THYROID DISORDERS

By Isabel Stephan and Olga Erokhina

CAUSESHyperthyroidism- Grave's disease- Toxic adenoma, toxic multinodular goitre

(Plummer's disease) - Thyroiditis → stored hormones released into

blood stream (Postpartum thyroiditis)- Excess Iodine

CAUSESHypothyroidism: - Autoimmune diseases (Hashimoto's thyroiditis)- Iodine deficiency- Different treatments: thyroid surgery, radiation

therapy against cancer, medications (e.g. lithium, amiodarone, interferons), treatment of hyperthyroidism

- Congenital diseases - Euthyroid sick syndrome- Pituitary disorder - Thyroid hormone resistance

Symptoms

Goitre

COMPLICATIONS

Hyperthyroidism Hypothyroidism

- Heart problems - Osteoporosis - Thyrotoxic crisis

(thyroid storm) : sudden worsening of symptoms → fever, delirium, fast/irregular heart beat

- Myxedema: low blood pressure, decreased breathing/body temperature, coma

- Heart problems- Peripheral neuropathy- Infertility - Birth defects → impaired

physical and mental growth: Cretinism

DIAGNOSIS

TSH  FREE T4FREE OR TOTAL T3

PROBABLE INTERPRETATION

High Normal Normal Mild (subclinical) hypothyroidism

High Low Low or normal Hypothyroidism

Low Normal Normal Mild (subclinical) hyperthyroidism

Low High or normal High or normal Hyperthyroidism

Low Low or normal Low or normal Non-thyroidal illness; pituitary (secondary) hypothyroidism

Normal High High Thyroid hormone resistance syndrome (a mutation in the thyroid hormone receptor decreases thyroid hormone function)

EPIDEMIOLOGY

- Iodine deficiency

- Iodine replete areas

- Factors: mountains, soil, goitrogenic plants, selenium deficiency

EPIDEMIOLOGY- Autoimmune thyroid disease: same frequency

in Caucasians, Hispanics, Asians lower African Americans

- All occur more frequently in women than in men- Autoimmune in people aged 20-40 years- The frequency of goiters decrease with age- Toxic multinodular goiters increase with age - Down and Turner syndromes

TREATMENT

Hyperthyroidism Hypothyroidism

Suppression of function- Radioactive iodine- Anti-thyroid

medication (propylthiouracil and methimazole)

- Beta blockers- Surgery and

treatment with levothyroxine

Hormonal treatment- Levothyroxine (Levothroid, Synthroid, others)

PREVENTION

- No known way in developed countries

- Iodine supplements in developing countries

- Avoiding radiation, “thyroid shield”

SOURCES http://emedicine.medscape.com/article/121865-overview#a6 http://www.ijem.in/article.asp?issn=2230-

8210;year=2011;volume=15;issue=6;spage=82;epage=88;aulast=Ogbera http://www.webmd.com/women/understanding-thyroid-problems-treatment?page=3 http://www.mayoclinic.org/diseases-conditions/hypothyroidism/basics/treatment/con-

20021179 http://www.emedicinehealth.com/thyroid_problems/page16_em.htm

http://renegadehealth.com/blog/wp-content/uploads/2012/12/Table-1.jpg https://ods.od.nih.gov/factsheets/Iodine-HealthProfessional/

http://bmb.oxfordjournals.org/content/99/1/39.long http://www.mayoclinic.org/diseases-conditions/hypothyroidism/basics/

complications/con-20021179 http://www.mayoclinic.org/diseases-conditions/hyperthyroidism/basics/

complications/con-20020986 https://en.wikipedia.org/wiki/Hypothyroidism https://en.wikipedia.org/wiki/Thyroid_disease http://www.nhs.uk/Conditions/Thyroid-under-active/Pages/Symptoms.aspx https://labtestsonline.org/understanding/analytes/tsh/tab/test https://www.nlm.nih.gov/medlineplus/thyroiddiseases.html#cat5 http://www.thyroid.ca/thyroid_gland.php