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Acromegaly. Bethesda, MD: National Endocrine and Metabolic Diseases Information Service. 2008. 10 p.
This fact sheet, from the National Endocrine and Metabolic Diseases Information Service (NEMDIS), describes acromegaly, a hormonal disorder that results from too much growth hormone (GH) in the body. Usually, the excess GH comes from benign, or noncancerous, tumors on the pituitary gland. The fact sheet is written in a question-and-answer format and covers the causes of acromegaly, the symptoms of this disorder, pituitary and nonpituitary tumors, the incidence of acromegaly, diagnostic tests used to confirm the condition, and treatment options, including surgical removal of the tumor, medical therapy, and radiation therapy of the pituitary. Common features of acromegaly include abnormal growth of the hands and feet; bone growth in the face that leads to a protruding lower jaw and brow and an enlarged nasal bone; joint aches; thick, coarse, oily skin; and enlarged lips, nose, and tongue. Acromegaly can cause sleep apnea, fatigue and weakness, headaches, impaired vision, menstrual abnormalities in women, and erectile dysfunction in men. Acromegaly is diagnosed through a blood test. Magnetic resonance imaging (MRI) of the pituitary is then used to locate and detect the size of the tumor causing GH overproduction. The fact sheet concludes with a list of three resource organizations through which readers can get more information and a brief description of the activities of the NEMDIS. 1 figure. 9 references.
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Hypothyroidism FAQ. Falls Church, VA: American Thyroid Association. 2008. 1 p.
This fact sheet outlines the symptoms, causes, diagnosis, and treatment of hypothyroidism, a condition that occurs when the thyroid gland produces too little thyroid hormone. Symptoms can include feeling tired, depressed, sluggish, or cold; having dry skin and hair; being constipated; experiencing muscle cramps; gaining weight; or, for women, having a heavier menstrual flow. Some patients have a goiter, a swelling in the front of the neck, due to thyroid enlargement. In the United States, most hypothyroidism is caused by Hashimoto’s thyroiditis, a condition in which the patient’s immune system attacks and destroys the thyroid. Diagnosis is based on symptoms, a physical examination, and laboratory tests that measure the amount of thyroid-stimulating hormone (TSH), thyroxine, and antithyroid antibodies. Treatment usually consists of a daily oral dosage of synthetic thyroxine. The fact sheet concludes by recommending regular annual follow-up by a health care provider to check hormone levels and make sure the drug therapy dosage is correct. Readers are referred to the American Thyroid Association website at www.thyroid.org for more information. 3 references.
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Hypothyroidism. 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 hypothyroidism, a disorder that results when the thyroid gland produces less 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 hypothyroidism, Hashimoto’s disease, thyroiditis, congenital hypothyroidism, surgical removal of the thyroid, radiation treatment of the thyroid, medications that can lead to hypothyroidism, the symptoms of hypothyroidism, who is at risk for developing hypothyroidism, diagnostic tests to confirm the presence of thyroid disease, the thyroid-stimulating hormone (TSH) test, pregnancy and hypothyroidism, and how hypothyroidism is treated. Hypothyroidism is most often caused by Hashimoto’s disease, an autoimmune disorder, and usually affects women. Some symptoms of hypothyroidism are fatigue, weight gain, cold intolerance, constipation, impaired fertility, and depression. Hypothyroidism is easily treated with synthetic thyroid hormone. The fact sheet concludes with a list of five 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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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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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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Alopecia Universalis Following Interferon Alfa-2b And Ribavirin Treatment for Hepatitis C. Gastroenterology and Hepatology. 3(8): 644-647. August 2007.
