ROJoson PEP Talk: HYPOTHYROIDISM – When to Suspect

1. June 15, 2024
1400H - 1500H
Via Zoom
HYPOTHYROIDISM
– WHEN TO
SUSPECT
Empowerment
objective - for
laypeople to have an
essential
understanding on
HYPOTHYROIDISM –
WHEN TO SUSPECT
as part of their
health management.

2. June 15, 2024
1400H - 1500H
Via Zoom
HYPOTHYROIDISM
– WHEN TO
SUSPECT
Empowerment
objective - for
laypeople to have an
essential
understanding on
HYPOTHYROIDISM –
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. HYPOTHYROIDISM
– WHEN TO
SUSPECT
Empowerment
objective - for
laypeople to have an
essential
understanding on
HYPOTHYROIDISM –
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. HYPOTHYROIDISM
– WHEN TO
SUSPECT
Empowerment
objective - for
laypeople to have an
essential
understanding on
HYPOTHYROIDISM –
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. HYPOTHYROIDISM
– WHEN TO
SUSPECT
Empowerment
objective - for
laypeople to have an
essential
understanding on
HYPOTHYROIDISM –
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. HYPOTHYROIDISM
– WHEN TO
SUSPECT
Empowerment
objective - for
laypeople to have an
essential
understanding on
HYPOTHYROIDISM –
WHEN TO SUSPECT
as part of their
health management.
My PEP TALK today is
entitled:
HYPOTHYROIDISM
–
WHEN TO SUSPECT

11. 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 HYPOTHYROIDISM?
• What is the disease process of HYPOTHYROIDISM?
• What are the complications of HYPOTHYROIDISM?
• When does one suspect HYPOTHYROIDISM?
• What are the diagnostic tests for HYPOTHYROIDISM?
• What are the causes of HYPOTHYROIDISM?
• What are the basic treatment modalities for
HYPOTHYROIDISM?
Disclaimer:
ROJoson PEP Talk
contains ROJoson’s
Thoughts,
Perceptions,
Opinions and
Recommendations
(TPORs) culled from
experiences of
ROJoson and
writings of other
health professionals.
HYPOTHYROIDISM
– WHEN TO
SUSPECT

12. 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.
HYPOTHYROIDISM
– WHEN TO
SUSPECT

13. 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)
HYPOTHYROIDISM
– WHEN TO
SUSPECT

14. 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.
HYPOTHYROIDISM
– WHEN TO
SUSPECT

15. 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
HYPOTHYROIDISM
– 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
HYPOTHYROIDISM
– 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
HYPOTHYROIDISM
– WHEN TO
SUSPECT

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

19. Producing deficient amount of thyroid hormones
will lead to HYPOTHYROIDISM
which is an abnormal condition = a medical
disease
which should be treated
otherwise, it can cause bad effects on the human
body, the most serious is MYXEDEMA COMA.
HYPOTHYROIDISM
– WHEN TO
SUSPECT

20. Myxedema coma is a severe form of
hypothyroidism that most commonly occurs in
individuals with undiagnosed or untreated
hypothyroidism who are subjected to an external
stress. Features are as follows:
· Altered mental status
· Hypothermia
· Bradycardia
· Hypercapnia
· Hyponatremia
· Cardiomegaly, pericardial effusion,
cardiogenic shock, and ascites may be present
HYPOTHYROIDISM
– WHEN TO
SUSPECT

21. If a MXEDEMA COMA does NOT develop,
untreated, hypothyroidism can cause serious
health problems, including
• Mood disorders, like depression
• Peripheral neuropathy
• Increased risk of heart disease and heart
failure
• Infertility
• Goiter
HYPOTHYROIDISM
– WHEN TO
SUSPECT

22. What are the symptoms of hypothyroidism?
Symptoms of hypothyroidism can vary from person to
person and may include
• fatigue
• weight gain
• trouble tolerating cold
• joint and muscle pain
• dry skin or dry, thinning hair
• heavy or irregular menstrual periods or fertility problems
• slowed heart rate
• depression
• AN ENLARGEMENT IN THE NECK, CALLED A GOITER
HYPOTHYROIDISM
– WHEN TO
SUSPECT

