Sick Euthyroid Syndrome refers to abnormal thyroid function test results that occur during non-thyroidal illness without pre-existing thyroid dysfunction. It is characterized by low T3 and elevated reverse T3 levels. This pattern results from impaired conversion of T4 to T3 in tissues due to reduced activity of deiodinase enzymes from cytokines. The severity of the thyroid hormone changes correlates with the severity of the underlying illness. Treatment with thyroid hormone is controversial, and thyroid function usually normalizes as the illness improves.
The jugular venous pressure (JVP, sometimes referred to as jugular venous pulse) is the indirectly observed pressure over the venous system via visualization of the internal jugular vein. It can be useful in the differentiation of different forms of heart and lung disease.
The jugular venous pressure (JVP, sometimes referred to as jugular venous pulse) is the indirectly observed pressure over the venous system via visualization of the internal jugular vein. It can be useful in the differentiation of different forms of heart and lung disease.
Introduction:
@ Thyroid releases T3 & T4
@ The ratio of T4 to T3 is 5:1, so most of the hormone released is
thyroxine
@ Most of the T3 in the blood is derived from thyroxine
@ T3 is three to four times more potent than T4
@ The affinity of the receptor site for T3 is about ten times higher than that for T4
Thyroid Hormones and Cardiovascular Function and Diseasesmagdy elmasry
Thyroid hormone system.
Thyroid hormone action on the CVS.
Thyroid hormones and cardioprotection.
How does thyroid disease affect the heart?
- Thyroid disease and CV risk factors.
- Thyroid dysfunction and CVD.
Thyroid hormones : a future therapeutic option?
New recommendations for a thyroid and CVD.
Thyroid and CV drugs.
Thyroid function tests (TFTs) are a suite of blood tests designed to assess the health and performance of the thyroid gland, a crucial organ with a central role in regulating metabolism, energy production, and overall bodily function. Understanding these tests is vital for diagnosing and managing thyroid disorders effectively.
Thyroid-Stimulating Hormone (TSH):
TSH is a hormone produced by the pituitary gland that stimulates the thyroid to release thyroid hormones (T3 and T4).
Elevated TSH levels typically indicate an underactive thyroid (hypothyroidism), suggesting insufficient production of thyroid hormones.
Free T3 and Free T4:
Free T3 and Free T4 are the active forms of thyroid hormones produced by the thyroid gland.
Abnormal levels of these hormones can signify thyroid dysfunction. Low levels may suggest hypothyroidism, while high levels could indicate hyperthyroidism.
Thyroid Antibodies:
Thyroid antibodies, including thyroid peroxidase (TPO) and thyroglobulin antibodies, are markers of autoimmune thyroid diseases.
Elevated antibody levels may indicate conditions like Hashimoto's thyroiditis (where the immune system attacks the thyroid) or Graves' disease (causing overproduction of thyroid hormones).
Thyroid Ultrasound:
While not a blood test, thyroid ultrasound provides imaging of the thyroid gland's structure, helping to detect nodules, evaluate size, and identify potential abnormalities.
Ultrasound is particularly useful in assessing the thyroid's physical characteristics.
Interpreting TFT results involves understanding the dynamic relationship between TSH, Free T3, and Free T4. In cases of primary hypothyroidism, TSH is often elevated, indicating an underactive thyroid, with Free T3 and Free T4 possibly being low. Conversely, in hyperthyroidism, TSH is typically low, accompanied by elevated Free T3 and Free T4.
Regular monitoring of TFTs is essential for managing thyroid disorders. Medication adjustments, lifestyle changes, and ongoing collaboration with healthcare professionals are often necessary to optimize thyroid function. Periodic thyroid ultrasounds and antibody tests aid in tracking disease progression and treatment efficacy.
Individuals with thyroid conditions should work closely with their healthcare providers to develop personalized treatment plans. This collaborative approach ensures that interventions are tailored to specific needs, leading to effective management of thyroid disorders and overall well-being. Always consult with a healthcare professional for accurate interpretation of test results and personalized medical advice
Thyroid function tests (TFTs) are a suite of blood tests designed to assess the health and performance of the thyroid gland, a crucial organ with a central role in regulating metabolism, energy production, and overall bodily function. Understanding these tests is vital for diagnosing and managing thyroid disorders effectively.
Thyroid-Stimulating Hormone (TSH):
TSH is a hormone produced by th
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.
8 July is World Hepatitis Day
World Hepatitis Day, 28 July, is an opportunity to step up national and international efforts on hepatitis, encourage actions and engagement by individuals, partners and the public and highlight the need for a greater global response as outlined in the WHO's Global hepatitis report of 2017.
