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By Isabel Stephan and Olga Erokhina
Thyroid disorders By Isabel Stephan and Olga Erokhina
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Causes Hyperthyroidism Grave's disease
Toxic adenoma, toxic multinodular goitre (Plummer's disease) Thyroiditis → stored hormones released into blood stream (Postpartum thyroiditis) Excess Iodine
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Causes Hypothyroidism: 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
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Symptoms
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Goitre
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Complications Heart problems Osteoporosis
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
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Diagnosis TSH FREE T4 FREE OR TOTAL T3 PROBABLE INTERPRETATION High
Normal Mild (subclinical) hypothyroidism Low Low or normal Hypothyroidism Mild (subclinical) hyperthyroidism High or normal Hyperthyroidism Non-thyroidal illness; pituitary (secondary) hypothyroidism Thyroid hormone resistance syndrome (a mutation in the thyroid hormone receptor decreases thyroid hormone function)
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Epidemiology Iodine deficiency Iodine replete areas
Factors: mountains, soil, goitrogenic plants, selenium deficiency
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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 years - The frequency of goiters decrease with age - Toxic multinodular goiters increase with age - Down and Turner syndromes
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Treatment Suppression of function Radioactive iodine
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)
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Prevention No known way in developed countries
Iodine supplements in developing countries Avoiding radiation, “thyroid shield”
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Sources http://emedicine.medscape.com/article/121865-overview#a6
;year=2011;volume=15;issue=6;spage=82;epage=88;aulast=Ogbera content/uploads/2012/12/Table-1.jpg
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