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7/31/2019 Presentation (Final) Ppt
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Thyroid DiseaseEmily Culvern Jocelyn Reddy Sarah Fecco Colin Fuqua Karly Childress
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Types of Thyroid
Disease
There are two different types of Thyroid disease:
Hyperthyroidism & Hypothyroidism
Hypothyroidism: thyroid is under-productive
Often caused by Hashimotos thyroiditis
Hyperthyroidism: thyroid is overactive
Often caused by Graves disease
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Hashimotos Disease
Hypothyroidism
It is an autoimmune disease that is caused by inflammation of
the thyroid gland
Symptoms include difficulty concentrating, fatigue frequent
bowel movements, goiter, heat intolerance, increased
appetite, and sweating among others
It tends to occur in families and is associated with other
autoimmune condition such as type 1 diabetes and celiac
disease
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Graves Disease
Hyperthyroidism
Graves disease is an autoimmune disease caused by thyroid
autoantibodies that activate the TSH receptor
It usually presents itself in early adolescence and affects 2%
of the female population
Symptoms include constipation, depression, fatigue, heavier
menstrual periods, joint and muscle pain, weakness, and
weight gain among others
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Who is at risk?
Females
Pregnant women and neonates
Ages 50 and over pose the highest risk of thyroid disease
Family history of thyroid/autoimmune disease
Removal of thyroid or radioactive treatment
Current or former smoker
Iodine or herbal supplements containing iodine
Over-consumption of soy foods
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Prevalence
can be close to 20 million cases of global thyroid conditions
over 1.5 million adults & more than 200,000 children in USA
had Hashimotos thyroiditis in the year 1996 alone
over 3 million people in USA in 1996 had Graves disease
4 out of 100 women have some type of autoimmune thyroid
disease
1 per 3,000-4,000 newborns are affected by congenital
hypothyroidism
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Methods of TreatmentTreatment depends on the type and the severity of the
disease
Treatment of Hashimotos disease/hypothyroidism:
no definitive cure
hormone replacement by medication
replacing one or more can alleviate the symptoms
Treatment of Graves disease/hyperthyroidism:
3 treatments:
1. Anti-thyroid medication
2. Beta blockers
3. Surgery
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Nutritional Interactions
Over the past thirty years, research has been conducted to
find new preventions or reverse of various types of diseases.
Many tests have been focused on the identification of
bioactive food components, which is why vitamins and
minerals showed particular promising results
We have decided to talk about vitamin D and Iodine and theirinteraction with Thyroid Disease
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Why Vitamin D?
Vitamin D has been shown to prevent bone loss associated
with hyperthyroidism
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The Objective of the Study
on Vitamin D
The objective of this study was to investigate the association
of hyperthyroidism and bone loss and its correlation with
Vitamin D
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Materials & Methods
80 consecutive patients (62 female an 18 males) with Graves disease were
tested for biochemical, thyroid functions, serum vitamin D levels, and BMD(bone mass density). They were treated and rendered euthyroid. Diagnosis
was based on clinical features of thyrotoxicosis, serum T4, and TSH levels
in hyperthyroid range, readio-iodine uptake, and diffuse thyromegaly
Healthy controls were used that composed mainly of hospital employees,students, and nurses where a low vitamin D status has been reported.
Extensive questioning with a detailed history and clinical examinations were
used
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Materials & Methods
continued...
