Hypothyroidism - PowerPoint PPT Presentation

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Hypothyroidism

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When you feel fatigue and it seems as if you are less energetic then it is high time to get your Thyroid checked. It might be Hypothyroidism, a very common phrase we hear these days affecting people in an enormous way. This is a condition where certain functions of the body is measured down leading to fatigue and various other problems. – PowerPoint PPT presentation

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Title: Hypothyroidism


1
HYPOTHYROIDISM
2
INTRODUCTION
  • Hypothyroidism is defined as a deficiency in
    thyroid hormone secretion and action
    that produces a variety of clinical signs and
    symptoms of Hypometabolism.
  • Overt Hypothyroidism is defined as an elevated
    serum TSH concentration (usually above 10 mIU/L)
    and reduced free Thyroxine concentration (fT4)
  • Subclinical Hypothyroidism is defined as serum
    TSH above the upper reference limit
    in combination with a normal free Thyroxine (fT4)

3
Prevalence
  • According to a projection from various studies on
    Thyroid disease, it has been estimated that about
    42 million people in India suffer from Thyroid
    diseases. The prevalence of Hypothyroidism was
    3.9. The prevalence of subclinical
    Hypothyroidism was 9.4. In women, the
    prevalence was higher, at 11.4, when compared
    with men, in whom the prevalence was 6.2.
    The prevalence of subclinical Hypothyroidism
    increased with age. About 53 of subjects
    with subclinical hypothyroidism were positive for
    anti-TPO antibodies.

4
CLINICAL PRESENTATION
  • Hypothyroidism can affect all organ systems
    these manifestations are largely independent of
    the underlying disorder but are a function of the
    degree of hormone deficiency.

5
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6
CAUSES OF HYPOTHYROIDISM
7
HASHIMOTOS THYROIDITIS
  • Hashimotos Thyroiditis is an autoimmune disease
    in which the thyroid gland is attacked by
    a variety of cell and antibody-mediated immune
    processes, causing primary Hypothyroidism.
    The resulting inflammation from Hashimotos
    disease, also known as Chronic Lymphocytic
    Thyroiditis, often leads to an underactive
    Thyroid gland (Hypothyroidism).
  • The diagnosis of Hashimotos Thyroiditis is
    supported by recognition of autoantibodies
    against TPO or Thyroglobulin. 90 of patients
    with Hashimotos Thyroiditis have anti-TPO
    antibodies and anti-Thyroglobulin antibodies,
    making these antibodies excellent markers for
    Hashimotos Thyroiditis. Anti-TPO antibody
    positivity is more common at the time of
    diagnosis than anti-Thyroglobulin antibody.

8
Hypothyroidism in Pregnancy
  • Convincing data suggest that pregnant women who
    are positive for Thyroid autoantibodies (especiall
    y anti-TPO antibodies) leads to higher frequency
    of miscarriage (13.8) than is seen in pregnant
    women who lack anti-TPO antibodies (2.4), and
    that T4 treatment of the anti-TPO antibody
    positive group reduces the risk of miscarriage to
    approximately 3.5.
  • Over Hypothyroidism (OH) in pregnancy is defined
    as an elevated TSH (gt2.5 mIU/L) in conjunction
    with a decreased FT4 concentration. Women with
    TSH levels of 10.0 mIU/L or above, irrespective
    of their FT4 levels, are also considered to have
    OH.
  • Sub-clinical Hypothyroidism (SCH) in pregnancy is
    defined as a serum TSH between 2.5 and 10 mIU/L
    with a normal FT4 concentration.
  • Isolated Hypothyroxinemia (IH) is defined as a
    normal maternal TSH concentration in conjunction
    with FT4 concentrations in the lower 5th or 10th
    percentile of the reference range.

