ROJoson PEP Talk: HYPERTHYROIDISM - When to Suspect

ROJoson PEP Talk: HYPERTHYROIDISM - When to Suspect

1. June 8, 2024 1400H - 1500H Via Zoom HYPERTHYROIDISM – WHEN TO SUSPECT Empowerment objective - for laypeople to have an essential  understanding on HYPERTHYROIDISM – WHEN TO SUSPECT as part of their health management.

2. June 8, 2024 1400H - 1500H Via Zoom HYPERTHYROIDISM – WHEN TO SUSPECT Empowerment objective - for laypeople to have an essential  understanding on HYPERTHYROIDISM – WHEN TO SUSPECT as part of their health management. Welcome all! MUTE yourself but always show your video picture. Sign in your name, FB account, or email address in the Chat Box! Include names of companions attending. Use the Chat Box to ask questions and make comments while the PEP TALK is on. There will be group pictures at start and end of PEP TALK – show your face in video.

3. Reminder after the PEP Talk: Take the Online Learning cum Evaluation Test Exercise (OLETE) for mastery of learning and have a perfect score to get a Certificate. Link is in Chat Box.

4. Reminder: 25 OLETE Certificates = 1 Voucher for ROJoson Medical Consultation either Face-to-Face or Telemedical.

5. HYPERTHYROIDISM – WHEN TO SUSPECT Empowerment objective - for laypeople to have an essential  understanding on HYPERTHYROIDISM – WHEN TO SUSPECT as part of their health management. ROJOSON’S REQUEST: FEEDBACK TO THIS PEP TALK! Pls. type in your feedback in the chat box during the open forum and before we adjourn! Thank you!

6. HYPERTHYROIDISM – WHEN TO SUSPECT Empowerment objective - for laypeople to have an essential  understanding on HYPERTHYROIDISM – WHEN TO SUSPECT as part of their health management. LET’S NOW HAVE A GROUP PICTURE TAKING BEFORE WE START PEP TALK PROPER IN 2 MINUTES! Pls. turn on your video! Show your face!

7. HYPERTHYROIDISM – WHEN TO SUSPECT Empowerment objective - for laypeople to have an essential  understanding on HYPERTHYROIDISM – WHEN TO SUSPECT as part of their health management. ROJoson PEP Talk I have a Patient Empowerment Program in which I like to empower the lay people or patients to take control in the management of their health.

8. I started the PEP Talk on May 15, 2021 during the COVID19 Pandemic. There are 3 courses in the PEP Talk. I completed the Core Course on October 9, 2021.

9. From October 23, 2021 onwards, I have been tackling Health Disorder and Health Issue Courses. May 18, 2024 marks the start of YEAR 4 of ROJoson PEP Talk. How long the PEP Talk will last will depend on our enthusiasm , discipline and perseverance .

10. HYPERTHYROIDISM – WHEN TO SUSPECT Empowerment objective - for laypeople to have an essential  understanding on HYPERTHYROIDISM – WHEN TO SUSPECT as part of their health management. My PEP TALK today is entitled: HYPERTHYROIDISM – WHEN TO SUSPECT

11. HYPERTHYROIDISM – WHEN TO SUSPECT Empowerment objective - for laypeople to have an essential  understanding on HYPERTHYROIDISM – WHEN TO SUSPECT as part of their health management.

12. Contents What is the thyroid gland? When does one say the thyroid gland is normal on palpation? What are the 3 scenarios (interpreted finings) after one palpates the thyroid gland? What is HYPERTHYROIDISM? What is the disease process of HYPERTHYROIDISM? What are the complications of HYPERTHYROIDISM? When does one suspect HYPERTHYROIDISM? What are the diagnostic tests for HYPERTHYROIDISM? What are the causes of HYPERTHYROIDISM? What are the basic treatment modalities for HYPERTHYROIDISM? Disclaimer: ROJoson PEP Talk contains ROJoson’s Thoughts, Perceptions, Opinions and Recommendations (TPORs) culled from experiences of ROJoson and writings of other health professionals . HYPERTHYROIDISM – WHEN TO SUSPECT

13. The THYROID gland is a gland that produces thyroid HORMONES that circulate in the blood and whose functions are to mainly to regulate body metabolism and promote growth and development of the body. HYPERTHYROIDISM – WHEN TO SUSPECT

14. The THYROID gland is a VITAL organ which all persons must have and where hormones produced by the gland must always be enough circulating in the blood. ENOUGH – normal (EUTHYROIDISM) EXCESS – abnormal (HYPERTHYROIDISM) DEFICIENT – abnormal (HYPOTHYROIDISM) HYPERTHYROIDISM – WHEN TO SUSPECT

