplasmic antibodies)
Rare With propylthiouracil
Abnormal sense of taste
or smell
Rare With methimazole only
32
33. WARNINGS
• Agranulocytosis:
Patients on PTU or methimazole should be
instructed to immediately report to their
physicians any symptoms suggestive of
agranulocytosis, such as fever or sore throat.
• Congenital Malformations:
Methimazole crosses the placental causing
fetal harm, when administered in the first
trimester of pregnancy
33
34. IODINE (Lugol's solution, potassium iodide)
Mechanism of action
• Inhibit thyroid hormone synthesis and release
• Block the peripheral conversion of T4 to T3
• The effect is not sustained ( produce a temporary
remission of symptoms )
34
36. 36
Therapeutic uses
• Prior to thyroid surgery to decrease vascularity &
size of the gland
•Following radio active iodine therapy
•Thyrotoxicosis
Examples
•Organic iodides as : iopanoic acid or ipodate
•Potassium iodide
37. 37
Precautions / toxicity
•Should not be used as a single therapy
•Should not be used in pregnancy
•May produce iodism ( Rare, as iodine is not much
used now)
Iodism Symptoms:
(skin rash , hypersalivation, oral ulcers,
metallic taste, bad breath).
38. 38
RADIOACTIVE IODINE ( RAI )
•131 I isotope ( therapeutic effect due to emission of β
rays )
•Accumulates in the thyroid gland and destroys
parenchymal cells, producing a long-term decrease in
thyroid hormone levels.
•Clinical improvement may take 2-3 months
•Half -life 5 days
•Cross placenta & excreted in breast milk
•Easy to administer ,effective , painless and less
expensive
39. 39
Radioactive Iodine ( con.)
•Available as a solution or in capsules
•Clinical uses :
Hyperthyroidism mainly in old patients (above 40)
Graves, disease
Patients with toxic nodular goiter
As a diagnostic
40. 40
Disadvantages
•High incidence of delayed hypothyroidism
•Large doses have cytotoxic actions ( necrosis of the
follicular cells followed by fibrosis )
•May cause genetic damage
•May cause leukemia & neoplasia
41. 41
ADRENOCEPTOR BLOCKING AGENTS
•Adjunctive therapy to relief the adrenergic symptoms
of hyperthyroidism such as tremor, palpitation, heat
intolerance and nervousness.
•E.g. Propranolol, Atenolol , Metoprolol
•Propranolol is contraindicated in asthmatic patients
42. 42
Thyrotoxicosis during pregnancy
•Better to start therapy before pregnancy with 131I or
subtotal thyroidectomy to avoid acute exacerbation
during pregnancy
•During pregnancy radioiodine is contraindicated.
•Propylthiouracil is the drug of choice during
pregnancy.
43. 43
THYROID STORM
•A sudden acute exacerbation of all of the symptoms of
thyrotoxicosis, presenting as a life threatening
syndrome.
•There is hyper metabolism, and excessive adrenergic
activity, death may occur due to heart failure and
shock.
•It is a medical emergency .
44. 44
Management of thyroid storm
•should be treated in an ICU for close monitoring of
vital signs and for access to invasive monitoring and
inotropic support
•Correct electrolyte abnormalities, Treat cardiac
arrhythmia( if present ) & Aggressively control
hyperthermia by applying ice packs
•Promptly administer antiadrenergic drugs (e.g.
propranolol) to minimize sympathomimetic symptoms
45. 45
Management of thyroid storm ( cont..)
•High-dose Propylthiouracil (PTU) is preferred because
of its early onset of action ( risk of severe liver injury
and acute liver failure )
• Administer iodine compounds (Lugol's iodine or
potassium iodide) orally or via a nasogastric tube
• Hydrocortisone 50 mg IV every 6 hours to prevent
shock.
•Rarely, plasmapheresis has been used to treat thyroid
storm
46. 46
Management of Hyperthyroidism due to Graves’ disease
Severe Hyperthyroidism
[ markedly elevated serum T4 or T3
very large goiter, >4 times normal ]
Definitive therapy with radioiodine preferred in adults
Normalization of thyroid function with anti-thyroid drugs before
surgery in elderly patients and those with heart disease
D. Cooper,N Engl J Med 2005;352:905-17
47. 47
Management of Hyperthyroidism due to Graves’ disease
Mild/moderate hyperthyroidism
[ small or moderately enlarged thyroid; children or pregnant or
lactating women ]
Primary anti-thyroid drug therapy
should be considered
Start methimazole, 5–30 mg/day,
(PTU preferred in pregnant women)
Monitor thyroid function every 4–6 wk
until euthyroid state achieved
48. 48
Management of Hyperthyroidism due to Graves’ disease
Mild/moderate hyperthyroidism
Discontinue drug therapy after 12–18 mo
Monitor thyroid function every 2 mo for 6 mo,
then less frequently
Relapse Remission
Definitive radioiodine Monitor thyroid function
therapy in adults every 12 mo indefinitely
(Second course of anti-thyroid
drug therapy in children)
D. Cooper,N Engl J Med 2005;352:905-17