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Hypothyroidism &

Hyperthyroidism
A PowerPoint Presentation
prepared by:
Group V
BSN 3A
Hypothyroidism
I. INTRODUCTION
 the disease state in humans and in vertebrates caused
by insufficient production of thyroid hormone by the
thyroid gland.
Signs and
symptoms
Early symptoms
 Poor muscle tone (muscle hypotonia)
 Fatigue
 Cold intolerance, increased sensitivity to cold
 Depression
 Muscle cramps and joint pain
 Carpal Tunnel Syndrome
 Goiter
 Thin, brittle fingernails
 Thin, brittle hair
 Paleness
 Osteoporosis
 Decreased sweating
 Dry, itchy skin
 Weight gain and water retention
 Bradycardia (low heart rate – less than sixty beats per minute)
 Constipation
Signs and
symptoms
Late symptoms
 Slow speech and a hoarse, breaking voice –
deepening of the voice can also be noticed
 Dry puffy skin, especially on the face
 Thinning of the outer third of the eyebrows (sign of
Hertoghe)
 Abnormal menstrual cycles
 Low basal body temperature
Signs and
symptoms
Less common symptoms
 Impaired memory
 Impaired cognitive function (brain fog) and inattentiveness
 A slow heart rate with ECG changes including low voltage
signals. Diminished cardiac output and decreased
contractility.
 Reactive (or post-prandial) hypoglycemia
 Sluggish reflexes
 Hair loss
 Anemia caused by impaired haemoglobin synthesis
(decreased EPO levels), impaired intestinal iron and folate
absorption or B12 deficiency from pernicious anemia
 Difficulty swallowing
Causes
• About three percent of the general population is
hypothyroidic. Factors such as iodine deficiency or
exposure to Iodine-131 can increase that risk. There are a
number of causes for hypothyroidism. Iodine deficiency is
the most common cause of hypothyroidism worldwide. In
iodine-replete individuals hypothyroidism is generally
caused by Hashimoto's thyroiditis, or otherwise as a result
of either an absent thyroid gland or a deficiency in
stimulating hormones from the hypothalamus or
pituitary.
Prognosis

Thyroid hormone replacement therapy generally


maintains normal thyroid hormone levels unless
treatment is interrupted or discontinued.
II. ANATOMY
&
PHYSIOLOGY
Introduction to the Endocrine
System

• The endocrine system refers to the hormone


system of the body.

• Hormones are chemicals produced by living


cells in very very small amounts. They are
transported around the body in the blood.
Hormones regulate and co-ordinate different
organs in the body.
Hormones are classified
into two groups:
• Peptides
1. Made of proteins
2. Fast acting
3. Short – lived
4. E.g. Insulin and ADH

• Steroids
1. Slow acting
2. Long lasting
3. Usually end in “one”
4. E.g. Testosterone and Progesterone.
The Structure of the
Endocrine system
The endocrine system is made up with a series of
glands located around the body. These glands
include:
Pituitary Gland
Thyroid Glands
Parathyroid Glands
Thymus
Pancreas
Adrenal Glands
Gonads
Each of these glands produces hormones, which
have a particular function in the body.
Pituitary Glands
• The Pituitary gland is located in
the hypothalamus (front of the
brain) and is the most important
part of the endocrine system. The
Pituitary gland has two parts,
the anterior and posterior.
1. The Anterior part produces two
hormones, ADH and Oxytocin.
2. The Posterior part of the
Pituitary produces a number of
important hormones. These
include FSH (Follicle Stimulating
Hormone), LH (Luteinizing
Hormone), Prolactin and Growth
Hormones.
Thyroid Glands
• The thyroid glands are found on the trachea.
The main hormone produced is called
thyroxine. This hormone controls the growth
and development of animals. Iodine is
required for its production.

• Lack of thyroxine causes deformation and


retardation. The glands swell if not enough
hormone is produced – this is called goitre in
humans.
Parathyroid Glands
 These are located on either side of the thyroid. They
produce two hormones: Parathormone and Calcitonin.
These hormones control the level of calcium,
magnesium and phosphate in the body.

