Thyroid: Bringing Life Back into Balance   Dany Zayour, MD Endocrinologist Via Christi Medical Associates
Why talk about the Thyroid? <ul><li>An estimated 27 million Americans have thyroid disease </li></ul><ul><li>More than hal...
Where is the Thyroid and What Does it Do? <ul><li>Your thyroid is a small bowtie or butterfly-shaped gland located in the ...
 
You have a higher risk of developing thyroid disease if   <ul><li>You're female </li></ul><ul><li>You have a family member...
What Diseases and Conditions Affect the Thyroid? <ul><li>Hypothyroidism -- An underactive thyroid </li></ul><ul><li>Hypert...
Hypothyroidism: Underactive Thyroid <ul><li>Improperly formed at birth  </li></ul><ul><li>surgically removed all or in par...
Risk factors for hypothyroidism <ul><li>____ I have a family history of thyroid disease  </li></ul><ul><li>____ I have had...
Risk factors for hypothyroidism <ul><li>____ I have a history of miscarriage  </li></ul><ul><li>____ I have had part/all o...
Symptoms of hypothyroidism   <ul><li>____ I am gaining weight inappropriately  </li></ul><ul><li>____ I'm unable to lose w...
Symptoms of hypothyroidism   <ul><li>____ My skin is coarse, dry, scaly, and thick  </li></ul><ul><li>____ I have a hoarse...
Symptoms of hypothyroidism   <ul><li>____ I feel depressed  </li></ul><ul><li>____ I feel restless  </li></ul><ul><li>____...
Hyperthyroidism <ul><li>When the thyroid gland becomes overactive and produces too much thyroid hormone  </li></ul><ul><li...
Risk factors for development of hyperthyroidism   <ul><li>Gender : affects women 8 times more often than men.  </li></ul><...
Risk factors for development of hyperthyroidism <ul><li>Exposure to or Excess of Iodine/Iodine Drugs   -- through medical ...
Symptoms of Graves' Disease/Hyperthyroidism <ul><li>Goiter:  Visibly larger neck, a feeling of fullness in the neck or thr...
Symptoms of Graves' Disease/Hyperthyroidism <ul><li>Heart and Blood Pressure Changes   -- racing, fast heartbeat, sensatio...
Symptoms of Graves' Disease/Hyperthyroidism <ul><li>Changes to Hair / Nails / Hands   -- Excessive hair loss from the head...
Symptoms of Graves' Disease/Hyperthyroidism <ul><li>Especially in Men   -- Men can experience a low sex drive, fertility p...
Thyroid Storm <ul><li>Life-threatening condition known as thyroid storm. During a thyroid storm, the heart rate, blood pre...
Goiter/Thyroid Nodules   <ul><li>When the thyroid become enlarged, this is known as a goiter </li></ul><ul><li>Solid or li...
Thyroid Cancer Statistics and Facts  <ul><li>The American Cancer Society estimates 37,340 new cases of thyroid cancer will...
 
Thyroid Cancer <ul><li>Too Little Iodine in the Diet </li></ul><ul><li>Exposure to Radiation </li></ul><ul><li>Heredity/Ge...
Symptoms of thyroid cancer <ul><li>A lump, or nodule in the neck Enlargement of the neck  </li></ul><ul><li>Enlarged lymph...
Treatment of Hypothyroidism <ul><li>When the thyroid is underactive (hypothyroidism) the key medical treatment is thyroid ...
Levothyroxine (Synthetic Thyroxine/T4) <ul><li>Among conventional physicians, the most popular and commonly prescribed thy...
Liothyronine (Synthetic Triiodothyronine/T3) <ul><li>The thyroid gland manufacturers both thyroxine and triiodothyronine (...
Liotrix (Synthetic Thyroxine/Triiodothyronine T4/T3 Combination) <ul><li>Liotrix is a synthetic combination of thyroxine a...
Desiccated Natural Thyroid <ul><li>Desiccated thyroid is a drug prepared from dried porcine (pig) thyroid </li></ul><ul><l...
The T4/T3 Thyroid Drug Controversy <ul><li>The use of T4 and T3 together as a treatment for hypothyroidism is controversia...
The Armour Thyroid / Desiccated Thyroid Controversy <ul><li>Desiccated thyroid drugs, including Armour Thyroid, have been ...
Treatment of hyperthyroidism   <ul><li>Antithyroid medications: Methimazole, PTU </li></ul><ul><li>Radioactive iodine abla...
