DOCSLIB.ORG

Thyroiditis ATA Web Brochure

Total Page：16

File Type：pdf, Size：1020Kb

Download full-text PDF Read full-text
Thyroiditis ATA Web Brochure This page and its contents are Copyright © 2012 Thyroiditis the American Thyroid Association SYMPTOMS WHAT ARE THE CLINICAL SYMPTOMS OF THYROIDITIS? There are no symptoms unique to thyroiditis. If the thyroiditis causes slow and chronic thyroid cell damage and destruction, leading to a fall in thyroid hormone levels in the blood, patients experience the symptoms of of hypothyroidism (see Hypothyroid- ism brochure). Typical hypothyroid symptoms include fatigue, weight gain, constipation, dry skin, depression and poor exercise tolerance. This would be the case in patients with Hashimoto’s thyroiditis. If the thyroiditis causes rapid thyroid cell damage and destruction, the thyroid hormone that is stored in the gland leaks out, increasing thyroid hormone levels in the blood. These patients will experience the symptoms of thyrotoxicosis, which are similar to hyperthyroidism (see Hyperthyroidism brochure). These symp- toms often include anxiety, insomnia, palpitations (fast heart rate), fatigue, weight loss, and irritability. This is seen in patients with WHAT IS THE THYROID GLAND? the toxic phase of subacute, painless and post-partum thyroiditis. The thyroid gland is a butterfly-shaped The symptoms of thyrotoxicosis and hyperthyroidism are both endocrine gland that is normally located caused by elevated levels of thyroid hormone in the blood, but in the lower front of the neck. The thyroid’s in thyrotoxicosis, the gland is not truly overactive. In subacute, painless and post-partum thyroiditis, the thyroid gland often be- job is to make thyroid hormones, which comes depleted of thyroid hormone as the course of inflammation are secreted into the blood and then continues leading to a fall in thyroid hormone levels in the blood carried to every tissue in the body. Thyroid and symptoms of hypothyroidism. Pain in the thyroid can be seen hormone helps the body use energy, stay in patients with subacute thyroiditis warm and keep the brain, heart, muscles, and other organs working as they should. CAUSES WHAT CAUSES THYROIDITIS? Thyroiditis is caused by an attack on the thyroid, causing inflam- WHAT IS THYROIDITIS? mation and damage to the thyroid cells. Antibodies that attack Thyroiditis is a general term that refers the thyroid cause most types of thyroiditis. As such, thyroiditis is often an autoimmune disease, like juvenile diabetes and rheu- to “inflammation of the thyroid gland”. matoid arthritis. No one knows why certain people make thyroid Thyroiditis includes a group of individual antibodies, although this tends to run in families. Thyroiditis can disorders causing thyroidal inflammation also be caused by an infection, such as a virus or bacteria, which but presenting in different ways. For works in the same way as antibodies to cause inflammation in the example, Hashimoto’s thyroiditis is the gland. Finally, drugs such as interferon and amiodarone, can also most common cause of hypothyroidism in damage thyroid cells and cause thyroiditis. the United States. Postpartum thyroiditis, WHAT IS THE CLINICAL COURSE OF THYROIDITIS? which causes temporary thyrotoxicosis The course of thyroiditis depends on the type of thyroiditis. (high thyroid hormone levels in the blood) Hashimoto’s thyroiditis – Patients usually present with hypothy- followed by temporary hypothyroidism, roidism, which is usually permanent. is a common cause of thyroid problems Painless and post-partum thyroiditis – These disorders after the delivery of a baby. Subacute are similar and follow the same general clinical course of thyroiditis is the major cause of pain in thyrotoxicosis followed by hypothyroidism. The only real the thyroid. Thyroiditis can also be seen difference between them is that post-partum thyroiditis occurs in patients taking the drugs interferon and after the delivery of a baby while painless thyroiditis occurs in men and in women not related to a pregnancy. Not all amiodarone. patients demonstrate evidence of going through both phases; approximately 1/3 of patients will manifest both phases, while 1/3 of patients will have only a thyrotoxic or hypothyroid phase. HOW YOU CAN HELP The thyrotoxic phase lasts for 1-3 months and is associated with A tax-deductible contribution to the symptoms including anxiety, insomnia, palpitations (fast heart American Thyroid Association supports rate), fatigue, weight loss, and irritability. The