Thymus
 A very small gland located on the neck. Has some
involvement in the production of lymphocytes, which
are involved in immune response.
Adrenal Glands

• The adrenal glands are found near the kidney.


They produce over fifty different hormones
which are vital for life.
Gonads

• The gonads are the testes and ovaries. The


hormones produced are involved in the
reproductive systems of the animal. These
include testosterone, oestrogen and
progesterone. These hormones will be looked
at in more detail in Animal Reproduction.
Normal Thyroid
Hypothyroidism
Hyperthyroidism
III.PATHOPHYSIOLOGY
IV. NURSING DIAGNOSIS
 Imbalanced Nutrition: More than Body Requirements
related to a slowed metabolic rate resulting in weight gain

 Activity Intolerance related to weakness and apathy


secondary to a decreased metabolic rate resulting in an
increased heart rate and shortness of breath with activity

 Constipation related to decreased peristalsis secondary to


slowed metabolic rate and activity intolerance, resulting
in decreased frequency of stools and painful defecation

 Hypothermia related to slowed metabolic rate resulting


in subnormal body temperature
V. NURSING
INTERVENTIONS
MODIFYING ACTIVITY
The patient with hypothyroidism experiences
decreased energy and moderate to severe
lethargy. As a result, the risk for
complications from immobility increases.
 A major role of the nurse is assisting with
care and hygiene while encouraging the
patient to participate in activities within
established tolerance levels to prevent the
complications of immobility.
MONITORING PHYSICAL
STATUS
The nurse closely monitors the patients ital signs
and cognitive level to detect the following:
Deterioration of physical and mental status
Signs and symptoms indicating that treatment
has resulted in the metabolic rate exceeding the
ability of the cardiovascular and pulmonary
systems to respond.
Continued limitations or complications of
myxedema
PROMOTING PHYSICAL
COMFORT
The patient often experiences chilling and
extreme intolerance to cold, even if the room
feels comfortable or hot to others.
Extra clothing and blankets are provided, and the
patient is protected from drops
Use of heating pads and electric blanket is avoided
because of the risk of peripheral vasodilation, further
loss of body heat, and vascular collapse.
PROVIDING EMOTIONAL
SUPPORT
The patient with moderate to severe
hypothyroidism may experience severe
emotionally actions to changes in appearance
and body image and the frequent delay in
diagnosis. As hypothyroidism is treated
successfully and symptoms subside, the patient
may experience depression and guilt as a result
of the progression and severity of symptoms that
occurred.
The nurse informs the patient and family that
the symptoms and inability to recognize them
are common and part of the disorder itself.
PROMOTING HOME AND
COMMUNITY-BASED CARE
Because most hypothyroidism treatment takes place
at home, the patient and family require information
and instruction that will enable them to monitor the
patients condition and response to therapy.
» The nurse instructs the patient about the desired
actions and side effects of meditations about how
and when to take prescribe medications.
» The nurse provides written instructions and
guidelines for the patient and family.
Cont’d
The patient with hypothyroidism and
myxedema need considerable follow-up
and healthcare.
Assistance the nurse reinforces the
importance of continued thyroid hormone
replacement and periodic follow-up and
instructs the patient and family members
about the signs of over medication and under
medication.
V. MEDICATIONS
Hypothyroidism is traditionally treated with thyroid
hormone replacement therapy (either synthetic or
natural). Thyroid replacement therapy could include
taking levothyroxine (T4), liothyronine (T3), or a
combination product that contains both T4 and T3. All of
these treatments work in the body like thyroxine, the
human hormone that is normally produced by the
thyroid gland, and subsequently converted to T3, the
active hormone.
•Levothyroxine
 The purpose of treatment is to replace the thyroid hormone
that is lacking. Levothyroxine is the most commonly used
medication. Doctors will prescribe the lowest dose that
effectively relieves symptoms and brings the TSH level to a
normal range. If you have heart disease or you are older, your
doctor may start with a very small dose.
 Lifelong therapy is required unless you have a condition called
transient viral thyroiditis.
 You must continue taking your medication even when your
symptoms go away. When starting your medication, your
doctor may check your hormone levels every 2 - 3 months.
After that, your thyroid hormone levels should be monitored at
least every year.
Important things to remember when you are
taking thyroid hormone are:
 Do NOT stop taking the medication when you feel better.
Continue taking the medication exactly as directed by your
doctor.
 If you change brands of thyroid medicine, let your doctor
know. Your levels may need to be checked.
 Some dietary changes can change the way your body
absorbs the thryoid medicine. Talk with your doctor if you
are eating a lot of soy products or a high-fiber diet.
 Thryoid medicine works best on an empty stomach and when
taken 1 hour before any other medications. Do NOT take
thyroid hormone with calcium, iron, multivitamins, alumin
hydroxide antacids, colestipol, or other medicines that bind
bile acids, or fiber supplements.
MEDICAL MANAGEMENT
(HYPOTHYROIDISM)
Treatment
Treating Overt Hypothyroidism.
Patients with overt hypothyroidism, indicated by clear
symptoms and blood tests that show high TSH (generally
10 mU/L and above) and low thyroxine (T4) levels, must
have thyroid replacement therapy.
Treating Subclinical or Mild Hypothyroidism.
Considerable debate exists about whether to treat
patients with subclinical hypothyroidism (slightly higher
than normal TSH levels, normal thyroxine levels, and no
obvious symptoms). Some doctors opt for treatment and
others opt for simply monitoring patients.
It is not clear if the benefits of treating subclinical hypothyroidism
outweigh the risks and potential complications. Doctors who do not
advocate treatment argue that thyroid levels can vary widely, and
subclinical hypothyroidism may not persist. In such cases,
overtreatment leading to hyperthyroidism is a real risk.