There are many cutaneous side effects associated with the use of combination pegylated interferon alfa-2b (PEG-IFN) and ribavirin (RBV) therapy, which are used to treat hepatitis C. The cutaneous side effects commonly include local reactions at the injection site and development of worsening lichen planus, psoriasis, and vitiligo. This article describes a case report of alopecia universalis (AU) following hepatitis C treatment with PEG-IFN and RBV. The case patient was a 45-year-old Caucasian woman with chronic hepatitis C (CHC) whose past medical history was significant only for hypothyroidism and whose physical examination was unremarkable before starting treatment with PEG-IFN/RBV. After 12 weeks of treatment, her hepatitis C virus RNA level was undetectable and her treatment course was rather typical, although she developed mild anemia. At 45 weeks, the patient reported a significant amount of hair loss from her scalp, which progressed to include her eyebrows and hair on her upper and lower extremities, followed by hair loss in axillary and pubic areas at the end of treatment at 48 weeks. A dermatologist who evaluated the patient diagnosed her condition as AU, confirmed by skin biopsy that showed multiple hair bulbs surrounded and focally infiltrated by a chronic inflammatory cell reaction. Even 1 year after therapy discontinuation, there was no hair regrowth in this patient. The authors briefly discuss the pathogenesis and etiology of AU, noting that their patient started to have hair regrowth after 1 year, without specific treatment for her AU. They conclude that, considering the benign and reversible nature of AU associated with PEG-IFN/RBV treatment, patients should not be discouraged to initiate or complete their treatment for CHC. Appended to the article is a commentary written by Taliani and Biliotti; they echo the conclusions reached by the reporting authors. 32 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 Hypertension. IN: Gardner, D.; Shoback, D., eds. Greenspan’s Basic and Clinical Endocrinology. 8th ed. Columbus, OH: McGraw Hill. 2007. pp 396-420.
This chapter about endocrine hypertension 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 although the kidney is not an endocrine organ per se, its role as both the origin of and target tissue for the hormones that comprise the renin-angiotensin-aldosterone system make hypertensive disorders of kidney origin an appropriate subject for a chapter on endocrine hypertension. Hypertension can be a prominent feature of other endocrine disorders, including acromegaly, thyrotoxicosis, hypothyroidism, and hyperparathyroidism, but these are discussed elsewhere in the text. In this chapter, the authors discuss the synthesis, metabolism, and action of mineralocorticoid hormones; the pathogenesis of mineralocorticoid hypertension; aldosterone and the heart; primary aldosteronism; syndromes due to excess deoxycorticosterone production; Cushing’s syndrome; pseudohyperaldosteronism; hypertension of renal origin; the renin-angiotensin system and hypertension; and other hormone systems and hypertension, including insulin, the natriuretic peptides, nitric oxide, endothelin, the kallikrein-kinin system, and the sympathetic nervous system. The chapter includes numerous black-and-white photographs and illustrations; a list of abbreviations is provided. 11 figures. 1 table. 15 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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Hashimoto’s Disease Chevy Chase, MD: Hormone Foundation. 2007. 1 p.
This brief fact sheet provides an overview of Hashimoto’s disease, an autoimmune disease that causes the thyroid gland to enlarge and results in hypothyroidism. Written in nontechnical language, the fact sheet answers common questions about Hashimoto’s disease, covering topics including the anatomy and function of the thyroid gland, possible symptoms of Hashimoto’s disease, risks associated with untreated Hashimoto’s 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 Hypothyroidism 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 hypothyroidism 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 hypothyroidism, a condition in which the mother has too little thyroid hormone. Readers are reminded that hypothyroidism can have harmful effects on pregnancy, so diagnosis and treatment are vital. Most cases of hypothyroidism worldwide are caused by not enough iodine in the diet. Although this is less common in the United States, the demands of pregnancy and breastfeeding increase the need for iodine. Another cause of hypothyroidism is Hashimoto’s thyroiditis, an autoimmune disease. The fact sheet reviews the typical symptoms of hypothyroidism, postpartum thyroiditis, recommended diagnostic tests during prenatal care, risk factors for thyroid disease, and treatment strategies. 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 FAQ. Falls Church, VA: American Thyroid Association. 2007. 1 p.
This brief 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 offers ideas for further reading, including the American Thyroid Association’s website at www.thyroid.org. 4 references.
