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Graves' Disease. Bethesda, MD: National Endocrine and Metabolic Diseases Information Service. 2008. 8 p.
This fact sheet, from the National Endocrine and Metabolic Diseases Information Service (NEMDIS), describes Graves’ disease, the most common cause of hyperthyroidism in the United States. Hyperthyroidism is a disorder that occurs when the thyroid gland makes more thyroid hormone than the body needs. In Graves’ disease, the immune system makes antibodies called thyroid-stimulating immunoglobulin (TSI) that attach to thyroid cells. TSI mimics the action of thyroid-stimulating hormone (TSH) and stimulates the thyroid to make too much thyroid hormone. The diagnosis and treatment of Graves’ disease is often performed by an endocrinologist, a doctor who specializes in the body’s hormone-secreting glands. The fact sheet reviews the symptoms of Graves’ disease, the condition called Graves’ ophthalmopathy, who is likely to develop Graves’ disease, diagnostic approaches to Graves’ disease, and treatment options, including radioiodine therapy, medications, surgery, and eye care. Common symptoms of hyperthyroidism include nervousness or irritability, heat intolerance, rapid and irregular heartbeat, frequent bowel movements or diarrhea, weight loss, and goiter. Graves’ ophthalmopathy is characterized by inflammation and a buildup in tissue and fat behind the eye socket, causing the eyeballs to bulge. Graves’ disease is most often treated with radioiodine therapy, which gradually destroys the cells of the thyroid gland. The fact sheet concludes with a list of six resource organizations through which readers can get more information and a brief description of the activities of the NEMDIS. 1 figure.
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Hyperthyroidism. Bethesda, MD: National Endocrine and Metabolic Diseases Information Service. 2008. 8 p.
This fact sheet, from the National Endocrine and Metabolic Diseases Information Service (NEMDIS), describes hyperthyroidism, a disorder that results when the thyroid gland produces more thyroid hormone than the body needs. The fact sheet is written in a question-and-answer format and covers the anatomy and function of the thyroid, the causes of hyperthyroidism, Graves’ disease, thyroid nodules, thyroiditis, iodine ingestion, overmedicating with thyroid hormone, the symptoms of hyperthyroidism, who is at risk for developing hyperthyroidism, hyperthyroidism in the aging population, diagnostic tests to confirm the presence of thyroid disease, the thyroid-stimulating hormone (TSH) test, pregnancy and hyperthyroidism, and how hyperthyroidism is treated, including antithyroid drugs, radioiodine therapy, and thyroid surgery. Some symptoms of hyperthyroidism include nervousness or irritability, fatigue or muscle weakness, trouble sleeping, heat intolerance, hand tremors, rapid and irregular heartbeat, frequent bowel movements or diarrhea, weight loss, mood swings, and goiter, an enlarged thyroid that can cause the neck to look swollen. Treatment depends on the cause and severity of the hyperthyroidism. The aim of treatment is to bring thyroid hormone levels to a normal state, thus preventing long-term complications and relieving uncomfortable symptoms. The fact sheet concludes with a list of six resource organizations through which readers can get more information and a brief description of the activities of the NEMDIS. 1 figure. 1 table.
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Pregnancy and Thyroid Disease. Bethesda, MD: National Endocrine and Metabolic Diseases Information Service. 2008. 8 p.
This fact sheet, from the National Endocrine and Metabolic Diseases Information Service (NEMDIS), describes pregnancy and thyroid disease. Thyroid disease is a disorder that results when the thyroid gland produces more or less thyroid hormone than the body needs. Too much thyroid hormone is called hyperthyroidism or Graves’ disease; too little thyroid hormone is called hypothyroidism. The fact sheet is written in a question-and-answer format and covers the anatomy and function of the thyroid, how pregnancy normally affects thyroid function, the causes of hyperthyroidism in pregnancy, how hyperthyroidism can affect the mother and baby, how hyperthyroidism in pregnancy is diagnosed, how hyperthyroidism is treated during pregnancy, the causes of hypothyroidism in pregnancy, how hypothyroidism can affect the mother and baby, how hypothyroidism in pregnancy is diagnosed, how hypothyroidism is treated during pregnancy, and postpartum thyroiditis. If uncontrolled during pregnancy, hyperthyroidism can be dangerous to the mother and cause health problems such as congestive heart failure and poor weight gain in the baby. Hypothyroidism during pregnancy also threatens the mother’s health and can lead to developmental disabilities in the baby. Hypothyroidism in pregnancy is safely and easily treated with synthetic thyroid hormone. The fact sheet concludes with a list of six resource organizations through which readers can get more information and a brief description of the activities of the NEMDIS. 1 figure.
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Radioactive Iodine FAQ. Falls Church, VA: American Thyroid Association. 2008. 1 p.