There is reasonable evidence and consensus to recommend


treatment for subclinical hypothyroidism in the presence of other
factors, including:

High total or LDL cholesterol levels


Blood tests that show autoantibodies indicating a future risk
 for Hashimoto's thyroiditis or other forms of other
 autoimmune hypothyroidism
Blood tests that show TSH levels greater than 10 mU/L
Goiter
Pregnancy
Female infertility associated with subclinical hypothyroidism
Treatment is optional in patients with subclinical
hypothyroidism who have no obvious symptoms and
normal cholesterol levels. Some doctors feel that treating
this group of patients will prevent progression to overt
hypothyroidism and future heart disease, as well as increase
a patient's sense of well-being. However, the evidence to
support treatment of this patient group is not nearly as
strong. Many doctors recommend against treatment and
suggest that these patients should simply have lab tests
every 6 - 12 months.
Suppressive Thyroid Therapy.
Suppressive thyroid therapy involves taking
levothyroxine in doses that are high enough to block the
production of natural TSH but too low to cause
hyperthyroid symptoms. It may be used for patients
with large goiters or thyroid cancer.
Treatment of Special Cases

Treating the Elderly and Patients with Heart Disease.

Thyroid dysfunction is common in elderly patients, with most


having subclinical hypothyroidism. There is no evidence that
this condition poses any great harm in this population, and
most doctors recommend treating only high-risk patients.
Elderly patients, particularly people with heart conditions,
usually start with very low doses of thyroid replacement,
since thyroid hormone may cause angina or even a heart
attack. Patients who have heart disease must take lower-
than-average maintenance doses. Doctors do not recommend
treatment for subclinical hypothyroidism in most elderly
patients with heart disease. Such patients should be closely
monitored, however.
Treating Newborns and Infants with Hypothyroidism.

