everything you ever wanted to know about thethyroid[1]
TRANSCRIPT
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Everything You Ever Wanted to
Know About the Thyroid
(but were afraid to ask…)
Caroline Messer, MD
Board Certified Internist, Endorinologist,and !hysiian "utrition #$eialist
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Topics
► Thyroid Nodules
► Hyperthyroidism
► Hypothyroidism
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Introduction
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%A&' If I have an issue with (y $arathyroid,
does this affet (y thyroid hor(one levels)
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Thyroid Nodules
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Thyroid Nodules
► Thyroid nodules are very common; up to half of
all people have at least one nodule althou!h
most do not know about it
► "ost nodules don#t chan!e the amount of
thyroid hormone in the body but some cause
the thyroid to make too (uh hormone$ These
nodules are very rarely cancerous$
%A&' Can thyroid nodules derease the a(ount
of thyroid hor(one (y body is (a*ing)
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%auses of Nodules
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&ossible 'ymptoms
► symptomatic found on routine e*am or
durin! ima!in! test performed for another
condition
► +ifficulty swallowin! voice hoarseness
shortness of breath
► 'ymptoms from havin! too much thyroid
hormone
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+ia!nosis Thyroid -ltrasound
► Thyroid ultrasound should be performed on allpatients with a suspected nodule or nodular !oiter onphysical e*amination or with nodules incidentally
noted on other ima!in! studies (carotid ultrasound%T ".I or &/T scan)
► Thyroid ultrasono!raphy is used to answer 0uestions
about the si1e and anatomy of the thyroid and nearbystructures in the neck
► ,indin!s can be used to select nodules that re0uire
,N biopsy based on si1e and features
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+ia!nosis ,N
► Thin needle used to remove small tissue samples fromthe nodule$ 'amples are e*amined with a microscope$
► ,N biopsy can be performed in the office with a localanesthetic (numbin! medicine)
► ccurately identifies cancer in a suspicious thyroidnodule$ In some cases the biopsy does not containenou!h tissue to make a dia!nosis and sur!ery isnecessary
► .esults of the biopsy will be one of the followin! 2 3eni!n (non cancerous) 2 "ali!nant (cancer) 2 &ossible or suspicious for mali!nancy
2 Non dia!nostic or insufficient
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+ia!nosis Thyroid 'can
► 4ow T'H the nodule may be producin!
hi!h levels of thyroid hormone
► The ne*t step is to have a thyroid scan to
see if the nodules are producin! thyroid
hormone
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► %an help determine if a nodule is producin! thyroidhormone (i$e$ 5hot6 or 5to*ic6)
►&erformed after swallowin! a small dose of aradioactive substance
► Nodules that absorb the substance are usuallynot cancerous
► Nodules that do not absorb the substance are called5cold6 and have a 78 risk of bein! cancerous
Thyroid Nodule +ia!nosis
Thyroid 'can
%A&' Can a thyroid san itself ause aner
beause of the radioative iodine)
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Thyroid 'can .esults
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Treatment
+epends on Type of Nodule
► 9atchin! : waitin! 2 we don#t always treat nodulesri!ht away$ 9e will often repeat yearly thyroidultrasounds to monitor their si1e
► .adioactive iodine 2 comes in a pill or li0uid that youswallow$ Has a small amount of radiation and candestroy a lot of the thyroid !land$ -sed only to treatnodules that make too much thyroid hormone$
► 'ur!ery to remove the thyroid nodule 2 a procedure todrain fluid from the thyroid nodule if it is filled with fluid
%A&' I was $laed on synthroid (any years ago to
shrin* the si+e of (y nodules-. Does this wor*)
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Hyperthyroidism
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9hat is it
► Hyperthyroidism is the medical term for anoverative thyroid (hyper < e*cessive)
► In people with hyperthyroidism the thyroid!land produces too (uh thyroid hormone
► 9hen this occurs the body=s metabolism isinreased which can cause a variety of