This fact sheet outlines the use of radioactive iodine (RAI) for thyroid imaging and treatment of thyroid disorders. The author first reminds readers that iodine is essential for the proper function of the thyroid gland, which uses it to make thyroid hormones. Iodine is made into two radioactive isotopes that give off radiation for medical uses: I-123, which is harmless to thyroid cells; and I-131, which destroys thyroid cells. I-123 is used to take diagnostic pictures and determine the activity of the thyroid gland; no special precautions are required after the use of I-123. I-131 is given to destroy overactive thyroid tissue that is causing hyperthyroidism or, in larger doses, to destroy thyroid cancer cells. The fact sheet outlines the long-term risks of I-131 RAI and notes special concerns for those who receive RAI treatment. One chart lists the instructions to reduce radiation exposure to others after I-131 RAI treatment, specifying the number of days recommended for each of a variety of activities, such as returning to work, preparing food for others, traveling, and avoiding contact with small children and pregnant women. Readers are referred to the American Thyroid Association website at www.thyroid.org for more information. 1 table. 2 references.
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Thyroid Medications. Rockville, MD: Food and Drug Administration. 2008. 2 p.
This fact sheet answers common questions about thyroid medications and thyroid dysfunction. Located in the lower front part of the neck, the thyroid gland makes hormones that regulate the body’s metabolism, or how the body uses energy. The author outlines how thyroid dysfunction can affect the body and then discusses medications used to treat hyperthyroidism, hypothyroidism, how to know if the correct dosage of medication is being used, the differences between generic and name brand thyroid medications, proper medication storage and administration, and the actions the U.S. Food and Drug Administration (FDA) has taken to improve the quality of levothyroxine sodium products. Readers are encouraged to work closely with their health care providers to ensure these medications are taken appropriately and working effectively. 3 references.
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Endocrine Autoimmunity. IN: Gardner, D.; Shoback, D., eds. Greenspan’s Basic and Clinical Endocrinology. 8th ed. Columbus, OH: McGraw Hill. 2007. pp 59-79.
This chapter about endocrine autoimmunity is from a textbook about endocrinology that describes the scientific principles and clinical management of patients with endocrine-related diseases and disorders. The author reviews basic immunologic concepts as they apply to clinical autoimmune endocrine diseases as sole entities and as polyglandular failure syndromes. Topics include basic immune components and mechanisms, autoimmunity is multifactorial, single gland autoimmune syndromes, and autoimmune polyglandular syndromes. The most common autoimmune endocrine diseases are autoimmune thyroid disease, including hypothyroidism (Hashimoto’s disease) and hyperthyroidism (Graves’ disease), and type 1 diabetes. The chapter includes numerous black-and-white photographs and illustrations; a list of abbreviations is provided. 7 figures. 3 tables. 12 references.
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Endocrine Surgery. IN: Gardner, D.; Shoback, D., eds. Greenspan’s Basic and Clinical Endocrinology. 8th ed. Columbus, OH: McGraw Hill. 2007. pp 911-932.
This chapter about endocrine surgery is from a textbook about endocrinology that describes the scientific principles and clinical management of patients with endocrine-related diseases and disorders. The authors provide an overview of the principles involved in the surgical therapy for many endocrine diseases. Topics covered include the thyroid gland, embryology and anatomy, indications for surgery, developmental thyroid abnormalities, hyperthyroidism, thyroiditis, goiter (nontoxic), thyroid nodules, thyroid cancer, the techniques used for thyroidectomy, the parathyroid gland, embryology and anatomy, primary hyperparathyroidism (PHPT), persistent and recurrent primary hyperparathyroidism, secondary hyperparathyroidism, familial hyperparathyroidism, complications of parathyroid surgery, the adrenal (suprarenal) gland, primary hyperaldosteronism, hypercortisolism, adrenal cortical carcinoma, sex steroid excess, pheochromocytoma, adrenal incidentaloma, techniques used for adrenalectomy, the endocrine pancreas, tumorogenesis, insulinoma, gastrinoma (Zollinger-Ellison syndrome), vipoma (Verner-Morrison) syndrome, glucagonoma, somatostatinoma, and nonfunctioning pancreatic tumors. 5 figures. 10 tables. 47 references.
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Endocrinology of Pregnancy. IN: Gardner, D.; Shoback, D., eds. Greenspan’s Basic and Clinical Endocrinology. 8th ed. Columbus, OH: McGraw Hill. 2007. pp 641-660.
This chapter about the endocrinology of pregnancy is from a textbook about endocrinology that describes the scientific principles and clinical management of patients with endocrine-related diseases and disorders. The authors stress that the endocrine changes associated with pregnancy are adaptive, allowing the mother to nurture the developing fetus. Maternal reserves are usually adequate; however, occasionally, as in the case of gestational diabetes or hypertensive disease of pregnancy, a woman may develop overt signs of disease as a direct result of pregnancy. Topics discussed include conception and implantation, the fetal-placental-decidual unit, polypeptide hormones, steroid hormones, maternal adaptation to pregnancy, fetal endocrinology, endocrine control of parturition, endocrinology of the puerperium, endocrine disorders and pregnancy pituitary disorders, pregnancy and breast cancer, hypertensive disorders of pregnancy, hyperthyroidism in pregnancy, and hypothyroidism in pregnancy. A list of abbreviations is provided. 2 figures. 1 table. 29 references.
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Graves Disease. Chevy Chase, MD: Hormone Foundation. 2007. 1 p.
