Imapct of Thyroid disorder on Reproduction-DrSelim.pdfShahjadaSelim1
Thyroid disorders are the commonest endocrine disorders in all people, though less talked about.
Thyroid disease is the second most common endocrine disorder after diabetes in pregnancy but more common than Diabetes in the community.
Female related infertility accounted for 37% and combined male and female factors for 35% of the causes of infertility.
Invited lecture by Dr Sujoy Dasgupta in the Webinar on “PCOS Advocacy” by Endocrinology Committee of FOGSI (Federation of Obstetric and Gynaecological Societies of India), held in September, 2020
Imapct of Thyroid disorder on Reproduction-DrSelim.pdfShahjadaSelim1
Thyroid disorders are the commonest endocrine disorders in all people, though less talked about.
Thyroid disease is the second most common endocrine disorder after diabetes in pregnancy but more common than Diabetes in the community.
Female related infertility accounted for 37% and combined male and female factors for 35% of the causes of infertility.
Invited lecture by Dr Sujoy Dasgupta in the Webinar on “PCOS Advocacy” by Endocrinology Committee of FOGSI (Federation of Obstetric and Gynaecological Societies of India), held in September, 2020
Uterine Fibroids: Symptoms, Causes, Risk Factors & Treatment uterine fibroids aren't associated with an increased risk of uterine cancer and almost never develop into cancer
Treatment and causes of Amenorrhea and diet in amenorrheaMedical Knowledge
In this slide, you can learn about the Amenorrhea, Mahvari or haiz.
No periods and no menstruation
You can learn about the types of Menstruation.
Types of Menstrual disorders.
cause of Amenorrhea
symptoms of Amenorrhea
diagnosis of Amenorrhea
Treatment of Amenorrhea
No bleeding or No periods
Menstrual cycle
Amenorrhea
You can download Powerpoint of menstrual disorders here:
https://drive.google.com/open?id=1X-R2Btz8nOgN-64GAOXywi2o-frM6Cpy8ornzfxN5aQ
You can download video from,
https://youtu.be/t4QQPq0n_tY
The menopause may be
Natural or induced
Natural menopause - the permanent cessation of menstruation for 12 months caused by failure of ovarian function with elevated gonadotropins (FSH, LH).
Average is 51 years
Concurrent imperforate hymen and transverse vaginal septum: A rare presentati...Apollo Hospitals
A 13 year old girl not attained menarche presented as a case of acute abdomen; she had a mass per abdomen, on ultrasound diagnosed as haematometra and hematocolpus; clinically had an imperforate hymen; further evaluation by MRI revealed a high vaginal cause of obstruction which cannot be differentiated as vaginal atresia or a combination of transverse vaginal septum and imperforate hymen; operative findings showed a imperforate hymen with a patent lower vagina and a transverse vaginal septum separating upper and lower vagina; surgical correction done and drained 1000 ml of blood and post operatively patient is followed up for a month and bleeding through vagina during the next cycle is noted showing the patent vagina. This is a first case of concurrent transverse vaginal septum and imperforate hymen without any other genitourinary anomalies in literature.
Uterine Fibroids: Symptoms, Causes, Risk Factors & Treatment uterine fibroids aren't associated with an increased risk of uterine cancer and almost never develop into cancer
Treatment and causes of Amenorrhea and diet in amenorrheaMedical Knowledge
In this slide, you can learn about the Amenorrhea, Mahvari or haiz.
No periods and no menstruation
You can learn about the types of Menstruation.
Types of Menstrual disorders.
cause of Amenorrhea
symptoms of Amenorrhea
diagnosis of Amenorrhea
Treatment of Amenorrhea
No bleeding or No periods
Menstrual cycle
Amenorrhea
You can download Powerpoint of menstrual disorders here:
https://drive.google.com/open?id=1X-R2Btz8nOgN-64GAOXywi2o-frM6Cpy8ornzfxN5aQ
You can download video from,
https://youtu.be/t4QQPq0n_tY
The menopause may be
Natural or induced
Natural menopause - the permanent cessation of menstruation for 12 months caused by failure of ovarian function with elevated gonadotropins (FSH, LH).