Babies born with hypothyroidism (congenital


hypothyroidism) should be treated with levothyroxine
(T4) as soon as possible to prevent complications. Early
treatment can help improve IQ and other developmental
factors. However, even with early treatment, mild
problems in mental functioning may last into adulthood.
In general, children born with milder forms of
hypothyroidism will fare better than those who have
more severe forms.
Treatment During Pregnancy and for Postpartum Thyroiditis.
Women who have hypothyroidism before becoming
pregnant may need to increase their dose of
levothyroxine during pregnancy. Women who are first
diagnosed with overt hypothyroidism during
pregnancy should be treated immediately, with quick
acceleration to therapeutic levels. Although not well
proven, doctors often recommend treating patients
diagnosed with subclinical hypothyroidism while
pregnant. There are no risks to the developing baby
when the pregnant woman takes appropriate doses
of thyroid hormones. The pregnant woman with
hypothyroidism should be monitored regularly and
doses adjusted as necessary. If postpartum thyroiditis
develops after delivery, any thyroid medication
should be reduced or temporarily stopped during this
period.
Treatment of Hypothyroidism and Iodide Deficiency.
People who are iodide deficient may be able
to be treated for hypothyroidism simply by
using iodized salt. In addition to iodized salt,
seafood is a good source. Except for plants
grown in iodine-rich soil, most other foods do
not contain iodine. The current RDA for iodide
is 150 micrograms for both men and women,
with an upper limit of 1,100 micrograms to
avoid thyroid injury.
Hyperthyroidism
I. INTRODUCTION
 Hyperthyroidism is the term for overactive tissue within the
thyroid gland, resulting in overproduction and thus an excess
of circulating free thyroid hormones: thyroxine (T4),
triiodothyronine(T3), or both. Thyroid hormone is important
at a cellular level, affecting nearly every type of tissue in the
body.
 Thyroid hormone functions as a stimulus to metabolism and
is critical to normal function of the cell. In excess, it both
overstimulates metabolism and exacerbates the effect of the
sympathetic nervous system, causing "speeding up" of
various body systems and symptoms resembling an overdose
of epinephrine (adrenaline). These include fast heart beat and
symptoms of palpitations, nervous system tremor and
anxiety symptoms, digestive system hypermotility (diarrhea),
and weight loss.
Signs and symptoms
weight loss (often accompanied by an increased
appetite)
 anxiety
 intolerance to heat
 hair loss
 muscle aches
 weakness
 fatigue
 hyperactivity
Irritability
Apathy
 depression
 polyuria and sweating.
Causes
The major causes in humans are:
Graves' disease (the most common etiology with 70-
80%)

Toxic thyroid adenoma

Toxic multinodular goitre


Prognosis

Hyperthyroidism is generally treatable and carries a good


prognosis. Most patients lead normal lives with proper
treatment. Thyroid storm, however, can be life threatening
and can lead to heart, liver, or kidney failure.
II. ANATOMY
&
PHYSIOLOGY
Introduction to the Endocrine
System

• The endocrine system refers to the hormone


system of the body.

• Hormones are chemicals produced by living


cells in very very small amounts. They are
transported around the body in the blood.
Hormones regulate and co-ordinate different
organs in the body.
Hormones are classified
into two groups:
• Peptides
1. Made of proteins
2. Fast acting
3. Short – lived
4. E.g. Insulin and ADH

• Steroids
1. Slow acting
2. Long lasting
3. Usually end in “one”
4. E.g. Testosterone and Progesterone.
The Structure of the
Endocrine system
The endocrine system is made up with a series of
glands located around the body. These glands
include:
Pituitary Gland
Thyroid Glands
Parathyroid Glands
Thymus
Pancreas
Adrenal Glands
Gonads
Each of these glands produces hormones, which
have a particular function in the body.
Pituitary Glands
• The Pituitary gland is located in
the hypothalamus (front of the
brain) and is the most important
part of the endocrine system. The
Pituitary gland has two parts,
the anterior and posterior.
1. The Anterior part produces two
hormones, ADH and Oxytocin.
2. The Posterior part of the
Pituitary produces a number of
important hormones. These
include FSH (Follicle Stimulating
Hormone), LH (Luteinizing
Hormone), Prolactin and Growth
Hormones.
Thyroid Glands
• The thyroid glands are found on the trachea.
The main hormone produced is called
thyroxine. This hormone controls the growth
and development of animals. Iodine is
required for its production.

