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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.
A complete presentation on hypothroidism endocrine disorder based on latest editon of harrison and reference books. this presentation will help to learn about this second most common endocrine disorder.
Thyroid Gland and Disease of Thyroid GlandRanadhi Das
The thyroid gland is one of the largest endocrine glands.
The thyroid gland is located immediately below the larynx and anterior to the upper part of the trachea. It weighs about 15-20g.
It consists of 2 lateral lobes connected by a narrow band of thyroid tissue called the isthmus.
The isthmus usually overlies the region from the 2nd to 4th tracheal cartilage.
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.
A complete presentation on hypothroidism endocrine disorder based on latest editon of harrison and reference books. this presentation will help to learn about this second most common endocrine disorder.
Thyroid Gland and Disease of Thyroid GlandRanadhi Das
The thyroid gland is one of the largest endocrine glands.
The thyroid gland is located immediately below the larynx and anterior to the upper part of the trachea. It weighs about 15-20g.
It consists of 2 lateral lobes connected by a narrow band of thyroid tissue called the isthmus.
The isthmus usually overlies the region from the 2nd to 4th tracheal cartilage.
Diabetes mellitus (DM) is a common, chronic, metabolic syndrome characterized by hyperglycemia as a cardinal biochemical feature. The major forms of diabetes are classified according to those caused by deficiency of insulin secretion due to pancreatic β-cell damage (type 1 DM, or T1DM) and those that are a consequence of insulin resistance occurring at the level of skeletal muscle, liver, and adipose tissue, with various degrees of β-cell impairment (type 2 DM, or T2DM). T1DM is the most common endocrine-metabolic disorder of childhood and adolescence, with important consequences for physical and emotional development. Individuals with T1DM confront serious lifestyle alterations that include an absolute daily requirement for exogenous insulin, the need to monitor their own glucose level, and the need to pay attention to dietary intake. Morbidity and mortality stem from acute metabolic derangements and from long-term complications (usually in adulthood) that affect small and large vessels resulting in retinopathy, nephropathy, neuropathy, ischemic heart disease, and arterial obstruction with gangrene of the extremities. The acute clinical manifestations are due to hypoinsulinemic hyperglycemic ketoacidosis. Autoimmune mechanisms are factors in the genesis of T1DM; the long-term complications are related to metabolic disturbances (hyperglycemia).
Type 1 Diabetes Mellitus
Formerly called insulin-dependent diabetes mellitus (IDDM) or juvenile diabetes, T1DM is characterized by low or absent levels of endogenously produced insulin and dependence on exogenous insulin to prevent development of ketoacidosis, an acute life-threatening complication of T1DM. The natural history includes 4 distinct stages: (1) preclinical β-cell autoimmunity with progressive defect of insulin secretion, (2) onset of clinical diabetes, (3) transient remission “honeymoon period,” and (4) established diabetes associated with acute and chronic complications and decreased life expectancy. The onset occurs predominantly in childhood, with median age of 7-15 yr, but it may present at any age. The incidence of T1DM has steadily increased in many parts of the world, including Europe and the USA. T1DM is characterized by autoimmune destruction of pancreatic islet β cells. Both genetic susceptibility and environmental factors contribute to the pathogenesis. Susceptibility to T1DM is genetically controlled by alleles of the major histocompatibility complex (MHC) class II genes expressing human leukocyte antigens (HLAs). It is also associated with autoantibodies to islet cell cytoplasm (ICA), insulin (IAA), antibodies to glutamic acid decarboxylase (GADA or GAD65), and ICA512 (IA2). T1DM is associated with other autoimmune diseases such as thyroiditis, celiac disease, multiple sclerosis, and Addison disease. There is some suggestion that high dietary intake of omega-3 polyunsaturated fatty acids and vitamin D supplementation in early childhood decreases the incidence of autoi
in this presentation lecture we gone take a hypo and hyper thyrodism that affect the human cell because both situation may increase or decrease the basal metabolic rate.