Average is 51 years
Concurrent imperforate hymen and transverse vaginal septum: A rare presentati...Apollo Hospitals
A 13 year old girl not attained menarche presented as a case of acute abdomen; she had a mass per abdomen, on ultrasound diagnosed as haematometra and hematocolpus; clinically had an imperforate hymen; further evaluation by MRI revealed a high vaginal cause of obstruction which cannot be differentiated as vaginal atresia or a combination of transverse vaginal septum and imperforate hymen; operative findings showed a imperforate hymen with a patent lower vagina and a transverse vaginal septum separating upper and lower vagina; surgical correction done and drained 1000 ml of blood and post operatively patient is followed up for a month and bleeding through vagina during the next cycle is noted showing the patent vagina. This is a first case of concurrent transverse vaginal septum and imperforate hymen without any other genitourinary anomalies in literature.
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.
Hypothyroidism is a condition marked by an underactive thyroid gland and may be present during pregnancy. It incidence
0.05% of pregnant women
31% positive for TPO Ab
Associated with Gest Hypertension.
Hyperthyroidism in pregnancy:
Hyperthyroidism is characterized by high level of serum thyroxine and triiodothyronine, low levels of thyroid-stimulating hormones.
Hyperthyroidism during pregnancy usually is caused by an
Autoimmune disorder called Grave’s disease. It incidence :-
- 0.2% of pregnant women
- 95% Grave’s disease
It is a presentation on Thyroid Disorder in Pregnancy 2023
The Newer Concepts In Endometriosis Management : Dr Sharda JainLifecare Centre
The Newer Concepts In
Endometriosis Management
ENDOMETRIOSIS IS ENIGMA
DIAGNOSTIC DELEMMA
DEBILITATING DISEASE QOL
PROGRESSIVE DISEASE
RECURRENCE IS BIG PROBLEM
NO FINAL VERDICT ON CAUSE
NO PERMANENT CURE
The exact prevalence of endometriosis is unknown, but estimates 10% in the general female population in India but up to 50% in infertile women
The Newer Concepts forReduced Surgery to preserve fertility in Endometrios...Lifecare Centre
The Newer Concepts forReduced Surgery to preserve fertility in Endometriosis
ENDOMETRIOSIS IS ENIGMA
DIAGNOSTIC DILEMMA
DEBILITATING DISEASE QOL
PROGRESSIVE DISEASE
RECURRENCE IS BIG PROBLEM
NO FINAL VERDICT ON CAUSE
NO PERMANENT CURE
The exact prevalence of endometriosis is unknown, but estimates 10% in the general female population in India but up to 50% in infertile women
Anemia Free India Gynaecologist to focuss on *12gm Haemoglobin at Delivery I...Lifecare Centre
Important Highlights
Prophylactic Iron and Folic Acid Supplementation in all six target age groups.
Intensified year-round Behaviour Change Communication (BCC) Campaign for:(a) improving compliance to IFA and deworming, (b) enhancing appropriate infant and young child feeding practices, (c) encouraging increase in intake of iron-rich food through diet and/or fortified foods (d) ensuring delayed cord clamping .
Testing and treatment of anaemia, using digital methods and point of care treatment, with special focus on pregnant women and school-going adolescents.
Addressing non-nutritional causes of anaemia
in endemic pockets with special focus on malaria, hemoglobinopathies and fluorosis
Strategies for Improving Success Rates in ART PARTLifecare Centre
Strategies for Improving Success Rates in ART
Part - 2
Strategies for Improving Success Rates in ART
Tailoring Controlled Ovarian Stimulation
Strategies for Luteal Phase in ART cycles
Endometrial Receptivity Array
How to optimize success rates in ART? : Dr Sharda JainLifecare Centre
How to optimize success rates in ART? : Dr Sharda Jain
How to improve success rates in ART?