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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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Natural History of Obesity: Differential Diagnosis, Clinical Types, and Age-Related Changes. IN: Bray, G.A. Metabolic Syndrome and Obesity. Totowa, NJ: Humana Press. 2007. pp 93-122.
This chapter about the natural history of obesity is from a book that presents an up-to-date survey of the current scientific understanding of obesity and the metabolic syndrome, as well as an overview of the most significant changes in the field in the past 30 years. This chapter is a transition from the basic concepts already discussed to a consideration of the types of clinical settings that are associated with increasing body fat. The author begins with the importance of including genetic factors as part of the discussion of the differential diagnosis of obesity. Polygenic causes of excess body fat include congenital disorder or genetic syndromes causing excess fat; and neuroendocrine causes of overweight can include hypothalamic causes of overweight, Cushing's syndrome, polycystic ovary syndrome (POS), growth hormone deficiency, hypothyroidism, and hyperparathyroidism. The chapter looks at age-related events that can precipitate increasing rates of fat deposition. The author stresses that weight gain in different times of life often has different causes. One section considers behavioral, psychological, and social factors, including restrained eating, binge-eating disorder, night-eating syndrome, socioeconomic factors, and ethnic factors. The chapter includes an outline, figures and tables; it concludes with an extensive list of references. 8 figures. 7 tables. 100 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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Disorders of the Thyroid Gland. IN: Jameson, J.L., ed. Harrison’s Endocrinology. Columbus, OH: McGraw Hill. 2006. pp 71-112.
This chapter on disorders of the thyroid gland is from a textbook that offers a comprehensive, practical look at the field of endocrinology. The thyroid hormones, thyroxine and triiodothyronine, play a critical role in cell differentiation during development and help maintain thermogenic and metabolic homeostasis in the adult. Disorders of the thyroid gland result primarily from autoimmune processes that either stimulate the overproduction of thyroid hormones––thyrotoxicosis––or cause glandular destruction and hormone deficiency––hypothyroidism. The authors discuss anatomy and development; regulation of the thyroid axis; thyroid hormone synthesis, metabolism, and action; hypothyroidism; thyrotoxicosis, including Graves' disease; thyroiditis; sick euthyroid syndrome; amiodarone effects on thyroid function; thyroid function in pregnancy; goiter and nodular thyroid disease; benign neoplasms; and thyroid cancer. The chapter includes full-color illustrations and black-and-white photographs. 13 figures. 12 tables. 15 references.
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Evaluation and Treatment of Constipation in Infants and Children. American Family Physician. 73(3): 479-480. February 1, 2006.
This article reviews the evaluation and treatment of constipation in infants and children, a problem that is usually functional and the result of stool retention. However, the authors encourage family physicians to be alert for indications of the presence of an uncommon but serious organic cause of constipation, such as Hirschsprung's disease, also called congenital aganglionic megacolon; pseudo-obstruction; spinal cord abnormality; hypothyroidism; diabetes insipidus; cystic fibrosis; gluten enteropathy; or congenital anorectal malformation. Functional constipation is treated with disimpaction using oral or rectal medication. Polyethylene glycol is effective and well-tolerated, but a number of alternatives are also available. After disimpaction, children may need to be on a maintenance program for months to years because relapse of functional constipation is common. Education of the family and, when possible, the child is important for improving functional constipation. Cow's milk may promote constipation in some children, so a trial period of withholding milk may be considered. Adding fiber to the diet is another recommended strategy. The authors conclude that, despite treatment, only 50 to 70 percent of children with functional constipation demonstrate long-term improvement. Two patient care algorithms are provided. 2 figures. 6 tables. 18 references.
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Haematological Changes in Systematic Disease. IN: Hoffbrand, A.V.; Moss, P.A.H.; Pettit, J.E. Essential Haematology. 5th ed. Williston, VT: Blackwell Publishing Inc. 2006. pp. 320-336.