hypothyroid phase valuable patient education and crucial typically occurs 1-3 months after the thyrotoxic phase and may thyroid research. New discoveries and last up to 9 – 12 months. Typical symptoms include fatigue, weight ADDITIONAL PATIENT RESOURCES better understanding will translate into gain, constipation, dry skin, • Patient Resources Home improved ways to prevent, diagnose, depression and poor exercise and treat thyroid disease. Give online at tolerance. Most patients (~80%) • ATA Patient Web Brochures www.thyroid.org. will have return of their thyroid • Hypothyroidism Brochure function to normal within 12- 18 months after the onset of • Hyperthyroidism Brochure symptoms. • Thyroid Hormone Treatment Brochure This page and its contents are Copyright © 2012 Thyroiditis the American Thyroid Association HOW YOU CAN HELP A tax-deductible contribution to the American Thyroid Association supports valuable patient education and crucial thyroid research. New discoveries and better understanding will translate into improved ways to prevent, diagnose, and treat thyroid disease. Give online at www.thyroid.org. TYPES WHAT ARE THE TYPES OF THYROIDITIS? There are many types of thyroiditis, which are summarized in the table below: TYPE CAUSE CLINICAL FEATURES DIAGNOSIS (NOT ALL TESTS MAY BE NEEDED) DURATION AND RESOLUTION Hashimoto’s thyroiditis Anti-thyroid antibodies, Hypothyroidism, rare cases of Thyroid function tests, thyroid Hypothyroidism is usually autoimmune disease transient thyrotoxicosis antibody tests permanent Subacute thyroiditis Possible viral cause Painful thyroid, thyrotoxicosis Thyroid function tests, Resolves to normal thyroid function (de Quervain’s thyroiditis) followed by hypothyroidism sedimentation rate, radioactive within 12-18 months, 5% possibility iodine uptake of permanent hypothyroidism. Silent thyroiditis, Painless Anti-thyroid antibodies, Thyrotoxicosis followed by Thyroid function tests, thyroid Resolves to normal thyroid thyroiditis autoimmune disease hypothyroidism. antibody tests, radioactive iodine function within 12-18 months, uptake 20% possibility of permanent hypothyroidism. Post partum thyroiditis Anti-thyroid antibodies, Thyrotoxicosis followed by Thyroid function tests, thyroid Resolves to normal thyroid autoimmune disease hypothyroidism. antibody tests, radioactive iodine function within 12-18 months, uptake (contraindicated if the 20% possibility of permanent women is breast-feeding) hypothyroidism Drug induced Drugs include: amiodarone, Either thyrotoxicosis or Thyroid function tests, thyroid Often continues as long as the drug lithium, interferons, cytokines hypothyroidism. antibody tests is taken Radiation induced Follows treatment with radioactive Occasionally thyrotoxicosis, Thyroid function tests Thyrotoxicosis is transient, iodine for hyperthyroidism or more frequently hypothyroidism is usually external beam radiation therapy hypothyroidism. permanent for certain cancers. Acute thyroiditis, Bacteria mainly, but any infectious Occasionally painful Thyroid function tests, radioactive Resolves after treatment of Suppurative thyroiditis organism thyroid, generalized iodine uptake, fine needle infectious cause, may cause severe illness, occasional mild aspiration biopsy illness hypothyroidism Subacute thyroiditis – Subacute thyroiditis TREATMENT If the hypothyroidism in these latter follows the same clinical course as painless disorders is mild and the patient has few, and post-partum thyroiditis, but is often HOW IS THYROIDITIS TREATED? if any, symptoms, then no therapy may be accompanied by thyroidal pain. The thyroidal Treatment depends on the type of thyroiditis necessary. If thyroid hormone therapy is pain in patients with subacute thyroiditis and the clinical presentation. begun in patients with subacute, painless usually follows the same time-frame of the • Thyrotoxicosis – Beta blockers to decrease and post-partum thyroiditis, the treatment thyrotoxic phase (1-3 months). However, not palpitations and reduce shakes and tremors should be continued for approximately all patients with thyroidal pain necessarily may be helpful. As symptoms improve, 6-12 months and then tapered to see if it have thyrotoxicosis. As noted with painless the medication is tapered off since the is required permanently. and post-partum thyroiditis, resolution thyrotoxic phase is temporary. Antithyroid • Thyroidal pain – The pain associated of all thyroidal abnormalities after 12-18 medications (see Hyperthyroid brochure) with