2012 Clinical Practice guidelines for hypothyroidism in adults: American Asso...Jibran Mohsin
This is presentation format of 2012 Clinical Practice guidelines for hypothyroidism in adults: American Association of Clinical Endocrinologists (AACE) / American Thyroid Association (ATA)
- 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
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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
These lecture slides, by Dr Sidra Arshad, offer a quick overview of physiological basis of a normal electrocardiogram.
Learning objectives:
1. Define an electrocardiogram (ECG) and electrocardiography
2. Describe how dipoles generated by the heart produce the waveforms of the ECG
3. Describe the components of a normal electrocardiogram of a typical bipolar leads (limb II)
4. Differentiate between intervals and segments
5. Enlist some common indications for obtaining an ECG
Study Resources:
1. Chapter 11, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 9, Human Physiology - From Cells to Systems, Lauralee Sherwood, 9th edition
3. Chapter 29, Ganong’s Review of Medical Physiology, 26th edition
4. Electrocardiogram, StatPearls - https://www.ncbi.nlm.nih.gov/books/NBK549803/
5. ECG in Medical Practice by ABM Abdullah, 4th edition
6. ECG Basics, http://www.nataliescasebook.com/tag/e-c-g-basics
Flu Vaccine Alert in Bangalore Karnatakaaddon Scans
As flu season approaches, health officials in Bangalore, Karnataka, are urging residents to get their flu vaccinations. The seasonal flu, while common, can lead to severe health complications, particularly for vulnerable populations such as young children, the elderly, and those with underlying health conditions.
Dr. Vidisha Kumari, a leading epidemiologist in Bangalore, emphasizes the importance of getting vaccinated. "The flu vaccine is our best defense against the influenza virus. It not only protects individuals but also helps prevent the spread of the virus in our communities," he says.
This year, the flu season is expected to coincide with a potential increase in other respiratory illnesses. The Karnataka Health Department has launched an awareness campaign highlighting the significance of flu vaccinations. They have set up multiple vaccination centers across Bangalore, making it convenient for residents to receive their shots.
To encourage widespread vaccination, the government is also collaborating with local schools, workplaces, and community centers to facilitate vaccination drives. Special attention is being given to ensuring that the vaccine is accessible to all, including marginalized communities who may have limited access to healthcare.
Residents are reminded that the flu vaccine is safe and effective. Common side effects are mild and may include soreness at the injection site, mild fever, or muscle aches. These side effects are generally short-lived and far less severe than the flu itself.
Healthcare providers are also stressing the importance of continuing COVID-19 precautions. Wearing masks, practicing good hand hygiene, and maintaining social distancing are still crucial, especially in crowded places.
Protect yourself and your loved ones by getting vaccinated. Together, we can help keep Bangalore healthy and safe this flu season. For more information on vaccination centers and schedules, residents can visit the Karnataka Health Department’s official website or follow their social media pages.
Stay informed, stay safe, and get your flu shot today!
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.
Prix Galien International 2024 Forum ProgramLevi Shapiro
June 20, 2024, Prix Galien International and Jerusalem Ethics Forum in ROME. Detailed agenda including panels:
- ADVANCES IN CARDIOLOGY: A NEW PARADIGM IS COMING
- WOMEN’S HEALTH: FERTILITY PRESERVATION
- WHAT’S NEW IN THE TREATMENT OF INFECTIOUS,
ONCOLOGICAL AND INFLAMMATORY SKIN DISEASES?
- ARTIFICIAL INTELLIGENCE AND ETHICS
- GENE THERAPY
- BEYOND BORDERS: GLOBAL INITIATIVES FOR DEMOCRATIZING LIFE SCIENCE TECHNOLOGIES AND PROMOTING ACCESS TO HEALTHCARE
- ETHICAL CHALLENGES IN LIFE SCIENCES
- Prix Galien International Awards Ceremony
Report Back from SGO 2024: What’s the Latest in Cervical Cancer?bkling
Are you curious about what’s new in cervical cancer research or unsure what the findings mean? Join Dr. Emily Ko, a gynecologic oncologist at Penn Medicine, to learn about the latest updates from the Society of Gynecologic Oncology (SGO) 2024 Annual Meeting on Women’s Cancer. Dr. Ko will discuss what the research presented at the conference means for you and answer your questions about the new developments.