• Lack of thyroxine causes deformation and


retardation. The glands swell if not enough
hormone is produced – this is called goitre in
humans.
Parathyroid Glands
 These are located on either side of the thyroid. They
produce two hormones: Parathormone and Calcitonin.
These hormones control the level of calcium,
magnesium and phosphate in the body.

Thymus
 A very small gland located on the neck. Has some
involvement in the production of lymphocytes, which
are involved in immune response.
Adrenal Glands

• The adrenal glands are found near the kidney.


They produce over fifty different hormones
which are vital for life.
Gonads

• The gonads are the testes and ovaries. The


hormones produced are involved in the
reproductive systems of the animal. These
include testosterone, oestrogen and
progesterone. These hormones will be looked
at in more detail in Animal Reproduction.
Normal Thyroid
Hypothyroidism
Hyperthyroidism
III. PATHOPHYSIOLOGY
IV. NURSING DIAGNOSIS
 Imbalanced Nutrition: Less than Body Requirements related
to accelerated metabolic rate resulting in weight loss and
decreased energy levels

 Activity Intolerance related to exhaustion secondary to


accelerated metabolic rate resulting in inability to perform
activity without shortness of breath and significant increases
in heart rate

 Hyperthermia related to accelerated metabolic rate resulting


in fever, diaphoresis, and reported heat intolerance

 Impaired Social Interaction related to extreme agitation,


hyperactivity, and mood swings resulting in inability to relate
effectively with others
V. NURSING
INTERVENTIONS
IMPROVING NUTRITIONAL
STATUS
Rapid movement of food through the
gastrointestinal tract may result to
nutritional imbalance and further
weight loss.
Highly seasoned foods and stimulants
such as coffee, tea, cola, and alcohol are
discouraged to reduce the area.
High calorie, high protein foods are
encouraged.
ENHANCING COPING
MEASURES
The patient needs reassurance that the emotional
reactions being experience are a result of the
disorder and that with effective treatment those
symptoms will be controlled.
Use a calm, unhurried approach with the
patient.
Stressful experiences are minimized; therefore,
if hospitalized, the patient is not placed in a
room with very ill or talkative patients.
The environment is kept quite and uncluttered.
The nurse encourages relaxing activities if they
do not overestimate the patient.
IMPROVING SELF-STEEM
The patient is likely to experience changes in
appearance, appetite and weight.
The nurse conveys and understanding of the
patients concern about these problems and assists
the patient to develop effective coping strategies.
If changes in appearance are very disturbing to
patient, mirrors maybe covered or removed.
The nurse reminds the family members and
personnel to avoid bringing these changes to the
patient’s attention.
The nurse explains to the patient and family that
most of these changes are expected to disappear
with effective treatment.
MAINTAINING BODY
TEMPERATURE
The patient finds a normal room temperature
too warm because of an exaggerated metabolic
rate and increased heat production.
The nurse maintains the environment at a
cool, comfortable temperature and changes
bedding and clothing as needed.
MONITORING AND MANAGING
POTENTIAL COMPLICATIONS
The nurse closely monitors the patient with
hyperthyroidism for signs and symptoms
that maybe indicative of thyroid storm.
Anti-thyroid medications maybe prescribe to
reduce thyroid hormone levels.
Propranolol and digitalis maybe prescribe to
treat cardiac symptoms.
PROMOTING HOME AND
COMMUNITY-BASED CARE
The nurse teaches the patient how and when to take
prescribe medication, and provides instructions about
the essential role of the medication and broader
therapeutic plan.
The nurse provides a written plan for the patient to use
at home
The nurse identifies adverse effects that should be
reported if they occur.
The nurse also advises the patient to avoid stressful
situations that may precipitate thyroid storm.
Cont’d
The nurse reinforces to the patient and family
the importance of long-term follow-up because
of the risk for hypothyroidism after
thyroidectomy or treatment with anti-thyroid
medications or radioactive iodine.
The nurse also assesses the patient for changes
indicating return to normal thyroid function
and signs and symptoms of hyperthyroidism
and hypothyroidism.
The nurse reminds the patients and family about
the importance of health promotion activities
and recommended health screening.
VI. MEDICAL
MANAGEMENT
Radioiodine is considered the treatment of choice for
hyperthyroidism, but in some situations, methimazole
therapy is preferred, such as in cats with pre-existing
renal insufficiency.