subacute thyroiditis usually can months is seen in most patients (~95%). are not used for the thyrotoxic phase of be managed with mild anti-inflamatory Recurrence of subacute thyroiditis is rare. thyroiditis of any kind since the thyroid is medications such as aspirin or ibuprofen. Drug-induced and radiation thyroiditis – Both not overactive. Occasionally, the pain can be severe and thyrotoxicosis and hypothyroidism may be seen • Hypothyroidism – Treatment is initiated require steroid therapy with prednisone. in these disorders. The thyrotoxicosis is usually with thyroid hormone replacement for short-lived. Drug-induced hypothyroidism often hypothyroidism due to Hashimoto’s
Load more

Recommended publications
  • Thyroiditis: an Integrated Approach LORI B
    Thyroiditis: An Integrated Approach LORI B. SWEENEY, MD, Virginia Commonwealth University Health System, Richmond, Virginia CHRISTOPHER STEWART, MD, Bayne-Jones Army Community Hospital, Fort Polk, Louisiana DAVID Y. GAITONDE, MD, Dwight D. Eisenhower Army Medical Center, Fort Gordon, Georgia Thyroiditis is a general term that encompasses several clinical disorders characterized by inflammation of the thyroid gland. The most common is Hashimoto thyroiditis; patients typically present with a nontender goiter, hypothyroid- ism, and an elevated thyroid peroxidase antibody level. Treatment with levothyroxine ameliorates the hypothyroid- ism and may reduce goiter size. Postpartum thyroiditis is transient or persistent thyroid dysfunction that occurs within one year of childbirth, miscarriage, or medical abortion. Release of preformed thyroid hormone into the bloodstream may result in hyperthyroidism. This may be followed by transient or permanent hypothyroidism as a result of depletion of thyroid hormone stores and destruction of thyroid hormone–producing cells. Patients should be monitored for changes in thyroid function. Beta blockers can treat symptoms in the initial hyperthyroid phase; in the subsequent hypothyroid phase, levothyroxine should be considered in women with a serum thyroid-stimulating hormone level greater than 10 mIU per L, or in women with a thyroid-stimulating hormone level of 4 to 10 mIU per L who are symptomatic or desire fertility. Subacute thyroiditis is a transient thyrotoxic state characterized by anterior neck pain, suppressed thyroid-stimulating hormone, and low radioactive iodine uptake on thyroid scanning. Many cases of subacute thyroiditis follow an upper respiratory viral illness, which is thought to trigger an inflammatory destruction of thyroid follicles. In most cases, the thyroid gland spontaneously resumes normal thyroid hormone production after several months.
    [Show full text]
  • Management of Graves Disease:€€A Review
    Clinical Review & Education Review Management of Graves Disease A Review Henry B. Burch, MD; David S. Cooper, MD Author Audio Interview at IMPORTANCE Graves disease is the most common cause of persistent hyperthyroidism in adults. jama.com Approximately 3% of women and 0.5% of men will develop Graves disease during their lifetime. Supplemental content at jama.com OBSERVATIONS We searched PubMed and the Cochrane database for English-language studies CME Quiz at published from June 2000 through October 5, 2015. Thirteen randomized clinical trials, 5 sys- jamanetworkcme.com and tematic reviews and meta-analyses, and 52 observational studies were included in this review. CME Questions page 2559 Patients with Graves disease may be treated with antithyroid drugs, radioactive iodine (RAI), or surgery (near-total thyroidectomy). The optimal approach depends on patient preference, geog- raphy, and clinical factors. A 12- to 18-month course of antithyroid drugs may lead to a remission in approximately 50% of patients but can cause potentially significant (albeit rare) adverse reac- tions, including agranulocytosis and hepatotoxicity. Adverse reactions typically occur within the first 90 days of therapy. Treating Graves disease with RAI and surgery result in gland destruction or removal, necessitating life-long levothyroxine replacement. Use of RAI has also been associ- ated with the development or worsening of thyroid eye disease in approximately 15% to 20% of patients. Surgery is favored in patients with concomitant suspicious or malignant thyroid nodules, coexisting hyperparathyroidism, and in patients with large goiters or moderate to severe thyroid Author Affiliations: Endocrinology eye disease who cannot be treated using antithyroid drugs.
