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Thyroid Health
This document discusses thyroid health and various thyroid conditions. It begins by describing the anatomy and function of the thyroid gland. It then discusses hypothyroidism (underactive thyroid), including causes, symptoms, diagnosis and treatment with levothyroxine replacement. Hyperthyroidism (overactive thyroid) is also covered, including causes, symptoms, diagnosis using labs and imaging, and treatment options. Goiter and thyroid nodules are briefly described.
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Thyroid Health
- 1. Thyroid Health Jeffrey Bauman,MD FACE ECNU Chair, Department of Endocrinology January 24, 2018
- 2. Outline • What isthe thyroid and what does it do? • Hypothyroidism (underactive): diagnosis and treatment • Hyperthyroidism (overactive): diagnosis and treatment • Thyroid nodules • Questions
- 3. • Butterfly-shaped gland •Right and Left lobes with connecting Isthmus in center • Parathyroids - nothing to do with thyroid Anatomy
- 4. Thyroid Function • Essentialfor life • Produces hormones • thyroxine (T4) - majority • triiodothyronine (T3) - minority • calcitonin - unclear clinical significance in humans • Thyroid hormone release controlled by pituitary
- 6. Iodine • Iodine isnecessary ingredient to make thyroid hormone • Not made by the body so we rely on our diet • Iodine deficiency most common cause of underactive thyroid and “goiter” worldwide • Salt iodization program starting in 1920’s has mostly eliminated iodine deficiency in US (and other 1st world countries)
- 7. Common Sources ofDietary Iodine • Dairy (milk, cheese, yogurt, ice cream) • Soy milk • Eggs • Fruits including strawberries, cranberries, bananas, pineapple • Vegetables including potatoes, green beans • Seawater fish • Some breads
- 8. Lab Evaluation ofThyroid Function • TSH • most reliable indicator of thyroid function • Main screening test • Free & Total T4 • Free & Total T3 • Thyroid antibodies (TPO most common) • Common in healthy population
- 9.
- 10. Hypothyroidism: Causes • Hashimotos(autoimmune) - most common in US • Surgery • Radiation treatment • Thyroiditis • Medications (lithium, amiodarone) • Iodine deficiency (most common worldwide) • Pituitary disease (uncommon) • Other (rare)
- 11. Symptoms of Hypothyroidism •Fatigue • Increased sensitivity to cold • Constipation • Dry skin • Weight gain • Puffy face • Hoarseness • Muscle weakness • Elevated blood cholesterol • Muscle aches • Pain, stiffness or swelling in your joints • Heavier than normal or irregular menstrual periods • Thinning hair • Slowed heart rate • Depression • Impaired memory
- 12. Hypothyroidism: Labs TSH: T4/T3: (canbe normal) TPO Antibodies: – often positive in Hashimotos
- 13. Treatment of Hypothyroidism •Levothyroxine/T4 (Synthroid, Levoxyl, Tirosint) • Liothyronine/T3 (Cytomel) • T4/T3 combination (Armour, NatureThyroid)
- 14. Thyroid Hormone Replacement •Long half-life, level is stable • Best absorbed on empty stomach • Allow time before eating/drinking/vitamins/other medications • Be consistent
- 15. • Adherence totaking medication • Interference with absorption • Change in weight • Pregnancy • Estrogen treatment (birth control) • Changing thyroid function Factors That Affect Level
- 16.
- 17. Hyperthyroidism: Causes • Graves(autoimmune) – most common • Hyperfunctioning nodules (toxic nodules) • Temporary thyroiditis • Medications (amiodarone)
- 18. Hyperthyroidism: Labs TSH: T4/T3: (canbe normal) Antibodies: often positive in Graves Sed Rate (ESR): often elevated in temporary thyroiditis
- 19. Hyperthyroidism: Imaging Thyroid Ultrasound •noninvasive, no radiation • general appearance of gland • identifies thyroid nodules Thyroid Uptake/Scan • assesses how much iodine taken up by thyroid and in the pattern
- 20.
- 21. Hyperthyroidism: Treatment 1. Reducethyroid hormone production (methimazole, PTU) 2. Radioactive iodine (RAI) 3. Surgery
- 22.
- 23. Goiter • Enlargement ofthyroid • Independent of function: • can be hypo, hyper, or normal • If very large, can cause obstructive symptoms
- 24. Causes of Goiter •Iodine deficiency • Hashimoto’s • Graves’ • Nodules • Medications
- 25. Thyroid Nodules • Verycommon • Often incidental on non-thyroid imaging • Thyroid Ultrasound - best test • Growth of thyroid cells forming a lump within the thyroid gland • Majority are benign • Thyroid cancers are usually curable
- 26. Fine Needle Aspiration/Biopsy •Safe and simple procedure • Often done in office • Ultrasound guidance to ensure correct placement of needle when sampling • Small needle - thinner than lab draw • Minimal discomfort