Khadeeja Nasser, a 35-year-old woman, presented with fatigue, weight gain, cold intolerance, dry skin, constipation, and irregular periods over the past six months. Examination found fatigue, puffy face, slow pulse, dry skin, and sluggish reflexes. Labs found elevated TSH and low T4, with positive thyroid peroxidase antibodies. This suggests Hashimoto's thyroiditis causing hypothyroidism. Hypothyroidism presents with the symptoms described and is diagnosed by elevated TSH and low T4. It is managed with levothyroxine replacement.
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
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.
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
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.
Thyroiditis is a general term that refers to “inflammation of the thyroid gland”. Thyroiditis includes a group of individual disorders causing thyroidal inflammation but presenting in different ways. For example, Hashimoto's thyroiditis is the most common cause of hypothyroidism in the United States.
Hypothyroidism Diagnosis, Etiopathogenesis and TreatmentPranatiChavan
Hypothyroidism is a condition in which the thyroid gland doesn't produce enough thyroid hormone.
Hypothyroidism's deficiency of thyroid hormones can disrupt such things as heart rate, body temperature and all aspects of metabolism. Hypothyroidism is most prevalent in older women.
Major symptoms include fatigue, cold sensitivity, constipation, dry skin and unexplained weight gain.
Treatment consists of thyroid hormone replacement.
2012 Clinical Practice guidelines for hypothyroidism in adults: American Asso...Jibran Mohsin
This is presentation format of 2012 Clinical Practice guidelines for hypothyroidism in adults: American Association of Clinical Endocrinologists (AACE) / American Thyroid Association (ATA)
These lecture slides, by Dr Sidra Arshad, offer a quick overview of physiological basis of a normal electrocardiogram.
Learning objectives:
1. Define an electrocardiogram (ECG) and electrocardiography
2. Describe how dipoles generated by the heart produce the waveforms of the ECG
3. Describe the components of a normal electrocardiogram of a typical bipolar leads (limb II)
4. Differentiate between intervals and segments
5. Enlist some common indications for obtaining an ECG
Study Resources:
1. Chapter 11, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 9, Human Physiology - From Cells to Systems, Lauralee Sherwood, 9th edition
3. Chapter 29, Ganong’s Review of Medical Physiology, 26th edition
4. Electrocardiogram, StatPearls - https://www.ncbi.nlm.nih.gov/books/NBK549803/
5. ECG in Medical Practice by ABM Abdullah, 4th edition
6. ECG Basics, http://www.nataliescasebook.com/tag/e-c-g-basics
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Similar to Thyroid disease, hypo & hyper thyrodisim
Thyroiditis is a general term that refers to “inflammation of the thyroid gland”. Thyroiditis includes a group of individual disorders causing thyroidal inflammation but presenting in different ways. For example, Hashimoto's thyroiditis is the most common cause of hypothyroidism in the United States.
Hypothyroidism Diagnosis, Etiopathogenesis and TreatmentPranatiChavan
Hypothyroidism is a condition in which the thyroid gland doesn't produce enough thyroid hormone.
Hypothyroidism's deficiency of thyroid hormones can disrupt such things as heart rate, body temperature and all aspects of metabolism. Hypothyroidism is most prevalent in older women.
Major symptoms include fatigue, cold sensitivity, constipation, dry skin and unexplained weight gain.
Treatment consists of thyroid hormone replacement.
2012 Clinical Practice guidelines for hypothyroidism in adults: American Asso...Jibran Mohsin
This is presentation format of 2012 Clinical Practice guidelines for hypothyroidism in adults: American Association of Clinical Endocrinologists (AACE) / American Thyroid Association (ATA)
Similar to Thyroid disease, hypo & hyper thyrodisim (20)
These lecture slides, by Dr Sidra Arshad, offer a quick overview of physiological basis of a normal electrocardiogram.
Learning objectives:
1. Define an electrocardiogram (ECG) and electrocardiography
2. Describe how dipoles generated by the heart produce the waveforms of the ECG
3. Describe the components of a normal electrocardiogram of a typical bipolar leads (limb II)
4. Differentiate between intervals and segments
5. Enlist some common indications for obtaining an ECG
Study Resources:
1. Chapter 11, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 9, Human Physiology - From Cells to Systems, Lauralee Sherwood, 9th edition
3. Chapter 29, Ganong’s Review of Medical Physiology, 26th edition
4. Electrocardiogram, StatPearls - https://www.ncbi.nlm.nih.gov/books/NBK549803/
5. ECG in Medical Practice by ABM Abdullah, 4th edition
6. ECG Basics, http://www.nataliescasebook.com/tag/e-c-g-basics
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
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.