    [Show full text]
  • Treating Thyroid Disease: a Natural Approach to Healing Hashimoto's
    Treating Thyroid Disease: A Natural Approach to Healing Hashimoto’s Melissa Lea-Foster Rietz, FNP-BC, BC-ADM, RYT-200 Presbyterian Medical Services Farmington, NM [email protected] Professional Disclosures I have no personal or professional affiliation with any of the resources listed in this presentation, and will receive no monetary gain or professional advancement from this lecture. Talk Objectives • Define hypothyroidism and Hashimoto’s. • Discuss various tests used to identify thyroid disease and when to treat based on patient symptoms • Discuss potential causes and identify environmental factors that contribute to disease • Describe how the gut (food sensitivities) and the adrenals (chronic stress) are connected to Hashimoto’s and how we as practitioners can work to educate patients on prevention before the need for treatment • How the use of adaptogens can enhance the treatment of Hashimoto’s and identify herbs that are showing promise in the research. • How to use food, exercise, and relaxation to improve patient outcomes. Named for Hakuro Hashimoto, a physician working in Europe in the early 1900’s. Hashimoto’s was the first autoimmune disease to be recognized in the scientific literature. It is estimated that one in five people suffer from an autoimmune disease and the numbers continue to rise. Women are more likely than men to develop an autoimmune disease, and it is believed that 75% of individuals with an autoimmune disease are female. Thyroid autoimmune disease is the most common form, and affects 7-8% of the population in the United States. Case Study Ms. R is a 30-year-old female, mother of three, who states that after the birth of her last child two years ago she has felt the following: • Loss of energy • Difficulty losing weight despite habitual eating pattern • Hair loss • Irregular menses • Joints that ache throughout the day • A general sense of sadness • Cold Intolerance • Joint and Muscle Pain • Constipation • Irregular menstruation • Slowed Heart Rate What tests would you run on Ms.
    [Show full text]
  • The Thyroid Nodule Information for Patients
    The Thyroid Nodule Information for Patients What is a thyroid nodule? operations, since fewer than 10% of the removed nodules proved to be cancer. Most removed The thyroid gland is located in the lower front nodules could have simply been observed or of the neck, below the larynx (“Adam’s apple”) treated medically. and above the collarbones. A thyroid nodule is a lump in or on the thyroid gland. Thyroid nodules It is not usually possible for a physician to are common and occur in about 4% of women determine whether a thyroid nodule is cancerous and 1% of men; they are less common in on the basis of a physical examination or younger patients and increase in frequency with blood tests. Endocrin ologists rely heavily on age. Sometimes several nodules will develop in 3 specialized tests for help in deciding which the same person. Any time a lump is discovered nodules should be treated surgically: in thyroid tissue, the possibility of malignancy (cancer) must be considered. Fortunately, the tThyroid fine needle biopsy vast majority of thyroid nodules are benign (not tThyroid scan cancerous). tThyroid ultrasonography Many patients with thyroid nodules have no symptoms whatsoever, and are found by What is a thyroid needle biopsy? chance to have a lump in the thyroid gland on a routine physical exam or an imaging study of A thyroid fine needle biopsy is a simple the neck done for unrelated reasons (CT or MRI pro ce dure that can be performed in the scan of spine or chest, carotid ultrasound, etc). physician’s office.
    [Show full text]
  • Hashimoto Thyroiditis
    Hashimoto thyroiditis Description Hashimoto thyroiditis is a condition that affects the function of the thyroid, which is a butterfly-shaped gland in the lower neck. The thyroid makes hormones that help regulate a wide variety of critical body functions. For example, thyroid hormones influence growth and development, body temperature, heart rate, menstrual cycles, and weight. Hashimoto thyroiditis is a form of chronic inflammation that can damage the thyroid, reducing its ability to produce hormones. One of the first signs of Hashimoto thyroiditis is an enlargement of the thyroid called a goiter. Depending on its size, the enlarged thyroid can cause the neck to look swollen and may interfere with breathing and swallowing. As damage to the thyroid continues, the gland can shrink over a period of years and the goiter may eventually disappear. Other signs and symptoms resulting from an underactive thyroid can include excessive tiredness (fatigue), weight gain or difficulty losing weight, hair that is thin and dry, a slow heart rate, joint or muscle pain, and constipation. People with this condition may also have a pale, puffy face and feel cold even when others around them are warm. Affected women can have heavy or irregular menstrual periods and difficulty conceiving a child ( impaired fertility). Difficulty concentrating and depression can also be signs of a shortage of thyroid hormones. Hashimoto thyroiditis usually appears in mid-adulthood, although it can occur earlier or later in life. Its signs and symptoms tend to develop gradually over months or years. Frequency Hashimoto thyroiditis affects 1 to 2 percent of people in the United States.