Methimazole blocks thyroid hormone synthesis, and


controls hyperthyroidism in more than 90% of cats that
tolerate the drug. Unfavorable outcomes are usually due
to side effects such as gastrointestinal (GI) upset, facial
excoriation, thrombocytopenia, neutropenia, or liver
enzyme elevations; warfarin-like coagulopathy or
myasthenia gravis have been reported but are rare.
Surgical Procedure
Surgery - this involves surgically removing the
thyroid gland (thyroidectomy). It may be an option for
patients who cannot tolerate anti-thyroid medications,
or those who do not wish to receive radioactive iodine
therapy. Patients will subsequently require thyroxine
treatment to make sure their blood levels of thyroid
hormones are adequate.
The operative procedure to treat hyperthyroidism is
known as a near total thyroidectomy
It is performed under general anesthesia.
The surgeon makes an incision in the skin lines across
the front of the neck and carefully exposes the thyroid
gland.
Precautions are taken to identify, isolate, and protect
important structures in the area of the thyroid gland. Two
are particularly important:
1. The laryngeal nerve, which is vital for the
proper function of the larynx or voice box, is
carefully identified and protected from trauma
during this procedure.
2. The four small parathyroid glands, which are
embedded in thyroid tissue and produce a
hormone necessary for maintenance of blood
calcium levels, are also identified and preserved.

Most of the thyroid gland is removed.

The surgeon usually leaves about 3 to 8 grams, which is


less the 0.3 ounces of thyroid tissue.
The procedure generally takes several hours.
The incision usually heals well and is usually not even
noticeable
Surgical Care
Thyroidectomy is no longer the recommended first-line
therapy for hyperthyroid Graves disease. However, a recent
retrospective cohort
studyjavascript:showcontent('active','references'); showed
that one-third of all patients electing surgery as definitive
management did so without a specific indication, and the
patient satisfaction with the decision for surgery as
definitive management of Graves disease was high. Surgery
is a safe alternative therapeutic option in patients who are
noncompliant with or cannot tolerate antithyroid drugs,
have moderate-to-severe ophthalmopathy, have large
goiters, or refuse or cannot undergo radioiodine therapy.
Thyroidectomy may be appropriate in the presence of a
thyroid nodule that is suggestive of carcinoma.
In certain cases (eg, in pregnant patients with severe
hyperthyroidism), thyroidectomy may be indicated because
radioactive iodine and antithyroid medications may be
contraindicated.
It generally is reserved for patients with large goiters
with or without compressive symptoms.
It also may be indicated in patients who refuse
radioiodine as definitive therapy or in those in whom the
use of antithyroid drugs and/or radioiodine does not
control hyperthyroidism.

Surgery provides rapid treatment of Graves disease


and permanent cure of hyperthyroidism in most patients,
and it has "negligible mortality and acceptable
morbidity" by experienced surgeons.
Ophthalmopathy
Near-total thyroidectomy has little, if any, effect on
the course of ophthalmopathy.
If ophthalmopathy is severe but inactive, orbital
decompression may be performed. Reducing proptosis
and decompressing the optic nerve can be achieved by
transantral orbital decompression.
The major adverse effect is postoperative diplopia,
which may necessitate a second surgery on the
extraocular muscles to correct the problem.