- 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
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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
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.
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Preoperative Management of Patients on GLP-1 Receptor Agonists like Ozempic and Semiglutide
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Knee anatomy and clinical tests 2024.pdfvimalpl1234
This includes all relevant anatomy and clinical tests compiled from standard textbooks, Campbell,netter etc..It is comprehensive and best suited for orthopaedicians and orthopaedic residents.
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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.
2. SLOS
SLO#1: Briefly describe the physiology of thyroid hormone synthesis and actions.
SLO#2: List the causes of hypothyroidism.
SLO#3: List the investigations to be done in a case of suspected thyroid disease and
how to interpret them.
SLO#4: Briefly describe Hashimoto’s thyroiditis, sick euthyroidism, subclinical
hypothyroidism, subclinical hyperthyroidism., thyrotoxic crisis, and myxedema coma.
SLO#5: Describe briefly the management of hypothyroidism, thyrotoxic crises, and
myxedema coma.
3. CASE
Khadeeja Nasser, a 35-year-old schoolteacher presented to the endocrinology clinic with a
complaint of persistent fatigue, unexplained weight gain, cold intolerance, and dry skin.
She reported that these symptoms had been progressively worsening over the past six months.
Additionally, she mentioned experiencing constipation and irregular menstrual periods.
Khadeeja expressed concern about her inability to lose weight despite dietary modifications and
regular exercise, which had previously been effective for her.
Khadeeja had no history of any illnesses or surgeries in the past. She had no family history of
thyroid disorders or autoimmune diseases. Her only medication at the time was an oral
contraceptive for birth control, which she had been taking for several years.
On examination, Khadeeja appeared tired and reported feeling fatigued throughout the day. Mild
puffiness was noted on her face. Her pulse was 58/min, and her BP was 130/84 mmHg. Her skin
was dry and her nails brittle. Her hair was thin. There was no palpable goiter or nodules in the
thyroid gland. Heart and lung sounds were heard normally. Her deep tendon reflexes were
sluggish.
6. The parafollicular C cells secrete calcitonin, which is of no apparent physiological significance in
humans.
The follicular epithelial cells synthesise thyroid hormones by incorporating iodine into the amino acid
tyrosine on the surface of thyroglobulin (Tg).
a protein secreted into the colloid of the follicle.
Iodide is a key substrate for thyroid hormone synthesis; a dietary intake in excess of 100 µg/day is
required to maintain thyroid function in adults.
The thyroid secretes predominantly thyroxine (T4) and only a small amount of triiodothyronine (T3).
approximately 85% ofT3 in blood is produced fromT4 by a family of monodeiodinase enzymes which
are active in many tissues, including liver, muscle, heart and kidney.
T4 can be regarded as a pro-hormone, since it has a longer half-life in blood thanT3 (approximately 1
week compared with approximately 18 hours), and binds and activates thyroid hormone receptors
less effectively thanT3.T4 can also be converted to the inactive metabolite, reverseT3.
THYROID PHYSIOLOGY
7. T3 andT4 circulate in plasma almost entirely (> 99%) bound to transport
proteins, mainly thyroxine-binding globulin (TBG).
Production ofT3 andT4 in the thyroid is stimulated by (thyroid-
stimulating hormone,TSH),
TSH released from the anterior pituitary in response to the
hypothalamic tripeptide, thyrotrophin-releasing hormone (TRH).
There is a negative feedback of thyroid hormones on the hypothalamus
and pituitary such that in thyrotoxicosis, when plasma concentrations of
T3 andT4 are raised,TSH secretion is suppressed. Conversely, in
hypothyroidism due to disease of the thyroid gland, lowT3 andT4 are
associated with high circulatingTSH levels.
THYROID PHYSIOLOGY
8. HYPOTHYROIDISM
Definition: It is when the thyroid gland doesn’t
make enough thyroid hormone to meet the body
demands.
