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08Nov – Hypo/Hyper Thyroidism & Parathyroid
Common symptoms and signs of Hyperthyroidism
Graves Disease - most common (90%) (TSI causes) / Thyroiditis / Toxic Nodule / Thyroid Hormone /
Placenta Tumor – Choriocarcinoma
Palpitations
Heat intolerance
Nervousness
Insomnia
Breathlessness
Increased bowel movements
Light or absent menstrual periods
Fatigue – “Big Symptom”
Fast heart rate
Trembling hands
Weight loss – Increased Appetite
Muscle weakness
Warm moist skin
Hair loss
Staring gaze
Radioactive Iodine (see lots in Graves / see none in Thyroiditis)
TSI – Made in Graves disease
TPO – Autoimmunity
Symptoms of Hypothyroidism
Hashimoto’s thyroiditis / Bacterial infection / Pituitary – hypothalamus disorders / Iodine issues / Meds
Fatigue
Weakness
Weight gain or increased difficulty losing weight
Coarse, dry hair – prematurely grey
Dry, rough pale skin
Hair loss
Cold intolerance (can't tolerate the cold like those around you)
Muscle cramps and frequent muscle aches
Constipation
Depression
Irritability
Memory loss
Abnormal menstrual cycles – Very Heavy
Decreased libido
Reduced Heart Rate
Check TSH (0.5-3 Normal / >3 Hypothyroidism / <0.5 Hyperthyroidism)
TPO – high can have permanent Hyperthyroidism
5% of people have a palpable thyroid nodules
50% at age 50
Only 5% of palpable nodules are cancerous
Thyroid – fine needle aspiration 30ga needle (biopsy)
Cancers
Papillary (finger like) cancer – most common
After nuclear disaster – radiation exposure
Rarely spread
Cured easily
Follicular Cancer – spread to other tissues
Cured easily
Medullary – kills people
Genetic
DNA blood test
Blood Test for Calcitonin
Diarrhea
Flushing
Anaplastic Cancer – Kills within a few months
Superior Veina Cava syndrome
Red Head & Swollen (from Heart up)
The function of the thyroid gland is to take iodine, found in many foods,
and convert it into thyroid hormones: thyroxine (T4) and triiodothyronine
(T3). Thyroid cells are the only cells in the body which can absorb iodine.
These cells combine iodine and the amino acid tyrosine to make T3 and T4. T3
and T4 are then released into the blood stream and are transported throughout
the body where they control metabolism (conversion of oxygen and calories to
energy). Every cell in the body depends upon thyroid hormones for regulation of their metabolism. The
normal thyroid gland produces about 80% T4 and about 20% T3, however, T3 possesses about four times the
hormone "strength" as T4
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Free thyroxine index (FTI or FT4). Free thyroxine (T4) can be measured directly (FT4) or calculated (FTI). The
FTI is a measure of the amount of T4 in relation to the amount of thyroxine-binding globulin present. The FTI is
calculated from the T4 and T3 uptake, or T3U, values. The FTI value can indicate when an abnormal level of T4 is
caused by an abnormal level of thyroxin-binding globulin in the blood.
Triiodothyronine (T3). T3 has a greater effect on metabolism than T4, even though T3 is normally present in
lower amounts than T4. The total amount of T3 in the blood or the amount of free T3 (FT3) can be measured.
Normally, less than 1% of the T3 is free.
Triiodothyronine uptake (T3U). The T3U test is an indirect measurement of the amount of the protein
(thyroxine-binding globulin) that can bind to T3 and T4. The results of this test are useful only when evaluated
along with other thyroid function tests.
Total Thyroxine (T4). Most of the T4 in blood is attached to a protein (called thyroxine-binding globulin). Less
than 1% of the T4 is unattached. A total T4 blood test measures both bound and free thyroxine. Free thyroxine
affects tissue function in the body, but bound thyroxine does not.
Anti-thyroid Meds can cause agranulocytosis - condition in which there is an insufficient number of white blood
cells called neutrophils
Parathyroid – regulate calcium
Vitamin D also regulates – allows gut to absorb calcium
9-10 mg/dL is normal
Hypoparathyroidism
Symptoms
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Tingling of lips, hands, and feet
Muscle cramps
Pain in face, legs, and feet
Abdominal pain
Dry hair
Brittle nails
Dry, scaly skin
Cataracts
Weakened tooth enamel in children
Muscle spasms called tetany (can lead to spasms of the larynx with breathing difficulties)
Convulsions or seizures
Additional symptoms that may be associated with this disease:
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Painful menstruation
Hand or foot spasms
Decreased consciousness
Delayed or absent tooth formation
Signs and tests
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Low serum calcium level
Elevated serum phosphorus
Decreased serum parathyroid hormone level ***
Decreased serum magnesium level (possible)
Abnormal heart rhythms on ECG (possible)
This disease may also alter the results of the following tests:
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Urine calcium
Ionized calcium in the blood
Hyperparathyroidism (Mones, stones & grones)
Symptoms
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Fatigue
Back pain
Joint pain
Fractures of long bones
Decreased height
Increased urine output
Increased thirst
Upper abdominal pain
Loss of appetite
Nausea
Muscular weakness
Muscle pain
Depression
Personality changes
Stupor and possibly coma
Itching of the skin
Blurred vision (because of cataracts)
Bone pain or tenderness
Signs and tests
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Serum calcium is increased.
Serum phosphorus is decreased.
Serum alkaline phosphatase may be increased.
Intact parathyroid hormone (PTH) in the blood is increased ***
Bone X-ray shows bone reabsorption or fractures.
Imaging of the kidneys or ureters may show calcification or obstruction.
Reduced bone mineral density on bone desitometry (DEXA), particularly of the forearm.
Urinary calcium may be increased.