23. What are the symptoms of hyperthyroidism?
HYPOTHYROIDISM
– WHEN TO
SUSPECT

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

25. HYPOTHYROIDISM
– WHEN TO
SUSPECT

26. When to suspect HYPOTHYROIDISM?
Based on SYMPTOMS of hypothyroidism (any one of these
– suspect but suspect more if more than one symptoms)
• fatigue
• weight gain
• trouble tolerating cold
• joint and muscle pain
• dry skin or dry, thinning hair
• heavy or irregular menstrual periods or fertility
problems
• slowed heart rate
• depression
• AN ENLARGEMENT IN THE NECK, CALLED A GOITER
Most reliable
symptom
Plus at least one of
these nonspecific
symptoms or better,
more
HYPOTHYROIDISM
– WHEN TO
SUSPECT

27. To have a more definite or more certain diagnosis
of hypothyroidism, 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 (depressed in hypothy)
T3 – triiodothyronine = FT3 (depressed in
hypothy)
A thyroid stimulating hormone (TSH) test can be
done to complement T3 / T4
Interpretation – elevated TSH (hypothy)
HYPOTHYROIDISM
– WHEN TO
SUSPECT

28. The Hypothalamus – Pituitary – Thyroid Axis
Feedback / Autoregulation Mechanism
HYPOTHYROIDISM
– WHEN TO
SUSPECT

29. After suspecting hypothyroidism based on
SYMPTOMS and SIGNS, the following lab results
can confirm its presence:
• Depressed FT4 alone
• Depressed FT3 alone
• Depressed FT4 and FT3
• Depressed FT4 and FT3, elevated TSH
• Depressed FT4 and elevated TSH
• Elevated TSH alone
Assuming not all FT4, FT3 and TSH are done
simultaneously
HYPOTHYROIDISM
– WHEN TO
SUSPECT

30. 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.
HYPOTHYROIDISM
– WHEN TO
SUSPECT

31. HYPOTHYROIDISM
– WHEN TO
SUSPECT

32. What are the causes of hypothyroidism?
• Iodine deficiency
• Autoimmune disease
• Thyroid surgery
• Radiation / radioactive iodine therapy
• Chronic thyroiditis
HYPOTHYROIDISM
– WHEN TO
SUSPECT

33. What are the treatment options for
hypothyroidism?
Medical – use of drugs – levothyroxine –
supplement and maintenance
• Will be discussed in another ROJoson PEP Talk
episode.
HYPOTHYROIDISM
– WHEN TO
SUSPECT

34. Summary – When to suspect HYPOTHYROIDISM
Bases for suspicion:
• Presence of symptoms of HYPOTHYROIDISM
• Presence of signs of HYPOTHYROIDISM
Confirmation of suspicion:
DEPRESSED FT4 and ELEVATED TSH
HYPOTHYROIDISM
– WHEN TO
SUSPECT

35. HYPOTHYROIDISM
– WHEN TO
SUSPECT
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 HYPOTHYROIDISM?
• What is the disease process of HYPOTHYROIDISM?
• What are the complications of HYPOTHYROIDISM?
• When does one suspect HYPOTHYROIDISM?
• What are the diagnostic tests for HYPOTHYROIDISM?
• What are the causes of HYPOTHYROIDISM?
• What are the basic treatment modalities for
HYPOTHYROIDISM?
Summary
Take Away

36. Take Away in
relation to
Patient
Empowerment
Be always in touch with reliable medical
information on HYPOTHYROIDISM – 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
HYPOTHYROIDISM – WHEN TO SUSPECT
as part of your health management.
HYPOTHYROIDISM
– WHEN TO
SUSPECT

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

38. 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.

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

40. HYPOTHYROIDISM
– WHEN TO
SUSPECT
Empowerment
objective - for
laypeople to have an
essential
understanding on
HYPOTHYROIDISM –
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!

41. Empowerment
objective - for
laypeople to have an
essential
understanding on
HYPOTHYROIDISM –
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!
HYPOTHYROIDISM
– WHEN TO
SUSPECT