Goiter and hypothyriodism

definition, symptoms, causes, diagnosis and treatment

1. GOITER AND HYPOTHYRODISM Presented by: Muhammad bilal BS ZOOLOGY University of education, township lahore

2. HYPOTHYRODISM it is a condition in which your thyroid gland doesn't produces enough hormones which are crucial for certain functions. It may not show any symptoms in earlier life. But, if left untreated it may cause obesity, pain joint, infertility and heart problems. Different tests are available to diagnose this disease. Treatment is done with different synthetic hormones.

3. SYMPTONS Symptoms depend upon the severity of hormone deficiency. It take many years to show symptoms. At first it only shows fatigue and weight gain. But, with the passage of time metabolism slows down and symptoms also develop into severe cases.

4. HYPOTHYRODISM IN INFANTS Mostly occurs in middle age people but can also occur in infants. Because of absence or infective thyroid gland. It shows following symptoms in infants: Yellowing of skin and whites of eyes(because babies cant metabolize bilirubin a chemical of blood recycling) Large protruding tongue Difficult breathing Hoarse crying Umbilical hernia Trouble feeding and difficulty in developing normally Constipation Poor muscle tone and excessive sleepiness If left untreated can also cause mental retardation

5. HYPOTHYROIDISM IN CHILDREN & TEENS In general, children and teens who develop hypothyroidism have the same signs and symptoms as adults do, but they may also experience: Poor growth, resulting in short stature Delayed development of permanent teeth Delayed puberty Poor mental development

6. When to see a doctor See your doctor if you're feeling tired for no reason or have any of the other signs or symptoms of hypothyroidism, such as dry skin, a pale, puffy face, constipation or a hoarse voice. If you're receiving hormone therapy for hypothyroidism, schedule follow-up visits as often as your doctor recommends. Initially, it's important to make sure you're receiving the correct dose of medicine. And over time, the dose you need may change.

7. CAUSES

8. CAUSES Hypothyroidism results when the thyroid gland fails to produce enough hormones. Hypothyroidism may be due to a number of factors, including: Autoimmune disease .  The most common cause of hypothyroidism is an autoimmune disorder known as Hashimoto's thyroiditis. Autoimmune disorders occur when your immune system produces antibodies that attack your own tissues. Sometimes this process involves your thyroid gland Over-response to hyperthyroidism treatment .  People who produce too much thyroid hormone (hyperthyroidism) are often treated with radioactive iodine or anti-thyroid medications. The goal of these treatments is to get thyroid function back to normal. But sometimes, correcting hyperthyroidism can end up lowering thyroid hormone production too much, resulting in permanent hypothyroidism.

9. CONTI… Over-response to hyperthyroidism treatment :  People who produce too much thyroid hormone (hyperthyroidism) are often treated with radioactive iodine or anti-thyroid medications. The goal of these treatments is to get thyroid function back to normal. But sometimes, correcting hyperthyroidism can end up lowering thyroid hormone production too much, resulting in permanent hypothyroidism. Thyroid surgery .: Removing all or a large portion of your thyroid gland can diminish or halt hormone production. In that case, you'll need to take thyroid hormone for life. Radiation therapy . Radiation used to treat cancers of the head and neck can affect your thyroid gland and may lead to hypothyroidism. Medications :  A number of medications can contribute to hypothyroidism. One such medication is lithium, which is used to treat certain psychiatric disorders. If you're taking medication, ask your doctor about its effect on your thyroid gland.

10. CAUSES Less often, hypothyroidism may result from one of the following: Congenital disease . Some babies are born with a defective thyroid gland or no thyroid gland. In most cases, the thyroid gland didn't develop normally for unknown reasons, but some children have an inherited form of the disorder. Often, infants with congenital hypothyroidism appear normal at birth. That's one reason why most states now require newborn thyroid screening. Pregnancy . Some women develop hypothyroidism during or after pregnancy (postpartum hypothyroidism), often because they produce antibodies to their own thyroid gland. Left untreated, hypothyroidism increases the risk of miscarriage, premature delivery and preeclampsia a condition that causes a significant rise in a woman's blood pressure during the last three months of pregnancy. It can also seriously affect the developing fetus.

11. CAUSES Iodine deficiency.  The trace mineral iodine found primarily in seafood, seaweed, plants grown in iodine-rich soil and iodized salt is essential for the production of thyroid hormones. Too little iodine can lead to hypothyroidism, and too much iodine can worsen hypothyroidism in people who already have the condition. In some parts of the world, iodine deficiency is common, but the addition of iodine to table salt has virtually eliminated this problem in the United States. Pituitary disorder . A relatively rare cause of hypothyroidism is the failure of the pituitary gland to produce enough thyroid-stimulating hormone (TSH) usually because of a benign tumor of the pituitary gland.

