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.
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.
The thyroid is a small, butterfly-shaped gland located at the base of your neck just below the Adam’s apple.
Several different disorders can arise when your thyroid produces too much hormone (hyperthyroidism) or not enough (hypothyroidism).
Four common disorders of the thyroid are Hashimoto’s disease, Graves’ disease, goiter, and thyroid nodules.
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The thyroid is a small, butterfly-shaped gland located at the base of your neck just below the Adam’s apple.
Several different disorders can arise when your thyroid produces too much hormone (hyperthyroidism) or not enough (hypothyroidism).
Four common disorders of the thyroid are Hashimoto’s disease, Graves’ disease, goiter, and thyroid nodules.
AUM ENT Clinic is dedicated to the delivery of compassionate, quality, state-of-the-art and cost effective health care with best-in-class technology and equipment.
Contact us @https://www.aumentclinic.com/contact-us.php
Anemia (pronounced /əˈniːmiə/, also spelled anaemia or anæmia; from Ancient Greek ἀναιμία anaimia, meaning "lack of blood") is a decrease in normal number of red blood cells (RBCs) or less than the normal quantity of hemoglobin in the blood.[1][2] However, it can include decreased oxygen-binding ability of each hemoglobin molecule due to deformity or lack in numerical development as in some other types of hemoglobin deficiency.
2012 Clinical Practice guidelines for hypothyroidism in adults: American Asso...Jibran Mohsin
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The thyroid gland is an endocrine gland in the neck consisting of two connected lobes.
The lower two thirds of the lobes are connected by a thin band of tissue called the thyroid isthmus.
The thyroid is located at the front of the neck, below the Adam's apple. Microscopically, the functional unit of the thyroid gland is the spherical thyroid follicle, lined with follicular cells (thyrocytes), and occasional parafollicular cells that surround a lumen containing colloid.
THYROID HORMONES:
The thyroid gland secretes three hormones: the two thyroid hormones – triiodothyronine (T3) and thyroxine (T4) – and a peptide hormone, calcitonin.
The thyroid hormones influence the metabolic rate and protein synthesis, and in children, growth and development.
Calcitonin plays a role in calcium homeostasis.
Secretion of the two thyroid hormones is regulated by thyroid-stimulating hormone (TSH), which is secreted from the anterior pituitary gland. TSH is regulated by thyrotropin-releasing hormone (TRH), which is produced by the hypothalamus.
Osteoporosis is a poorly recognized entity in India, especially among the non-endocrine physicians. Talk given to chest physicians focusing on glucocorticoid induced osteoporosis
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
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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.
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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!
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.
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NVBDCP.pptx Nation vector borne disease control programSapna Thakur
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The prostate is an exocrine gland of the male mammalian reproductive system
It is a walnut-sized gland that forms part of the male reproductive system and is located in front of the rectum and just below the urinary bladder
Function is to store and secrete a clear, slightly alkaline fluid that constitutes 10-30% of the volume of the seminal fluid that along with the spermatozoa, constitutes semen
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Prix Galien International 2024 Forum ProgramLevi Shapiro
June 20, 2024, Prix Galien International and Jerusalem Ethics Forum in ROME. Detailed agenda including panels:
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Ethanol (CH3CH2OH), or beverage alcohol, is a two-carbon alcohol
that is rapidly distributed in the body and brain. Ethanol alters many
neurochemical systems and has rewarding and addictive properties. It
is the oldest recreational drug and likely contributes to more morbidity,
mortality, and public health costs than all illicit drugs combined. The
5th edition of the Diagnostic and Statistical Manual of Mental Disorders
(DSM-5) integrates alcohol abuse and alcohol dependence into a single
disorder called alcohol use disorder (AUD), with mild, moderate,
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In the DSM-5, all types of substance abuse and dependence have been
combined into a single substance use disorder (SUD) on a continuum
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drinking, negative social consequences, risky use, and altered physiological
effects (tolerance, withdrawal). This chapter presents an overview
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the systemic nature of the disease, neurocircuitry and stages of AUD,
comorbidities, fetal alcohol spectrum disorders, genetic risk factors, and
pharmacotherapies for AUD.
2. Case
32 year old lady was evaluated for generalized
paraesthesias with aches and pains in different joints.
No arthritis was noted.