    [Show full text]
  • Thyroid Nodules Update in Diagnosis and Management Shrikant Tamhane1* and Hossein Gharib2,3
    Tamhane and Gharib Clinical Diabetes and Endocrinology (2015) 1:11 DOI 10.1186/s40842-015-0011-7 REVIEW ARTICLE Open Access Thyroid nodules update in diagnosis and management Shrikant Tamhane1* and Hossein Gharib2,3 Abstract Thyroid nodules are very common. With widespread use of sensitive imaging in clinical practice, incidental thyroid nodules are being discovered with increasing frequency. Their clinical importance is primarily related to the need to exclude malignancy (4.0 to 6.5 percent of all thyroid nodules), assess for their functional status and any pressure symptoms caused by them. New Molecular tests are marketed for the assessment of thyroid nodules for the presence of cancer. The high prevalence of thyroid nodules requires evidence-based rational strategies for their differential diagnosis, risk stratification, treatment, and follow-up. This review addresses advances and controversies in thyroid nodule evaluation, including the new molecular tests, and their management considering the current guidelines and supporting evidence. Keywords: Thyroid, Thyroid Nodules, Molecular markers, Benign, Malignant, FNA, Management, Ultrasonography Introduction disorders, benign and malignant can cause thyroid nod- Thyroid nodule is a discrete lesion within the thyroid ules (Table 1) [1, 5]. gland that is radiologically distinct from the surrounding Fine needle aspiration (FNA) biopsy is the most accur- thyroid parenchyma. Thyroid nodules are common. ate method for evaluating thyroid nodules and helps to They are discovered as an accidental finding by a pa- identify patients who require surgical resection [6]. If a tient, or as an incidental finding during a routine phys- serum TSH is normal or elevated, and the nodule meets ical examination in 3 to 7 % [1] or by a radiologic criteria for sampling, the next step in the evaluation of a procedure: 67 % with ultrasonography (US) imaging, thyroid nodule is a FNA biopsy.
    [Show full text]
  • Heterogenous Morphologic Forms of Goiter in Autoimmune Thyroid Disease
    WJOES Heterogenous Morphologic Forms of Goiter in Autoimmune Thyroid Disease: An Insight based10.5005/jp-journals-10002-1140 on a Prospective Surgical Series ORIGINAL ARTICLE Heterogenous Morphologic Forms of Goiter in Autoimmune Thyroid Disease: An Insight based on a Prospective Surgical Series of 88 Cases PRK Bhargav ABSTRACT Usually, both GD and HT have diffuse goiter due to bilateral Two commonest forms of autoimmune thyroid disease (AITD) symmetrical involvement of thyroid gland by the disease are Graves’ disease (GD) and Hashimoto’s thyroiditis (HT) with process.7 But, in 20 to 30% of cases, they may be associated a diffuse goiter. The nature of goiter apart from clinical presenta- with nodules or assymetrical enlargement.8-11 The variability tion is crucial in the management of AITD. But, the goiter is not always diffuse, leading to diagnostic confusion. In this context, in proportion of nodularity depends upon clinical or sono- we conducted a prospective study on the goiter morphology in graphic methods of evaluation. In a classical case of AITD AITD. This is a prospective study conducted in Endocrine Surgery department of a teritiary care teaching hospital in South India (i.e. with usual clinical presentation, cardinal signs and over a period of 1 year. The cohort is a surgical series of 88 cases diffuse goiter), the standard diagnostic protocol with imaging of AITD (GD = 53; HT = 35). Morpho logy of all the ex vivo speci- and serology suffices, but appears to be insufficient in AITD mens were studied, documented and correlated with clinical and radiological forms of goiter. Sex ratio was M:F = 74:14.