9
Prevalence
  • 10-20 of all pregnant women in the first
    trimester of pregnancy are Thyroid
    Peroxidase (TPO) or Thyroglobulin (Tg) antibody
    positive and Euthyroid
  • 16 of the women who are Euthyroid and positive
    for TPO or Tg antibody in the first
    trimester will develop a TSH that exceeds 4.0
    mIU/L by the third trimester, and 33-50 of
    women who are positive for TPO or Tg antibody in
    the first trimester will develop postpartum
    Thyroiditis
  • 23 of apparently healthy, non-pregnant women
    of childbearing age have an elevated serum TSH.
    Among these healthy non-pregnant women of
    childbearing age it is estimated that 0.3-0.5
    of them would, after having Thyroid function
    tests, be classified as having OH, while 22.5
    of them would be classified as having SCH

10
Specific adverse outcomes associated
with maternal Hypothyroidism include
  • An increased risk of premature birth, low
    birth weight, and miscarriage. Such patients
    carry an estimated 60 risk of fetal loss when
    OH was not adequately detected and treated
  • Negro and colleagues published data suggesting
    SCH also increases the risk of pregnancy
    complications in anti-thyroid peroxidase antibody
    positive (TPOAb) women
  • Negro et al. reported a significantly
    higher miscarriage rate in TPOAb_ women with
    TSH levels between 2.5 and 5.0 mIU/ L
    compared with those with TSH levels below 2.5
    mIU/L

11
Recommendations
  • Women who are positive for TPOAb and have SCH
    should be treated with LT4
  • Women with SCH in pregnancy, who are not
    initially treated, should be monitored for
    progression to OH with a serum TSH and FT4
    approximately every 4 weeks until 16-20 weeks
    gestation and at least once between 26 and 32
    weeks gestation
  • Isolated Hypothyroxinemia should not be treated
    in pregnancy

12
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13
Recommendations
  • Anti-Thyroid Peroxidase Antibody (TPOAb)
    measurements should be considered when evaluating
    patients with subclinical Hypothyroidism.
  • If anti-thyroid antibodies are positive,
    Hypothyroidism occurs at a rate of 4.3 per year
    versus 2.6 per year when anti-thyroid antibodies
    are negative.
  • Assessment of serum free T4, in addition to TSH,
    should be considered when monitoring L-thyroxine
    therapy.
  • Treatment based on individual factors for
    patients with TSH levels between the upper limit
    of a given laboratorys reference range and 10
    mIU/L should be considered particularly if
    patients have symptoms suggestive of
    Hypothyroidism, positive TPOAb or evidence of
    atherosclerotic cardiovascular disease, heart
    failure, or associated risk factors for these
    diseases.

14
Recommendations
  • Patients whose serum TSH levels exceed 10 mIU/L
    are at increased risk for heart failure and
    cardiovascular mortality, and should be
    considered for treatment with L-thyroxine.
  • Euthyroid women (not receiving LT4) who are TPOAb
    require monitoring for Hypothyroidism during
    pregnancy. In addition to the risk of
    Hypothyroidism, it has been described that being
    TAb constitutes a risk factor for miscarriage,
    premature delivery, Perinatal death , post-partum
    dysfunction, and low motor and intellectual
    development (IQ) in the offspring.

15
TEST RANGE AVAILABLE
16
References
  1. Indian Journal of Endocrinology Metabolism.
    2011 Jul 15(Suppl2) S78S81.
  2. Williams text book of Endocrinology, Eleventh
    edition
  3. Tietz Textbook of Clinical Biochemistry, Fifth
    Edition
  4. Clinical Practice Guidelines for Hypothyroidism
    in Adults Cosponsored by the American Association
    of Clinical Endocrinologists and the American
    Thyroid Association

17
References
  1. Negro R, Schwartz A, Gismondi R, Tinelli A,
    Mangieri T, Stagnaro-Green A 2010
    Universal screening versus case finding for
    detection and treatment of thyroid hormonal
    dysfunction during pregnancy. J Clin Endocrinol
    Metab 9516991707.
  2. Negro R, Schwartz A, Gismondi R, Tinelli A,
    Mangieri T, Stagnaro-Green A 2010
    Increased pregnancy loss rate in thyroid antibody
    negative women with TSH levels between 2.5
    and 5.0 in the first trimester of pregnancy. J
    Clin Endocrinol Metab 95E448

18
  • For more information about Health Disease visit
    https//www.lalpathlabs.com
  • Hyperthyroidism

19
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