No fever/red eyes/ extraarticular
manifestations of collagen vascular diseases
Seen by a neurologist and investigated
Blood sugars : normal CPK: 300 U/L ( Normal < 200 )
Calcium parameters: normal
ANA/ dsDNA : negative RA factor : 86 ( Normal< 60 )
ESR: 26 mm / 1 hr Uric acid : 8.6 mg/dl (< 6 )
CBC: normal except for Hb: 9.8 gm/dl , MCV: 104
NCV: bilateral CTS
5. What further to look before
starting treatment ?
• Diagnosis
• Coexistent conditions
age of patient
severity of hypothyroidism
coexistent drugs
coexistent medical conditions
6. The patient was seen by
physician
Additional information generated
• Strong family history of hypothyroidism
• Delivered 6 months back and breast feeding
• Taking iron and calcium tablets
• Small firm goiter
• TSH > 100 IU/ml Free T4: 0.45 ng/dl
8. Etiology
PRIMARY HYPOTHYROIDISM
• Hashimoto’s thyroiditis-most common
Post partum thyroiditis
• Atrophic hypothyroidism
• Irradiation of thyroid
• Surgical removal
• Late stage invasive fibrous thyroiditis
• Iodine deficiency
• Drug therapy (Lithium, Interferon)
• Infiltrative Diseases:Sarcoidosis, Amyloidosis
Scleroderma, Hemochromatosis
9. Diagnosis
Thyroid hormones
feedback inhibit TSH
So
If T3, T4 reduces
TSH increases
Primary hypothyroidism
10. The spectrum of disease
Euthyroid
Free T4/ T4: normal
TSH : normal
Subclinical hypothyroidism
Free T4/ T4 : normal
TSH : elevated
Overt Hypothyroidism
Free T4/ T4 : low
TSH : elevated
11. The spectrum of disease
Euthyroid
Free T4/ T4: normal
TSH : normal
Subclinical hypothyroidism
Free T4/ T4 : normal
TSH : elevated
Overt Hypothyroidism
Free T4/ T4 : low
TSH : elevated
12. The spectrum of disease
Euthyroid
Free T4/ T4: normal
TSH : normal
Subclinical hypothyroidism
Free T4/ T4 : normal
TSH : elevated
Overt Hypothyroidism
Free T4/ T4 : low
TSH : elevated
13. Further testing
• Anti TPO antibody (Thyroid Peroxidase)
• Anti Tg( Thyroglobulin) antibody
marker of autoimmunity
• Ultrasound thyroid : usually not needed
• FNAC thyroid:
usually not needed in autoimmune thyroiditis
needed in infiltrative diseases
14. Treatment
• Treated with thyroid replacement
• Normal thyroid produces both T4 and T3 ,
predominantly T4
• T3 is formed in periphery by deiodination of T4
• Commercial preparations are usually only L-thyroxine
( T4)
15. Dose
Thyroxine ( T4)
• Strengths: 25 mcg, 50 mcg, 75 mcg,88 mcg, 100 mcg and 125
mcg
• Adults require 1.6 mcg/kg/day
• Elderly : 1.0 mcg/kg/day
T3 (Triodothyronine) : available as Tetroxin/ Cytomel
T3 as compare to T4 is
• 4 times more potent.
• Short duration of activity.
• Rapid onset of action
• Can be used for myxedema coma
16. Starting therapy
• Adults
50 to 100 mcg/day of thyroxine
• Elderly / Cardiac disease
25 mcg/day of thyroxine
• 80% bioavailability
• t1/2 1 week. Need 6 weeks for equilibration
17. Titrating therapy
• Call back after 6 –12 weeks with TSH
• Titrate 25-50 mcg/ day increments
• Repeat testing only by 3 months
• Only TSH is usually required for monitoring
• Target TSH – lower half of the normal range (~2.5-
3mU/L)
• Once TSH stable, repeat TFT annually. Ensure
compliance
18. Changes with treatment
• Begin to feel better within 2 weeks
• Full symptom relief may take 3-6 months after TSH
levels are normal
• Risk of over treatment
– atrial fibrillation
– osteoporosis
19. Our patient
• Started on 100 mcg/day thyroxine in empty stomach
• Called back after 6 weeks
TSH : 63 mIU/L
• Patient reports good compliance
• Increased doses to 125 mcg/day
• Called back after 3 months
TSH : 38 mIU/L
Not controlled ?
