ROJoson PEP Talk: HYPERTHYROIDISM - When to Suspect

1. June 8, 2024
1400H - 1500H
Via Zoom
HYPERTHYROIDISM
– WHEN TO
SUSPECT
Empowerment
objective - for
laypeople to have an
essential
understanding on
HYPERTHYROIDISM
– WHEN TO SUSPECT
as part of their
health management.

2. June 8, 2024
1400H - 1500H
Via Zoom
HYPERTHYROIDISM
– WHEN TO
SUSPECT
Empowerment
objective - for
laypeople to have an
essential
understanding on
HYPERTHYROIDISM
– WHEN TO SUSPECT
as part of their
health management.
Welcome all!
MUTE yourself but always
show your video picture.
Sign in your name, FB
account, or email address in
the Chat Box! Include names
of companions attending.
Use the Chat Box to ask
questions and make
comments while the PEP
TALK is on.
There will be group pictures
at start and end of PEP TALK
– show your face in video.

3. Reminder after the PEP
Talk:
Take the Online Learning
cum Evaluation Test
Exercise (OLETE) for
mastery of learning and
have a perfect score to get
a Certificate.
Link is in Chat Box.

4. Reminder:
25 OLETE Certificates = 1
Voucher for ROJoson
Medical Consultation
either Face-to-Face or
Telemedical.

5. HYPERTHYROIDISM
– WHEN TO
SUSPECT
Empowerment
objective - for
laypeople to have an
essential
understanding on
HYPERTHYROIDISM
– WHEN TO SUSPECT
as part of their
health management.
ROJOSON’S REQUEST:
FEEDBACK TO THIS
PEP TALK!
Pls. type in your
feedback in the chat
box during the open
forum and before we
adjourn!
Thank you!

6. HYPERTHYROIDISM
– WHEN TO
SUSPECT
Empowerment
objective - for
laypeople to have an
essential
understanding on
HYPERTHYROIDISM
– WHEN TO SUSPECT
as part of their
health management.
LET’S NOW HAVE A
GROUP PICTURE
TAKING BEFORE WE
START PEP TALK
PROPER IN 2
MINUTES!
Pls. turn on your
video!
Show your face!

7. HYPERTHYROIDISM
– WHEN TO
SUSPECT
Empowerment
objective - for
laypeople to have an
essential
understanding on
HYPERTHYROIDISM
– WHEN TO SUSPECT
as part of their
health management.
ROJoson PEP Talk
I have a Patient
Empowerment
Program in which I
like to empower the
lay people or
patients to take
control in the
management of
their health.

8. I started the PEP Talk
on May 15, 2021
during the COVID19
Pandemic. There are
3 courses in the PEP
Talk. I completed the
Core Course on
October 9, 2021.

9. From October 23, 2021
onwards, I have been
tackling Health Disorder
and Health Issue Courses.
May 18, 2024 marks the
start of YEAR 4 of
ROJoson PEP Talk.
How long the PEP Talk
will last will depend on
our enthusiasm,
discipline and
perseverance.

10. HYPERTHYROIDISM
– WHEN TO
SUSPECT
Empowerment
objective - for
laypeople to have an
essential
understanding on
HYPERTHYROIDISM
– WHEN TO SUSPECT
as part of their
health management.
My PEP TALK today is
entitled:
HYPERTHYROIDISM
–
WHEN TO SUSPECT

11. HYPERTHYROIDISM
– WHEN TO
SUSPECT
Empowerment
objective - for
laypeople to have an
essential
understanding on
HYPERTHYROIDISM
– WHEN TO SUSPECT
as part of their
health management.