The big debate कार्य में आनंद
Evolution of In-vitro Fertilization (IVF)
Factors Influencing IVF Success Ist Part
Strategies for Improving Success Rates in ART Second Part
Innovations & Breakthroughs in IVF Part Three
OPEN DEBATE
SOCIALEGG FREEZING : Dr Poorva Bhargav and Dr Sharda JainLifecare Centre
SOCIALEGG FREEZING : Dr Poorva Bhargav and Dr Sharda Jain
Introduction
Social egg freezing (oocyte cryopreservation for non-medical reasons) has evolved as a proactive option for women looking to extend their reproductive possibilities past their peak childbearing years
It is the process of saving or protecting eggs, or reproductive tissues so that a person can use them to have biological children in future
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
Factory Supply Best Quality Pmk Oil CAS 28578–16–7 PMK Powder in Stockrebeccabio
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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
Couples presenting to the infertility clinic- Do they really have infertility...Sujoy Dasgupta
Dr Sujoy Dasgupta presented the study on "Couples presenting to the infertility clinic- Do they really have infertility? – The unexplored stories of non-consummation" in the 13th Congress of the Asia Pacific Initiative on Reproduction (ASPIRE 2024) at Manila on 24 May, 2024.
Lung Cancer: Artificial Intelligence, Synergetics, Complex System Analysis, S...Oleg Kshivets
RESULTS: Overall life span (LS) was 2252.1±1742.5 days and cumulative 5-year survival (5YS) reached 73.2%, 10 years – 64.8%, 20 years – 42.5%. 513 LCP lived more than 5 years (LS=3124.6±1525.6 days), 148 LCP – more than 10 years (LS=5054.4±1504.1 days).199 LCP died because of LC (LS=562.7±374.5 days). 5YS of LCP after bi/lobectomies was significantly superior in comparison with LCP after pneumonectomies (78.1% vs.63.7%, P=0.00001 by log-rank test). AT significantly improved 5YS (66.3% vs. 34.8%) (P=0.00000 by log-rank test) only for LCP with N1-2. Cox modeling displayed that 5YS of LCP significantly depended on: phase transition (PT) early-invasive LC in terms of synergetics, PT N0—N12, cell ratio factors (ratio between cancer cells- CC and blood cells subpopulations), G1-3, histology, glucose, AT, blood cell circuit, prothrombin index, heparin tolerance, recalcification time (P=0.000-0.038). Neural networks, genetic algorithm selection and bootstrap simulation revealed relationships between 5YS and PT early-invasive LC (rank=1), PT N0—N12 (rank=2), thrombocytes/CC (3), erythrocytes/CC (4), eosinophils/CC (5), healthy cells/CC (6), lymphocytes/CC (7), segmented neutrophils/CC (8), stick neutrophils/CC (9), monocytes/CC (10); leucocytes/CC (11). Correct prediction of 5YS was 100% by neural networks computing (area under ROC curve=1.0; error=0.0).
CONCLUSIONS: 5YS of LCP after radical procedures significantly depended on: 1) PT early-invasive cancer; 2) PT N0--N12; 3) cell ratio factors; 4) blood cell circuit; 5) biochemical factors; 6) hemostasis system; 7) AT; 8) LC characteristics; 9) LC cell dynamics; 10) surgery type: lobectomy/pneumonectomy; 11) anthropometric data. Optimal diagnosis and treatment strategies for LC are: 1) screening and early detection of LC; 2) availability of experienced thoracic surgeons because of complexity of radical procedures; 3) aggressive en block surgery and adequate lymph node dissection for completeness; 4) precise prediction; 5) adjuvant chemoimmunoradiotherapy for LCP with unfavorable prognosis.
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,
and severe subclassifications (American Psychiatric Association, 2013).
In the DSM-5, all types of substance abuse and dependence have been
combined into a single substance use disorder (SUD) on a continuum
from mild to severe. A diagnosis of AUD requires that at least two of
the 11 DSM-5 behaviors be present within a 12-month period (mild
AUD: 2–3 criteria; moderate AUD: 4–5 criteria; severe AUD: 6–11 criteria).
The four main behavioral effects of AUD are impaired control over
drinking, negative social consequences, risky use, and altered physiological
effects (tolerance, withdrawal). This chapter presents an overview
of the prevalence and harmful consequences of AUD in the U.S.,
the systemic nature of the disease, neurocircuitry and stages of AUD,
comorbidities, fetal alcohol spectrum disorders, genetic risk factors, and
pharmacotherapies for AUD.