Rehabilitative (extraocular muscle or eyelid) surgery


is often needed. Eyelid surgery (eg, severance of the
Müller muscle, scleral or palatal graft insertion) can be
performed to improve exposure keratitis.
VII. MEDICATIONS
Hyperthyroidism can be treated using medicine,
radiation, or surgery. Many factors, such as the person's
age and the severity and type of hyperthyroidism, are
important in determining which treatment is best. The
two main types of medicines used to treat
hyperthyroidism are antithyroid drugs and beta-
blockers.
Anti-thyroid Drugs
Antithyroid drugs, such as methimazole (MMI or
Tapazole) and propylthiouracil (PTU), work by
decreasing the production of thyroid hormone.
Both are very effective, but methimazole is
generally preferred because of a rare risk of
serious side effects with PTU. The illustration
shows that some hormone is made, but the thyroid
becomes much less efficient. When taken
faithfully, these drugs are usually very effective in
controlling hyperthyroidism within a few weeks.
Cont’d
For pregnant women, PTU is the preferred
drug during the first trimester. After the first
trimester, methimazole is preferred.
 For patients with sustained forms of
hyperthyroidism,
 such as Graves' disease or toxic nodular
goiter, anti-thyroid medications are often
used. The goal with this form of drug therapy
is to prevent the thyroid from producing
hormones.
Cont’d
Very rarely, patients treated with these medications
can develop liver inflammation or a deficiency of
white blood cells therefore, patients taking
antithyroid drugs should be aware that they must
stop their medication and call their doctor promptly
if they develop yellowing of the skin, a high fever, or
severe sore throat. The main shortcoming of
antithyroid drugs is that the underlying
hyperthyroidism often comes back after they are
discontinued. For this reason, many patients with
hyperthyroidism are advised to consider a
treatment that permanently prevents the thyroid
gland from producing too much thyroid hormone.
SIDE EFFECTS:
Rash
 itching or fever (but these are
uncommon)
Methimazole (MMI) 
MMI is usually preferred over PTU because it
reverses hyperthyroidism more quickly and
has fewer side effects. MMI requires an
average of 6 weeks to lower T4 levels to
normal and is often given before radioactive
iodine treatment. MMI can be taken once per
day.
Propylthiouracil
(PTU) 
PTU blocks the conversion of T4 to T3 in non-
thyroid tissue, but it does not reverse
hyperthyroidism as rapidly as MMI. PTU must be
taken two to three times per the day.
Antithyroid drugs during
pregnancy
PTU used to be the drug of choice during pregnancy because
it is thought to have a lower risk of causing birth defects. But
experts now recommend that PTU be given during the first
trimester only. This is because there have been rare cases of
liver damage in people taking PTU. After the first trimester,
women should switch to methimazole for the rest of the
pregnancy.
Beta-blockers 
Beta-blockers, such as atenolol, are often
started as soon as the diagnosis of
hyperthyroidism is made. While beta-blockers
do not reduce thyroid hormone production,
they can control many of the bothersome
symptoms, such as rapid heart rate, tremors,
anxiety, and heat intolerance. Once the
hyperthyroidism is under control (by
antithyroid drugs, surgery, or radioactive
iodine), the beta-blocker is stopped.
Radioactive iodine 
Destroying the thyroid with radiation, called
radioiodine ablation, is a permanent way to
resolve hyperthyroidism. The amount of radiation
used is small and does not cause cancer. This is the
most widely used treatment in the United States.
Radioiodine is given in liquid or capsule form, and
it works by attacking and destroying much of the
thyroid tissue. This takes about 6 to 18 weeks.
People with severe symptoms, older adults, and
people with heart problems should first be treated
with an antithyroid drug to control symptoms.
Most patients who receive radioiodine develop
hypothyroidism and need to take thyroid hormone
supplements for the rest of their lives.
As with most treatments, there
are some risks:
Sometimes, after apparently successful treatment, the
condition returns and further treatment is needed.
About 20 percent of those who use radioiodine
treatment require a second dose. These people usually
have severe hyperthyroidism or a very large goiter.
Occasionally, people whose hyperthyroidism is caused
by Graves' disease may find that their eye symptoms
worsen after therapy.
Cont’d
People who undergo this therapy should avoid
close physical contact, especially with young
children and pregnant women, for three to seven
days after treatment because of the possibility of
exposing them to low doses of radiation. This can
be difficult for parents of young children. Patients
will need to see their clinician on a regular basis
after treatment to have thyroid hormone levels
checked and monitor for hypothyroidism or
recurrent hyperthyroidism.
VIII. DIAGNOSTIC
PROCEDURES
Hypothyroidism
&
Hyperthyroidism
TSH
The TSH (or Thyroid Stimulating
Hormone) assay has been recognized as
an exquisitely sensitive indicator of
thyroid status.
T4
The T4 (or Thyroxin) assay complements
the TSH assay, and is used to confirm a
thyroid disorder when suggested by an
abnormal TSH.