Causes:
1) Autoimmune disease ( Hashimoto’s thyroiditis )
2) Thyroid failure following 131I
3) Surgical treatment of thyrotoxicosis
4) Iodine deficiency
9. Common:
less Common:
Rare:
Clinical feature:
- The clinical presentation depends on the duration and severity of the
hypothyroidism.
- Due to prolonged hypothyroidism :
infiltration of many body tissues by mucopolysaccharides, hyaluronic
acid and chondroitin sulphate, resulting in:
a low-pitched voice
poor hearing
slurred speech due to a large tongue
compression of the median nerve at the wrist (carpal
tunnel syndrome)
Infiltration of the dermis gives rise to:
nonpitting oedema (myxoedema) in the skin of the hands,
feet and eyelids
facial pallor due to vasoconstriction and anaemia,
lemon-yellow tint to the skin caused by carotenaemia,
purplish lips and malar flush
10. Investigation:
1. Primary hypothyroidism:T4 is low &TSH is elevated
2. Secondary hypothyroidism (rare):T4 & TSH are low.
3. Thyroid peroxidase antibodies
4. ECG : shows sinus bradycardia with low voltage complexes and ST segment andT wave abnormalities
Management:
levothyroxine replacement:
start with a low dose of 50 µg per day for 3 weeks, increasing thereafter to 100 µg per day for a further 3
weeks and finally to a maintenance dose of 100–150 µg per day.
In younger patients, it is safe to initiate levothyroxine at a higher dose (for example, 100 µg per day), to allow
a more rapid normalization of thyroid hormone levels.
Levothyroxine has a half-life of 7 days so it should always be taken as a single daily dose and at least 10
weeks should pass before repeating thyroid function tests and adjusting the dose, usually by 25 µg per day.
Patients feel better within 2–3 weeks.
Reduction in weight and periorbital puffiness occurs quickly unlike skin and hair that take 3-6 months
The dose of levothyroxine should be adjusted to maintain serumTSH within the reference range.To achieve
this, serumT4 often needs to be in the upper part of the reference range or even slightly raised, because the
T3 required for receptor activation is derived exclusively from conversion ofT4 within the target tissues,
without the usual contribution from thyroid secretion.
11. Levothyroxine replacement in ischaemic heart disease:
Hypothyroidism and ischaemic heart disease are common conditions that often occur
together.
In patients with known ischaemic heart disease, thyroid hormone replacement should
be introduced at low dose and increased very slowly under specialist supervision.
Coronary intervention may be required if angina is exuberated by levothyroxine
replacement therapy.
Hypothyroidism in pregnancy:
Most pregnant women with primary hypothyroidism require an increase in the
dose of levothyroxine .
Inadequately treated hypothyroidism in pregnancy has been associated with
impaired cognitive development in the fetus.
12. Myxoedema coma:
Rare presentation of hypothyroidism, It is a medical emergency.
Begin treatment before biochemical confirmation of the diagnosis
Presents with :
There is a depressed level of consciousness (elderly patients).
Body temperature may be as low as 25°C
convulsions
cerebrospinal fluid (CSF) pressure and protein content are raised.
Treatment:
1. IV 20 µg liothyronine followed by further injections of 20 µg 3 times daily until there is
sustained clinical improvement. In survivors, there is a rise in body temperature within 24 hours.
2. Oral levothyroxine ( for coma survivors ) After 48–72, 50 µg daily.
3. Hydrocortisone 100 mg IM 3 times daily the patient has primary hypothyroidism, the
thyroid failure should also be assumed to be secondary to hypothalamic or pituitary disease,
pending the results of T4,TSH and cortisol measurement.
4. Rewarming IV fluids
5. Broad spectrum antibiotics
6. High flow O2
13. Thyrotoxic crisis (‘thyroid storm’)
This is a rare but life-threatening complication of thyrotoxicosis, It is a medical emergency (mortality of
10%).
• Signs:
Fever
Agitation
Confusion
Tachycardia or atrial fibrillation
Cardiac failure in old patients
• Treatment:
Rehydrate patient
propranolol, orally (80 mg 4 times daily) or intravenously (1–5 mg 4 times daily).
Both glucocorticoids (hydrocortisone 100 mgIV every 8 hours) & iodine important to reduce
the conversion ofT4 toT3.
Sodium ipodate (500 mg per day orally) (restores serumT3 level to normalise in 48–72 hours.