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.
- 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
- Link to NephroTube website: www.NephroTube.com
- Link to NephroTube social media accounts: https://nephrotube.blogspot.com/p/join-nephrotube-on-social-media.html
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!
Thyroid and comorbid conditions, Dr. Jyoti Agarwal Life Care Centre
1. Thyroid and comorbid conditions
Dr. Jyoti Agarwal
Dr.Sharda Jain
Dr. Jyoti Bhaskar
2. Dr. Sharda Jain / Dr Jyoti Agarwal
Life Care Centre has a over 200 ppt on shildeshare.net
For benefit of Medical fraternity.
use it yourself & share among your friends
5. Major Comorbid Conditions
AACE medical guidelines for clinical practice for the evaluation and treatment of hyperthyroidism and hypothyroidism, 2006:1-13
6. Autoimmune diseases that occur
concurrently with hypothyroidism
• Diabetes mellitus
• Vitiligo,
• Rheumatoid arthritis
• Addison’s disease
• Coelic disaese
• Pernicious anemia
• Autoimmune diseases
are associated
with autoimmune
thyroiditis
7.
8. Diabetes Mellitus
• Hashimoto’s thyroiditis
is associated with 10%
of patients with type 1
diabetes mellitus
• Approximately one-fourth
of female patients with
type 1 diabetes mellitus
develop postpartum
thyroiditis
9. AACE recommends that
All Diabetic patients
• Examine for goiter
• Assess TSH levels regularly especially in the
presence of a goiter or other autoimmune
disorders
10. 10
• Increased estrogen
production.
• Defective
spermatogenesis.
• Low sperm count with
• sperm motility defect.
Thyroid and InfertilityThyroid and Infertility
FEMALES MALES
11. Subclinical overt hypothyroidism has been
reported to be linked with insulin resistance.
In patients on treatment for both thyroid
disorders and diabetes, thyroid status
should be kept in mind while titrating ant
diabetic therapy .
11Reference : Kalra S et al. The hypoglycemic side of hypothyroidism.
Indian Journal of Endocrinology Metabolism 2014;18(1)1.3.
Diabetes
13. Impact on Female Fertility
• Over 50 % of hypothyroid patients have menstrual
irregularities
• one third of subfertile patients have thyroid disease
• 46 % of infertile patients with hypothyroidism have
hyperprolactinaemia
Thyroid dysfunction is associated with
short luteal phase, failure to sustain a
fertilized egg, and loss of early pregnancy.
14. Impact on Female Fertility
• Controlled ovarian hyperstimulation leads to
increase in estradiol, which in turn has an
adverse effect on thyroid hormones
• In presence of autoimmune thyroid disease ,
the impact of controlled ovarian
hyperstimulation becomes more severe
Treatment with LT4 replacement therapy restores
normal menstrual cycle and fertility
15. In males infertility starts in childhood
• Thyroid failure in the pre-pubertal period is
associated with testicular enlargement and
alterations in sexual hormones
• There is macro orchidism without virilization
• Longer the hypothyroidism persists, greater
is the degree of damage to the testes
• If adequately treated these boys progress through
puberty normally
17. Infertility tip
An Endocrine society clinical practice guideline
Screening of Hypothyroidism is recommended in
women suffering from infertility
Reference : De Groot L et al. Management of thyroid dysfunction during
pregnancy and postpartum an endocrine society clinical practice guideline J Cline
Endocrinal Metab. 2012;97(8);2543-65
18.
19. Depression
• Diagnosis of overt or
subclinical hypothyroidism
should be considered in
every patient with
depression
• Periodic evaluation for
thyroid function should be
performed in patients
receiving lithium therapy
because lithium is known to
induce goiter and
hypothyroidism
20. Depression
• All depressed patients
should be evaluated
for thyroid dysfunction
• Antidepressants may
be less effective if
thyroid functions are
not normalized
• Occasionally thyroxin
is given with
antidepressants even in
euthyroid patients
21.