12. Contents
• What is the thyroid gland?
• When does one say the thyroid gland is normal on
palpation?
• What are the 3 scenarios (interpreted finings) after one
palpates the thyroid gland?
• What is HYPERTHYROIDISM?
• What is the disease process of HYPERTHYROIDISM?
• What are the complications of HYPERTHYROIDISM?
• When does one suspect HYPERTHYROIDISM?
• What are the diagnostic tests for HYPERTHYROIDISM?
• What are the causes of HYPERTHYROIDISM?
• What are the basic treatment modalities for
HYPERTHYROIDISM?
Disclaimer:
ROJoson PEP Talk
contains ROJoson’s
Thoughts,
Perceptions,
Opinions and
Recommendations
(TPORs) culled from
experiences of
ROJoson and
writings of other
health professionals.
HYPERTHYROIDISM
– WHEN TO
SUSPECT

13. The THYROID gland is a gland that produces
thyroid HORMONES that circulate in the blood
and whose functions are to mainly to regulate
body metabolism and promote growth and
development of the body.
HYPERTHYROIDISM
– WHEN TO
SUSPECT

14. The THYROID gland is a VITAL organ
which all persons must have and
where hormones produced by the gland must
always be enough circulating in the blood.
ENOUGH – normal (EUTHYROIDISM)
EXCESS – abnormal (HYPERTHYROIDISM)
DEFICIENT – abnormal (HYPOTHYROIDISM)
HYPERTHYROIDISM
– WHEN TO
SUSPECT

15. The THYROID gland is located on the front and
central part of the neck.
Normally, the thyroid gland is not palpable or
impalpable (cannot be palpated) except for the
very thin persons with thin soft tissues over the
neck.
Usually, if the thyroid gland is not palpable, it is
considered clinically “normal” at least in
anatomical structure particularly in terms of size.
HYPERTHYROIDISM
– WHEN TO
SUSPECT

16. If the thyroid gland is palpable,
3 scenarios or interpreted findings or conclusions:
• Slightly enlarged which may still be a variant of
normal or it may be the start of a disease
process called goiter.
• Definitely enlarged – diffusely enlarged – both
lobes are enlarged with no nodules = diffuse
goiter
• Presence of nodules, single, multiple = nodular
goiter
HYPERTHYROIDISM
– WHEN TO
SUSPECT

17. If the thyroid gland is palpable,
3 scenarios or interpreted findings or conclusions:
• Slightly enlarged which may still be a variant of
normal or it may be the start of a disease
process called goiter.
• Definitely enlarged – diffusely enlarged – both
lobes are enlarged with no nodules = diffuse
goiter
• Presence of nodules, single, multiple = nodular
goiter
HYPERTHYROIDISM
– WHEN TO
SUSPECT

18. If the thyroid gland is palpable,
3 scenarios or interpreted findings or conclusions:
• Slightly enlarged which may still be a variant of
normal or it may be the start of a disease
process called goiter.
• Definitely enlarged – diffusely enlarged – both
lobes are enlarged with no nodules = diffuse
goiter
• Presence of nodules, single, multiple = nodular
goiter
HYPERTHYROIDISM
– WHEN TO
SUSPECT

19. HYPERTHYROIDISM
– WHEN TO
SUSPECT
Empowerment
objective - for
laypeople to have an
essential
understanding on
HYPERTHYROIDISM
– WHEN TO SUSPECT
as part of their
health management.
My PEP TALK today is
entitled:
HYPERTHYROIDISM
–
WHEN TO SUSPECT
Today’s focused
discussion is on
HYPERTHYROIDISM!

20. Producing excessive beyond normal amount of
thyroid hormones will lead to HYPERTHYROIDISM
which is an abnormal condition = a medical
disease
which should be treated
otherwise, it can cause bad effects on the human
body notably on the heart and worse, a thyroid
storm which is a deadly complication.
HYPERTHYROIDISM
– WHEN TO
SUSPECT

21. A THYROID STORM is an undiagnosed or poorly
controlled overactive thyroid that can lead to a
serious, life-threatening condition.
It is a sudden flare-up of symptoms of
hyperthyroidism that include:
• a rapid heartbeat
• a high temperature
• high blood pressure (hypertension)
• yellowing of the skin and eyes (jaundice)
• severe agitation and confusion
• loss of consciousness
HYPERTHYROIDISM
– WHEN TO
SUSPECT

