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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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