symptoms
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'ymptoms
► n*iety irritability trouble sleepin! even psychosisor depression
► 9eakness (particularly the upper arms and thi!hs
makin! it difficult to lift heavy items or climb stairs)
► Tremors (of the hands)
► &erspirin! more than normal difficulty toleratin!hot weather
►.apid or irre!ular heartbeats
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'ymptoms
► ,ati!ue
► 9ei!ht loss in spite of a normal or increased appetite
► ,re0uent bowel movements
► 'ome women have irre!ular menstrual periods orstop havin! their periods alto!ether$ This can be
associated with infertility
► "en may develop enlar!ed or tender breasts orerectile dysfunction which resolves when
hyperthyroidism is treated
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%auses >raves#
► "ost common cause of hyperthyroidism
► Not clear why it develops in most peoplealthou!h it is more common in certain families
► In people with >raves= disease the immunesystem produces an antibody that stimulates thethyroid to produce too much thyroid hormone
► "ost common in women between the a!es of?@AB@ but can occur at any a!e in men orwomen
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Hyperthyroidism Thyroiditis
► &ainless (Dsilent6 or 5lymphocyticD) thyroiditis and
postpartum thyroiditis are disorders in which the thyroidbecomes temporarily inflamed and releases thyroidhormone into the bloodstream causin! hyperthyroidism
► &ostpartum thyroiditis can occur several months afterdelivery$ 'ymptoms may last for several months oftenfollowed by months of hypothyroid symptoms such asfati!ue muscle cramps bloatin! and wei!ht !ain
► 'ubacute thyroiditis is thou!ht to be caused by a virus$ Itcauses a painful tender enlar!ed thyroid !land$ Thethyroid becomes inflamed and releases thyroid hormoneinto the bloodstream; the hyperthyroidism resolves when
the viral infection improves
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+ia!nosis
► 4ow T'H elevated TB and TE► TE levels are often disproportionately hi!her
than TB in hyperthyroidism; TE
measurements may be valuable forevaluatin! and followin! patients with this
disorder$
► Thyroid scan may also be recommended tohelp determine the cause of hyperthyroidism
(>raves= disease to*ic nodular !oiter or
thyroiditis)
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Thyroid 'can .esults
E. Thyroiditis
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Treatment ntiAThyroid +ru!s
► ntiAthyroid dru!s such as methima1ole and propylthiouracil workby decreasin! how much thyroid hormone the body makes$ 3othare very effective but methima1ole is preferred because of a!reater risk of serious side effects with &T-
► These medications can be used
2 s a short term (BAF weeks) treatment in people with >raves=disease or to*ic nodular !oiter before treatment withradioiodine or sur!ery
2 s a lon! term (GA? years) treatment for >raves= disease$ Thedisease !oes into remission in about E@8 of people and antiA
thyroid dru!s can be used to control hyperthyroidism whilewaitin! to see if remission occurs
► &eople who have very mild >raves= disease may have as hi!h as a7@A@8 chance of remission$ It is possible to have a relapse yearslater and most people will need to eventually consider permanenttreatment with radioactive iodine or sur!ery
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Treatment 3etaA 3lockers
► 3etaAblockers such as atenolol are often started as
soon as the dia!nosis of hyperthyroidism is made
► 9hile betaAblockers do not reduce thyroid hormoneproduction they can control many of the symptoms
such as rapid heart rate tremors an*iety and heat
intolerance
► Cnce the hyperthyroidism is under control (with antiA
thyroid dru!s sur!ery or radioactive iodine) the
betaAblocker is stopped
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Treatment .adioactive Iodine
► +estroyin! the thyroid with radiation called radioiodine
ablation is a permanent way to treat hyperthyroidism
► The amount of radiation used is small and does not causecancer or infertility
► .adioiodine is !iven in li0uid or capsule form and worksby destroyin! much of the thyroid; takes JAGF weeks
► &eople with severe symptoms older adults and people
with heart problems should first be treated with an antiAthyroid dru! to control symptoms