22. If a THYROID STORM does NOT develop,
untreated, hyperthyroidism can cause serious
health problems, including
• an irregular heartbeat that can lead to blood
clots, stroke, heart failure, and other heart-
related problems (most serious complications)
• an eye disease called Graves’ ophthalmopathy
• thinning bones, osteoporosis and muscle
problems
• menstrual cycle and fertility issues
HYPERTHYROIDISM
– WHEN TO
SUSPECT

23. What are the symptoms of hyperthyroidism?
Symptoms of hyperthyroidism can vary from
person to person and may include
• weight loss despite an increased appetite
• rapid or irregular heartbeat
• nervousness, irritability, trouble sleeping,
fatigue
• shaky hands, muscle weakness
• sweating or trouble tolerating heat
• frequent bowel movements
• an enlargement in the neck, called a goiter
HYPERTHYROIDISM
– WHEN TO
SUSPECT

24. What are the symptoms of hyperthyroidism?
HYPERTHYROIDISM
– WHEN TO
SUSPECT

25. HYPERTHYROIDISM
– WHEN TO
SUSPECT

26. When to suspect HYPERTHYROIDISM?
Based on SYMPTOMS of hyperthyroidism (any one of
these – suspect but suspect more if more than one
symptoms)
• weight loss despite an increased appetite
• rapid or irregular heartbeat
• nervousness, irritability, trouble sleeping, fatigue
• shaky hands, muscle weakness
• sweating or trouble tolerating heat
• frequent bowel movements
• Exophthalmos (protruding eyeball)
• AN ENLARGEMENT IN THE NECK, CALLED A GOITER
HYPERTHYROIDISM
– WHEN TO
SUSPECT
Most reliable
symptom
Plus at least one of
these nonspecific
symptoms or better,
more

27. When to suspect
HYPERTHYROIDISM?
Graves’ Disease – a type of
hyperthyroidism caused by an
autoimmune disease.
Typically, there is an associated
exophthalmos together with
diffuse goiter and other symptoms
of hyperthyroidism.
HYPERTHYROIDISM
– WHEN TO
SUSPECT

28. To have a more definite or more certain diagnosis
of hyperthyroidism, after suspecting based on
SYMPTOMS and SIGNS,
laboratory tests on levels or amount of thyroid
hormones in the blood may be done.
T4 – thyroxine = FT4 (elevated in hyperthy)
T3 – triiodothyronine = FT3 (elevated in
hyperthy)
A thyroid stimulating hormone (TSH) test can be
done to complement T3 / T4
Interpretation – depressed TSH (hyperthy)
HYPERTHYROIDISM
– WHEN TO
SUSPECT

29. The Hypothalamus – Pituitary – Thyroid Axis
Feedback / Autoregulation Mechanism
HYPERTHYROIDISM
– WHEN TO
SUSPECT

30. After suspecting hyperthyroidism based on
SYMPTOMS and SIGNS, the following lab results
can confirm its presence:
• Elevated FT4 alone
• Elevated FT3 alone
• Elevated FT4 and FT3
• Elevated FT4 and FT3, depressed (lower than
normal) TSH
• Elevated FT4 and depressed TSH
• Depressed TSH alone
Assuming not all FT4, FT3 and TSH are done
simultaneously
HYPERTHYROIDISM
– WHEN TO
SUSPECT

31. FT4. FT3, and TSH as a package is frequently
ordered by physicians.
Usually, it is enough to order FT4 and TSH
(without FT3 anymore) initially as laboratory
diagnostic tests in patients with suspected
hyperthyroidism or hypothyroidism.
Changes in FT3 usually occur late.
HYPERTHYROIDISM
– WHEN TO
SUSPECT