This brief fact sheet provides an overview of Graves’ disease, an immune system disease that causes the thyroid gland to enlarge and results in hyperthyroidism. Written in nontechnical language, the fact sheet answers common questions about Graves’ disease, covering topics including the anatomy and function of the thyroid gland, possible symptoms of Graves’ disease, risks associated with untreated Graves’ disease, diagnostic tests used to confirm the condition, and the role of the endocrinologist. Readers are referred to the Hormone Foundation (www.hormone.org or 1–800–HORMONE) for more information. The fact sheet is also available in Spanish. 1 figure.
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Hormone Foundation’s Patient Guide to the Management of Maternal Hyperthyroidism Before, During and After Pregnancy. Chevy Chase, MD: Hormone Foundation. 2007. 2 p.
This fact sheet provides a patient guide to the management of maternal hyperthyroidism before, during, and after pregnancy. The guide is based on clinical guidelines written to help physicians who are evaluating and treating various types of thyroid dysfunction in pregnancy. The authors note that pregnancy, even in women with no thyroid abnormalities, causes major changes in thyroid hormone levels. This fact sheet focuses on maternal hyperthyroidism, a condition in which the mother has too much of the thyroid hormones T3 and T4, sometimes called an overactive thyroid. Readers are reminded that hyperthyroidism can have harmful effects on pregnancy, so diagnosis and treatment are vital. Most cases of hyperthyroidism during pregnancy are caused by Graves’ disease. The fact sheet outlines typical symptoms of hyperthyroidism, notes risk factors for the condition, and summarizes the recommended treatments for hyperthyroidism, notably antithyroid drug therapy. Readers are referred to the Hormone Foundation (www.hormone.org or 1–800–HORMONE) for more information. 2 figures.
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Iodine Deficiency. Falls Church, VA: American Thyroid Association. 2007. 3 p.
This fact sheet answers common questions asked about iodine deficiency. Iodine is essential for the production of thyroid hormone and must come from the diet because the body does not make iodine. Iodine is found in various foods and is present naturally in soil and seawater. The fact sheet lists the symptoms of iodine deficiency, which include goiter, hypothyroidism, and pregnancy-related problems. Other topics include the causes of iodine deficiency, diagnosing iodine deficiency in populations, and treatment approaches, which focus on prevention. The author notes that individuals in the United States can maintain adequate iodine in their diet by using iodized table salt; by eating foods high in iodine, including dairy products, seafood, meat, some bread, and eggs; and by taking a multivitamin containing iodine. A final section considers problems encountered in people who take too much iodine, including causing or worsening hyperthyroidism and hypothyroidism. Readers are referred to the American Thyroid Association’s website at www.thyroid.org for more information. 2 tables.
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Management of Thyroid Dysfunction During Pregnancy And Postpartum: An Endocrine Society Clinical Practice Guideline. Journal of Clinical Endocrinology and Metabolism. 92(8): S1-S47. August 2007.
Management of thyroid disease during pregnancy requires special considerations because pregnancy induces major changes in thyroid function, and maternal thyroid disease can have adverse effects on both the pregnancy and fetus. This document presents clinical guidelines for the management of thyroid problems present during pregnancy and during the postpartum period. The guidelines were created using the methodology of the United States Preventive Service Task Force (USPSTF). The guidelines stress the importance of avoiding maternal and fetal hypothyroidism because of potential damage to fetal neural development, an increased incidence of miscarriage, and preterm delivery. Maternal hyperthyroidism and its treatment may be accompanied by problems in fetal thyroid function. Autoimmune thyroid disease is associated with increased rates of miscarriage and with postpartum thyroiditis. Radioactive isotopes, used for diagnosis and treatment, should be avoided during pregnancy and lactation. More than half of the document consists of a detailed, annotated bibliography of research studies on which the guidelines are based. 426 annotated references.
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Other Complications and Associated Conditions. Pediatric Diabetes. 8: 171-176. 2007.
This article presents information from the International Society for Pediatric and Adolescent Diabetes (ISPAD) Clinical Practice Consensus Guidelines (2006–2007) on other complications and associated conditions in children with diabetes. Topics covered include impaired growth and development; associated autoimmune conditions, such as hypothyroidism, hyperthyroidism, celiac disease, vitiligo, and primary adrenal insufficiency (Addison disease); lipodystrophy; necrobiosis lipoidica diabeticorum; limited joint mobility; and edema. The authors briefly review the literature on which their discussion is based and then summarize with a set of recommendations. They stress that monitoring of growth and physical development and the use of growth charts are essential elements in the continuous care of children and adolescents with type 1 diabetes. Screening of thyroid function and screening for celiac disease is recommended at the diagnosis of diabetes and thereafter, every second year. Routine clinical examination should be undertaken for skin and joint changes. There is no established therapeutic intervention for lipodystrophy, necrobiosis lipoidica, or limited joint mobility. 81 references.
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Thyroid Disorders. IN: Camacho, P.M.; Gharib, H.; Sizemore, G.W., eds. Evidence-Based Endocrinology. 2nd ed. Philadelphia, PA: Lippincott Williams and Wilkins. 2007. pp 31-56.