Ozempic: Preoperative Management of Patients on GLP-1 Receptor Agonists Saeid Safari
Preoperative Management of Patients on GLP-1 Receptor Agonists like Ozempic and Semiglutide
ASA GUIDELINE
NYSORA Guideline
2 Case Reports of Gastric Ultrasound
These simplified slides by Dr. Sidra Arshad present an overview of the non-respiratory functions of the respiratory tract.
Learning objectives:
1. Enlist the non-respiratory functions of the respiratory tract
2. Briefly explain how these functions are carried out
3. Discuss the significance of dead space
4. Differentiate between minute ventilation and alveolar ventilation
5. Describe the cough and sneeze reflexes
Study Resources:
1. Chapter 39, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 34, Ganong’s Review of Medical Physiology, 26th edition
3. Chapter 17, Human Physiology by Lauralee Sherwood, 9th edition
4. Non-respiratory functions of the lungs https://academic.oup.com/bjaed/article/13/3/98/278874
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Ve...kevinkariuki227
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Verified Chapters 1 - 19, Complete Newest Version.pdf
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Verified Chapters 1 - 19, Complete Newest Version.pdf
ARTIFICIAL INTELLIGENCE IN HEALTHCARE.pdfAnujkumaranit
Artificial intelligence (AI) refers to the simulation of human intelligence processes by machines, especially computer systems. It encompasses tasks such as learning, reasoning, problem-solving, perception, and language understanding. AI technologies are revolutionizing various fields, from healthcare to finance, by enabling machines to perform tasks that typically require human intelligence.
2. INTRODUCTION
• First endocrine disorder treated by replacement with the
deficient hormone
• Development of purified thyroid hormone preparationsmimic
the function of the normal thyroid gland with thyroid hormone
replacement therapy.
• Safe and well tolerated by most patients
• Thyroid glandthyroxine (T4) and triiodothyronine (T3).
• Autoimmune disorders of the thyroid glandglandular
destruction and hormone deficiency
(hypothyroidism)/thyrotoxicosis
3. ANATOMY
• two lobes connected by an isthmus.
• Location:Anterior to the trachea between the cricoid cartilage and the
suprasternal notch.
• 20 g in size, highly vascular, and soft in consistency.
• Four parathyroid glandsparathyroid hormone are located posterior
to each pole of the thyroid.
10. Epidemiology
• The National Health and Nutrition Examination Survey
(NHANES 1999-2002) of 4392 individuals3.7%
hypothyroid. (defined as TSH levels exceeding 4.5
mIU/L)[22]
• World Health Organization (WHO) data from 130
countries taken from January 1994 through December
2006 found inadequate iodine nutrition in 30.6% of the
population.
• WHOurinary iodine concentrations100 to 199 μg/L
in the general population.
• 150-249 μg/L in pregnant women.
11. • Age-related demographics:The frequency increases with
age.
• Most prevalent in elderly populations-The Framingham
study found hypothyroidism (TSH > 10 mIU/L) in 5.9% of
women and 2.4% of men older than 60 years.[24]
• Sex-related demographics:2 to 8 times higher in females.
• Race-related demographics:NHANES 1999-2002 whites
(5.1%) and Mexican Americans than in African Americans
(1.7%).
12. • Iodine deficiencymore common in less-developed
countries.
• Out of an estimated world population of 5.8 billion in
different regions, 3.8% are estimated to be suffering
from iodine deficiency in some form, though only 12% is
affected by goitre.
• Areas of adequate iodine intake-Autoimmune thyroid
disease (Hashimoto disease).
• Prevalence of antibodies is higher in women and
increases with age.
13.
14. Primary hypothyroidism
Types of primary hypothyroidism include the following:
• Chronic lymphocytic (autoimmune) thyroiditis
• Postpartum thyroiditis
• Subacute (granulomatous) thyroiditis
• Drug-induced hypothyroidism
• Iatrogenic hypothyroidism
15. Chronic lymphocytic (autoimmune)
thyroiditis
• Most frequent cause of acquired hypothyroidism
• Thyroid antigens as foreign chronic immune reaction
ensues resulting in lymphocytic infiltration of the gland
progressive destruction of functional thyroid tissue.