Treatment of Thyroid Cancer   <ul><li>Surgery </li></ul>
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Thyroid: Dr. Dany Zayour

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Dany Zayour, MD, an endocrinologist with Via Christi Clinic, gave an educational, entertaining talk about the thyroid to the members of Women’s Connection, a free networking group created by Via Christi to give women an opportunity to network while also learning more about their health.

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Thyroid: Dr. Dany Zayour

  1. 1. Thyroid: Bringing Life Back into Balance Dany Zayour, MD Endocrinologist Via Christi Medical Associates
  2. 2. Why talk about the Thyroid? <ul><li>An estimated 27 million Americans have thyroid disease </li></ul><ul><li>More than half are undiagnosed </li></ul><ul><li>Women are at the greatest risk, developing thyroid problems seven times more often than men </li></ul><ul><li>A woman faces as high as a one in five chance of developing thyroid problems during her lifetime </li></ul><ul><li>Risk increases with age and family history of thyroid problems </li></ul>
  3. 3. Where is the Thyroid and What Does it Do? <ul><li>Your thyroid is a small bowtie or butterfly-shaped gland located in the neck </li></ul><ul><li>Wrapped around the windpipe </li></ul><ul><li>Below the Adam's Apple area. </li></ul><ul><li>The thyroid produces several hormones: triiodothyronine (T3) and thyroxine (T4) </li></ul><ul><li>These hormones help oxygen get into cells, and make your thyroid the master gland of metabolism. </li></ul>
  4. 5. You have a higher risk of developing thyroid disease if <ul><li>You're female </li></ul><ul><li>You have a family member with a thyroid problem </li></ul><ul><li>You or a family member have an autoimmune disease </li></ul><ul><li>You've been diagnosed with Chronic Fatigue Syndrome </li></ul><ul><li>You've been diagnosed with Fibromyalgia </li></ul><ul><li>You've just had a baby </li></ul><ul><li>You're a smoker </li></ul><ul><li>You've been exposed to radiation </li></ul><ul><li>You've been treated with lithium </li></ul>
  5. 6. What Diseases and Conditions Affect the Thyroid? <ul><li>Hypothyroidism -- An underactive thyroid </li></ul><ul><li>Hyperthyroidism -- An overactive thyroid </li></ul><ul><li>Goiter -- An enlarged thyroid </li></ul><ul><li>Thyroid Nodules -- Lumps in the thyroid gland </li></ul><ul><li>Thyroid Cancer -- Malignant thyroid nodules or tissue </li></ul><ul><li>Thyroiditis -- Inflammation of the thyroid </li></ul>
  6. 7. Hypothyroidism: Underactive Thyroid <ul><li>Improperly formed at birth </li></ul><ul><li>surgically removed all or in part </li></ul><ul><li>Autoimmune disease called Hashimoto's disease, in which antibodies gradually target the thyroid and destroy its ability to produce thyroid hormone </li></ul>
  7. 8. Risk factors for hypothyroidism <ul><li>____ I have a family history of thyroid disease </li></ul><ul><li>____ I have had my thyroid &quot;monitored&quot; in the past to watch for changes </li></ul><ul><li>____ I had a previous diagnosis of goiters/nodules </li></ul><ul><li>____ I currently have a goiter </li></ul><ul><li>____ I was treated for hypothyroidism in the past </li></ul><ul><li>____ I had post-partum thyroiditis in the past </li></ul><ul><li>____ I had a temporary thyroiditis in the past </li></ul><ul><li>____ I have another autoimmune disease </li></ul><ul><li>____ I have had a baby in the past nine months </li></ul>
  8. 9. Risk factors for hypothyroidism <ul><li>____ I have a history of miscarriage </li></ul><ul><li>____ I have had part/all of my thyroid removed due to cancer </li></ul><ul><li>____ I have had part/all of my thyroid removed due to nodules </li></ul><ul><li>____ I have had part/all of my thyroid removed due to hyperthyroidism </li></ul><ul><li>____ I have had radioactive iodine due to hyperthyroidism </li></ul><ul><li>____ I have had anti-thyroid drugs due to hyperthyroidism </li></ul>
  9. 10. Symptoms of hypothyroidism <ul><li>____ I am gaining weight inappropriately </li></ul><ul><li>____ I'm unable to lose weight with diet/exercise </li></ul><ul><li>____ I am constipated, sometimes severely </li></ul><ul><li>____ I have hypothermia/low body temperature </li></ul><ul><li>(I feel cold when others feel hot, I need extra sweaters, </li></ul><ul><li>etc.) </li></ul><ul><li>____ I feel fatigued, exhausted </li></ul><ul><li>____ Feeling run down, sluggish, lethargic </li></ul><ul><li>____ My hair is coarse and dry, breaking, brittle, falling out </li></ul>