The date of 28 July was chosen because it is the birthday of Nobel-prize winning scientist Dr Baruch Blumberg, who discovered hepatitis B virus (HBV) and developed a diagnostic test and vaccine for the virus.
Low coverage of testing and treatment is the most important gap to be addressed in order to achieve the global elimination goals by 2030.
New Drug Discovery and Development .....NEHA GUPTA
The "New Drug Discovery and Development" process involves the identification, design, testing, and manufacturing of novel pharmaceutical compounds with the aim of introducing new and improved treatments for various medical conditions. This comprehensive endeavor encompasses various stages, including target identification, preclinical studies, clinical trials, regulatory approval, and post-market surveillance. It involves multidisciplinary collaboration among scientists, researchers, clinicians, regulatory experts, and pharmaceutical companies to bring innovative therapies to market and address unmet medical needs.
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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Couples presenting to the infertility clinic- Do they really have infertility...Sujoy Dasgupta
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Title: Sense of Taste
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the structure and function of taste buds.
Describe the relationship between the taste threshold and taste index of common substances.
Explain the chemical basis and signal transduction of taste perception for each type of primary taste sensation.
Recognize different abnormalities of taste perception and their causes.
Key Topics:
Significance of Taste Sensation:
Differentiation between pleasant and harmful food
Influence on behavior
Selection of food based on metabolic needs
Receptors of Taste:
Taste buds on the tongue
Influence of sense of smell, texture of food, and pain stimulation (e.g., by pepper)
Primary and Secondary Taste Sensations:
Primary taste sensations: Sweet, Sour, Salty, Bitter, Umami
Chemical basis and signal transduction mechanisms for each taste
Taste Threshold and Index:
Taste threshold values for Sweet (sucrose), Salty (NaCl), Sour (HCl), and Bitter (Quinine)
Taste index relationship: Inversely proportional to taste threshold
Taste Blindness:
Inability to taste certain substances, particularly thiourea compounds
Example: Phenylthiocarbamide
Structure and Function of Taste Buds:
Composition: Epithelial cells, Sustentacular/Supporting cells, Taste cells, Basal cells
Features: Taste pores, Taste hairs/microvilli, and Taste nerve fibers
Location of Taste Buds:
Found in papillae of the tongue (Fungiform, Circumvallate, Foliate)
Also present on the palate, tonsillar pillars, epiglottis, and proximal esophagus
Mechanism of Taste Stimulation:
Interaction of taste substances with receptors on microvilli
Signal transduction pathways for Umami, Sweet, Bitter, Sour, and Salty tastes
Taste Sensitivity and Adaptation:
Decrease in sensitivity with age
Rapid adaptation of taste sensation
Role of Saliva in Taste:
Dissolution of tastants to reach receptors
Washing away the stimulus
Taste Preferences and Aversions:
Mechanisms behind taste preference and aversion
Influence of receptors and neural pathways
Impact of Sensory Nerve Damage:
Degeneration of taste buds if the sensory nerve fiber is cut
Abnormalities of Taste Detection:
Conditions: Ageusia, Hypogeusia, Dysgeusia (parageusia)
Causes: Nerve damage, neurological disorders, infections, poor oral hygiene, adverse drug effects, deficiencies, aging, tobacco use, altered neurotransmitter levels
Neurotransmitters and Taste Threshold:
Effects of serotonin (5-HT) and norepinephrine (NE) on taste sensitivity
Supertasters:
25% of the population with heightened sensitivity to taste, especially bitterness
Increased number of fungiform papillae
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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!
Explore natural remedies for syphilis treatment in Singapore. Discover alternative therapies, herbal remedies, and lifestyle changes that may complement conventional treatments. Learn about holistic approaches to managing syphilis symptoms and supporting overall health.
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
A healthy human prostate measures (4cm-vertical, by 3cm-horizontal, 2cm ant-post ).
It surrounds the urethra just below the urinary bladder. It has anterior, median, posterior and two lateral lobes
It’s work is regulated by androgens which are responsible for male sex characteristics
Generalised disease of the prostate due to hormonal derangement which leads to non malignant enlargement of the gland (increase in the number of epithelial cells and stromal tissue)to cause compression of the urethra leading to symptoms (LUTS
Recomendações da OMS sobre cuidados maternos e neonatais para uma experiência pós-natal positiva.