• Anti–thyroid peroxidase (anti-TPO) antibodies are the hallmark
of this disease.
• Antibody levels can vary over time.
• Absence of antibodies does not exclude the diagnosis
16. Postpartum thyroiditis
• Up to 10% of postpartum develop lymphocytic thyroiditis in the
2-12 months after delivery.
• Transient (2-4 months).
• Increased risk of permanent hypothyroidism or recurrence of
postpartum thyroiditis with future pregnancies.
• In a 12-year longitudinal study, Stuckey et al found that
hypothyroidism developed in 27 of 71 women (38%) who had a past
history of postpartum thyroid dysfunction (PPTD). In comparison,
only 14 of 338 women (4%) who had not had PPTD developed
hypothyroidism.[5]
17. Subacute granulomatous thyroiditis
• Also known as de Quervain disease,
• Relatively uncommon disease
• Most frequently middle-aged women.
• Low grade fever, thyroid pain, dysphagia, and elevated erythrocyte
sedimentation rate (ESR).
• Self-limited
• inflammatory conditions or viral syndromes may be associated with
transient hyperthyroidism transient hypothyroidism.
18. Drug-induced& iatrogenichypothyroidism
• The following medications reportedly have the potential to cause
hypothyroidism:
• Iodine excess (including iodine-containing contrast media and
amiodarone),
• lithium,
• antithyroid drugs,
• p-aminosalicylic acid,
• interferon-
• tyrosine kinase inhibitors – Sunitinib, imatinib[6]
• Bexarotene[7]
19. • Radioactive iodine (I-131) for treatment of Graves disease results
in permanent hypothyroidism within 3-6 months after therapy.
• External neck irradiation (for head and neck neoplasms, breast
cancer, or Hodgkin disease)
• Thyroidectomy-approximately 15-30%
20. Genetics
• Genome-wide association studies FOXE1 gene hypothyroidism.
• 10% of patients with congenital hypothyroidism have an error in
thyroid hormone synthesis.[9]
• Mutations in the TPO gene appear to be the most common error of
hormone synthesis, causing failure to produce adequate amounts of
TPO.[10]
• Mutations in the TSHR and PAX8 genes congenital hypothyroidism
without goiter.[11, 12]
21. • Pendred syndrome mutation in the SLC26A4 gene defect in
the organification of iodine
congenital sensorineural hearing loss,
enlarged thyroid gland.
autosomal recessive manner.[13]
• Autoimmune polyendocrinopathy
typeIAIRE genecharacterized by the presence of Addison
disease, hypoparathyroidism, and mucocutaneous candidiasis.
• Autoimmune polyendocrinopathy type 2 (Schmidt syndrome) is
associated with adrenal insufficiency and hypothyroidism
22. Iodine deficiency or excess
• Most common cause of hypothyroidism. Excess iodine can transiently
inhibit iodide organification and thyroid hormone synthesis (the
Wolff-Chiakoff effect).
• Healthy individualsphysiologic escape from this effect. In patients
with iodine overloadsodium-iodide symporter shuts downallows
intracellular iodine levels to drop and hormone secretion to resume.
• The Wolff-Chiakoff effect is short-livedsodium-iodide symporter is
capable of rapidly downregulation.
• exposure to excess iodineprofound and sustained hypothyroidism
in individuals with abnormal thyroid glands.[15]
23. Goitre can be classified as
per WHO classification
• Grade 0 – no goitre presence is found (the
thyroid impalpable and invisible)
• Grade 1 – neck thickening is present in result of
enlarged thyroid, palpable,not visible in normal
position of the neck.
• Grade 2 – neck swelling, visible when the neck is
in normal position, corresponding to enlarged
thyroid – found in palpation.
24. Central hypothyroidism[16, 17]
• Central hypothyroidismhypothalamic-pituitary axis is
damaged. The following potential causes should be
considered :
Pituitary adenoma-exerting pressure on normal
pituitary cells
Tumors impinging on hypothalamus
Lymphocytic hypophysitis- cause death of cells.
Sheehan syndrome
History of brain or pituitary irradiation
25. • Drugs (eg, dopamine, prednisone, or opioids)-decreased TSH
secretion.