    [Show full text]
  • Thyroid Nodules MARY JO WELKER, M.D., and DIANE ORLOV, M.S., C.N.P
    PRACTICAL THERAPEUTICS Thyroid Nodules MARY JO WELKER, M.D., and DIANE ORLOV, M.S., C.N.P. Ohio State University College of Medicine and Public Health, Columbus, Ohio Palpable thyroid nodules occur in 4 to 7 percent of the population, but nodules found incidentally on ultrasonography suggest a prevalence of 19 to 67 percent. The major- O A patient informa- ity of thyroid nodules are asymptomatic. Because about 5 percent of all palpable nod- tion handout on thy- roid nodules, written ules are found to be malignant, the main objective of evaluating thyroid nodules is to by the authors of this exclude malignancy. Laboratory evaluation, including a thyroid-stimulating hormone article, is provided on test, can help differentiate a thyrotoxic nodule from an euthyroid nodule. In euthyroid page 573. patients with a nodule, fine-needle aspiration should be performed, and radionuclide scanning should be reserved for patients with indeterminate cytology or thyrotoxico- sis. Insufficient specimens from fine-needle aspiration decrease when ultrasound guidance is used. Surgery is the primary treatment for malignant lesions, and the extent of surgery depends on the extent and type of disease. Ablation by postopera- tive radioactive iodine is done for high-risk patients—identified as those with metasta- tic or residual disease. While suppressive therapy with thyroxine is frequently used postoperatively for malignant lesions, its use for management of benign solitary thy- roid nodules remains controversial. (Am Fam Physician 2003;67:559-66,573-4. Copy- right© 2003 American Academy of Family Physicians.) Members of various thyroid nodule is a palpable jects 19 to 50 years of age had an incidental family practice depart- swelling in a thyroid gland with nodule on ultrasonography.
    [Show full text]
  • Thyroid Disease
    Thyroid Disease Thyroid disease occurs when the thyroid (a small, butterfly-shaped gland in the front of your neck) does not produce the right amount of thyroid hormone. These hormones control how your body uses energy. If you are feeling fatigued, notice skin or hair changes, or have hoarseness or pain, your doctor may conduct a physical exam and order blood tests. If these tests indicate a problem, your doctor may order thyroid scan and uptake, thyroid biopsy, or imaging tests to help diagnose and evaluate a thyroid condition. Treatment will depend on the specific nature of your thyroid condition and its underlying cause. What is thyroid disease? The thyroid is a small, butterfly-shaped gland in the front of your neck that wraps around your windpipe (trachea). The two halves of the thyroid gland are connected in the middle by a thin layer of tissue known as the isthmus. The thyroid gland uses iodine (mostly absorbed from food) to produce hormones that control how your body uses energy. Nearly every organ in the body is affected by the function of the thyroid gland. The pituitary gland and hypothalamus, an area at the base of the brain, control the rate at which the thyroid produces and releases these hormones. The main function of the thyroid gland is to release a hormone called thyroxine or T4, which is converted into a hormone called T3. Both of these hormones circulate in the bloodstream and help regulate your metabolism. The amount of T4 produced by the thyroid gland is determined by a hormone produced by the pituitary gland called TSH or thyroid-stimulating hormone.