15. The THYROID gland is located on the front and central part of the neck. Normally, the thyroid gland is not palpable or impalpable (cannot be palpated) except for the very thin persons with thin soft tissues over the neck. Usually, if the thyroid gland is not palpable, it is considered clinically “normal” at least in anatomical structure particularly in terms of size. HYPERTHYROIDISM – WHEN TO SUSPECT

16. If the thyroid gland is palpable, 3 scenarios or interpreted findings or conclusions: Slightly enlarged which may still be a variant of normal or it may be the start of a disease process called goiter. Definitely enlarged – diffusely enlarged – both lobes are enlarged with no nodules = diffuse goiter Presence of nodules, single, multiple = nodular goiter HYPERTHYROIDISM – WHEN TO SUSPECT

17. If the thyroid gland is palpable, 3 scenarios or interpreted findings or conclusions: Slightly enlarged which may still be a variant of normal or it may be the start of a disease process called goiter. Definitely enlarged – diffusely enlarged – both lobes are enlarged with no nodules = diffuse goiter Presence of nodules, single, multiple = nodular goiter HYPERTHYROIDISM – WHEN TO SUSPECT

18. If the thyroid gland is palpable, 3 scenarios or interpreted findings or conclusions: Slightly enlarged which may still be a variant of normal or it may be the start of a disease process called goiter. Definitely enlarged – diffusely enlarged – both lobes are enlarged with no nodules = diffuse goiter Presence of nodules, single, multiple = nodular goiter HYPERTHYROIDISM – WHEN TO SUSPECT

19. HYPERTHYROIDISM – WHEN TO SUSPECT Empowerment objective - for laypeople to have an essential  understanding on HYPERTHYROIDISM – WHEN TO SUSPECT as part of their health management. My PEP TALK today is entitled: HYPERTHYROIDISM – WHEN TO SUSPECT Today’s focused discussion is on HYPERTHYROIDISM!

20. Producing excessive beyond normal amount of thyroid hormones will lead to HYPERTHYROIDISM which is an abnormal condition = a medical disease which should be treated otherwise, it can cause bad effects on the human body notably on the heart and worse, a thyroid storm which is a deadly complication. HYPERTHYROIDISM – WHEN TO SUSPECT

21. A THYROID STORM is an undiagnosed or poorly controlled overactive thyroid that can lead to a serious, life-threatening  condition. It is a sudden flare-up of symptoms of hyperthyroidism that include: a rapid heartbeat a high temperature high blood pressure (hypertension) yellowing of the skin and eyes (jaundice) severe agitation and confusion loss of consciousness HYPERTHYROIDISM – WHEN TO SUSPECT

22. If a THYROID STORM does NOT develop, untreated , hyperthyroidism can cause serious health problems, including an irregular heartbeat that can lead to blood clots, stroke, heart failure, and other heart-related problems (most serious complications) an eye disease called Graves’ ophthalmopathy thinning bones,  osteoporosis and muscle problems menstrual cycle and fertility issues HYPERTHYROIDISM – WHEN TO SUSPECT

23. What are the symptoms of hyperthyroidism? Symptoms of hyperthyroidism can vary from person to person and may include weight loss despite an increased appetite rapid or irregular heartbeat nervousness, irritability, trouble sleeping, fatigue shaky hands, muscle weakness sweating or trouble tolerating heat frequent bowel movements  an enlargement in the neck, called a goiter HYPERTHYROIDISM – WHEN TO SUSPECT

24. What are the symptoms of hyperthyroidism ? HYPERTHYROIDISM – WHEN TO SUSPECT

25. HYPERTHYROIDISM – WHEN TO SUSPECT

26. When to suspect HYPERTHYROIDISM? Based on SYMPTOMS of hyperthyroidism (any one of these – suspect but suspect more if more than one symptoms) weight loss despite an increased appetite rapid or irregular heartbeat nervousness, irritability, trouble sleeping, fatigue shaky hands, muscle weakness sweating or trouble tolerating heat frequent bowel movements  Exophthalmos (protruding eyeball) AN ENLARGEMENT IN THE NECK, CALLED A GOITER HYPERTHYROIDISM – WHEN TO SUSPECT Most reliable symptom Plus at least one of these nonspecific symptoms or better, more

27. When to suspect HYPERTHYROIDISM? Graves’ Disease – a type of hyperthyroidism caused by an autoimmune disease. Typically, there is an associated exophthalmos together with diffuse goiter and other symptoms of hyperthyroidism. HYPERTHYROIDISM – WHEN TO SUSPECT

28. To have a more definite or more certain diagnosis of hyperthyroidism, after suspecting based on SYMPTOMS and SIGNS, laboratory tests on levels or amount of thyroid hormones in the blood may be done. T4 – thyroxine = FT4 (elevated in hyperthy ) T3 – triiodothyronine = FT3 (elevated in hyperthy ) A thyroid stimulating hormone (TSH) test can be done to complement T3 / T4 Interpretation – depressed TSH ( hyperthy ) HYPERTHYROIDISM – WHEN TO SUSPECT

