Many Faces of

Hypothyroidism

Dr. Sharda Jain Dr. Jyoti AgarwalDr. Jyoti Bhaskar

Dr. Indu TyagiDr. Rashmi Jain

Public Awareness

Dr. Sharda Jain / Dr Jyoti Agarwal / Dr. Jyoti BhaskarLife Care Centre has a over 200 ppt on shildeshare.net

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Hypothyroidism WOMEN AND MEN >35 YEARS OF AGE SHOULD BE SCREENED EVERY 5 YEARS.

As suggested by

ATA/AACE: American thyroid Association / American Association of Clinical

Endocrinologists.

Reference :1. Garbar JR, Cubin H, Hennessey , JB, Klein I , Mechanic Ji, et al. Clinical practice guidelines for hypothyroidism in adults. Cosponsored by he American Association of Clinical Endocrinologists and the American Thyroid Association Endoor pract. 2012 Nov-Dec;18(6):988-1028.

Hypothyroidism and women

Thyroid dysfunction is quite prevalent in Indian, particularly in female.

Life Care centre experience

in female clinic population --16%.

Reference : 1. Unnikrishnan AG et al. Prevalence of hypothyroidism in adults : an epidemiological study in eight cities of India. India Journal of Endocrinology ad Metabolism 2013;17(4) ;647-52

In the cross-sectional epidemiological study in eight cities of India (March 2011 to July 2011)

in 5376 participants,

The prevalence of hypothyroidism was found to be approximately one in 10 adults.

A significantly higher (p<0.05) proportion of females were diagnosed with hypothyroidism

than males (15.86% vs 5.02 %).

Hypothyroidism and women

Hypothyroidism and Infertility

• According to Endocrine Society practice Guideline 2012

“Screening of Hypothyroidism is recommended in women

suffering from infertility”Reference 1. De Groot L et al. Management of thyroid dysfunction during pregnancy and postpartum : an Endocrine Society clinical practice guideline. J Clin Endocrinal Metab. 2012;97(8);2543-65

In males infertility starts in

childhood

• Thyroid failure in the pre-pubertal period is associated with testicular enlargement and alterations in sexual hormones

• There is macro orchidism without virilization

• Longer the hypothyroidism persists, greater is the degree of damage to the testes

• If adequately treated these boys progress through puberty normally

Hypothyroidism and Pregnancy

Maternal hypothyroidism - early diagnosis is must in the first

prenatal visit or at diagnosis of pregnancy.

Reference : 1 Banerjee S. Thyroid disorders in pregnancy. Indian thyroid guidelines 2011, Downloaded from http://www.japi.org/thyroid_speicail _ja_issue_2011/article_07(Last accessed October 2015)

American thyroid Association 2014 recommend

Trimester specific TSH range.Ist Trimester : 0.1-2.5 mIU/L

2nd Trimester : 0.2-3.0 mIU/L

3rd Trimester : 0.3 -3.0 mIU/L

Hypothyroidism and Pregnancy

Reference : 2. Jonklaas J, et al. Guidelines for the treatment of hypothyroidism : prepaid the American thyroid Association task force on thyroid hormone replacement . Thyroid 2014 Dec. 24(12) : 1670-751

Hypothyroidism and Newborn

American Academy of pediatrics Guidelines

“Screening of Hypothyroidism is recommended within first seven

days of birth”

Refernce : 1 . Smith L. Updated AAP Guidelines on newborn screening and therapy for congenital hypothyroidism. Am Fam Physican . 2007;76(3); 439 -44

Hypothyroidism and Children

Hypothyroidism is the most common abnormality of thyroid function in children

and adolescents

Diagnosis of hypothyroidism is important in adolescence because this condition retards

growth in height and development of secondary sexual characteristics, delayed

onset of puberty

Reference : capetio –Ventura n, Beeza I . Psychiatric Symptoms due to Thyroid Disease in a Female Adolescent . Case Rap Endocrinal 2014;2014;972348

Hypothyroidism and Menopause

• Symptoms of hypothyroidism are often similar to menopausal symptoms

• Screening should be done in peri-and post menopausal women to prevent complications of hypothyroidism.

Reference . Josni SA et al. Screening of peri-and postmenopausal women for hypothyroidism, Journal of scuth Asian Federation of Obstetrics and Gynecology. January –April 2011;3(1);14-16

Depression “The diagnosis of hypothyroidism must

be considered in every patient with depression”

• ATA/AACE: American Thyroid Association /American Association of clinical Endocrinologists

2012 Guidlines

Reference : 1. Garber JR, Cobin RH , Gharib H, Hennessey JV Klein I , Mechanick JI, Pessac-Pollack R, Singer PA, Viewer KA; American Association of Clinical Endocrinologists And American Thyroid Association Taskforce On hypothyroidism in Adults. Clinical practice guidelines for hypothyroidism in adults; cosponsored by the American Association f0 Clinical Endocrinologists and the American Thyroid Association. Thyroid 2012 Dec;22(12) : 1200-35.

Hypothyroidism and Diabetes

• Subclinical and overt hypothyroidism has been reported to be linked with insulin

resistance

In patients on treatment for both thyroid disorders and diabetes, thyroid status should

be kept in mind while titrating ant diabetic therapy.

Reference 1. Kalra S et al. The hypoglycemic sideof hypothyroidism. Indian Journal of Endocrinology and Metabolism 2014;18(1)1-3

Diabetes Mellitus

• Hashimoto’s thyroiditisis associated with 10% of patients with type 1 diabetes mellitus

• Approximately one-fourth of female patients with type 1 diabetes mellitus develop postpartum thyroiditis

Hypothyroidism and CKD

Unresolved subclinical hypothyroidism in chronic kidney disease patients can be associated with

a rapid decline in renal function Thyroid function should b be assessed early in patient

with renal impairment.

Reference : 1. Kim EO, et al : Unresolved subclinical hypothyroidism is independently associated with progression of chronic disease Int J Med Sci 2013 Dec 20 ; (1)52-9 doi : 10.7150/ijms.7186 . eCllection 2014. 2. Connor A et al, Renal impairment resulting from hypothyroidism Nephro Dialysis Transplantation plus 2008 : 6 440-441

Hypothyroidism and

Dyslipidemia

Indian Thyroid Guidelines 2011

“All patients with elevated lipid levels should be screened for

Hypothyroidism”.

Reference : Tandon N et al. Management of Hypothyroidism in adults. J Assoc Physicians Indian. Jan 2011; 59 Suppl: 21-5

Hypothyroidism and Elderly

ATA / AACE Guidelines 2012

Increased TSH values are increasingly noted in the elderly population. Thus,

very mild TSH elevations in older individuals may not reflect subclinical thyroid dysfunction, but rather be a

normal manifestation of ageing. Reference : Garber JR et al. Clinical practice guidelines' for hypothyroidism in adults cosponsored by the American Association of clinical Endocrinologists and the American Thyroid Association Endocr pract 2012;18(6) 988-1028

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