• Congenital non goiterous hypothyroidism type 4Mutation in
theTSHB geneautosomal recessive pattern
• TRH resistanceTRHR geneautosomal recessive manner.
hypothyroidism and, unsurprisingly, have insensitivity to
thyrotropin secretion.[19]
• TRH deficiencymutation in the TRH geneautosomal recessive
manner.[20]
27. • Menstrual disturbances,infertility
• Paresthesias, nerve entrapment syndromes
• Blurred vision
• Decreased hearing
• Fullness in the throat, hoarseness
Hashimoto thyroiditis is difficult to distinguish clinically, but the
following symptoms are more specific to this condition:
• Feeling of fullness in the throat
• Painless thyroid enlargement
• Exhaustion
• Transient neck pain, sore throat, or both
29. LABORATORY ASSESSMENT
1.Tests of the Hypothalamic-Pituitary-Thyroid Axis
• TSH secretion: precise and specific indicator of the thyroid
status
• Normal range of the serum TSH:0.5 to 4.7 mU/L
• Diurnal variation of TSH secretion with peak values in the early
evening
30. TSH as a screening test
:misleading
INCREASED TSH
• TSH-secreting pituitary tumor
• Thyroid hormone resistance
• Assay artifact
DECREASED TSH
• 1ST trimester of pregnancy (due to hCG secretion),
• After treatment of hyperthyroidism
• Response to high doses of glucocorticoids or dopamine
Secondary hypothyroidism:
• Low to high-normal TSH level, inappropriate for the low T4 level.
33. Sick Euthyroid Syndrome
• Acute, severe illness causes abnormalities of TSH or
thyroid hormone levels in the absence of underlying
thyroid disease
• Major cause cytokines such as IL-6.
• M/C hormone patterndecrease in total and unbound
T3 levels (low T3 syndrome) with normal levels of T4 and
TSH.
• Magnitude of the fall in T3 correlates with the severity of
the illness.
• T4 conversion to T3 via peripheral deiodination is
impaired, leading to increased reverse T3 (rT3).
34. • Very sick patients :fall in total T4 and T3 levels (low T4
syndrome)
• TSH levels may range from <0.1 to >20 mIU/L
Diagnosis of SES
• Previous history of thyroid disease and TFT
• Evaluation of the patient's acute illness
• Measurements of Rt3 with unbound thyroid hormones
and TSH.
• Diagnosis of SES is presumptive
• Resolution of the test results with clinical recovery can
clearly establish this disorder.
37. CLINICAL IMPROVEMENT
• Wt loss of 2 to 4 kg
• Pulse rate increase
• Appetite improves, Constipation disappears
• Psychomotor activity increases
• Hoarseness ,changes in skin and hair improve last
38. Special Treatment
Considerations
PREGNANCY:Increase in serum TBG
• The mean increment in dose is 50μg/dayapparent
by the end of the first trimester, though may be
delayed to as late as the 6th month of gestation in
some women.
• A similar up-titration of thyroxine dose may be
required in women who are on estrogen preparations
including the oral contraceptive pill.
39. • TOC : Synthetic levothyroxine
• Most patients with postpartum thyroiditis
require treatment during the hypothyroid phase
• Long-term follow-up of patientsrisk of
permanent hypothyroidism
• Subclinical hypothyroidism in pregnancy requires
replacement treatment
40. Hypocortisolemia:
• Co-existence of thyroid hormone deficiency and
glucocorticoid deficiency
• Important to replace glucocorticoid before starting
thyroxine.
• Thyroxine therapy may lead to an increased
metabolism,increased demand of cortisol increasing
the likelihood of precipitating an adrenal crisis.
41. Central hypothyroidism:
• Important to replace glucocorticoid before starting
thyroxine.
• Monitoring of therapyserum T4 levels instead of
serum TSH levelssample should be collected prior to
ingesting the morning dose of thyroxine.
42. Ischemic heart disease:
• Thyroxine therapyimproves myocardial
function reduces peripheral vascular resistance
• Increases the myocardial oxygen demand
angina in 2% patients.