This chapter on thyroid disorders is from a concise, reference-based handbook that is intended to help busy clinicians with endocrine-related diagnostic and therapeutic decisions required in their practices. Using a modification of the McMaster criteria, the contributors to the text have critically assessed and graded studies, assisting readers in quickly evaluating the articles that have led to practice recommendations. Topics covered in this chapter include evaluation of the thyroid function, thyroid imaging, hyperthyroidism, hypothyroidism, thyroid nodules, thyroid cancer, and euthyroid sick syndrome. For each disease state included, the authors discuss etiology, epidemiology, pathophysiology, diagnosis, and treatment considerations. The chapter includes an outline and an extensive, annotated list of references. 1 table. 79 references.
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Thyroid Gland. IN: Gardner, D.; Shoback, D., eds. Greenspan’s Basic and Clinical Endocrinology. 8th ed. Columbus, OH: McGraw Hill. 2007. pp 209-280.
This chapter about the thyroid gland is from a textbook about endocrinology that describes the scientific principles and clinical management of patients with endocrine-related diseases and disorders. The authors note that the thyroid hormones promote normal fetal and childhood growth and development; regulate heart rate and myocardial contractility; affect gastrointestinal motility and renal water clearance; and modulate the body’s energy expenditure, heat generation, and weight. After a section on embryology, anatomy, and histology, the authors describe thyroid physiology, including the structure and synthesis of thyroid hormones, iodine metabolism, thyroid hormone synthesis and secretion, abnormalities in thyroid hormone synthesis and release, metabolism of thyroid hormones, control of thyroid function and hormone action, physiologic changes in thyroid function, and thyroid autoimmunity. Additional sections review tests of thyroid function and disorders of the thyroid, including hypothyroidism, hyperthyroidism and thyrotoxicosis, thyroid hormone resistance syndromes, nontoxic goiter, thyroiditis, the effects of ionizing radiation on the thyroid gland, and thyroid nodules and thyroid cancer. The chapter includes numerous black-and-white photographs and illustrations; a list of abbreviations is provided. 50 figures. 13 tables. 97 references.
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American Association of Clinical Endocrinologists and Associazione Medici Endocrinologi Medical Guidelines for Clinical Practice for the Diagnosis and Management of Thyroid Nodules. Endocrine Practice. 12(1): 63-102. January-February 2006.
This article presents medical guidelines for clinical practice for the diagnosis and management of patients with thyroid nodules. The document was prepared as a collaborative effort between the American Association of Clinical Endocrinologists (AACE) and the Associazione Medici Endocrinologi (AME); the group used the AACE protocol for clinical practice guidelines, with rating of available evidence, linking the guidelines to the strength of recommendations. Although most patients with thyroid nodules are asymptomatic, occasionally patients complain of dysphagia, dysphonia, pressure, pain, or symptoms of hyperthyroidism or hypothyroidism. Absence of symptoms does not rule out a malignant lesion, so reviewing the patient‘s risk factors for malignant disease is important. Thyroid ultrasound should not be used as a screening test; however, all patients with a palpable thyroid nodule should undergo ultrasound examination. The introduction of sensitive thyrotropin—thyroid-stimulating hormone, or TSH—assays, the widespread application of fine-needle aspiration (FNA) biopsy, and the availability of high-resolution ultrasound have substantially improved the management of thyroid nodules. The guidelines also include suggestions for thyroid nodule management during pregnancy. 2 figures. 22 tables. 142 references.
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Celiac Disease and Thyroid Conditions. Auburn, WA: Gluten Intolerance Group. December 2006. 2 p.
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Drug Insight: Renal Indications of Calcimimetics. Nature Clinical Practice Urology. 2(6): 316-325. June 2006.
Calcimimetics suppress the secretion of parathyroid hormone by sensitizing the parathyroid calcium receptor to serum calcium. This review article focuses on the role of calcimimetic drugs such as cinacalcet in the treatment of uremic secondary hyperparathyroidism. The authors present evidence to support their assertion that cinacalcet plus higher doses of calcium-based oral phosphate binders is a safe and effective alternative to currently recommended regimens. Other indications for calcimimetic drugs, such as predialysis secondary hyperparathyroidism and hypercalcemic hyperparathyroidism following kidney transplantation, are discussed. Cinacalcet has been approved for treatment of dialysis patients with secondary hyperthyroidism. 54 references.
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Graves’ Disease. National Women’s Health Information Center. 2006. 3 p.
This fact sheet answers common questions about Graves’ disease, a type of autoimmune disease that causes overactivity of the thyroid gland, causing hyperthyroidism. The fact sheet describes the characteristics of an autoimmune disease; the symptoms of Graves’ disease; risk factors for the condition, including heredity; diagnostic tests used to confirm the presence of hyperthyroidism; treatment options; complications of Graves’ in untreated patients; and concerns for women with Graves’ who become pregnant. Treatment strategies for Graves’ disease include medications, notably antithyroid drugs; radioactive iodine, which damages thyroid cells to reduce hormone levels; and surgery, usually consisting of thyroidectomy. Patients are cautioned that they will have to take thyroid hormone supplements after any treatment that destroys the thyroid completely. Readers are referred to three resource organizations for more information: the Graves’ Disease Foundation of America (www.ngdf.org), the American Thyroid Association (www.thyroid.org), and the Thyroid Foundation of America (www.allthyroid.org).
