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Thyroid gland
• What is the thyroid gland?
• What is its function?
• What hormones does it secrete?
• Common conditions of the thyroid
• Thyroid nodules
• Questions???
• Butterfly shaped endocrine gland
• In front lower neck
• Below Adam’s apple
• 2 lobes
• Wrap either side of windpipe
• Manages growth and energy metabolism
• 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 as they should
• 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)
• 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
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
Hypothyroidism
• Hashimotos thyroiditis
• Surgery
• Radiation treatment
• Thyroiditis
• Medications
• Too much or too little iodine
• Damage to pituitary
How to diagnose
• Bloodwork
• High TSH and low FT4
• Consider antibodies to check if Hashimotos thyroiditis
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
Pregnancy goals
• When to treat?
• What to do if you find out you are pregnant and have underactive thyroid?
Hyperthyroidism
• Graves disease
• Toxic nodular/toxic multinodular goiter
• Thyroiditis
• Medication
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
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
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
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.
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
Goiter
• Abnormal enlargement of thyroid
• Can have normal thyroid function
• Can have overactive or underactive thyroid
• If very large, can cause obstructive symptoms
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
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 used to sample cells from nodule
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 bulging, tremors, anxiety