Statistical methods such as mean, standard deviation were
applied to summarize the variables. Proportions and
percentages were used to summarize the categorical
variables
For comparison of baseline continuous variables between
groups was done by applying independent T-test
For comparison of categorical variables, chi square or fishers
exact test was applied
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Results
The mean radioactive uptake at 2 hours was 38.56 and at 24 hours was 65.89%
Serum creatine, BMI, and TSH were lower in Graves patients compared to healthy
controls
Serum T4, ALP, duration of sun exposure and serum calcium were higher in people with
hyperthyroid Graves patients compared to healthy euthyroid controls
those patients were treated with carbimazole and all became euthyroid
In 2-4 months those patients began having a normal T4 range
Mean serum T4 levels at baseline were 20.94
Mean levels increased as months progressed. The TSH levels at baseline increased from
.08 to 1.67 at the end
BMI was shown to increase with therapy
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Discussion
Hyperthyroid state is associated with an increase in bone turnover with a possibly
direct effect of T4 on osteoclast, resulting in hypercalcemia with suppressed PTH
both patients and controls were vitamin D deficient
The high levels of PTH could be due to vitamin D deficiency associated with
secondary hyperthyroidism overwhelming T4 mediated PTH suppression
In a study of 34 untreated hyperthyroid patients, a mean 25(OH)D level of
23.4ng/ml was compared the to normal control level of 28ng/ml
In another study of 208 Graves patients, serum 25(OH)D value of less the 10ng/dlwas found in 40% of female and 18% of male patients
no healthy control was taken and thus cannot determine if the high vitamin D
deficiency was due to the high prevalence in general population or due to
hyperthyroidism itself
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Discussion continued...
A strong positive correlation between BMI and BMD at all sites was found
Lack of substantial increase in BMD after 2 years of treatment with attainment of
euthyroid state could occur because the bone turnover may not be normalized for asufficient length of time
Limitations to study:
area of sunlight exposure has not been recorded making it difficult to correlate sun
exposure and vitamin D status
clinical scoring was not done nor was history of menopause recorded
dietary calcium intakes of subjects and their socioeconomic status was notrecorded
urinary creatine ratio or phosphate excretion index could not be derived
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Why Iodine?
Iodine has been shown to be positively linked to the thyroid
Iodine is valuable in maintaining a proper thyroid function
3 iodine is added to make T3 and 4 iodine to make T4, whichare the two main hormones that the thyroid procuces
Deficiency has been shown to cause hypothyroidism
One particular study suggests a connection between iodine
deficiency in old age and the increase of thyroid
autoantibodies
In other words, an adequate intake of iodine can reduce the
presence of thyroid autoantibodies in the consumer
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The Objective
Thyroid disease - a common autoimmune disorder, which canbe detected by the presence of thyroid antibodies
To asses thyroid autoimmunity among elderly people in a
town with low iodine intake in comparison to a town with
sustained recommended iodine intake from a natural sources
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Materials & Methods
The study was carried out in the towns of Randers and Skagen inDenmark
the study was conducted on mostly elders as a representation of
long term iodine deficiencyPopulation, both men and women born in 1920 living in Randers, andpopulation both men and women born in 1918 through 1923 living inSkagen took part in the study
Questionnaire regarding treatment for thyroid disease use iodine
continuing vitamin and mineral preparations, duration of residence,smoking habits, and alcohol use
Iodine Deficiency - Randers
Iodine Replete (showing recommended levels) - Skagen
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Materials & Methods
continued...
A blood sample was drawn using minimal tourniquet and non fastingspot urine sample was collected in iodine free polyethylene containers
Dynotest RIA with functional sensitivity of 30 u/: used to measurethyroid antibodies
A functional sensitivity of 20 u/L used to measure thyroglobulinantibodies
The iodine content is urine was examined via Sandell - Kolthoffreaction modified
Urinary creatine was determined by kinetic Jaffe Method and used toestimate age and gender specific iodine/creatine ratio
The stats of each group and town recorded along with possibleinterfering variables: gender, smoking, alcohol, intake, and location ortown
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Results
Participation rate was 47%
More women then men took part in the study
75% of participants had been residents of one of the two
towns for over 40 years
The difference among towns was apparent in duration ofresidence as well as those abstaining from alcohol. Smoking
frequencies were similar
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Results continued...
Elders with a deficient Iodine intake - thyroid antibodies shown to be
more prevalent
Elders within recommended Iodine intake - thyroid antibodies not as
common
Those with moderate iodine deficiency (measured by urinary iodine
excretion below 50 u/24 hrs) had increased risk of harboring thyroid
antibodies
With Randers being an iodine deficient zone, the increase inoccurrence of thyroid antibodies directly coincided with length of
time as a resident
Skagen (iodine replete) did not have as strong of a correlation
between time as a resident and number of thyroid antibodies
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Iodine Intake Level
Hosting a thyroid antibody was more common in elders from
iodine deficient zone compared to those from iodine replete
zone
Thyroid antibodies were common in 75-80 year old men and
women from both iodine deficient and iodine replete levels
In short - more iodine deficient than iodine replete eldersharbored a thyroid autoantibody and differences increased
with duration of residence
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Variables to Consider
As age increases, immune system function is compromised.
