|Instructor:||Dr. Peter Loewen|
|Important Course Pages|
- Be able to describe the physiology of thyroid function.
- Be able to explain the biochemical parameters used to evaluate thyroid function.
- Be able to describe the pathophysiology of the most common causes of hyper- and hypothyroidism.
- Be able to name the signs and symptoms of hyper- and hypo-thyroidism.
By the end of the the session and upon further study and reflection, students should be able to
- rationalize a diagnosis of hypothyroidism on the basis of signs and symptoms combined with biochemical tests.
- design, implement and monitor (efficacy/toxicity) an effective pharmacotherapeutic plan for managing primary hypothyroidism.
- dentify and manage common drug related-causes of hypothyroidism.
- Obtain Peter Loewen's Thyroid Physiology, Pharmacology, & Pharmacotherapy PLOP.
- Read McDermott MT. Hypothyroidism. Ann Intern Med. 2009; ITC6 (1DEC09)
- Complete the self-assessment questions below
- Obtain and review the session slides, posted in Connect
Preparatory self-assessment questions
1. The predominant hormone secreted by the thyroid gland is
- a. Triiodothyronine
- b. Tetraiodothyronine
- c. Liothyronine
- d. Parathyroid hormone
2. The metabolically active thyroid hormone, (________), is produced mainly (_________)
- a. T3, in peripheral tissues
- b. T4, in peripheral tissues
- c. T3, in the thyroid
- d. T4, in the thyroid
3. The most common cause of hypothyroidism in North America is
- a. Iodine deficiency
- b. Graves’ disease
- c. Amiodarone
- d. Autoimmune thyroiditis
4. The most common cause of hyperthyroidism in North America is
- a. Iodine excess
- b. Graves’ disease
- c. Autoimmune thyroiditis
- d. Toxic multinodular goitre
5. Which constellation of symptoms is most consistent with hyperthyroidism
- a. Depression, constipation, ascites, bradycardia
- b. Normocytic anemia, pleural effusion, menorrhagia, myalgia
- c. Bradyphasia, eczema, proptosis, paresthesia
- d. Thinning of hair, amenorrhea, osteoporosis, muscle weakness
References & Additional Reading
- ASCE / ATA Clinical Practice Guidelines for Hypothyroidism in Adults Endocrine Practice 2012;18(6):989-1027
- Levy M. ￼How to interpret thyroid function tests. Clin Med 2013;13:282–6.
- Nygaard B. Hypothyroidism (Primary). ClinicalEvidence 2010;01:605.
- Effects of evening vs morning levothyroxine intake: a randomized double-blind crossover trial. Arch Intern Med. 2010 Dec 13;170(22):1996-2003.
- Chaker L, van den Berg ME, Niemeijer MN, et al. Thyroid Function and Sudden Cardiac Death Circulation. 2016;134(10):713-722
- Hennessey, J. V., & Espaillat, R. Diagnosis and Management of Subclinical Hypothyroidism in Elderly Adults: A Review of the Literature. Journal of the American Geriatrics Society, 2015:63(8), 1663–1673.
- Garg A, Vanderpump MPJ. Subclinical thyroid disease. British Medical Bulletin 2013;107:101–16.
- Pham & Shaugnessy. Should we treat subclinical hypothyroidism? BMJ 2008;337:a834 doi:10.1136/bmj.a834
Pregnancy & Hypothyroidism
- Jouyandeh, Z., Hasani-Ranjbar, S., Qorbani, M., & Larijani, B. (2014). Universal screening versus selective case-based screening for thyroid disorders in pregnancy. Endocrine, 1–8.
- Maraka, S., O’Keeffe, D. T., & Montori, V. M. (2015). Subclinical Hypothyroidism During Pregnancy—Should You Expect This When You Are Expecting?: A Teachable Moment. JAMA Internal Medicine, 175(7), 1088.
- Nathan N, Sullivan SD. Thyroid disorders during pregnancy. Endocrinology and Metabolism Clinics of North America. 2014 Jun;43(2):573–97.
- Lazarus J, Brown RS, Daumerie C, Hubalewska-Dydejczyk A, Negro R, Vaidya B. 2014 European thyroid association guidelines for the management of subclinical hypothyroidism in pregnancy and in children. Eur Thyroid J. 2014 Jun;3(2):76–94.
- Casey B, de Veciana M. Thyroid screening in pregnancy debate. Am J Obstet Gynecol. 2014 Aug 17.