This chapter on hematological changes in systemic disease is from a hematology textbook that offers a comprehensive look at the biochemical, physiological, and immunological processes involved in normal blood cell formation and function and the disturbances that may occur in different diseases. The authors discuss anemia associated with chronic disorders, malignant diseases, rheumatoid arthritis, renal failure, liver disease, hypothyroidism, infections, and inborn errors of metabolism. For each condition, the authors describe the symptoms, diagnostic tests used, and treatment strategies. A final section considers nonspecific monitoring of systemic disease, including the use of the erythrocyte sedimentation rate, plasma viscosity, and C-reactive protein tests. The chapter features full-color photographs and illustrations. 13 figures. 6 tables. 7 references.
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Hypothyroidism. Jacksonville, FL: American Association of Clinical Endocrinologists (AACE). 2006. 2p.
This fact sheet reviews the problem of hypothyroidism, a condition that occurs when the thyroid gland produces less than the normal amount of thyroid hormones. The fact sheet first reviews the symptoms of hypothyroidism, which can include pervasive fatigue, drowsiness, forgetfulness, difficulty with learning, dry hair and nails, dry skin, puffy face, constipation, sore muscles, weight gain, heavy menstrual flow, and increased sensitivity to many medications. The fact sheet then considers the causes of hypothyroidism, which can include autoimmune disease such as Hashimoto's thyroiditis, radioactive iodine treatment, spontaneous onset, thyroid operation, medications, subacute thyroiditis, postpartum thyroiditis, congenital condition, and pituitary hypothyroidism. The fact sheet also reviews the diagnostic tests that may be used to confirm hypothyroidism and treatment, which is usually a single daily dose of levothyroxine given as a tablet. The author cautions that thyroid hormone acts very slowly in the body, so it may take several months of treatment to notice improvement in symptoms. Periodic monitoring of thyroid-stimulating hormone (TSH) levels and clinical status are necessary to ensure the proper dose is being given because medication doses may have to be adjusted from time to time. 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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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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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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Hypothyroidism. Falls Church, VA: American Thyroid Association. 2005. 2 p.
This fact sheet answers common questions about hypothyroidism, defined as an underactive thyroid gland. Causes of hypothyroidism can include autoimmune disease, surgical removal of the thyroid, and radiation treatment. The fact sheet discusses the typical symptoms of hypothyroidism, including feeling cold, fatigue, constipation, and depression. The fact sheet emphasizes the importance of telling family members and health care providers about the presence of hypothyroidism. Other topics include the chronic nature of hypothyroidism and how it can be managed over a lifetime to avoid complications; the causes of hypothyroidism, including autoimmune disease, surgery removal of the thyroid gland, radiation treatment, congenital hypothyroidism, thyroiditis, drug side effects, too much or too little iodine, damage to the pituitary gland, and rare disorders that infiltrate the thyroid; diagnostic tests used to confirm the condition; and treatment options, notably with thyroxine replacement. A final section reminds readers of the importance of follow up and regular medical care, as well as knowing when to contact a health care provider for problems with thyroxine treatment. 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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Postpartum Thyroiditis. Falls Church, VA: American Thyroid Association. 2005. 1 p.
This fact sheet answers common questions about postpartum thyroiditis, an inflammation of the thyroid that occurs in women after the delivery of a baby. Thyroiditis can cause both thyrotoxicosis, which is high thyroid hormone levels in the blood, and hypothyroidism, which is low thyroid hormone levels in the blood. The normal pattern in postpartum thyroiditis is thyrotoxicosis, followed by hypothyroidism. Topics covered include the causes of postpartum thyroiditis, the role of the immune system, the incidence of postpartum thyroiditis in the United States, risk factors for developing postpartum thyroiditis, the clinical course of the condition, and treatment options, which vary depending on the phase of thyroiditis and the degree of symptoms that patients exhibit. The author stresses that it is important to try to discontinue thyroid hormone after postpartum thyroiditis because 80 percent of patients will regain normal thyroid function and not require chronic therapy after approximately 6 to 12 months. Readers are referred to the American Thyroid Association (www.thyroid.org) for more information.