32. HYPERTHYROIDISM
– WHEN TO
SUSPECT

33. What are the causes of hyperthyroidism?
• Graves’ Disease – an autoimmune disease
• Factitious hyperthyroidism – taking too much
thyroid hormones
• Overactive thyroid nodules (single, multiple)
• Chronic thyroiditis
HYPERTHYROIDISM
– WHEN TO
SUSPECT

34. What are the treatment options for
hyperthyroidism?
• Medical – use of drugs – anti-thyroid drugs
• Surgical – operation to reduce size and amount
of thyroid gland and tissue
• Radioactive iodine therapy – radiation to burn
the thyroid gland
• Will be discussed in another ROJoson PEP Talk
episode.
HYPERTHYROIDISM
– WHEN TO
SUSPECT

35. Summary – When to suspect HYPERTHYROIDISM
Bases for suspicion:
• Presence of symptoms of HYPERTHYROIDISM
particularly SUDDEN WEIGHT LOSS,
PALPITATIONS, and ENLARGED THYROID
GLAND
• Presence of signs of HYPERTHYROIDISM
particularly DIFFUSE GOITER or ENLARGEMENT
OF THYROID GLAND and INCREASED PULSE
RATE
Confirmation of suspicion:
ELEVATED FT4 and DEPRESSED TSH
HYPERTHYROIDISM
– WHEN TO
SUSPECT

36. HYPERTHYROIDISM
– WHEN TO
SUSPECT
Summary
Take Away
Contents
• What is the thyroid gland?
• When does one say the thyroid gland is normal on
palpation?
• What are the 3 scenarios (interpreted finings) after one
palpates the thyroid gland?
• What is HYPERTHYROIDISM?
• What is the disease process of HYPERTHYROIDISM?
• What are the complications of HYPERTHYROIDISM?
• When does one suspect HYPERTHYROIDISM?
• What are the diagnostic tests for HYPERTHYROIDISM?
• What are the causes of HYPERTHYROIDISM?
• What are the basic treatment modalities for
HYPERTHYROIDISM?

37. Take Away in
relation to
Patient
Empowerment
Be always in touch with reliable medical
information on HYPERTHYROIDISM – WHEN TO
SUSPECT.
Knowledge is power; it gives power.
Use the 4Ks of Patient Empowerment:
Kaalaman, Kakayanan, Karapatan and
Kapangyarihan to gain greater control over
decisions / make better decisions on
HYPERTHYROIDISM – WHEN TO SUSPECT
as part of your health management.
HYPERTHYROIDISM
– WHEN TO
SUSPECT

38. HYPERTHYROIDISM
– WHEN TO
SUSPECT
Empowerment
objective - for
laypeople to have an
essential
understanding on
HYPERTHYROIDISM
– WHEN TO SUSPECT
as part of their
health management.
This ends my PEP
TALK today on:
HYPERTHYROIDISM
–
WHEN TO SUSPECT

39. Reminder after the PEP
Talk:
Take the Online Learning
cum Evaluation Test
Exercise (OLETE) for
mastery of learning and
have a perfect score to get
a Certificate.
Link is in Chat Box.

40. Reminder:
25 OLETE Certificates = 1
Voucher for ROJoson
Medical Consultation
either Face-to-Face or
Telemedical.

41. HYPERTHYROIDISM
– WHEN TO
SUSPECT
Empowerment
objective - for
laypeople to have an
essential
understanding on
HYPERTHYROIDISM
– WHEN TO SUSPECT
as part of their
health management.
ROJOSON’S REQUEST:
FEEDBACK TO THIS
PEP TALK!
Pls. type in your
feedback in the chat
box during the open
forum and before we
adjourn!
Thank you!

42. HYPERTHYROIDISM
– WHEN TO
SUSPECT
Empowerment
objective - for
laypeople to have an
essential
understanding on
HYPERTHYROIDISM
– WHEN TO SUSPECT
as part of their
health management.
LET’S NOW HAVE A
GROUP PICTURE
TAKING BEFORE WE
START Q&A AND
INTERACTIONS!
Pls. turn on your
video!
Show your face!