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Hyperthyroidism. Jacksonville, FL: American Association of Clinical Endocrinologists (AACE). 2006. 2p.
This fact sheet reviews hyperthyroidism, a condition that develops when the body is exposed to excessive amounts of thyroid hormone. When hyperthyroidism develops, a goiter—enlargement of the thyroid—is usually present and may be associated with other symptoms including fast heart rate, anxiousness, irritability, trembling hands, weight loss, intolerance of warm temperatures, loss of scalp hair, muscle weakness, change in bowel and menstrual patterns, and protrusion of the eyes. The fact sheet reviews the causes of hyperthyroidism, including Graves' disease, toxic multinodular goiter, toxic nodule, subacute thyroiditis, postpartum thyroiditis, silent thyroiditis, excessive iodine ingestion, and overmedication with thyroid hormone. The fact sheet also explains some of the diagnostic tests that may be used to confirm hyperthyroidism and then considers treatment options, including antithyroid drugs, radioactive iodine treatment, and surgical removal of the thyroid. The fact sheet concludes that appropriate management of hyperthyroidism requires careful evaluation and ongoing care by a physician experienced in the treatment of this complex condition. Readers are referred to www.thyroidawareness.com for more information.
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Radioiodine Therapy. Jacksonville, FL: American Association of Clinical Endocrinologists (AACE). 2006. 2p.
This fact sheet reviews the use of radioactive iodine, or radioiodine, used to treat thyroid cancer or an overactive thyroid gland, called hyperthyroidism. The fact sheet briefly reviews the physiology of the thyroid gland and the development of radioiodine as a treatment. The fact sheet then reviews how radioiodine is used in people who have hyperthyroidism to destroy the diseased thyroid gland. This results in the intentional development of an underactive thyroid state, called hypothyroidism, which is easily, predictably, and inexpensively corrected by lifelong daily use of oral thyroid hormone replacement therapy. The fact sheet goes on to explain what people with thyroid cancer can expect after removal of their thyroid and during follow-up. The remainder of the fact sheet answers common questions about radioiodine therapy, including what happens to the radioiodine after a treatment, breast-feeding during treatment, future pregnancies after radioiodine treatment, outpatient versus hospital treatment, and exposure to others after treatment with radioiodine. Readers are referred to www.thyroidawareness.com for more information.
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Thyroid Disorders. IN: Nilsson, K.R.; Piccini, J.P., eds. Osler Medical Handbook. Philadelphia, PA: Saunders. 2006. pp. 321-334.
This chapter on thyroid disorders is from a handbook that provides the essentials of diagnosis and treatment, as well as the latest in evidence-based medicine, for residents working bedside, in-patient care. The chapter begins with a presentation of essential Fast Facts and concludes with Pearls and Pitfalls useful to the practicing internist. The body of the chapter is divided into sections: Epidemiology, Clinical Presentation, Diagnosis, and Management. Specific topics covered in this chapter include the use of thyroid-stimulating hormone (TSH) level as an index of thyroid function; primary hypothyroidism, which is characterized by an elevated TSH level in conjunction with a low thyroxine level; primary hyperthyroidism, which is characterized by a low TSH level in conjunction with an elevated thyroxine level; screening recommendations; levothyroxine replacement therapy used to treat hypothyroidism; the use of beta-blockers, antithyroid drugs, or radioactive iodine ablation therapy to treat hyperthyroidism; and amiodarone-induced thyroid dysfunction. The chapter concludes with a list of references, each labeled with a 'strength of evidence' grade to help readers determine the type of research available in that reference source. 2 figures. 4 tables. 21 references.
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Thyroid Nodule. Jacksonville, FL: American Association of Clinical Endocrinologists (AACE). 2006. 2p.
This fact sheet reviews the problem of thyroid nodules, a lump in or on the thyroid gland. Thyroid nodules are common and are detected in about 6.4 percent of women and 1.5 percent of men; they are less common in younger patients and occur 10 times as often in older individuals, but are usually not diagnosed. Nodules can be caused by a simple overgrowth of normal thyroid tissue; fluid-filled cysts; inflammation, called thyroiditis; or a tumor, either benign or cancerous. The fact sheet explains the three diagnostic tests that are used to determine which nodules must be removed surgically: thyroid fine needle biopsy, thyroid scan, and thyroid ultrasonography. The best use of thyroid ultrasonography is in guiding the placement of a biopsy needle to decrease the frequency of inadequate specimens. The fact sheet concludes with a brief explanation of the treatments that may be indicated, depending on the results of the tests described. Readers are referred to www.thyroidawareness.com for more information.
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Endocrine Dysfunction in Chronic Kidney Disease. In: Clinical Dialysis. 4th ed. New York, NY: McGraw-Hill. 2005. pp. 795-830.