Em consonância com os ODS – Objetivos do Desenvolvimento Sustentável e a Estratégia Global para a Saúde das Mulheres, Crianças e Adolescentes, e aplicando uma abordagem baseada nos direitos humanos, os esforços de cuidados pós-natais devem expandir-se para além da cobertura e da simples sobrevivência, de modo a incluir cuidados de qualidade.
Estas diretrizes visam melhorar a qualidade dos cuidados pós-natais essenciais e de rotina prestados às mulheres e aos recém-nascidos, com o objetivo final de melhorar a saúde e o bem-estar materno e neonatal.
Uma “experiência pós-natal positiva” é um resultado importante para todas as mulheres que dão à luz e para os seus recém-nascidos, estabelecendo as bases para a melhoria da saúde e do bem-estar a curto e longo prazo. Uma experiência pós-natal positiva é definida como aquela em que as mulheres, pessoas que gestam, os recém-nascidos, os casais, os pais, os cuidadores e as famílias recebem informação consistente, garantia e apoio de profissionais de saúde motivados; e onde um sistema de saúde flexível e com recursos reconheça as necessidades das mulheres e dos bebês e respeite o seu contexto cultural.
Estas diretrizes consolidadas apresentam algumas recomendações novas e já bem fundamentadas sobre cuidados pós-natais de rotina para mulheres e neonatos que recebem cuidados no pós-parto em unidades de saúde ou na comunidade, independentemente dos recursos disponíveis.
É fornecido um conjunto abrangente de recomendações para cuidados durante o período puerperal, com ênfase nos cuidados essenciais que todas as mulheres e recém-nascidos devem receber, e com a devida atenção à qualidade dos cuidados; isto é, a entrega e a experiência do cuidado recebido. Estas diretrizes atualizam e ampliam as recomendações da OMS de 2014 sobre cuidados pós-natais da mãe e do recém-nascido e complementam as atuais diretrizes da OMS sobre a gestão de complicações pós-natais.
O estabelecimento da amamentação e o manejo das principais intercorrências é contemplada.
Recomendamos muito.
Vamos discutir essas recomendações no nosso curso de pós-graduação em Aleitamento no Instituto Ciclos.
Esta publicação só está disponível em inglês até o momento.
Prof. Marcus Renato de Carvalho
www.agostodourado.com
2. Sick Euthyroid Syndrome
• Abnormal findings in thyroid function tests
• Occur in the setting of a non thyroidal
illness(NTI)
• Without pre-existing hypothalamic-pituitary-
thyroid gland dysfunction.
5. Function of Deiodinase Enzyme
Parameters D1 D2 D3
Act on rT3 ,T4 T4 ,rT3 T3,T4
Tissue location Liver ,Kidney
Thyroid ,Pituitary
CNS, Pituitary
Skeletal muscle,
Placenta,
Thyroid, Heart
Placenta,CNS
Hemangiomas,
skeletal muscle
liver
Function Degradation of rT3
and T3 Synthesis
Main source of
T3
Inactivation of
T3 and T4
6. • Normally T3, T4 and TSH levels are well regulated
• Most prominent are low T3 & elevated rT3
• Leading to the term “low T3 syndrome.”
• As the severity of non thyroidal illness increases,
both T3 and T4 levels drop that usually normalizes
as the underlying illness recovers.
7. Mechanisms
• Cytokines particularly IL-1, IL-6, TNF-α and
Interferon-β.
• Impaired peripheral deiodination of T4 to T3.
• Decreased clearance of rT3.
• Inhibition of thyroid hormone binding to
thyroid hormone binding proteins and tissues.
• Insufficient levels of thyroid hormone binding
proteins(TBG, TBPA & TBA).
8. • During inflammatory states, there is increase
in Reactive Oxygen Species(ROS).
• The active centers of both D1 & D2 are
intracellular, and that of D3 is extracellular,
which do not pass easily through the cell
membrane.
9. • D1 & D2 inactivated
• However D3 is spared {and Type 2 Deiodinase
in Tanycytes is also spared}
• Leading to decreased T3 & Increased rT3
• Reduced clearance of rT3 due to reduced
activity of D1 & D2
10. • D2 is thought to be negatively regulated by
thyroid hormone
• Normal to increased production of T3 via
increased activity of D2 in Tanycytes
(Speciliased cells in the wall of 3rd Ventricle).
11. • Cytokines like IL-1, IL-6, TNF-α & Interferon-γ
also affect hypothalamus, pituitary and other
tissues.
• Interferon-γ inhibits TSH & cAMP induced up-
regulation of TSH receptors on thyroid cells.