12. OTHER RISK FACTORS Although anyone can develop hypothyroidism, you're at an increased risk if you: Are a woman Are older than 60 Have a family history of thyroid disease Have an autoimmune disease, such as type 1 diabetes or celiac disease Have been treated with radioactive iodine or anti-thyroid medications Received radiation to your neck or upper chest Have had thyroid surgery (partial thyroidectomy) Have been pregnant or delivered a baby within the past six months

13. COMPLICATIONS Untreated hypothyroidism can lead to a number of health problems: Goiter . Constant stimulation of your thyroid to release more hormones may cause the gland to become larger a condition known as a goiter. Although generally not uncomfortable, a large goiter can affect your appearance and may interfere with swallowing or breathing. Heart problems . Hypothyroidism may also be associated with an increased risk of heart disease and heart failure, primarily because high levels of low-density lipoprotein (LDL) cholesterol the "bad" cholesterol can occur in people with an underactive thyroid. Mental health issues.  Depression may occur early in hypothyroidism and may become more severe over time. Hypothyroidism can also cause slowed mental functioning.

14. COMPLICATIONS Myxedema . This rare, life-threatening condition is the result of long-term, undiagnosed hypothyroidism. Its signs and symptoms include intense cold intolerance and drowsiness followed by profound lethargy and unconsciousness. Infertility . Low levels of thyroid hormone can interfere with ovulation, which impairs fertility. In addition, some of the causes of hypothyroidism such as autoimmune disorder can also impair fertility.

15. COMPLICATIONS Peripheral neuropathy . Long-term uncontrolled hypothyroidism can cause damage to your peripheral nerves. These are the nerves that carry information from your brain and spinal cord to the rest of your body. for example, your arms and legs. Peripheral neuropathy may cause pain, numbness and tingling in affected areas. Birth defects .  Babies born to women with untreated thyroid disease may have a higher risk of birth defects compared to babies born to healthy mothers. These children are also more prone to serious intellectual and developmental problems. Infants with untreated hypothyroidism present at birth are at risk of serious problems with both physical and mental development. But if this condition is diagnosed within the first few months of life, the chances of normal development are excellent.

16. DIAGNOSIS Blood tests Level of TSH is measured and sometimes, the level of the thyroid hormone thyroxine is als o measured TSH tests also play an important role in managing hypothyroidism. They help your doctor determine the right dosage of medication, both initially and over time. In addition, TSH tests are used to help diagnose a condition called subclinical hypothyroidism, which usually causes no outward signs or symptoms. In this condition, you have normal blood levels of triiodothyronine and thyroxine, but higher than normal levels of TSH.

17. Conti … There are certain factors that can affect blood tests for thyroid problems. One is the blood-thinning medication called heparin. Another is biotin, a vitamin taken as a stand-alone supplement or as part of a multivitamin. Let your doctor know about any medications or supplements you take before having blood tests done.

18. TREATMENT treatment for hypothyroidism involves daily use of the synthetic thyroid hormone levothyroxine (Levo-T, Synthroid, others). The medication gradually lowers cholesterol levels elevated by the disease and may reverse any weight gain To determine the right dosage of levothyroxine initially, your doctor generally checks your level of TSH after six to eight weeks. After that, blood levels are generally checked six months later. If you have coronary artery disease or severe hypothyroidism, your doctor may start treatment with a smaller amount of medication and gradually increase the dosage

19. ABSORPTION OF LEVOTHYROXIN Levothyroxine causes virtually no side effects when used in the appropriate dose and is relatively inexpensive. Levothyroxine is best taken on an empty stomach at the same time every day. Ideally, you'll take the hormone in the morning and wait an hour before eating or taking other medications. If you take it at bedtime, wait four hours after your last meal or snack. If you miss a dose of levothyroxine, take two pills the next day.

20. GOITER

21. GOITER Goiter is a condition in which the thyroid gland grows larger.  Although  goiters  are usually painless, a large  goiter  can cause a cough and make it difficult for you to swallow or breathe. The thyroid gland is a small, butterfly-shaped gland located in the neck, below the Adam's apple. The thyroid gland produces the hormones thyroxine (also called T4) and triiodothyronine (also called T3). (Most of the T4 is changed to T3 outside of the thyroid.) These hormones play a role in certain bodily functions, including body temperature, mood and excitability, pulse rate, digestion and others.