    [Show full text]
  • Care Step Pathway – Thyroiditis (Inflammation of the Thyroid Gland)
    Care Step Pathway – Thyroiditis (inflammation of the thyroid gland) Assessment Look: Listen: Recognize: - Appear unwell? - Appetite/weight changes? - Other immune-related toxicity? - Changes in weight since last visit? - Hot or cold intolerance? - Prior thyroid dysfunction? o Appear heavier? Thinner? - Change in energy, mood, or behavior? - Prior history of radiation therapy? - Changes in hair texture/thickness? - Palpitations? - Signs of thyroid storm (fever, tachycardia, sweating, dehydration, cardiac - Appear hot/cold? - Increased fatigue? decompensation, delirium/psychosis, liver failure, abdominal pain, - Look fatigued? - Bowel-related changes? nausea/vomiting, diarrhea) - Sweating? Constipation/diarrhea - Hyperactive or lethargic? o - Signs of airway compression - Difficulty breathing? - Shortness of breath/edema? - Clinical presentation: Occasionally thyroiditis with transient hyperthyroidism - Swollen neck? - Skin-related changes? (low TSH and high free T4) may be followed by more longstanding - Voice change (e.g., deeper voice) o Dry/oily hypothyroidism (high TSH and low free T4) - Differential diagnosis-- Primary hypothyroidism: High TSH with low free T4; secondary (central) hypothyroidism due to hypophysitis: both TSH and free T4 are low (see HCP Assessment below for more detail about testing) Grading Toxicity HYPOTHYROIDISM Definition: A disorder characterized by decreased production of thyroid hormones from the thyroid gland Asymptomatic, subclinical Asymptomatic, subclinical Symptomatic, primary Severely symptomatic, Life-threatening,
    [Show full text]
  • Hyperthyroidism in Adults: Variable Clinical Presentations and Approaches to Diagnosis
    J Am Board Fam Pract: first published as 10.3122/jabfm.8.2.109 on 1 March 1995. Downloaded from Hyperthyroidism In Adults: Variable Clinical Presentations And Approaches To Diagnosis Paul B. Knudson, MD Background: Hyperthyroidism is a disease that has various symptoms and can present in many ways. In the elderly patient hyperthyroidism often is not expressed in the classical manner. Acase report of a middle-aged man who had hyperthyroidism with only one symptom is detailed. Methods: Aliterature review utilizing MEDLINE files from 1988 to the present, as well as current textbooks of medicine and endocrinology, was used to prepare this report. Keywords for the search were "hyperthyroidism," "symptoms," "unintentional weight loss," and "differential diagnosis." Results and Conclusions: The clinical presentation of hyperthyroidism can vary from almost asymptomatic to apathetic in appearance to a marked hyperdynamic physiologic response. Family physicians must be well informed of this variation in disease expression. Overlooking the diagnosis of this relatively easily treated condition can be detrimental to patient care and expensive. (J Am Board Fam Pract 1995; 8:109-13.) Thyroid dysfunction is important to understand amounts of sweating, heat intolerance, palpita­ because it occurs often. The incidence of hypo­ tions, dyspnea, fatigue, weight loss, and various eye thyroidism when looked for in large elderly complaints. Common signs of hyperthyroidism populations varies up to 17 percent. Women are include thyroid gland enlargement and a thyroid affected more often than men, and subclinical bruit, exophthalmos, lid lag, tremor, tachycardia, disease is very common. Hyperthyroidism is also hyperkinetic muscular activity, and warm moist common but much less so than hypothyroidism, hands.
    [Show full text]
  • Is It Possible to Predict the Onset of Graves' Disease?
    EDITORIAL www.nature.com/clinicalpractice/endmet Is it possible to predict the onset of Graves’ disease? Nobuyuki Amino Ideally, medicine enables us to prevent disease; It might be microsomes. Of the 71 of these antibody- failing that, it should allow us to detect and possible to positive women examined after preg- diagnose diseases at an early stage, and to nancy, 5 developed Graves’ disease. Hidaka stop them from progressing to a severe state. predict the et al. confirmed that all the women with post- Endocrine diseases are no exception to postpartum partum Graves’ disease had TRAb in early preg- these ideals. Autoimmune thyroid disease is onset of nancy that were detectable by highly sensitive a frequently observed illness (predominantly Graves’ bioassay. It might be possible, therefore, to affecting females), and hyperthyroid or hypo- disease, if predict the postpartum onset of Graves’ disease, thyroid conditions markedly disturb the quality if a sensitive enough assay for TRAb is used in of life. It is well established that hyperthyroidism a sensitive early pregnancy; however, cost-effectiveness of in Graves’ disease is induced by antibodies enough assay this approach should be considered. against the TSH receptor (TRAb) that stimulate is used in early Predicted cases of postpartum Graves’ the thyroid gland. Sensitive assay techniques pregnancy disease could, moreover, be prevented by for the detection of TRAb have been developed, short-term corticosteroid therapy initiated and these show a positive reaction in 99% of immediately after delivery, similar to the patients with Graves’ disease. In other auto- prevention of postpartum development of hypo- immune diseases, detection of the appropriate thyroidism (Tada H et al.
    [Show full text]