13. • Prolonged critical illness there is decreased
food intake
• Decreased level of hormone leptin
• Cytokines, cortisol and leptin alters secretion
of TRH and TSH
• Reduction in leptin levels cause increase in
Type 3 Deiodinase activity.
14. Effect of NTI on T3 & rT3
MCR : Metabolic Clearance Rate
PR : Production Rate
15. Diagnosis
• Low T3 and T4 levels.
• TSH : can be Low, Normal or slightly Elevated.
• Reverse T3(rT3) : Elevated.
• Sr. Cortisol levels : Usually Elevated.
17. Differential Diagnosis
Hypothyroidism : Low T3 & T4 with markedly
increased TSH with low Cortisol.
Acute exposure to heat : Low T3 (free & total) with
increased rT3 and TSH.
Fasting/Starvation : Total T4 usually unchanged, free
T4 normal or elevated due to increase in FFA.
Total & free T3 decreased. Elevated rT3 with
diminished response of TSH to TRH.
18. Surgery : Total T3 level falls, free T3 level
increases on the day of surgery that eventually
falls postoperatively. T4 & TSH levels are
usually unaltered.
Myocardial Infarction : In 1-3 days post infarction,
total T3 low, rT3 elevated and TSH may be
normal or elevated.
19. CKD : Total & Free T4 normal or decreased, Total
& Free T3 reduced, rT3 unchanged, Basal TSH
unchanged or reduced. Low FT3 is an
independent predictor of death in
hemodialysis patients.
Liver Disease : Total T4 unchanged or increased,
Free T4 unchanged or reduced, Free T3
reduced or unchanged, rT3 elevated, TSH
reduced, normal or slightly elevated.
20. HIV Infection : Patients with asymptomatic HIV
infection have TFT results WNL or slightly
increased TSH levels.
Psychiatric Illness : In acute psychosis, there is
elevated T4. Patients with PTSD may have
slightly high serum T3 concentrations, but
their serum FT3, FT4, and TSH are normal.
21. Severity of Illness and Pattern of Sick
Euthyroid Syndrome
• The changes in hormonal status depends upon the
duration of the illness
-Acute illness -mild ,moderate ,severe
-Chronic illness
• Magnitude of change in T3 and rT3 reflects severity
of illness
• Total T3 fall is faster than FT3, T4 level is generally
within normal range, however T4 level may fall as the
severity of NTI increases.
22. • Low T3 - D2,D1 in peripheral
tissue
• TSH (N) with T3 : Suppression
of TSH by T3 produced by D2
located in tanycytes
TRH
TSH (N)
FT4 (N)
FT3 rT3
T2
D2,D1
D1,D2
D3
Free T3 Free T4 RT3 TSH Cause
N (2 -3 fold) N D2,D1 D350%
Mild Illness (acute illness)
23. Moderate To Severe Illness (Acute Illness)
• TSH - cytokine ,drugs
suppress H-P level
• FT4 ( ,N) even with TSH
FFA and other substances
reduce the binding to TBG
• in Tissue FT3 similar that of
serum FT3
TRH
TSH
FT4
FT3 rT3
T2
D2 ,D1 D3
(N , , )
D1,D2D3
Free T3 Free T4 RT3 TSH Cause
N, (2 -3 fold) N , D2,D1 ,D3
(N, )
50-70%
24. Changes in Chronic Critical Illness
TRH
TSH
FT4
FT3 rT3
T2
Free T3 Free T4 RT3 TSH Cause
D2,D1, D3
• FT4 and TSH marked
reduced
• FT3 marked reduced
,barely detected in
tissue level
25. Changes in Thyroid Hormone Levels
During Illness
Severity of
Illness
Free T3 Free T4 Reverse T3 TSH Probable
Cause
Mild N N D2,D1
Moderate N, , N, D2,D1,
? D3
Severe D2,D1,
D3
Recovery ?
27. Treatment
• Treatment with Thyroid Hormone
Replacement is controversial.
• Whether there is any beneficial role behind
these alterations is still not clear.
• When the underlying illness is treated, results
of thyroid tests usually normalize of its own.
28. • The only positive outcomes of T3 treatment is seen
in patients undergoing cardiac surgery.
• Postoperative intravenous T3 therapy increases
cardiac index
• No difference in mortality benefit
29. • Co-infusion of GHRH plus TRH is better
• Induce restoration of pulsatile growth
hormone and TSH release
• Near-normal serum T4 and T3 values
• Shift from catabolism towards anabolism
• Rise in circulating rT3 avoided.