20. Follow up
• What are the cause for high dose requiremts ?
• Is thyroxine treatment during breast feeding harmful
to baby ?
• How long to continue treatment ?
22. What to do ?
• Space out tablets of thyroxine from other offending
drugs
• Can be converted to night dosing
• Empty stomach : 30-60 minutes before breakfast
• To minimize interference with food
• No dose adjustment for kidney and liver disease
23. Hashimoto’s thyroiditis
Chronic lymphocytic thyroiditis
• Most common cause of hypothyroidism
• Can be goitrous or non goitrous
• Anti TPO antibody positive
• Euthyroid Hashimoto’s : no treatment/ LT4 to reduce
goiter size and antibody levels
• Very rarely associated with thyroid lymphoma
• Can have co-existent papillary carcinoma
24. Postpartum thyroiditis
• Usually 2-6 months after delivery
• Transient thyrotoxicosis followed by hypothyroidism
/hypothyroidism
• Silent thyroiditis in postpartum period
• 23 % progress to permanent hypothyroidism
• More common with
severe hypothyroidism
higher Anti TPO antibody titre
26. Case continued
• Patient evaluated after spacing out the iron/calcium
tablets
• TSH : reduced to 2.8 mU/L
• Continued same dose of LT4 125 mcg/day
• Asked to come back after 3 months
TSH: < 0.01 mU/L
Next ?
27. Reversibility of primary
hypothyroidism
• Reversible hypothyroidism: Post partum
Drug induced( alfa interferon, Li )
Infectious ( Whipple’s disease, Sub acute thyroiditis) )
• 20 % of autoimmune hypothyroidism has been
found to be reversible
• Spontaneous disappearance of blocking antibodies
28. Do you need to treat subclinical
hypothyroidism
• 3-8 % of individuals have subclinical thyroid disease
•
• Most common cause is autoimmune thyroid disease
• 4.3 % progress to hypothyroidism is anti TPO
antibody present
1. TSH > 10 mU/ml
• Therapy indicated if 2. Anti TPO positive
3. Goiter present
4. Menstrual irregularities/ infertility
5. Childhood
6. Bipolar disease/ depression
7. Increasing TSH
29. Hypothyroid symptoms and normal
TFT (functional hypothyroidism)
• Many patients, especially in internet era
• Wilson's syndrome ( not Wilson’s disease) refers to the
presence of common and nonspecific symptoms,
relatively low body temperature, and normal levels of
thyroid hormones in blood.
ATA : no scientific basis for Wilson Syndrome
American Thyroid Association Statement on "Wilson's Syndrome" , Updated May 24, 2005
31. Functional somatic syndromes.
• More than 20% of adults report significant fatigue
• 30% have current musculoskeletal symptoms
• Typical adult has one of the symptoms every 4 to 6
days
• More than 80% of the general population has one of
these symptoms during any 2 to 4 week period.
Barsky AJ, Borus JF. Functional somatic syndromes Ann Intern Med 1999;130:910-21
32. Deja vu
• A lady with weight gain
• A lady with lowish resting heart rates
• Lady with tiredness
• Lady with memory loss
• Lady with “ low” pressure
• A lazy boy with poor school performance
Have you ever started thyroxine for these people ?
33. Messages
• Suspect hypothyroidism
• Thyroxine is the treatment for primary
hypothyroidism
• Dose changes in thyroxine according to TSH
• Some causes of primary hypothyroidism are
reversible
• Treat patients only with abnormal thyroid functions
35. Diagnosis
2.0 ng/dl TSH
Normal range for patient
Normal range of population
0.8 ng/dl
Free T4
4 mIU/L
Free T4
0.3 mIU/L
Euthyroid Subclinical
hypothyroidism
Not drawn to scale
36. Disclaimer
The material for these slides were derived from various sources including
pictures and cartoons from the world wide web. I have tried my best to
acknowledge all possible sources and references. However, if I have overlooked
any particular reference, it is not done intentionally. Anyone reproducing
materials from this presentations should acknowledge the author of the original
work. The case given is imaginary and is given only to support the purpose of
this talk. Any similarity to published case report/ patient is unintentional.