Older age in some participants could play as much of a role
on thyroid disease as being iodine deficient
Alcohol consumption and smoking can play a contradicting
role against minerals and should be considered when
assessing iodine levels
The location of the iodine experiment degrades some
relevance to us
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Aging & Thyroid
The aging process affects the immune system that becomes lessresponsive to antigenic challenges and the incidence and morbidity ofinfections increase with age
Immune system is activated in elderly with increased concentration of
inflammatory cytokines causing a pro-inflammatory environment andcomplicates degenerative disease and increases incidence ofautoimmune disorders
Age influences the prevalence of TGAb and TPOAb
These antibodies increased with age from 7-9% in the young to 22-
20% for TGAb and TPOAb respectively in the 60-65 year old womenA higher prevalence rates of both TGAb and TPOAb of 37% and 28% inwomen irrespective of iodine intake level
Results suggest a peak in thyroid autoimmunity between age of 65 and100 years
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Aging continued...
Iodine intake did not influence the occurrence of thyroidautoantibody in those under age of 45 years in a largepopulation based survey
The findings that thyroid autoantibodies occurred morefrequently with iodine deficiency was dominated by adifference in TGAb. Iodine deficiency associated with a rise infrequency especially among men who rose almost to the level
of womenSuggests that iodine deficiency may increase pro-inflammatory environment in men in old age asthyroglobulin levels were elevated with iodine deficiency inboth men and women
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Conclusion
In Hyperthyroid Graves patients, BMD was found to be
significantly lower at hip, spine, and forearm compared to healthy,
euthyroid controls
When treated for hyperthyroidism, the absolute BMD improved,
but BMD corrected for BMI showed a decrease
Damage in BMD caused by thyroid hormone ecess is not made
up even after two years of patent being euthyroid
The impact of aging on the immune system is modified by iodine
Data suggests a peak in thyroid autoimmunity between the age of
65 and 100 years
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References
1.Andersen, Stig, Finn Iversen, Steen Terpling, Klaus M. Pedersen, Peter Gustenhoff, and Peter Laurberg. "Iodine Deficiency Influences
Thyroid Autoimmunity in Old Age - A Comparative Population-based Study. Thesis. Aalborg University Hospital, Denmark, 9
November 2011. Iodine Deficiency Influences Thyroid Autoimmunity in Old Age A Comparative Population. Science Direct, 9 Nov. 2011.
Web. 5 Apr. 2012.
2. Dar, Rayees A., Nisar A. Chowdri, Fazl Q. Parray, and Sabiya H. Wani. "An Unusual Case of Hashimoto's Thyroiditis with Four Lobed
Thyroid Gland. PubMed. North American Journal of Medical Sciences, 4 Mar. 2012. Web. 2 Apr. 2012.
3. Godbole, Madan M., Geeta Rao, By N. Paul, Vishwa Mohan, Preeti Singh, Drirh Khare, Satish Babu, Alok Nath, P. K. Singh, and
Swasti Tiwari. "Prenatal Iodine Deficiency Results in Structurally and Functionally Immature Lungs in Neonatal Rats." Thesis. Sanjay Gandhi
Postgraduate Institute of Medical Sciences, 2011. American Physiological Society. American Journal of Physiology, 12 Mar. 2012. Web. 2
Apr. 2012.
4. Jyotsna, Viveka P., Abhay Sahoo, Achouba Singh, V. Sreenivas, and Nandita Gupta. "Bone Mineral Density in Patients of Graves Disease
Pre- & Post-treatment in a Predominantly Vitamin D Deficient Population." Thesis. Department of Endocrinology & Metabolism, All India
Institute of Medical Sciences, 2009. Bone Mineral Density in Patients of Graves Disease Pre- & Post-treatment in a Predominantly Vitamin D
Deficient Population. Indian Journal of Medical of Research, 4 Nov. 2009. Web. 2 Mar. 2012.
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Questions?