Patients with advanced chronic kidney disease (CKD) may display a wide range of hormonal and metabolic disturbances. There may be abnormalities in both the secretion and metabolism of the endocrine hormones as well as target-organ sensitivity to these hormones. This chapter on endocrine dysfunction in CKD is from a comprehensive textbook on the clinical management of patients on dialysis. The authors focus on the abnormalities of pancreatic, thyroid, adrenal, and gonadal hormones (derangements in parathyroid hormone, vitamin D, and erythropoietin metabolism are discussed in other chapters). Topics include carbohydrate and insulin metabolism; the problem of hypoglycemia (low blood glucose); insulin requirements in patients on dialysis; carbohydrate intolerance after kidney transplantation; thyroid hormone and iodide metabolism; normal thyroid hormone physiology; the management of patients with uremia who do not have hypothalamic, pituitary, or thyroid diseases; the management of patients with uremia who have goiter, thyroid nodules, thyroid cancer, hypothyroidism, or hyperthyroidism; the role of cortisol; aldosterone secretion in CKD, including that in patients on dialysis and posttransplantation; and the hypothalamic-pituitary-gonadal axis, including sexual dysfunction in prepubertal boys and men with CKD, sexual dysfunction in girls and adult women with CKD, the effect of dialysis therapy, and the effect of kidney transplantation. 12 figures. 7 tables. 307 references.
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Enfermedad De Graves’ [Graves’ Disease]. Falls Church, VA: American Thyroid Association. 2005. 2 p.
This Spanish language fact sheet answers common questions about Graves’ disease, a type of hyperthyroidism that is caused by a generalized overactivity of the entire thyroid gland. The fact sheet reviews the symptoms of Graves’ disease, eye disease associated with Graves’, skin disease called pretibial myxedema, the role of the immune system in causing Graves‘ disease, diagnostic tests that can confirm the presence of Graves’ disease, treatment options, including antithyroid drugs, radioactive iodine, or surgery, the anticipated outcome of treatment, and risk factors for other members of the family, with screening recommendations. The fact sheet stresses that hyperthyroidism due to Graves’ disease is usually easily controlled and safely treated, and treatment is usually successful. Readers are referred to the American Thyroid Association (www.thyroid.org) for more information. The fact sheet is also available in English.
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Graves’ Disease. Falls Church, VA: American Thyroid Association. 2005. 2 p.
This fact sheet answers common questions about Graves’ disease, a type of hyperthyroidism that is caused by a generalized overactivity of the entire thyroid gland. The fact sheet reviews the symptoms of Graves’ disease; eye disease associated with Graves’ disease; skin disease called pretibial myxedema; the role of the immune system in causing Graves’ disease; diagnostic tests that can confirm the presence of Graves’ disease; treatment options, including antithyroid drugs, radioactive iodine, or surgery; the anticipated outcome of treatment; and risk factors for other members of the family, with screening recommendations. The fact sheet stresses that hyperthyroidism due to Graves’ disease is usually easily controlled and safely treated, and treatment is usually successful. Readers are referred to the American Thyroid Association (www.thyroid.org) for more information. The fact sheet is also available in Spanish.
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Guide to Care for Patients: Thyroid Disorders. Nurse Practitioner. 30(6): 1-2. June 2005.
This brochure provides information for readers newly diagnosed with thyroid disorders. The brochure first reviews how the thyroid works, then discusses the physiology of underactive and overactive thyroid glands. Topics include the symptoms of thyroid disease, the role of the autoimmune system in thyroid disease, diagnostic approaches used to confirm the presence of thyroid disease, and treatment options. Treatments can include the use of thyroid hormone replacement (the synthetic hormone levothyroxine) for hypothyroidism and radioactive iodine for hyperthyroidism. Simple line drawings illustrate the anatomy of the thyroid and a recommended self-check for thyroid problems. 4 figures.
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Hyperthyroidism. Falls Church, VA: American Thyroid Association. 2 p. 2005.
This fact sheet answers common questions about hyperthyroidism, defined as any condition in which there is too much thyroid hormone in the body. Topics covered include the symptoms of hyperthyroidism, the role of thyroid hormone in the body, metabolism, Graves’ disease, the causes of hyperthyroidism, diagnostic tests used to confirm the condition, and treatment options, including antithyroid drugs, radioactive iodine, and surgery. A final section discusses the use of beta blockers, drugs that block the action of thyroid hormone on the body, even though they do not reduce the actual levels of the hormone. The fact sheet reminds readers to consider having family members screened for hyperthyroidism because the condition can run in families. Readers are referred to the American Thyroid Association (www.thyroid.org) for more information. The fact sheet is also available in Spanish.
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La Enfermedad De La Tiroides Y El Embarazo [Thyroid Disease and Pregnancy]. Falls Church, VA: American Thyroid Association. 2005. 4 p.
This Spanish language fact sheet reviews thyroid disease and pregnancy. Written in nontechnical language, the fact sheet answers common questions about thyroid function, hyperthyroidism and pregnancy, and hypothyroidism and pregnancy. Specific topics include the normal changes in thyroid function associated with pregnancy, the interaction between the thyroid function of the mother and the baby, the most common causes of hyperthyroidism during pregnancy, the risks of Graves’ disease to the mother and to the baby, treatment options for a pregnant woman with Graves’ disease, breastfeeding while on anti-thyroid drugs, the most common causes of hypothyroidism during pregnancy, the risks of hypothyroidism to the mother and the fetus, and treating hypothyroidism in a pregnant woman. Readers are referred to the American Thyroid Association website (www.thyroid.org) for additional information. The fact sheet is also available in English. 1 table.
