The document summarizes information about the thyroid gland and common thyroid conditions. It discusses that the thyroid gland is located in the front of the neck and produces thyroid hormones that help regulate growth and metabolism. It also describes common thyroid disorders like hypothyroidism and hyperthyroidism, their symptoms, diagnostic tests and treatment options. These include levothyroxine medication for hypothyroidism and antithyroid drugs, radioactive iodine or surgery to treat hyperthyroidism. The document also discusses thyroid nodules, goiter and provides some case examples of patients that may have thyroid issues.

1. THYROID
Tess Jacob M.D
Endocrinology
Livingston Public Library
Thursday, November 30, 2017

2. Thyroid gland
• What is the thyroid gland?
• What is its function?
• What hormones does it secrete?
• Common conditions of the thyroid
• Thyroid nodules
• Questions???

3. • Butterfly shaped endocrine gland
• In front lower neck
• Below Adam’s apple
• 2 lobes
• Wrap either side of windpipe
• Manages growth and energy metabolism

4. • Role of thyroid ->produce thyroid
hormones
• Essential for life
• Secreted into the blood and then carried to
every tissue in the body
• Thyroid hormones: T4, T3
• Thyroid hormone helps the body use
energy, stay warm and keep the brain,
heart, muscles and other organs working

5. • T4 under influence of TSH by pituitary
gland
• T4 inactive/storage form(thyroid)
• Converted to T3 active form when
reaches organs and body tissue
• Numbers –iodine atoms
• Iodine(element for thyroid hormone)

6. • Iodine not made by the body so we rely on
our diet
• Too much and too little iodine is bad for
you
• Too little iodine – Goiter and
hypothyroidism

7. Common sources of dietary
iodine
• Cheese
• Cows milk
• Eggs
• Frozen yogurt
• Ice cream
• Iodine containing
multivitamins
• Iodized table salt
• Saltwater fish
• Seaweed( kelp)
• Shellfish
• Soy milk
• Soy sauce
• Yoghurt

8. Thyroid gland

9. Symptoms of hypo(underactive)
and hyperthyroidism
(overactive)
• Show of hands ??
• Nonspecific

11. Hypothyroidism
• Hashimotos thyroiditis
• Surgery
• Radiation treatment
• Thyroiditis
• Medications
• Too much or too little iodine
• Damage to pituitary

12. How to diagnose
• Bloodwork
• High TSH and low FT4
• Consider antibodies to check if Hashimotos
thyroiditis

13. Subclinical Hypothyroidism
• When to treat?
• How to treat hypothyroidism?
• Levothyroxine vs Synthroid vs Tirosint
• Levothyroxine and liothyronine or cytomel
• Side effects of medication ->
overtreatment vs undertreatment

14. Pregnancy goals
• When to treat?
• What to do if you find out you are pregnant
and have underactive thyroid?

15. Hyperthyroidism
• Graves disease
• Toxic nodular/toxic multinodular goiter
• Thyroiditis
• Medication

16. How to diagnose
• Blood tests
• Low TSH and high TT3, FT4
• Thyroid uptake scan

17. How to treat?
• No single treatment is best for all
hyperthyroid patients
• Treatment usually individualized (age,
needs)
• Antithyroid drugs and Beta blockers vs
Radioactive Iodine vs Surgery

18. Antithyroid drugs
• Methimazole/Tapazole
• Propylthiouracil or PTU
• 20-30% of those with Graves dx can go into
remission with ATD’s for 12-18mo’s
• Toxic MNG – can use as bridge to RAI or
surgery

19. Side effects
• Allergic reactions – 5%, Hives, red rash
• Rarer and serious –suppression of white
blood cells. Notify your physician
immediately if you get fever and sore
throat
• Liver toxicity – dark urine, nausea, fatigue,
abdominal pain

20. Radioactive Iodine
• More than 70% of adults in the US with hyperthyroidism
are treated with RAI.
• Pill form
• Ingestion of RAI - uptake of iodine by the overactive
thyroid tissue from the bloodstream.
• Whatever not taken up, leaves your body over days
• Over weeks to months, RAI destroys tissue that took it
up.
• When used to treat Graves disease, you often become
hypothyroid following that but that is easily treated with
levothyroxine.

21. Surgery
• Individualized
• Hyperthyroidism should first be controlled
prior to surgery with antithyroid drugs
• Permanent cure
• Need levothyroxine replacement
• Complications: low calcium, vocal cord
nerves - hoarseness

22. Goiter

23. Goiter
• Abnormal enlargement of thyroid
• Can have normal thyroid function
• Can have overactive or underactive thyroid
• If very large, can cause obstructive
symptoms

24. Causes of Goiter
• Iodine deficiency
• Hashimoto’s thyroiditis
• Graves disease
• Nodules

25. Thyroid nodules
• Very common
• Diagnosed on physical exam or more
commonly incidentally on imaging done
for other reasons
• Thyroid Ultrasound to evaluate it
• Abnormal growth of thyroid cells forming a
lump within the thyroid gland
• Majority are benign

26. Thyroid ultrasound

27. Fine needle aspiration biopsy
• Do not need to fast on the day of the
biopsy
• Safe and simple procedure
• Usually do not need to hold blood thinners
• Gel with ultrasound to take images and
ensure correct placement of needle when
sampling
• Small needle – smaller than a blood draw

28. Cases
• 30yo F – fatigue, low mood, constipation and
depression, BMI 26
• 59yo M – fatigue, leg swelling, sleepy during the
day, BMI 35
• 20yo F – fatigue, lack of concentration, hair loss,
sleeping too much
• 50yo M – palpitations, lack of energy, anxiety,
work stress
• 22yo F – palpitations, losing weight, eyes

30. Thank you!