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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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Hyponatremia: How to Recognize the Cause Promptly and Avoid Treatment Pitfalls. Consultant. 43(7): 861-865, 869-870. June 2003.
This article discusses the diagnosis and treatment of hyponatremia (low levels of sodium in the blood). The authors recommend that to identify the cause of hyponatremia, the physician should determine the patient's volume status and measure urinary sodium and osmolality, and also ask about diuretic use. Hypovolemic hyponatremia is associated with vomiting, diarrhea, laxative abuse, renal disease, nasogastric suction, salt-wasting nephropathy, Addison disease, solute diuresis, and diuretic use. Euvolemic hyponatremia with a normal urinary sodium level can result from glucocorticoid deficiency, hypothyroidism, certain drugs, and the syndrome of inappropriate antidiuretic hormone secretion. Euvolemic hyponatremia with low urinary osmolality can be caused by psychogenic polydipsia, 'tea and toast' syndrome, or beer potomania. Hypervolemic hyponatremia is associated with congestive heart failure, nephrotic syndrome, and cirrhosis. The article includes two patient care algorithms. 2 figures. 10 references.
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Williams Textbook of Endocrinology. 10th ed. St. Louis, MO: Elsevier, Health Sciences Division. 2003. (CD-ROM)
This textbook of endocrinology serves as a bridge between basic science and clinical endocrinology. Forty-one chapters are provided in ten sections: hormones and hormone action, hypothalamus and pituitary, thyroid, adrenal, reproduction, endocrinology and the life span, mineral metabolism, disorders of carbohydrate and lipid metabolism, polyendocrine disorders, and paraendocrine and neoplastic syndromes. Specific topics include: principles of endocrinology; the endocrine patient; genetic control of peptide hormone formation; mechanism of action of hormones that act as nuclear hormone receptors; mechanism of action of hormones that act at the cell surface; laboratory techniques for recognition of endocrine disorders; neuroendocrinology; the anterior pituitary; the posterior pituitary; thyroid physiology and diagnostic evaluation of patients with thyroid disorders; thyrotoxicosis; hypothyroidism and thyroiditis; nontoxic goiter and thyroid neoplasia; the adrenal cortex; endocrine hypertension; the physiology and pathology of the female reproductive axis; fertility control: current approaches and global aspects; disorders of the testes and the male reproductive tract; sexual dysfunction in men and women; endocrine changes of pregnancy; endocrinology of fetal development; disorders of sex differentiation; normal and aberrant growth; puberty: ontogeny, neuroendocrinology, physiology, and disorders; endocrinology and aging; hormones and disorders of mineral metabolism; metabolic bone disease; kidney stones; type 2 diabetes mellitus; type 1 diabetes mellitus; complications of diabetes mellitus; glucose homeostasis and hypoglycemia; obesity; disorders of lipid metabolism; pathogenesis of endocrine tumors; multiple endocrine neoplasias; the immunoendocrinopathy syndromes; gastrointestinal hormones and gut endocrine tumors; endocrine-responsive cancer; humoral manifestations of malignancy; carcinoid tumors, carcinoid syndrome, and related disorders. Each chapter is written by experts in the field and concludes with extensive references; a subject index concludes the textbook. The CD-ROM format enables powerful search capabilities, as well as links to MEDLINE abstracts for many of the references.
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Diabetes and Thyroid Disease: A Likely Combination. Diabetes Spectrum. 15(3): 140-142. 2002.
In this article, the authors present a case of a 70 year old woman with type 2 diabetes who is diagnosed with thyroid disease (hypothyroidism). The authors discuss the likelihood of hypothyroidism in elderly women, the possibility of hypothyroidism as a strong risk factor for cardiovascular disease (CVD), the benefits of treating subclinical hypothyroidism, the prevalence of subclinical hypothyroidism, the prevalence of thyroid disease in patients with diabetes, symptoms of subclinical hypothyroidism, dyslipidemia, the interplay between blood glucose levels and hypothyroidism, insulin resistance and hypothyroidism, and recommended interventions. 9 references.