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Thyroid And Weight. Falls Church, VA: American Thyroid Association. 2005. 2 p.
A complex relationship exists between thyroid disease, body weight, and metabolism. This fact sheet answers common questions about this relationship and discusses the diagnostic tests used to measure metabolism, the use of the basal metabolic rate (BMR), the relationship between BMR and weight, energy balance and caloric intake, the role of other hormones besides the thyroid hormone, the relationship between hyperthyroidism and weight, weight gain during treatment for hyperthyroidism, weight loss after hypothyroidism if appropriately treated, and the use of thyroid hormones as a weight loss tool. Readers are referred to the American Thyroid Association (www.thyroid.org) for more information.
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Thyroid Disease and Pregnancy. Falls Church, VA: American Thyroid Association. 2005. 3 p.
This fact sheet reviews thyroid disease and pregnancy. Written in nontechnical language, the fact sheet answers common questions about thyroid function, hyperthyroidism and pregnancy, and hypothyroidism and pregnancy. Specific topics include the normal changes in thyroid function associated with pregnancy, the interaction between the thyroid function of the mother and the baby, the most common causes of hyperthyroidism during pregnancy, the risks of Graves’ disease to the mother and to the baby, treatment options for a pregnant woman with Graves’ disease, breastfeeding while on anti-thyroid drugs, the most common causes of hypothyroidism during pregnancy, the risks of hypothyroidism to the mother and the fetus, and treating hypothyroidism in a pregnant woman. Readers are referred to the American Thyroid Association website (www.thyroid.org) for additional information. The fact sheet is also available in Spanish. 1 table.
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Thyroid Disease in the Older Patient. Falls Church, VA: American Thyroid Association. 2 p. 2005.
This fact sheet answers common questions about thyroid disease in older adults. The fact sheet first presents brief synopses of symptoms in six representative older adults; three adults’ symptoms are due to hyperthyroidism and three to hypothyroidism. All six patients presented with different symptoms. The author notes that an important clue to the presence of thyroid disease in an older adult is a history of thyroid disease in another close family member. The fact sheet discusses the diagnosis and treatment of hyperthyroidism, and the diagnosis and treatment of hypothyroidism. The author concludes by cautioning that despite the increased frequency of thyroid problems in older adults, physicians need a high index of suspicion to make the diagnosis because thyroid disorders often look like a disorder of another system in the body. Readers are referred to the American Thyroid Association (www.thyroid.org) for more information.
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Thyroid Function Tests. Falls Church, VA: American Thyroid Association. 2005. 2 p.
This fact sheet reviews thyroid function tests, which are used to diagnose thyroid problems and monitor patients receiving medication for thyroid problems. Written in nontechnical language, the fact sheet answers common questions about the anatomy and function of the thyroid gland, and the tests used to evaluate thyroid function. Specific tests discussed include TSH tests, T4 tests, T3 tests, thyroid antibody tests, radioactive iodine uptake, and thyroid scan. A figure illustrates the normal interplay between the thyroid and pituitary glands, as well as how it is changed in hyperthyroidism and hypothyroidism. Readers are referred to the American Thyroid Association website (www.thyroid.org) for additional information. 1 figure.
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Thyroiditis. Falls Church, VA: American Thyroid Association. 2005. p.
This fact sheet answers common questions about thyroiditis, a general term that means inflammation of the thyroid gland. The author notes that thyroiditis includes a group of individual disorders that all cause thyroidal inflammation and thus create many different clinical presentations. The fact sheet discusses the clinical symptoms of thyroiditis, including hypothyroidism, thyrotoxicosis, and hyperthyroidism; the causes of thyroiditis, including autoimmune disease, infection, and medications; the typical clinical course of different types of thyroiditis, including Hashimoto’s thyroiditis, painless and postpartum thyroiditis, subacute thyroiditis, drug-induced and radiation thyroiditis, and acute or infectious thyroiditis; and treatment options, including those for thyrotoxicosis, hypothyroidism, and thyroidal pain. Readers are referred to the American Thyroid Association (www.thyroid.org) for more information. The fact sheet is also available in Spanish. 1 table.
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Endocrinology. New York, NY: Elsevier Science, Inc. 2003. 737 p.
This book on endocrinology is from a series that provides the latest on evaluation, diagnosis, management, outcomes and prevention. The book offers concise, action-oriented recommendations for primary care medicine. It includes MediFiles (sections) on acromegaly, Addison's disease (hypoaldosteronism), Cushing's syndrome, diabetes insipidus, type 1 diabetes mellitus, type 2 diabetes mellitus, diabetic ketoacidosis, Gilbert's disease, gynecomastia, hirsutism, hypercalcemia, hyperkalemia, hyperthyroidism, hypocalcemia, hypokalemia, hyponatremia, hypopituitarism, hypothyroidism, Klinefelter's syndrome, osteomalacia and rickets, osteoporosis, pheochromocytoma, polycystic ovarian syndrome, precocious puberty, thyroid carcinoma, thyroid nodule, thyroiditis, and Turner's syndrome. Each MediFile covers summary information and background on the condition, and comprehensive information on diagnosis, treatment, outcomes, and prevention. Each section concludes with a list of resources.
