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Thyroid - Thyroid Disease Facts Jeffrey Medland Lt Col USAF...

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Thyroid Disease Facts Jeffrey Medland Lt Col, USAF, MC, SFS Chief, Endocrinology MGMC, Andrews AFB, MD Capital Conference-June 2007
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Outline Thyroid Testing Hypothyroidism Causes Signs/symptoms Treatment Hyperthyroidism Causes Signs/symptoms Treatment Thyroid Nodules/ Cancer Thyroid Disease and Pregnancy Hypothyroidism Hyperthyroidism (Hyperemesis Gravidarum, Graves’) Thyroiditis Factors affecting Thyroid function, LT4
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Thyroid Colloid Apical Membrane Basal Membrane
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Thyroid Peroxidase (TPO) Iodination Reaction” Coupling Reaction”
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Thyroid Testing TSH Best test for screening for thyroid dysfunction! Log/linear response w/ FT4 A 2-fold change in FT4 produces a 100-fold change in TSH Not specific for a particular thyroid disease. Don’t use TSH alone for diagnosis! Also useful in Assessing LT4 tx in 1 ° hypothyroidism Monitoring TSH-suppressive tx in thyroid Ca
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Thyroid Testing FT4 Testing methods: Equilibrium dialysis Analog assays Abnormal TSH check this next Indications: In conjunction w/ TSH for diagnosing hyperthyroidism or hypothyroidism. Monitoring LT4 replacement in central hypothyroidism (TSH not helpful) Assessing response to tx following 131-RAIA (Graves, toxic nodules) Monitoring ATD tx in pregnant females FT3 Abnormal TSH + normal FT4, then check this (T3 Thyrotoxicosis)
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TSH HIGH LOW FT4 Clinical Status LOW Primary Hypo thyroidism, Thyroiditis (stage 3) NORMAL Subclinical Hypo thyroidism HIGH Pituitary Hyper thyroidism HIGH Thyrotoxicosis, Thyroiditis (stage 1) NORMAL Subclinical Hyper thyroidism, Autonomous nodules LOW Pituitary Hypo thyroidism Overview of Thyroid Function Tests
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Thyroid Testing Thyroid Antibodies (TPO, Tg, TSI, TRAb) TPO TPO + Tg Ab’s assoc w/ Hashimoto’s. TPO more sensitive . Helpful in predicting those w/ subclinical hypothyroidism who are at ↑ risk for progression to overt hypothyroidism. TSI When dx of Graves’ in question Note: a negative test does not r/o Graves’ Pregnant women w/ Graves’ to determine fetal risk of thyroid dysfunction (due to transplacental passage of stimulating or blocking Ab’s). Suspected euthyroid ophthalmopathy. In pt’s w/ alternating hyper- and hypothyroidism (due to fluctuations in TSH receptor stimulating and blocking and stimulating Ab’s) Thyroglobulin (Tg) Indications Thyroid cancer recurrence Factitious (exogenous) vs. endogenous hyperthyroidism Note: Most assays are not reliable in pt’s (+) for anti-Tg Ab Interferes w/ method of Tg measurement (causing factitious low Tg)
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Thyroid Testing Radioactive Iodine Uptake and Scan (RAIU/Scan) 123-RAIU/Scan or 131-RAIU/Scan Indications: biochemically hyperthyroid pt No role in euthyroid or hypothyroid pt’s RAIU produces a number .
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