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Many Faces of
Hypothyroidism
Dr. Sharda Jain Dr. Jyoti AgarwalDr. Jyoti Bhaskar
Dr. Indu TyagiDr. Rashmi Jain
Public Awareness
Dr. Sharda Jain / Dr Jyoti Agarwal / Dr. Jyoti BhaskarLife Care Centre has a over 200 ppt on shildeshare.net
For benefit of Medical fraternity.use it yourself & share among your friends
Hypothyroidism WOMEN AND MEN >35 YEARS OF AGE SHOULD BE SCREENED EVERY 5 YEARS.
As suggested by
ATA/AACE: American thyroid Association / American Association of Clinical
Endocrinologists.
Reference :1. Garbar JR, Cubin H, Hennessey , JB, Klein I , Mechanic Ji, et al. Clinical practice guidelines for hypothyroidism in adults. Cosponsored by he American Association of Clinical Endocrinologists and the American Thyroid Association Endoor pract. 2012 Nov-Dec;18(6):988-1028.
Hypothyroidism and women
Thyroid dysfunction is quite prevalent in Indian, particularly in female.
Life Care centre experience
in female clinic population --16%.
Reference : 1. Unnikrishnan AG et al. Prevalence of hypothyroidism in adults : an epidemiological study in eight cities of India. India Journal of Endocrinology ad Metabolism 2013;17(4) ;647-52
In the cross-sectional epidemiological study in eight cities of India (March 2011 to July 2011)
in 5376 participants,
The prevalence of hypothyroidism was found to be approximately one in 10 adults.
A significantly higher (p<0.05) proportion of females were diagnosed with hypothyroidism
than males (15.86% vs 5.02 %).
Hypothyroidism and women
Hypothyroidism and Infertility
• According to Endocrine Society practice Guideline 2012
“Screening of Hypothyroidism is recommended in women
suffering from infertility”Reference 1. De Groot L et al. Management of thyroid dysfunction during pregnancy and postpartum : an Endocrine Society clinical practice guideline. J Clin Endocrinal Metab. 2012;97(8);2543-65
In males infertility starts in
childhood
• Thyroid failure in the pre-pubertal period is associated with testicular enlargement and alterations in sexual hormones
• There is macro orchidism without virilization
• Longer the hypothyroidism persists, greater is the degree of damage to the testes
• If adequately treated these boys progress through puberty normally
Hypothyroidism and Pregnancy
Maternal hypothyroidism - early diagnosis is must in the first
prenatal visit or at diagnosis of pregnancy.
Reference : 1 Banerjee S. Thyroid disorders in pregnancy. Indian thyroid guidelines 2011, Downloaded from http://www.japi.org/thyroid_speicail _ja_issue_2011/article_07(Last accessed October 2015)
American thyroid Association 2014 recommend
Trimester specific TSH range.Ist Trimester : 0.1-2.5 mIU/L
2nd Trimester : 0.2-3.0 mIU/L
3rd Trimester : 0.3 -3.0 mIU/L
Hypothyroidism and Pregnancy
Reference : 2. Jonklaas J, et al. Guidelines for the treatment of hypothyroidism : prepaid the American thyroid Association task force on thyroid hormone replacement . Thyroid 2014 Dec. 24(12) : 1670-751
Hypothyroidism and Newborn
American Academy of pediatrics Guidelines
“Screening of Hypothyroidism is recommended within first seven
days of birth”
Refernce : 1 . Smith L. Updated AAP Guidelines on newborn screening and therapy for congenital hypothyroidism. Am Fam Physican . 2007;76(3); 439 -44
Hypothyroidism and Children
Hypothyroidism is the most common abnormality of thyroid function in children
and adolescents
Diagnosis of hypothyroidism is important in adolescence because this condition retards
growth in height and development of secondary sexual characteristics, delayed
onset of puberty
Reference : capetio –Ventura n, Beeza I . Psychiatric Symptoms due to Thyroid Disease in a Female Adolescent . Case Rap Endocrinal 2014;2014;972348
Hypothyroidism and Menopause
• Symptoms of hypothyroidism are often similar to menopausal symptoms
• Screening should be done in peri-and post menopausal women to prevent complications of hypothyroidism.
Reference . Josni SA et al. Screening of peri-and postmenopausal women for hypothyroidism, Journal of scuth Asian Federation of Obstetrics and Gynecology. January –April 2011;3(1);14-16
Depression “The diagnosis of hypothyroidism must
be considered in every patient with depression”
• ATA/AACE: American Thyroid Association /American Association of clinical Endocrinologists
2012 Guidlines
Reference : 1. Garber JR, Cobin RH , Gharib H, Hennessey JV Klein I , Mechanick JI, Pessac-Pollack R, Singer PA, Viewer KA; American Association of Clinical Endocrinologists And American Thyroid Association Taskforce On hypothyroidism in Adults. Clinical practice guidelines for hypothyroidism in adults; cosponsored by the American Association f0 Clinical Endocrinologists and the American Thyroid Association. Thyroid 2012 Dec;22(12) : 1200-35.
Hypothyroidism and Diabetes
• Subclinical and overt hypothyroidism has been reported to be linked with insulin
resistance
In patients on treatment for both thyroid disorders and diabetes, thyroid status should
be kept in mind while titrating ant diabetic therapy.
Reference 1. Kalra S et al. The hypoglycemic sideof hypothyroidism. Indian Journal of Endocrinology and Metabolism 2014;18(1)1-3
Diabetes Mellitus
• Hashimoto’s thyroiditisis associated with 10% of patients with type 1 diabetes mellitus
• Approximately one-fourth of female patients with type 1 diabetes mellitus develop postpartum thyroiditis
Hypothyroidism and CKD
Unresolved subclinical hypothyroidism in chronic kidney disease patients can be associated with
a rapid decline in renal function Thyroid function should b be assessed early in patient
with renal impairment.
Reference : 1. Kim EO, et al : Unresolved subclinical hypothyroidism is independently associated with progression of chronic disease Int J Med Sci 2013 Dec 20 ; (1)52-9 doi : 10.7150/ijms.7186 . eCllection 2014. 2. Connor A et al, Renal impairment resulting from hypothyroidism Nephro Dialysis Transplantation plus 2008 : 6 440-441
Hypothyroidism and
Dyslipidemia
Indian Thyroid Guidelines 2011
“All patients with elevated lipid levels should be screened for
Hypothyroidism”.
Reference : Tandon N et al. Management of Hypothyroidism in adults. J Assoc Physicians Indian. Jan 2011; 59 Suppl: 21-5
Hypothyroidism and Elderly
ATA / AACE Guidelines 2012
Increased TSH values are increasingly noted in the elderly population. Thus,
very mild TSH elevations in older individuals may not reflect subclinical thyroid dysfunction, but rather be a
normal manifestation of ageing. Reference : Garber JR et al. Clinical practice guidelines' for hypothyroidism in adults cosponsored by the American Association of clinical Endocrinologists and the American Thyroid Association Endocr pract 2012;18(6) 988-1028
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