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Thyroid Autoimmunity in Children and Adolescents with Type 1 Diabetes: A Multicenter Survey. Diabetes Care. 25(8): 1346-1350. August 2002.
This article reports on a study undertaken to investigate thyroid autoimmunity in a very large nationwide cohort of children and adolescents with type 1 diabetes. Data were analyzed from 17,749 patients with type 1 diabetes aged 0.1 to 20 years who were treated in 118 pediatric diabetes centers in Germany and Austria. A total of 49.5 of these patients were boys, the mean age was 12.4 years and the mean duration of diabetes was 4.5 years. In 1,530 patients, thyroid antibody levels were elevated on at least one occasion, whereas 5,567 were antibody-negative during the observation period. Patients with thyroid antibodies were significantly older, had a longer duration of diabetes, and developed diabetes later in life than those without antibodies. A total of 63 percent of patients with positive antibodies were girls, compared with 45 percent of patients without antibodies. The authors conclude that thyroid autoimmunity seems to be particularly common in girls with diabetes during the second decade of life and may be associated with elevated TSH (thyroid-stimulating hormone) levels, indicating subclinical hypothyroidism. 3 figures. 1 table. 20 references.
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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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Endocrine Regulation of Calcium and Phosphate Metabolism. In: Porterfield, S.P. Endocrine Physiology. 2nd ed. St. Louis, MO: Mosby, Inc. 2001. p. 107-129.
This chapter, which is part of a textbook on endocrine physiology, focuses on endocrine regulation of serum calcium and phosphate. The chapter begins with an examination of the role of calcium and phosphate in the body. This is followed by a discussion of serum calcium and phosphate levels and serum calcium and phosphate balance. The chapter then describes the role of osteoblasts, osteocytes, and osteoclasts in bone metabolism and identifies major growth factors in bone such as insulin like growth factors. These components, which are mitogenic polypeptides that resemble insulin structure and function, are present in bone matrix. They stimulate bone and cartilage growth and increase osteoblast proliferation. Insulin and growth hormone control their production. The chapter next discusses parathyroid hormone, calcitonin, and vitamin D in terms of their structure, control of secretion, and actions on bone and kidney. The actions of other hormones are also highlighted, including estrogens, glucocorticoids, and thyroid hormones. In addition, the chapter describes pathologic disorders of calcium and phosphate balance, including hyperparathyroidism, hypercalcemia of malignancy, pseudohypoparathyroidism, hypothyroidism, vitamin D deficiency, Paget's disease, and bone problems of renal failure. The chapter includes a list of key words and concepts and presents self study problems. 15 figures. 1 table. 11 references.
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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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Management of Dyslipidemia in Adults with Diabetes. Diabetes Care. 23(Supplement 1): S57-S60. January 2000.
This position statement provides recommendations for managing dyslipidemia in adults who have diabetes. The most common pattern of dyslipidemia in people who have type 2 diabetes is elevated triglyceride levels and decreased high density lipoprotein cholesterol levels. Lipid levels may be affected by factors unrelated to glycemia or insulin resistance, including renal disease, hypothyroidism, and the frequent occurrence of genetically determined lipoprotein disorders. The position statement discusses the prevalence of dyslipidemia in people who have type 2 diabetes, lipoprotein risk factors for coronary heart disease (CHD), clinical trials of lipid lowering in people who have diabetes, and risk factors versus markers. Other topics include the modification of lipoproteins by nutritional therapy and physical activity, the modification of lipoproteins by glucose lowering agents, treatment goals for lipoprotein therapy, and lipid lowering agents. In addition, the position statement considers issues in the treatment of adults with type 1 diabetes. The statement concludes that aggressive therapy of diabetic dyslipidemia will probably reduce the risk of CHD in patients who have diabetes. Primary therapy should be directed at lowering low density lipoprotein levels by using statin therapy with the addition of a resin if needed. 4 tables. 8 references.
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