ROJoson PEP Talk: HYPOTHYROIDISM – When to Suspect

ROJoson PEP Talk: HYPOTHYROIDISM – When to Suspect

1. June 15, 2024 1400H - 1500H Via Zoom HYPOTHYROIDISM – WHEN TO SUSPECT Empowerment objective - for laypeople to have an essential  understanding on HYPOTHYROIDISM – WHEN TO SUSPECT as part of their health management.

2. June 15, 2024 1400H - 1500H Via Zoom HYPOTHYROIDISM – WHEN TO SUSPECT Empowerment objective - for laypeople to have an essential  understanding on HYPOTHYROIDISM – 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. HYPOTHYROIDISM – WHEN TO SUSPECT Empowerment objective - for laypeople to have an essential  understanding on HYPOTHYROIDISM – 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. HYPOTHYROIDISM – WHEN TO SUSPECT Empowerment objective - for laypeople to have an essential  understanding on HYPOTHYROIDISM – 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. HYPOTHYROIDISM – WHEN TO SUSPECT Empowerment objective - for laypeople to have an essential  understanding on HYPOTHYROIDISM – 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. HYPOTHYROIDISM – WHEN TO SUSPECT Empowerment objective - for laypeople to have an essential  understanding on HYPOTHYROIDISM – WHEN TO SUSPECT as part of their health management. My PEP TALK today is entitled: HYPOTHYROIDISM – WHEN TO SUSPECT

11. 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 HYPOTHYROIDISM ? What is the disease process of HYPOTHYROIDISM ? What are the complications of HYPOTHYROIDISM ? When does one suspect HYPOTHYROIDISM ? What are the diagnostic tests for HYPOTHYROIDISM ? What are the causes of HYPOTHYROIDISM ? What are the basic treatment modalities for HYPOTHYROIDISM ? Disclaimer: ROJoson PEP Talk contains ROJoson’s Thoughts, Perceptions, Opinions and Recommendations (TPORs) culled from experiences of ROJoson and writings of other health professionals . HYPOTHYROIDISM – WHEN TO SUSPECT

12. 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. HYPOTHYROIDISM – WHEN TO SUSPECT

13. 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) HYPOTHYROIDISM – WHEN TO SUSPECT

14. 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. HYPOTHYROIDISM – WHEN TO SUSPECT

15. 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 HYPOTHYROIDISM – 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 HYPOTHYROIDISM – 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 HYPOTHYROIDISM – WHEN TO SUSPECT

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

19. Producing deficient amount of thyroid hormones will lead to HYPOTHYROIDISM which is an abnormal condition = a medical disease which should be treated otherwise, it can cause bad effects on the human body, the most serious is MYXEDEMA COMA. HYPOTHYROIDISM – WHEN TO SUSPECT

20. Myxedema coma is a severe form of hypothyroidism that most commonly occurs in individuals with undiagnosed or untreated hypothyroidism who are subjected to an external stress. Features are as follows: ·       Altered mental status ·       Hypothermia ·       Bradycardia ·       Hypercapnia ·       Hyponatremia ·       Cardiomegaly, pericardial effusion, cardiogenic shock, and ascites may be present HYPOTHYROIDISM – WHEN TO SUSPECT

21. If a MXEDEMA COMA does NOT develop, untreated , hypothyroidism can cause serious health problems, including Mood disorders, like depression Peripheral neuropathy Increased risk of heart disease and heart failure Infertility Goiter HYPOTHYROIDISM – WHEN TO SUSPECT

22. What are the symptoms of hypothyroidism ? Symptoms of hypothyroidism can vary from person to person and may include fatigue weight gain trouble tolerating cold joint and muscle pain dry skin or dry, thinning hair heavy or irregular menstrual periods or fertility problems slowed heart rate depression AN ENLARGEMENT IN THE NECK, CALLED A  GOITER HYPOTHYROIDISM – WHEN TO SUSPECT

23. What are the symptoms of hyperthyroidism ? HYPOTHYROIDISM – WHEN TO SUSPECT

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

25. HYPOTHYROIDISM – WHEN TO SUSPECT

26. When to suspect HYPOTHYROIDISM ? Based on SYMPTOMS of hypothyroidism (any one of these – suspect but suspect more if more than one symptoms ) fatigue weight gain trouble tolerating cold joint and muscle pain dry skin or dry, thinning hair heavy or irregular menstrual periods or fertility problems slowed heart rate depression AN ENLARGEMENT IN THE NECK, CALLED A GOITER Most reliable symptom Plus at least one of these nonspecific symptoms or better, more HYPOTHYROIDISM – WHEN TO SUSPECT

27. To have a more definite or more certain diagnosis of hypothyroidism , 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 (depressed in hypothy ) T3 – triiodothyronine = FT3 ( depressed in hypothy ) A thyroid stimulating hormone (TSH) test can be done to complement T3 / T4 Interpretation – elevated TSH ( hypothy ) HYPOTHYROIDISM – WHEN TO SUSPECT

28. The Hypothalamus – Pituitary – Thyroid Axis Feedback / Autoregulation Mechanism HYPOTHYROIDISM – WHEN TO SUSPECT

29. After suspecting hypothyroidism based on SYMPTOMS and SIGNS, the following lab results can confirm its presence: Depressed FT4 alone Depressed FT3 alone Depressed FT4 and FT3 Depressed FT4 and FT3, elevated TSH Depressed FT4 and elevated TSH Elevated TSH alone Assuming not all FT4, FT3 and TSH are done simultaneously HYPOTHYROIDISM – WHEN TO SUSPECT

30. 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. HYPOTHYROIDISM – WHEN TO SUSPECT

31. HYPOTHYROIDISM – WHEN TO SUSPECT

32. What are the causes of hypothyroidism? Iodine deficiency Autoimmune disease Thyroid surgery Radiation / radioactive iodine therapy Chronic thyroiditis HYPOTHYROIDISM – WHEN TO SUSPECT

33. What are the treatment options for hypothyroidism ? Medical – use of drugs – levothyroxine – supplement and maintenance Will be discussed in another ROJoson PEP Talk episode. HYPOTHYROIDISM – WHEN TO SUSPECT

34. Summary – When to suspect HYPOTHYROIDISM Bases for suspicion: Presence of symptoms of HYPOTHYROIDISM Presence of signs of HYPOTHYROIDISM Confirmation of suspicion: DEPRESSED FT4 and ELEVATED TSH HYPOTHYROIDISM – WHEN TO SUSPECT

35. HYPOTHYROIDISM – WHEN TO SUSPECT 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 HYPOTHYROIDISM ? What is the disease process of HYPOTHYROIDISM ? What are the complications of HYPOTHYROIDISM ? When does one suspect HYPOTHYROIDISM ? What are the diagnostic tests for HYPOTHYROIDISM ? What are the causes of HYPOTHYROIDISM ? What are the basic treatment modalities for HYPOTHYROIDISM ? Summary Take Away

36. Take Away in relation to Patient Empowerment Be always in touch with reliable medical information on HYPOTHYROIDISM – 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 HYPOTHYROIDISM – WHEN TO SUSPECT as part of your health management. HYPOTHYROIDISM – WHEN TO SUSPECT

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

38. 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.

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

40. HYPOTHYROIDISM – WHEN TO SUSPECT Empowerment objective - for laypeople to have an essential  understanding on HYPOTHYROIDISM – 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!

41. Empowerment objective - for laypeople to have an essential  understanding on HYPOTHYROIDISM – 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! HYPOTHYROIDISM – WHEN TO SUSPECT