► "ost people who take radioiodine develop hypothyroidismand will need to take thyroid hormone supplements for the
rest of their lives
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Treatment 'ur!ery
► lthou!h sur!ical removal of the thyroid is a permanent curefor hyperthyroidism it is used far less often than antiAthyroiddru!s or radioactive iodine because of the risks (ande*pense) associated with thyroid sur!ery
► The risks include dama!e to the nerves of the voice bo* andparathyroid !lands
► However sur!ery is recommended when 2 lar!e !oiter blocks the airways makin! it difficult to breathe$
2 Kou cannot tolerate antiAthyroid dru!s and you do not want to useradioiodine
2 There is a nodule in the thyroid !land that could be cancerous
► "ost people develop hypothyroidism after sur!ery and
re0uire treatment with thyroid hormone
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Hypothyroidism
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► Hypothyroidism is a condition in whichthe thyroid !land does not produceenou!h thyroid hormone
► It is the most common thyroid disorder
9hat is it
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%auses
► In L78 of cases hypothyroidism is due to aproblem in the thyroid !land itself and is calledprimary hypothyroidism
► .arely hypothyroidism is a result of decreasedproduction of thyroidAstimulatin! hormone(T'H) by the pituitary !land
► Thyroid problems are more common in womenincrease with a!e and are more common inwhites and "e*ican mericans than in blacks
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'ymptoms
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'ymptoms
► +ecreased sweatin! thick skin coarse or thin hair
brittle nails
► "ild swellin! around the eyes
► 'lowed heart rate and decreased overall cardiac
function leadin! to fati!ue and shortness of breath
with e*ercise
► "ild hi!h blood pressure and elevated cholesterol
► Ton!ue swellin! hoarse voice and sleep apnea
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'ymptoms
► %onstipation
► bsent or infre0uent periods to very fre0uent and
heavy periods
► "y*edema coma 2 in people with severe
hypothyroidism trauma infection e*posure to the
cold and certain medications can rarely tri!!er a
lifeAthreatenin! condition called my*edema coma
which causes a loss of consciousness and
hypothermia (low body temperature)
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+ia!nosis
► Blood tests 2 T'H is the most sensitive
test because it can be elevated even with
small decreases in thyroid function
► Thyro*ine (TB) the main product of the
thyroid !land may also be measured to
confirm and assess the de!ree ofhypothyroidism
%A&' Why aren/t you he*ing (y T0 levels)
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Treatment
► >oal of hypothyroidism treatment is to return blood levels ofT'H and TB to the normal ran!e and to alleviate symptoms
► Treatment for hypothyroidism is thyroid hormone
replacement therapy usually !iven as an oral form of TB
► TB should be taken G* per day on an empty stomach (Ghour before eatin! or ? hours after)$ >eneric (levothyro*ine)and brandAname ('ynthroidM 4evo*ylM 4evothroidM
-nithyroidM) formulations are e0ually effective
► However it is preferable to stay on the same type of TBrather than switch between brand name andor !enericformulations
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Treatment
► If a switch is necessary a blood test is usuallydone J weeks later to determine if the dose
needs to be adOusted$ %olorAcoded tablets
can help with dose adOustments$
► 'ome clinicians prescribe another form of
thyroid hormone triiodothyronine (TE) in
combination with TB$ However since TB isconverted into TE in other or!ans most
studies have not shown an advanta!e of
combination TE : TB therapy over TB alone$
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Treatment
► In most cases symptoms be!in to improve
within ? weeks of startin! thyroid replacement
therapy$ However people with more severe
symptoms may re0uire several months of
treatment before they fully recover$
%A&' All the hat sites reo((end Ar(our1
thyroid. Why don/t you)
%A&' Why an/t I treat (y hy$othyroidis( with
iodine)
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&2A
%aroline "esser "+ %%+LGB ?BGAG@7@
cmesserPmkm!$com
mailto:[email protected]:[email protected]