The document discusses treatments for overactive and underactive thyroid conditions. The main treatments described are antithyroid medications like carbimazole and propylthiouracil, radioactive iodine treatment, and surgery to remove part or all of the thyroid gland. It also discusses lifelong levothyroxine treatment for an underactive thyroid and monitoring of hormone levels through blood tests to ensure the correct levothyroxine dose is taken. Side effects of treatments are also summarized.

1. By :haneen ayad

2. In general The treatment they receive will
depend on:
the size of the goitre
the symptoms the goitre is causing
whether they have any underlying thyroid
condition
If goitre is interfering with breathing or
swallowing and it hasn't responded to other
forms of treatment,they need surgery to
remove part or all of thyroid gland. This
procedure is known as a thyroidectomy.


3. Observtion in :
Small goiter
Euthyroid
Asymptomatic

5. The main treatments are:
medication
radioiodine treatment
surgery

6. called thionamides are a common treatment
for an overactive thyroid. These stop thyroid
producing excess hormones.
The main types used are carbimazole and
propylthiouracil.
And use b-blocker to quickly relieve the
symptoms in the meantime.

7. During the first couple of months, some
people experience the following side effects:
feeling sick
headaches
aching joints
an upset stomach
an itchy rash
A less common but more serious side effect is
a sudden drop in white blood cell
level (agranulocytosis), which can mean very
vulnerable to infections.

8. Antithyroid drugs:
Either blocks the iodine binding to tyrosine and
decrease antibody titers (carbimazole )
Or block iodine binding and prevent
conversionof T4 to T3 (propylthiouracil )
(inhibit hormone synthesis )

9. CMZ, usually 20-40mg daily,
PTU
In hyperthyroidisim (300_450mg/day)
Maintenance (100_150 mg/day)
In thyrotoxic crisis initialy ( 200_300mg /day)
Maintenance (100_150mg/day)
In graves disease (50_150mg/day)
Maintenance 50mg/12h
Then taper and discontinoue if TSH is normal

10. and start taking levothyroxine (usually 50-
150mcg daily) to replace the thyroid
hormone that body would normally produce.

11. treatment for a child with an over-active
thyroid gland. The usual dose used is CMZ
0.5-1mg per kg bodyweight per day or PTU 5-
10mg per kg bodyweight per day.
PTU is not recommended for children
unless they are allergic to CMZ as there is an
increased risk of liver damage.

12. *normally be referred to an endocrinologist
*important to take tablets every day.
*Forgetting to take tablets will affect blood
test results and health
*If develop a sore throat, mouth ulcers or
unexplained fever, immediately and ask for a
white blood cell count
*If notice yellowing of the eyes or skin should
ask for a liver enzyme test

13. is where radiation is used to damage your
thyroid, reducing the amount of hormones it can
produce. It's a highly effective treatment that
can cure an overactive thyroid.
given a drink or capsule that contains a low
dose of radiation, which is then absorbed by
thyroid. Most people only require a single
treatment.
take a few weeks or months for the full benefits
to be felt, so may need to take one of the
medications mentioned above for a short time.

14. avoid prolonged close contact with children
and pregnant women for a few days or weeks
women should avoid getting pregnant for at
least six months
men shouldn't father a child for at least four
months
Radioiodine treatment isn't suitable for
pregnant ,breastfeeding or overactive
thyroid that causing severe eye problems.

15. surgery to remove all or part of thyroid may be
recommended.
in severely swollen (a large goitre)
in severe eye problems resulting from an overactive
thyroid
In other therapy are not practical or ineffective
Removing the entire thyroid gland is normally
recommended, as this cures an overactive thyroid
and means there's no chance of the symptoms coming
back.
But will need to take medication for rest life to make
up for not having a thyroid – these are the same
medications used to treat an underactive thyroid.

17. Thyroid cancer
Toxic thyroid nodule (produces too much
thyroid hormone)
Multinodular goiter (enlarged thyroid gland
with many nodules), especially if there is
compression of nearby structures
Graves' disease, especially if there
is exophthalmos (bulging eyes)
Thyroid nodule, if fine needle aspirate (FNA)
results are unclear

18. Hemithyroidectomy—Entire isthmus is
removed along with 1 lobe. Done in benign
diseases of only 1 lobe.
Subtotal thyroidectomy—Removal of majority
of both lobes leaving behind 4-5 grams
(equivalent to the size of a normal thyroid
gland) of thyroid tissue on one or both sides—
this used to be the most common operation
for multinodular goitre.

19. Partial thyroidectomy—Removal of gland in front
of trachea after mobilization. Done in nontoxic
MNG. Its role is controversial.
Near total thyroidectomy—Both lobes are
removed except for a small amount of thyroid
tissue (on one or both sides) in the vicinity of the
recurrent laryngeal nerve entry point and the
superior parathyroid gland.
Total thyroidectomy—Entire gland is removed.
Done in cases of papillary or follicular carcinoma
of thyroid, medullary carcinoma of thyroid. This
is now also the most common operation for
multinodular goitre.

21. Hypothyroidism in up to 50% of patients after
ten years.
Laryngeal nerve injury in about 1% of
patients, in particular the recurrent
laryngeal nerve: Unilateral damage results in
a hoarse voice. Bilateral damage presents as
laryngeal obstruction after surgery and can
be a surgical emergency: an
emergency tracheostomy may be needed.
Recurrent Laryngeal nerve injury may occur
during the ligature of the inferior thyroid
artery.

22. Hypoparathyroidism temporary (transient) in
many patients, but permanent in about 1-4%
of patients
Anesthetic complications
Infection (at about a 2% rate. Drainage is an
important part of treatment.
Stitch granuloma
Chyle leak
Haemorrhage/Hematoma (This may compress
the airway, becoming life-threatening.)

Removal or devascularization of the
parathyroids (hypoparathyroidisim )


23. Endoscopic subtotal thyroidectomy
Embolization of thyroid arteries
Plasmaphoresis
Percutaneous ethanol injection in to toxic
nodule
L-carnitine supplementation may improve
symptoms and may prevent bone loss

25. is usually treated by taking daily hormone
replacement tablets called levothyroxine.
Should have regular blood tests until the
correct dose of levothyroxine is reached.
. Treatment was initiated with thyroxine 50
μg/d if there was a history of cardiac disease
and 100 μg/d otherwise. Blood pressure,
weight and TSH, fT4, fT3, cystatin C and
creatinine were measured once a week.
Thyroxine dose was increased by 25 μg every
8 weeks until TSH normalised.

26. taking the correct dose will do blood test once a
year to monitor hormone levels.
should take 1 tablet at the same time every day.
The effectiveness of the tablets can be altered
by other medications, supplements or foods, so
they should be swallowed with water on an
empty stomach, and should avoid eating for 30
minutes afterwards.
If forget to take a dose, take it as soon as
remember, if this is within a few hours of usual
time. If don't remember until later than this,
skip the dose and take the next dose at the usual
time, unless advised otherwise by doctor.

27. usually only occur if you're taking too much
levothyroxine. This can cause problems
including sweating, chest
pain, headaches, diarrhoea and vomiting.
In most cases, suppressing thyroid-stimulating
hormone (TSH) using high dose thyroid
replacement therapy should be avoided
because it carries a risk of causing adverse
side effects, such as atrial
fibrillation, strokes, osteoporosis and
fracture.