  10. 11. Symptoms of hypothyroidism <ul><li>____ My skin is coarse, dry, scaly, and thick </li></ul><ul><li>____ I have a hoarse or gravely voice </li></ul><ul><li>____ I have puffiness and swelling around the eyes and face </li></ul><ul><li>____ I have pains, aches in joints, hands and feet </li></ul><ul><li>____ I have developed carpal-tunnel syndrome, or it's getting worse </li></ul><ul><li>____ I am having irregular menstrual cycles (longer, or heavier, or more frequent) </li></ul><ul><li>____ I am having trouble conceiving a baby </li></ul>
  11. 12. Symptoms of hypothyroidism <ul><li>____ I feel depressed </li></ul><ul><li>____ I feel restless </li></ul><ul><li>____ My moods change easily </li></ul><ul><li>____ I have feelings of worthlessness </li></ul><ul><li>____ I have difficulty concentrating </li></ul><ul><li>____ I have more feelings of sadness </li></ul><ul><li>____ I seem to be losing interest in normal daily activities </li></ul><ul><li>____ I'm more forgetful lately </li></ul>
  12. 13. Hyperthyroidism <ul><li>When the thyroid gland becomes overactive and produces too much thyroid hormone </li></ul><ul><li>The most common cause of hyperthyroidism is the autoimmune condition known as Graves' disease, where antibodies target the gland and cause it to speed up hormone production. </li></ul>
  13. 14. Risk factors for development of hyperthyroidism <ul><li>Gender : affects women 8 times more often than men. </li></ul><ul><li>History : Having any past history of thyroid problems, autoimmune disease, or endocrine disease yourself or in your family </li></ul><ul><li>Age : between 20 and 40. </li></ul><ul><li>Pregnancy: Pregnancy and the year after childbirth </li></ul><ul><li>Smoking </li></ul><ul><li>Excessive Intake of Thyroid Hormone : Over-the-counter energy, diet and glandular supplements also may contain some active thyroid hormone, </li></ul>
  14. 15. Risk factors for development of hyperthyroidism <ul><li>Exposure to or Excess of Iodine/Iodine Drugs -- through medical tests, topical exposure, or ingesting of iodine or supplements containing iodine (i.e., kelp, bladderwrack) </li></ul><ul><li>Certain Medical Treatments and Drugs -- Interferon Beta-1b and Interleukin-4, immunosuppressant therapy, antiretroviral treatment for AIDS, and lithium. A third of patients receiving monoclonal antibody (Campath-1H) therapy for multiple sclerosis (MS) develop Graves' disease within six months, and receiving a donated organ or bone marrow transplant from someone with Graves' disease </li></ul><ul><li>Trauma to the Thyroid -- vigorous manipulation or palpation of the thyroid; surgery to the thyroid, parathyroids, or the area surrounding the thyroid; injection to the thyroid; biopsy of the thyroid; and neck injury, i.e., whiplash, or from an automobile seat belt after a crash. </li></ul><ul><li>Major Stress -- death of a spouse, divorce or separation, loss of a job, death of close family member, major accident/personal injury, moving, marriage </li></ul>
  15. 16. Symptoms of Graves' Disease/Hyperthyroidism <ul><li>Goiter: Visibly larger neck, a feeling of fullness in the neck or throat, discomfort with ties or scarves, a feeling like the thyroid is vibrating or buzzing, a choking sensation, pain or tenderness in the neck or hoarseness. </li></ul><ul><li>Weight Changes: Weight loss or weight gain </li></ul><ul><li>Pregnancy Problems </li></ul><ul><li>Temperature Problems: warm or hot when others are cold, or feel warm all the time, low grade fever, sweat more, or feel thirsty. </li></ul>
  16. 17. Symptoms of Graves' Disease/Hyperthyroidism <ul><li>Heart and Blood Pressure Changes -- racing, fast heartbeat, sensation of a &quot;loud&quot; or pounding heartbeat, skipped beats, palpitations, or abnormal heart rhythms. </li></ul><ul><li>Gastrointestinal Problems -- frequent bowel movements, loose bowel movements, diarrhea, more frequent urination, or nausea. </li></ul><ul><li>Energy / Muscles / Joints -- extreme fatigue, muscle and joint fatigue, especially in leg and arm muscles, difficulty climbing stairs, exercise intolerance </li></ul><ul><li>Skin Changes -- smoother, younger-looking or velvety skin, worsening acne, bruising, spider veins on the face and neck, blister-like bumps on the forehead and face, flushing in the face, hives, itching, vitiligo. </li></ul><ul><li>Graves' Dermopathy/ Pretibial Myxedema -- waxy, reddish-brown lesions on the shins and lower legs skin (and less often the extremities, face or trunk) that are itchy and inflamed. These lesions heal into rough patches. </li></ul>
