Thyroid Gland Disorders for Nurses and Health Care Staff

A presentation about the common thyroid disorders aimed for nurses and health care assistants

1. THYROID

2. 1.What is thyroid? thyroid is a gland in the front of neck Regulated by hypothalmo - pituiatry - thyroid axis On a simple level the hypothalamus secretes thyrotropin -releasing hormone (TRH) which stimulates the anterior pituitary to secrete thyroid-stimulating hormone (TSH). This then acts on the thyroid gland increasing the production of thyroxine (T4) and triiodothyronine (T3), the two main thyroid hormones. These then act on a wide variety of tissues, helping to regulate the use of energy sources, protein synthesis, and controls the body's sensitivity to other hormones .

3. 2. What are the common symptoms of hypothyroidim and hyperthyroidim ?

4. Symptoms of hypothyroidism and hyperthyroidism

5. 3. What are the investigations to check the thyroid function?

6. What are the investigations to check the thyroid function? Blood investigations TSH, FT4,FT3 Thyroid autoantibodies- thyroid peroxidase antibodies, TSH receptor antibodies, thyroglobulin – used to diagnose specific disease conditions USS of the neck Radioiodine uptake scans

7. 4. What do you know about thyroid function tests?

8. only minor circadian rhythms and measurements may be made at any time No need of fasting As a single test of thyroid function, TSH measurement is sensitive in most circumstances- can be used for screening For accurate diagnosis requires at least two tests: for example, TSH plus free T4 or free T3 where hyperthyroidism is suspected; TSH plus serum free T4 where hypothyroidism is likely

9. 5. What is the treatment for hypothyroidism?

10. Replacement therapy with levothyroxine synthetic thyroid hormone Most of the time, given for life

11. 6 . levothyroxine, patient education What do you need to tell to a patient?

12. Take levothyroxine once a day in the morning, ideally at least 30 minutes before having breakfast or a drink containing caffeine, like tea or coffee Levothyroxine starts working straight away, but it may be several weeks before your symptoms start to improve. The dose of levothyroxine varies from person to person- depends on underlying condition, body weight, age etc

13. If you forget to take it If you forget to take a dose, take it as soon as you remember, unless it's almost time for your next dose. In this case just skip the forgotten dose and take the next one at the usual time. Do not take 2 doses together to make up for a missed dose. If you often forget doses, it may help to set an alarm to remind you.

14. taking more than the prescribed dose of levothyroxine can give rise to symptoms of hyperthyroidim Regular monitoring with thyroid functions Do not stop during intercurrent illnesses

15. 7 . What are the treatment options for hyperthyroidism?

16. Depends on the cause Most common available options Drugs Surgery Radio-Iodine

17. 8. What are the common antithyroid drugs being used?

18. Carbimazole propylthiouracil

19. 9. Carbimazole patient education

20. Use to treat hyperthyroidism. Reduces hormone synthesis When you first start taking this medicine, it can take up to 3 weeks to see an improvement in your symptoms. One rare side effect can be a sudden drop in your white blood cell count. This makes it harder to fight infections- tell doctor immediately if sore throat, mouth ulcers, bruising or bleeding, fever, malaise or non-specific illness develops Need frequent monitoring of thyroid status Ensure adequate contraception during treatment

21. Precautions and Warnings Females of childbearing potential, Pregnancy Breastfeeding Glucose- galactose malabsorption syndrome, Lactose intolerance( Contains lactose) Mild hepatic impairment Retrosternal goitre - Use with caution in patients with retrosternal goitre as carbimazole may exacerbate this condition and tracheal obstruction may occur Discontinue treatment temporarily at time of administration of radio-iodine

22. Monitor creatine kinase levels in patients reporting myalgia Monitor for signs of bone marrow depression Monitor thyroid function regularly and adjust dose accordingly Perform white blood cell count if clinical evidence of infection Advise patient to report unexplained fever, sore throat, bruising, bleeding Advise patients to report signs of hepatic damage (malaise, jaundice etc .) Discontinue permanently if acute pancreatitis occurs Discontinue if evidence of significant bone marrow depression Discontinue if jaundice or other evidence of hepatic impairment occurs Discontinue if liver function tests become abnormal

23. 10. Thyroid and pregnancy

24. In pregnancy, there is an increase in the levels of thyroxine -binding globulin (TBG). This causes an increase in the levels of total thyroxine but does not affect the free thyroxine level.

25. Hypothyroidism and pregnancy Thyroxine is safe during pregnancy serum thyroid-stimulating hormone measured in each trimester and 6-8 weeks post-partum women require an increased dose of thyroxine during pregnancy by up to 50% as early as 4-6 weeks of pregnancy breastfeeding is safe whilst on thyroxine

26. Thyrotoxicosis- Untreated thyrotoxicosis increases the risk of fetal loss, maternal heart failure and premature labour Graves' disease is the most common cause of thyrotoxicosis in pregnancy. Management propylthiouracil  has traditionally been the antithyroid drug of choice however, propylthiouracil is associated with an increased risk of severe hepatic injury therefore , ' Propylthiouracil is used in the first trimester of pregnancy in place of carbimazole , as the latter drug may be associated with an increased risk of congenital abnormalities. At the beginning of the second trimester, the woman should be switched back to carbimazole ' maternal free thyroxine levels should be kept in the upper third of the normal reference range to avoid fetal hypothyroidism thyrotrophin receptor stimulating antibodies should be checked at 30-36 weeks gestation - helps to determine the risk of neonatal thyroid problems block-and-replace regimes should not be used in pregnancy radioiodine therapy is contraindicated

27. Iodization of salt Iodization is the process of fortifying salt for human consumption with iodine and is an effective strategy to increase iodine intake at the population level . associated with reduced risk or prevalence of goitre , cretinism, low intelligence or low urinary iodine excretion, as well as increased mean IQ and increased median and mean urinary iodine excretion