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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 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 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: Painful menstruation Hand or foot spasms Decreased consciousness Delayed or absent tooth formation Signs and tests 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: Urine calcium Ionized calcium in the blood Hyperparathyroidism (Mones, stones & grones) Symptoms 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 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.