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Hyperthyroidism. In: PDxMD. Endocrinology. New York, NY: Elsevier Science, Inc. 2003. p. 341-365.
Hyperthyroidism refers to conditions caused by excessive thyroid hormone produced by the thyroid gland. This chapter on hyperthyroidism is from a book on endocrinology that offers concise, action-oriented recommendations for primary care medicine. The chapter covers summary information and background on the condition, and comprehensive information on diagnosis, treatment, outcomes, and prevention. Specific topics covered include the ICD9 code, urgent action, cardinal features, causes (etiology), epidemiology, differential diagnosis, signs and symptoms, associated disorders, investigation of the patient, appropriate referrals and consultations, diagnostic considerations, clinical tips, treatment options, patient management and caregiver issues, drug therapies, prognosis, complications, lifestyle considerations, risk factors, and how to prevent recurrence. The information is provided in outline and bulleted format, for ease of accessibility. The final section of the chapter offers resources, including related associations, key references, and the answers to frequently asked questions (FAQs). 5 references.
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Constipation: Getting Relief. San Bruno, CA: StayWell Company. 2002. [2 p.].
This patient education brochure describes constipation and its treatment. Written in nontechnical language, the brochure first defines constipation as bowel movements that occur less often than usual or the need to strain to pass hard, dry stool. Symptoms of constipation include a feeling of fullness in the rectum, bloating and gas, feeling the urge but being unable to pass stool, abdominal pain and cramping, and nausea. One of the main causes of constipation is a diet that is too low in dietary fiber and water. Other causes can include travel (and changes in diet and bowel habits), pregnancy, too little exercise, misuse of laxatives, side effects of certain medications, systemic diseases (diabetes or hyperthyroidism, for example), and ignoring the urge to have a bowel movement. Diagnosis will include the patient's medical history and some diagnostic tests such as sigmoidoscopy and barium enema. Most treatment plans focus on increasing dietary fiber, getting regular exercise, and avoiding chronic laxative use. One section of the brochure illustrates and describes the physiology of normal bowel movements and what happens in constipation. The last page of the brochure summarizes the recommendations for increasing dietary fiber. The brochure is illustrated with full color line drawings. 7 figures.
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Thyroid Disease and Diabetes. Diabetes Spectrum. 15(3): 143. 2002.
Diabetes and thyroid disease are both endocrine, or hormone, problems. This patient education handout reviews the interplay of thyroid disease, mostly hypothyroidism, and diabetes. When thyroid disease occurs in someone with diabetes, it can make blood glucose control more difficult. The handout reviews the symptoms of hyperthyroidism and hypothyroidism, the effects of each on diabetes, diagnostic tests used to confirm these conditions, and treatment options.
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Thyroid Disorders and Diabetes. Diabetes Self-Management. 18(3): 6-12. May-June 2001.
This article discusses the occurrence of thyroid disorders among people who have diabetes. The thyroid, a butterfly shaped gland located in the neck, plays a main role in the regulation of metabolism, so abnormal thyroid function can have a major effect on the control of diabetes. Untreated thyroid disorder can increase the risk of certain diabetic complications and aggravate many diabetes symptoms. The thyroid produces thyroxine and triiodothyronine. These hormones enter the bloodstream and affect the metabolism of the heart, liver, muscles, and other organs. Any changes in the blood level of thyroid hormones can affect many body systems and cause various symptoms. The basic disorders of the thyroid are hypothyroidism, or an underactive thyroid gland, and hyperthyroidism, or an overactive thyroid gland. The causes of hypothyroidism include the surgical removal of the thyroid, exposure to radiation, and use of certain drugs. The symptoms and effects of hypothyroidism can vary greatly depending on the age and gender of the affected person. The most common cause of hyperthyroidism in people under 40 years old is Graves disease. Other causes include thyroid nodules and thyroiditis. The symptoms of hyperthyroidism are varied and can be vague. People who have diabetes have an increased risk of developing thyroid disorder. Although both hyperthyroidism and hypothyroidism can affect the course of diabetes, their effects are somewhat different. Hyperthyroidism is usually associated with worsening blood glucose control and increased insulin requirements, whereas hypothyroidism rarely causes significant changes in blood glucose control but is accompanied by various abnormalities in blood lipid levels. Pregnant women who have diabetes have a greater risk of pregnancy related thyroid dysfunction, so they should be monitored closely. The most reliable test to diagnose thyroid disease is the thyroid stimulating hormone blood test. The treatment for hypothyroidism is to replace the missing thyroid hormone with a synthetic thyroid hormone derivative. Hyperthyroidism can be treated with oral antithyroid medicines, radioactive iodine therapy, or surgery to remove the gland. The article includes a list of additional resources.
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