Oral prophylthiouracil (PTU) (200 mg every day) to inhibit the synthesis of new thyroid
hormone.
PTU is preferred to carbimazole (20mg every 6 hours) as it also inhibit the conversion ofT4 toT3.
Unconcious patient PTU & propranolol can be administered by nasogastric tube.
After 10-14 days patient can be maintained on carbimazole alone.
• Precipitated by:
– infection
– shortly after subtotal thyroidectomy in an ill-
prepared patient
– within a few days of 131I therapy when acute
radiation damage may lead to a transient rise in
serum thyroid hormone level.
15. SUBCLINICAL THYROTOXICOSIS
Definition: Serum TSH is undetectable, and serum T3 and T4 are at the upper end
of the reference range.
This combination is most often found in older patients with multinodular goiter.
Complications: atrial fibrillation and osteoporosis.
Treatment: Iodine – 131 or low dose thionamide
16. SUBCLINICAL HYPOTHYROIDISM
Definition: Serum TSH is raised, and serum T3 andT4 concentrations are at the
lower end of the reference range.
Complication: Risk of progression to thyroid failure especially if thyroid peroxidase
antibodies present or TSH rises above 10 mlU/L.
Treatment:
Levothyroxine In patients with non-specific symptoms.
In those with positive autoantibodies or TSH greater than 10 mU/L, it is better to
treat the thyroid failure early rather than risk loss to follow-up and subsequent
presentation with profound hypothyroidism.
17. NON-THYROIDAL ILLNESS (SICK EUTHYROIDISM)
Definition: low serumTSH, raisedT4 and normal or lowT3, in a patient with systemic illness who
does not have clinical evidence of thyroid disease.
Causes:
decreased peripheral conversion ofT4 toT3.
altered levels of binding proteins and their affinity for thyroid hormones.
reduced secretion of TSH.
During convalescence, serumTSH concentrations may increase to the level found in primary
hypothyroidism.
Thyroid function test is difficult to interpret in patient with non thyroidal illness ,thus it is better not
to do the test unless there is a clinical evidence of thyroid disease.
If an abnormal result is found, treatment should only be given with specialist advice and the diagnosis
should be re-evaluated after recovery.
18. HASHIMOTO’S THYROIDITIS
Definition: destructive lymphoid infiltration of the thyroid, ultimately leading to a varying degree of fibrosis and
thyroid enlargement.
There is an increased risk of thyroid lymphoma.
Clinical examination finding: Patients present with a small or moderately sized diffuse goitre, which is
characteristically firm or rubbery in consistency,The goitre may be soft, however, and impossible to differentiate
from simple goitre by palpation alone.
25% of patients are hypothyroid at presentation.
Investigation:
1. Anti thyroid peroxidase antibodies : present
2. TSH : normal or high
3. T4 : normal
Management:
Levothyroxine therapy for hypothyroidism and also to
shrink an associated goitre.
19. CASE
Khadeeja Nasser, a 35-year-old schoolteacher presented to the endocrinology clinic with a complaint of
persistent fatigue, unexplained weight gain, cold intolerance, and dry skin. She reported that these
symptoms had been progressively worsening over the past six months. Additionally, she mentioned
experiencing constipation and irregular menstrual periods.
Khadeeja expressed concern about her inability to lose weight despite dietary modifications and regular
exercise, which had previously been effective for her.
Khadeeja had no history of any illnesses or surgeries in the past. She had no family history of thyroid
disorders or autoimmune diseases. Her only medication at the time was an oral contraceptive for birth
control, which she had been taking for several years.
On examination, Khadeeja appeared tired and reported feeling fatigued throughout the day. Mild puffiness
was noted on her face. Her pulse was 58/min, and her BP was 130/84 mmHg. Her skin was dry and her
nails brittle. Her hair was thin. There was no palpable goiter or nodules in the thyroid gland. Heart and lung
sounds were heard normally. Her deep tendon reflexes were sluggish.
21. MCQ:
60 years old patient admitted with depressed level of consciousness, convulsions, body temperature
< 25C, CSF pressure and protein are high, what is the diagnosis:
A. Myxoedema coma
B. Thyrotoxicosis crisis
C. Hashimoto thyroiditis
D. sick euthyroidism
Which of the following is not a symptom of hypothyroidism:
A. Cold intolerance
B. Hair loss
C. Weight loss
D. Menorrhagia