T3
The T3 (or Triiodothyronine) assay is
another assay which is used in the
diagnosis of thyroid disorders.
T3 Resin Uptake
The T3 Resin Uptake assay is used in calculating
the Free Thyroxin Index (FTI).

Other Tests
Autoantibodies of clinical interest in thyroid
disease include thyroid-stimulating antibodies
(TSAb), TSH receptor-binding inhibitory
immunoglobulins (TBII), antithyroglobulin
antibodies (Anti-Tg Ab) and the antithyroid
peroxidase antibody (Anti-TPO Ab).
Ultrasound
Similar in its use for evaluating a breast
mass, ultrasound can be used to assess a
thyroid nodule.
Fine Needle
Aspiration
Fine Needle Aspiration (FNA) has become
the single-most important step in the
evaluation of a thyroid nodule.
Thyroid Scan
The thyroid glands' ability to concentrate iodine and certain
radioactive isotopes has been exploited in a nuclear imaging
technique known as the thyroid scan.
X. DIET
No foods have been shown in clinical studies to
improve or worsen the symptoms of
hyperthyroidism. However, that doesn't mean
you shouldn't pay attention to what you eat. A
healthy, well-balanced diet is important for
those with hyperthyroidism -- both during and
after treatment. It should include things like
fruits, vegetables, and lean proteins, with limited
amounts of foods high in fat and cholesterol.
Weight Gain and
Hyperthyroidism
Healthcare providers generally advise their
patients to follow good dietary habits following
treatment for hyperthyroidism. The reason is that
considerable weight gain is common with this
condition. One study showed an average weight
gain of about 12 pounds (5.4 kg) in people followed
for up to two years after hyperthyroidism
treatment.
Factors that seemed to increase
the chance for weight gain
included:

Graves' disease
Preexisting obesity
Previous weight loss as a result of
hyperthyroidism
Hypothyroidism following treatment.
The Well-Balanced Diet
The good news is that research has also shown that
this weight gain can be minimized by following
sensible dietary habits. If you have an overactive
thyroid, you should strive to eat a well-balanced diet
and control your weight.
 A well-balanced diet can help you feel better and can
be a positive step in dealing with hyperthyroidism. It
can also help decrease your chances of developing
heart disease or certain types of cancer.
Some suggestions for eating a well-balanced diet and
controlling your weight during and after treatment for
an overactive thyroid include the following:

 Eat a heart-healthy diet. This diet should include foods


such as:
Fruits, vegetables, grains, and fat-free or low-fat
milk and milk products
Lean meats, poultry, fish, beans, eggs, and nuts.
 Limit foods with saturated fats, trans fats, cholesterol,
sodium (salt), and added sugars.
 Get regular physical activity for at least 30 minutes a
day on most days of the week.
 Limit your intake of alcohol.
END
-To God be the Glory-