29. The Hypothalamus – Pituitary – Thyroid Axis Feedback / Autoregulation Mechanism HYPERTHYROIDISM – WHEN TO SUSPECT

30. After suspecting hyperthyroidism based on SYMPTOMS and SIGNS, the following lab results can confirm its presence: Elevated FT4 alone Elevated FT3 alone Elevated FT4 and FT3 Elevated FT4 and FT3, depressed (lower than normal) TSH Elevated FT4 and depressed TSH Depressed TSH alone Assuming not all FT4, FT3 and TSH are done simultaneously HYPERTHYROIDISM – WHEN TO SUSPECT

31. FT4. FT3, and TSH as a package is frequently ordered by physicians. Usually , it is enough to order FT4 and TSH (without FT3 anymore) initially as laboratory diagnostic tests in patients with suspected hyperthyroidism or hypothyroidism . Changes in FT3 usually occur late. HYPERTHYROIDISM – WHEN TO SUSPECT

32. HYPERTHYROIDISM – WHEN TO SUSPECT

33. What are the causes of hyperthyroidism? Graves’ Disease – an autoimmune disease Factitious hyperthyroidism – taking too much thyroid hormones Overactive thyroid nodules (single, multiple) Chronic thyroiditis HYPERTHYROIDISM – WHEN TO SUSPECT

34. What are the treatment options for hyperthyroidism? Medical – use of drugs – anti-thyroid drugs Surgical – operation to reduce size and amount of thyroid gland and tissue Radioactive iodine therapy – radiation to burn the thyroid gland Will be discussed in another ROJoson PEP Talk episode. HYPERTHYROIDISM – WHEN TO SUSPECT

35. Summary – When to suspect HYPERTHYROIDISM Bases for suspicion: Presence of symptoms of HYPERTHYROIDISM particularly SUDDEN WEIGHT LOSS, PALPITATIONS, and ENLARGED THYROID GLAND Presence of signs of HYPERTHYROIDISM particularly DIFFUSE GOITER or ENLARGEMENT OF THYROID GLAND and INCREASED PULSE RATE Confirmation of suspicion: ELEVATED FT4 and DEPRESSED TSH HYPERTHYROIDISM – WHEN TO SUSPECT

36. HYPERTHYROIDISM – WHEN TO SUSPECT Summary Take Away Contents What is the thyroid gland? When does one say the thyroid gland is normal on palpation? What are the 3 scenarios (interpreted finings) after one palpates the thyroid gland? What is HYPERTHYROIDISM? What is the disease process of HYPERTHYROIDISM? What are the complications of HYPERTHYROIDISM? When does one suspect HYPERTHYROIDISM? What are the diagnostic tests for HYPERTHYROIDISM? What are the causes of HYPERTHYROIDISM? What are the basic treatment modalities for HYPERTHYROIDISM?

37. Take Away in relation to Patient Empowerment Be always in touch with reliable medical information on HYPERTHYROIDISM – WHEN TO SUSPECT. Knowledge is power; it gives power. Use the 4Ks of Patient Empowerment: Kaalaman , Kakayanan , Karapatan and Kapangyarihan to gain greater control over decisions / make better decisions on HYPERTHYROIDISM – WHEN TO SUSPECT as part of your health management. HYPERTHYROIDISM – WHEN TO SUSPECT

38. HYPERTHYROIDISM – WHEN TO SUSPECT Empowerment objective - for laypeople to have an essential  understanding on HYPERTHYROIDISM – WHEN TO SUSPECT as part of their health management. This ends my PEP TALK today on : HYPERTHYROIDISM – WHEN TO SUSPECT

39. Reminder after the PEP Talk: Take the Online Learning cum Evaluation Test Exercise (OLETE) for mastery of learning and have a perfect score to get a Certificate. Link is in Chat Box.

40. Reminder: 25 OLETE Certificates = 1 Voucher for ROJoson Medical Consultation either Face-to-Face or Telemedical.

41. HYPERTHYROIDISM – WHEN TO SUSPECT Empowerment objective - for laypeople to have an essential  understanding on HYPERTHYROIDISM – WHEN TO SUSPECT as part of their health management. ROJOSON’S REQUEST: FEEDBACK TO THIS PEP TALK! Pls. type in your feedback in the chat box during the open forum and before we adjourn! Thank you!

42. HYPERTHYROIDISM – WHEN TO SUSPECT Empowerment objective - for laypeople to have an essential  understanding on HYPERTHYROIDISM – WHEN TO SUSPECT as part of their health management. LET’S NOW HAVE A GROUP PICTURE TAKING BEFORE WE START Q&A AND INTERACTIONS! Pls. turn on your video! Show your face!