22. Dyslipidemia and cardiovascular sequelae
comorbid with overt hypothyroidism
Dyslipidemia is
characterized by
• Increased levels of
total cholesterol
• Increased LDL and
deranged lipid profile
If untreated leads to severe
cardiovascular sequelae
• Pericardial effusion
• Congestive heart failure
• Coronary artery disease
23. HYPOTHYROIDISM AND
DYSLIPIDEMIA TIP
All patients with elevated lipid levels
should be screened for
Hypothyroidism.
Reference : Tandon N. et al. Management of hypothyroidism in adults. J Assoc
Physicians India.
24. 24
Lipids in Patient with Hypothyroidism
Hypercholesterolemia
(>200 mg/dL)
Hypertriglyceridemia
(>150 mg/dL)
Hypercholesterolemia +
mild Hyper TG
Normal Lipids
N= 268
Approximately 3/4th
of patients with overt
hypothyroidism have increased cholesterol
and triglycerides
26. Cardiovascular sequelae comorbid with
subclinical hypothyroidism
• Impaired diastolic function
and left ventricular
function
• Hypercoagulable state
• Increased risks of
atherosclerosis and
myocardial infarction
• Mortality in patients
less than 65 years of
age
The Cycle of Disease
Subclinical
Hypothyroidism
Emerging Risk
Factors CVD
Endothelial
Dysfunction
Cardiac
Alterations
Blood
Pressure
Hyperlipidemia
Hemostatic
Balance
Obesity
27. LT4 therapy for subclinical
hypothyroidism
• Reduces cardiovascular
risk factors
• Improves dyslipidaemia
• Minimizes
neurobehavioral changes
Decrease in total cholesterol with thyroxine replacement
therapy may be considered as an important predictor for
cardiovascular risk
28.
29. Hypothyroidism and CKD
Please remember
Unresolved subclinical hypothyroidism in chronic
kidney disease patients can be associated with a
rapid decline in renal function.
Thyroid function should be assessed early in patients
with renal impairment.
References : Kim EO, et al. Unresolved subclinical hypothyroidism is independently
associated with progression of chronic kidney disease. Int J Med Sci.2013 Dec 20; 11
(1);52-9. doi 10.7150/ijms.7186 recollection 2014. 2. Connor A et al . Renal impairment
resulting from hypothyroidism
Nephro Dialysis Transplantation plus. 2008 : 6: 440-41.
31. Over-replacement risks
• Reduced bone density
osteoporosis
• Tachycardia,
arrhythmia , atrial
fibrillation and
myocardial infarction
Under-replacement risks
• Hypothyroid state
continues with
• Long-term end-organ
effects
• Increased risk of
hyperlipidemia
www.drsarma.in 31
Inappropriate Dosage
32. Learning Activity
Which of the following statements are TRUE
regarding LT4 therapy in hypothyroidism?
A.Congenital hypothyroidism is treated with LT4 at a dose of
50-100 mcg/kg orally once-daily.
B.LT4 therapy for subclinical hypothyroidism reverses cardiovascular
alterations.
C.LT4 is contraindicated in combination with antidepressants in euthyroid
patients with depression.
D.Both mild as well as overt hypothyroidism are managed by administering
levothyroxine therapy.
34. Thyroid dysfunction is quite prevalent in India,
particularly in females
Women and men >35 years of age should be
screened every 5 years
Screening of hypothyroidism is recommended
in women suffering from infertility
The diagnosis of hypothyroidism must be
considered in every patient with depression.
All patients with elevated lipid levels should
be screened for hypothyroidism .
Screening should be done in peri-and post
menopausal women to prevent complications of
hypothyroidism.
Conclusion of HYPOTHYROIDISM in women
35. Diagnosis of hypothyroidism is important in
adolescence because this condition retards Growth in
height and development of secondary sexual
characteristics and delayed onset of puberty
In patients on treatment for both thyroid disorders
and diabetes,
Thyroid status should be kept in mind while
titrating anti - diabetic therapy
Increased TSH values are increasingly noted in the
elderly population.