22. CAUSES Goiters have different causes, depending on their type. Simple goiters develop when the thyroid gland does not make enough hormones to meet the body's needs. The thyroid gland tries to make up for this shortage by growing larger. Endemic   goiters occur in people in certain parts of the world who do not get enough iodine in their diet (iodine is necessary to make thyroid hormone). For instance, a lack of iodine in the diet is still a common problem in parts of central Asia and central Africa. Endemic goiters

23. SPORDIC OR NOTOXIC GOITER Sporadic goiters, in most cases, have no known cause. In some cases, certain drugs can cause this type of goiter. For example, the drug  lithium , which is used to treat certain mental health conditions, as well as other medical conditions, can cause this type of goiter. Toxic nodular or multinodular goiter This type of goiter forms one or more small nodules as it enlarges. The nodules produce their own thyroid hormone, causing  hyperthyroidism . It generally forms as an extension of a simple goiter. Multinodular goiter

24. GOITER DUE TO OTHER DISEASES Graves' disease . Graves' disease is an autoimmune disease (your body's immune system mistakenly attacks your healthy body). Hashimoto's disease This is another autoimmune disease. In this case, the disease causes inflammation (swelling) of the thyroid gland. This type of goiter usually gets better on its own over time. Nodular goiter In this condition, growths called nodules occur on one or both sides of the thyroid gland, causing it to grow larger.

25. Thyroid cancer Cancer of the thyroid gland often enlarges the thyroid. Pregnancy Human chorionic gonadotropin, a hormone that a woman produces during pregnancy, can cause the thyroid to grow. Thyroiditis Inflammation of the thyroid gland itself can cause the thyroid gland to grow. Exposure to radiation . A person who has had medical radiation treatments to the head and neck has a greater risk of developing goiter.

26. SYMPTONS The main symptoms of goiter include: A swelling in the front of the neck, just below the Adam's apple A feeling of tightness in the throat area Hoarseness (scratchy voice) Neck vein swelling Dizziness when the arms are raised above the head Other, less common symptoms include: Difficulty breathing (shortness of breath) Coughing Wheezing (due to squeezing of the windpipe) Difficulty swallowing (due to squeezing of the esophagus, or “food tube”)

27. SYMPTONS… Some people who have a goiter may also have  hyperthyroidism ,  or overactive thyroid. Symptoms of hyperthyroidism can include: An increased resting pulse rate Rapid heartbeat Diarrhea, nausea, vomiting Sweating without exercise or increased room temperature Shaking Agitation

28. Some people with goiter may also have  hypothyroidism , or underactive thyroid. Symptoms of hypothyroidism can include: Fatigue (feeling tired) Constipation Dry skin Weight gain Menstrual irregularities.

29. DIAGNOSIS AND TESTS Several tests can be used to diagnose and evaluate goiter, including the following: Physical exam:  Your doctor may be able to tell if the thyroid gland has grown by feeling the neck area for nodules and signs of tenderness. Hormone test:  This blood test measures thyroid hormone levels, which tell if the thyroid is working properly. Antibody test:  This blood test looks for certain antibodies that are produced in some forms of goiter. An antibody is a protein made by white blood cells. Antibodies help defend against invaders (for example, viruses) that cause disease or infection in the body.

30. Ultrasound of the thyroid:  Ultrasound  is a procedure that sends high-frequency sound waves through body tissues. The echoes are recorded and transformed into video or photos. Ultrasound of the thyroid reveals the gland's size and finds nodules. Thyroid scan:  This imaging test provides information on the size and function of the gland. In this test, a small amount of radioactive material is injected into a vein to produce an image of the thyroid on a computer screen. CT scan or MRI (magnetic resonance imaging) of the thyroid:  If the goiter is very large or spreads into the chest, a  CT scan  or  MRI  is used to measure the size and spread of the goiter.

31. MANAGEMENT AND TREATMENT Treatment for goiter depends on how large the thyroid has grown, symptoms, and what caused it. Treatments include: No treatment/"watchful waiting .“  If the goiter is small and is not bothering you, your doctor may decide that it doesn’t need to be treated. However, the goiter will be closely watched for any changes. Medications .  Levothyroxine  is a thyroid hormone replacement therapy. It is prescribed if hypothyroidism. Other medications are prescribed if the cause of the goiter is an overactive thyroid (hyperthyroidism). These drugs include  methimazole and  propylthiouracil . The doctor might prescribe aspirin or a  corticosteroid medicatioN  if goiter is caused by inflammation. Biopsy . A biopsy is the removal of a sample of tissue or cells to be studied in a laboratory. A biopsy may be needed if there are large nodules in the thyroid gland. A biopsy is taken to rule out cancer.

32. Radioactive iodine treatment . This treatment, used in cases of an overactive thyroid gland, involves taking radioactive iodine orally. The iodine goes to the thyroid gland and kills thyroid cells, which shrinks the gland. After radioactive iodine treatment, the patient usually has to take thyroid hormone replacement therapy for the rest of his or her life. Surgery . Surgery is performed to remove all or part of the thyroid gland. Surgery may be needed if the goiter is large and causes problems with breathing and swallowing. Surgery is also sometimes used to remove nodules. Surgery must be done if cancer is present.

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