  17. 18. Symptoms of Graves' Disease/Hyperthyroidism <ul><li>Changes to Hair / Nails / Hands -- Excessive hair loss from the head and body, nails that easily break </li></ul><ul><li>Eye Problems -- bulging of the eyeballs, dry eyes, achiness or pain behind the eyes, redness in the eyes, puffiness, and a wide-eyed look. </li></ul><ul><li>Thinking/Cognition Problems -- difficulty concentrating or making decisions, memory problems, and racing thoughts. </li></ul><ul><li>Mood Problems --depression, mood swings, uncontrollable anger, and irrational anger. </li></ul><ul><li>Panic and Anxiety – Anxiety, restlessness, nervousness, and even panic attacks. In rare cases, mania, psychosis, or delirium </li></ul><ul><li>Reflex/Movement Issues --fast reflexes, startle easily, and jumpy, and have tremors. They may be always moving, jiggling, tapping a foot, etc. </li></ul><ul><li>Sleep Problems -- Insomnia, or difficulty going back to sleep after waking </li></ul>
  18. 19. Symptoms of Graves' Disease/Hyperthyroidism <ul><li>Especially in Men -- Men can experience a low sex drive, fertility problems, and gynecomastia, an enlargement or tenderness in the breasts. </li></ul><ul><li>Especially in Women -- In women, infertility, miscarriage, changes to sex drive, worsening premenstrual syndrome, erratic or even nonexistent menstrual periods. </li></ul><ul><li>Especially in Teenagers -- dramatic increase in appetite, or unusual weight loss, sports performance problems, and delayed puberty. </li></ul><ul><li>Especially in the Elderly / Seniors -- frequent falls, tremors, atrial fibrillation, or dementia, &quot;apathetic hyperthyroidism&quot; --appearing depressed, lacking in energy, confused, forgetful, and constipated -- without weight loss. </li></ul>
  19. 20. Thyroid Storm <ul><li>Life-threatening condition known as thyroid storm. During a thyroid storm, the heart rate, blood pressure and body temperature can become uncontrollably high </li></ul><ul><li>chest pain, shortness of breath, high blood pressure, confusion, delirium, psychosis, stupor, fatigue </li></ul><ul><li>fatal complications such as stroke or heart attack. </li></ul>
  20. 21. Goiter/Thyroid Nodules <ul><li>When the thyroid become enlarged, this is known as a goiter </li></ul><ul><li>Solid or liquid filled cysts, lumps, bumps and tumors -- both benign and cancerous </li></ul>
  21. 22. Thyroid Cancer Statistics and Facts <ul><li>The American Cancer Society estimates 37,340 new cases of thyroid cancer will be diagnosed each year in the United States, most of them in women </li></ul><ul><li>An estimated 1,590 people will die of thyroid cancer each year </li></ul><ul><li>Thyroid cancer is considered one of the least deadly and most survivable cancers, and 5-year survival rates for thyroid cancer is almost 97%. </li></ul><ul><li>Thyroid cancer is more common in younger people, and nearly two-thirds of those diagnosed with thyroid cancer are between the ages of 20 and 55. </li></ul><ul><li>Thyroid cancer is one of the few cancers on the rise in recent years, with a growth rate of about 6% a year since 1997. </li></ul><ul><li>Having one or more thyroid cancer risk factors does not mean that you will definitely develop the disease </li></ul><ul><li>Even if you have no risk factors, you can still develop thyroid cancer </li></ul>
  22. 24. Thyroid Cancer <ul><li>Too Little Iodine in the Diet </li></ul><ul><li>Exposure to Radiation </li></ul><ul><li>Heredity/Genetics/Family History </li></ul><ul><li>Gender: women are two to three times more likely than men to develop thyroid cancer. </li></ul><ul><li>Age: nearly two-thirds of those diagnosed with thyroid cancer are between the ages of 20 and 55. </li></ul><ul><li>May not cause any symptoms at all. </li></ul>