Screening should be done I peri -and menopausal women
To prevent complications of hypothyroidism
Conclusion
37. ADDRESS
11 Gagan Vihar, Near
Karkari Morh Flyover,
Delhi - 51
CONTACT US
9650588339
011-22414049
WEBSITE :
www.lifecareivf.in
www.lifecarecentre.in
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…..Caring hearts, healing hands
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Helpline : 9599044257
Web.www.lifecareivf.in
Helpline : 9910081484
Helpline 9599044357
Editor's Notes
Now, let’s discuss the major comorbid conditions associated with hypothyroidism.
The major comorbid conditions include autoimmune disorders, infertility, depression, and hyperlipidemia.1(/p465/col2/para3,4)2(/p27/col1/para1) The autoimmune diseases that occur concurrently with hypothyroidism are diabetes mellitus, vitiligo, rheumatoid arthritis, Addison’s disease, and pernicious anemia. Autoimmune diseases are associated with autoimmune thyroiditis.1(/p463/col2/para4)
References
AACE medical guidelines for clinical practice for the evaluation and treatment of hyperthyroidism and hypothyroidism. American College of Endocrinology.8, 6. 1-13.Available at: http://www.aace.com/pub/pdf/guidelines/hypo_hyper.pdf. Accessed March 1, 2011.
Duntas LH, Biondi B. New insights into subclinical hypothyroidism and cardiovascular risk. Semin Thromb Hemost. 2011;37(1):27-34.
Let’s now have a look at the effect of the above-mentioned comorbid conditions on hypothyroidism.
Diabetes mellitus
Hashimoto’s thyroiditis may be associated with 10% patients of type 1 diabetes mellitus. Approximately one-fourth of female patients with type 1 diabetes mellitus develop postpartum thyroiditis. The AACE recommends that patients with diabetes mellitus should be examined for goiter development and should assess TSH levels regularly in the presence of a goiter or other autoimmune disorders.(/p465/col2/para2)
Infertility
In some patients, it is found that infertility and menstrual irregularities have underlying thyroid disorder. Chronic thyroiditis can be confirmed by physical examination and laboratory evaluation. Treatment with LT4 replacement therapy restores normal menstrual cycle and fertility.(/p465/col2/para3)
Reference
AACE medical guidelines for clinical practice for the evaluation and treatment of hyperthyroidism and hypothyroidism. American College of Endocrinology.8, 6. 1-13.Available at: http://www.aace.com/pub/pdf/guidelines/hypo_hyper.pdf. Accessed March 1, 2011.
Depression
According to the AACE recommendations, in every patient with depression, diagnosis of overt or subclinical hypothyroidism should be considered. Periodic evaluation for thyroid function should be performed in patients receiving lithium therapy, because lithium is known to induce goiter and hypothyroidism. LT4 replacement therapy is used in the management of depression associated with hypothyroidism. It is indicated occasionally in combination with antidepressants in euthyroid patients with depression.(/p465/col2/para5)
Reference
AACE medical guidelines for clinical practice for the evaluation and treatment of hyperthyroidism and hypothyroidism. American College of Endocrinology.8, 6. 1-13.Available at: http://www.aace.com/pub/pdf/guidelines/hypo_hyper.pdf. Accessed March 1, 2011.
In middle-aged patients with subclinical hyperthyroidism, impaired diastolic function and reduced left ventricular systolic function at rest and during physical exertion are noted.(/p29/col1/para1) Studies reveal that subclinical hyperthyroidism is also associated with atherosclerosis and myocardial infarction.(/p29/col1/para4) Meta-analysis of high-quality studies reveal that total and cardiovascular-related mortality was noted only in patients who had subclinical hyperthyroidism and were less than 65 years of age.(/p29/col2/para4)
Subclinical hyperthyroidism is associated with proatherogenic mechanisms leading to low-grade inflammation and this may also suggest cardiovascular disease.(/p30/col2/para4) Subclinical hyperthyroidism is known to be linked to a hypercoagulable state, but the degree of impact is yet to be studied.(/p32/col1/para1)
LT4 therapy for subclinical hyperthyroidism reverses cardiovascular alterations, reduces risk factors, improves dyslipidaemia, and minimizes neurobehavioral changes.(/p31/col1/para1)
Reference
Duntas LH, Biondi B. New insights into subclinical hypothyroidism and cardiovascular risk. Semin Thromb Hemost. 2011;37(1):27-34.