• Patients with pre-existing angina should ideally
undergo a cardiac evaluation prior to initiating
thyroxine therapy.
• Therapystarted at 25μg/day or even less and
increased no faster than at 4 weekly intervals.
43. Patients unable to take oral
thyroxine:
• Intravenous thyroxine can be given in a dose
approximately 70% of the oral dose, which
reflects the fractional absorption of the oral
dose.
44. Persistently elevated TSH
despite thyroid hormone
replacement
• poor compliance- try ‘catch up’ when a physician
visit approachesfree T4 NORMAL,TSH
ELEVATED
• Tissue-level unresponsiveness to thyroid
hormoneRARE
• Only 300 families have been identified with this
genetic mutation.
45. Myxedema Coma
• Myxedema coma is a severe life threatening situation
• Most commonly occurs in individuals with undiagnosed
or untreated hypothyroidism who are subjected to an
external stress, such as low temperature, infection,
myocardial infarction, stroke.
• Respiratory depression,Bradycardia, Hypotension,
decreased intestinal motility, Hyponatremia, Altered
sensorium, Infections and Hypothermia.
• Most patients need ventilatoryat least 24-48
hoursmeasurement of arterial blood gases is
mandatory.
46. TREATMENT
• Management includes maintaining of vital parameters
• Administration400 to 500 mcg of L-thyroxine through
nasogastric tube initially and subsequently 100 mcg/day.
• route is suboptimalconcerns of erratic
absorption(gastric atony)
• Corticosteroids may be given along with assisted
ventilation and O2 administration.
• Hypothermiainsulating blankets.
47. Subclinical Hypothyroidism
• Persistently elevated TSH levels and free
thyroxine (T4) levels are not below normal
• May resolve on its own or remain unchanged.
• Rest of the patients proceed to develop overt
hypothyroidism (low free T4 and raised TSH
levels) within a few years.
• Patients with raised TSH elevations and
detectable anti-thyroid antibody
levelsincreased risk of developing overt
disease.
48. • mild hypothyroid symptoms
• subtle serum lipoprotein
• cardiac function abnormalities
• Progression to overt hypothyroidism5 to 20%
per year in patients with both mildly elevated
TSH levels and antithyroid antibodies.
49.
50. Important clinical pointers when
monitoring thyroid replacement
therapy
• Serial TSH measurements in patients with an intact
hypothalamic-pituitary axis.
• Important to keep in mind that changes in TSH levels lag
behind changes in thyroid hormone levels.
• Subsequent to adjustment of levothyroxine dosage, TSH
levels should be assessed only at least after four weeks.
• Changes in TSH levelsafter eight weeks of therapy with
thyroid hormone replacement.
51. • Adequacy of treatment in patients with pituitary
insufficiency measurements of free T4 and T3
levels.
• Increasing age is associated with declining
thyroid binding and serum albumin levels,dosage
requirementreduced by up to 20%.
• Elderly patientsannual monitoring for thyroid
function in order to avoid over replacement.
52. • Most hypothyroid patientstested annually for
TSH or free T4 levelsno data exists to support
this practice.
• Stable maintenance dosage of levothyroxine is
achieved, it is adequate to maintain a euthyroid
state until the patient becomes 6o to 70 years
old.
53. Potential adverse effects of
treatment
• Regular monitoring of serum TSH levelsmid-
normal serum TSH values ensuresis safe and
free from adverse events.
• In the event that thyroxinesuppressive
dosesafter carcinoma thyroid
surgerypotential adverse effectsskeletal and
cardiovascular system.
• A TSH value of <0.1mU/lrisk factor for
atrial fibrillation,
left ventricular hypertrophy and
enhanced risk for ischemic heart disease.
55. 5-Stuckey BG, Kent GN, Ward LC, Brown SJ, Walsh JP. Postpartum thyroid
dysfunction and the long-term risk of hypothyroidism: results from a 12-year
follow-up study of women with and without postpartum thyroid
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6-Wolter P, Dumez H, Schöffski P. Sunitinib and hypothyroidism. N Engl J
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Smit JW, Stokkel MP, Pereira AM, Romijn JA, Visser TJ. Bexarotene-induced
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