  23. 25. Symptoms of thyroid cancer <ul><li>A lump, or nodule in the neck Enlargement of the neck </li></ul><ul><li>Enlarged lymph nodes in the neck </li></ul><ul><li>Hoarseness, difficulty speaking normally, voice changes </li></ul><ul><li>Difficulty swallowing, or a choking feeling </li></ul><ul><li>Difficulty breathing </li></ul><ul><li>Pain in the neck or throat, including pain from the neck to the ears </li></ul><ul><li>Sensitivity in the neck -- discomfort with neckties, turtlenecks, scarves, necklaces </li></ul><ul><li>Persistent or chronic cough not due to allergies or illness </li></ul><ul><li>Asymmetry in the thyroid (big nodule on one side, nothing on the other) </li></ul>
  24. 26. Treatment of Hypothyroidism <ul><li>When the thyroid is underactive (hypothyroidism) the key medical treatment is thyroid hormone replacement with a prescription medication. </li></ul>
  25. 27. Levothyroxine (Synthetic Thyroxine/T4) <ul><li>Among conventional physicians, the most popular and commonly prescribed thyroid hormone replacement drug is levothyroxine, a synthetic form of thyroxine (the thyroid hormone abbreviated as T4). Levothyroxine is also referred to as l-thyroxine. </li></ul><ul><li>In the United States, levothyroxine is available as generic levothyroxine, as well as Synthroid and Levoxyl brand name tablets of levothyroxine. Tirosint is a brand name gel-cap liquid form of levothyroxine.Many doctors do not recommend generic levothyroxine </li></ul><ul><li>Brand names are preferred, and each is generally considered equally effective. </li></ul>
  26. 28. Liothyronine (Synthetic Triiodothyronine/T3) <ul><li>The thyroid gland manufacturers both thyroxine and triiodothyronine (T3) </li></ul><ul><li>Liothyronine is a synthetic form of T3, and it is available in a manufactured form as the brand Cytomel, and also as generic liothyronine </li></ul><ul><li>T3 can also be compounded. </li></ul><ul><li>In recent years, some practitioners have been prescribing T3 in addition to T4. One 2009 study showed that the majority of patients preferred levothyroxine plus T3 compared to levothyroxine-only treatment. </li></ul><ul><li>A prominent study published in the New England Journal of Medicine found that patients benefited from T4/T3 combination treatment </li></ul><ul><li>Some other studies have failed to demonstrate a benefit and the use of T4/T3 combination treatments remains controversial </li></ul>
  27. 29. Liotrix (Synthetic Thyroxine/Triiodothyronine T4/T3 Combination) <ul><li>Liotrix is a synthetic combination of thyroxine and triiodothyronine (T4 and T3) </li></ul><ul><li>Liotrix is available in a manufactured form, known by the brand name Thyrolar </li></ul><ul><li>Thyrolar has been in back-order and short supply for a number of years, and is rarely used in the United States .  </li></ul>
  28. 30. Desiccated Natural Thyroid <ul><li>Desiccated thyroid is a drug prepared from dried porcine (pig) thyroid </li></ul><ul><li>Desiccated thyroid was the only thyroid drug available in the early 1900s, until levothyroxine was introduced in the 1950s </li></ul><ul><li>Natural thyroid fell out of favor as the synthetic product was touted as more modern and stable </li></ul><ul><li>Since the 1990s, desiccated thyroid has enjoyed a resurgence, primarily with older doctors and holistically-oriented physicians who claim that it resolves symptoms better than synthetics in some patients </li></ul><ul><li>Several brands of desiccated thyroid are available by prescription, including Nature-Throid and Armour Thyroid </li></ul>
  29. 31. The T4/T3 Thyroid Drug Controversy <ul><li>The use of T4 and T3 together as a treatment for hypothyroidism is controversial </li></ul><ul><li>The standard treatment is levothyroxine (T4) alone </li></ul><ul><li>The addition of T3 to the levothyroxine/T4-only treatment is, however, a topic of ongoing research and discussion </li></ul>
  30. 32. The Armour Thyroid / Desiccated Thyroid Controversy <ul><li>Desiccated thyroid drugs, including Armour Thyroid, have been in use for more than 100 years </li></ul><ul><li>Remain popular with holistic, alternative and integrative physicians as a thyroid treatment and for thyroid hormone replacement in hypothyroid patients </li></ul><ul><li>These drugs are controversial, however; it can be a challenge to find doctors who will prescribe them. </li></ul>
  31. 33. Treatment of hyperthyroidism <ul><li>Antithyroid medications: Methimazole, PTU </li></ul><ul><li>Radioactive iodine ablation </li></ul><ul><li>Surgery </li></ul>
  32. 34. Treatment of Thyroid Cancer <ul><li>Surgery </li></ul>
  33. 35. THANK YOU

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