Thyroid Dysfunction: Thyroid Glands Disorders
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Thyroid Dysfunction: Thyroid Glands Disorders

Approximately 20 million Americans are afflicted with thyroid disease. Sixty percent of the population with thyroid disorders are believed to be unaware of their abnormality.
                 thyroid gland

Image Source - Thyroid

• Approximately 20 million Americans are afflicted with thyroid disease.

• 60% of the population with thyroid disorders are believed to be unaware of their abnormality.

• Women are five to eight times more likely than men to have a thyroid problem.

• Palpable thyroid nodules are found in 5% to 7% of the North American population.

• Thyroid imaging studies (radioisotope scans or ultrasounds) increase the number of nodules found in an individual and in a population. However, thyroid cancers are rare (<5% of thyroid nodules) and deaths from thyroid cancer are also very uncommon.

• Hypothyroidism (clinical and subclinical) is 10 times more prevalent than hyperthyroidism (clinical or subclinical).

• Screening for a thyroid disorder with a TSH value is controversial.

• Most thyroid diseases require lifelong follow-up and medical management.

Physiology

• Thyroxine (T4) is the principal product of the thyroid gland. However, T4 is sometimes considered a prohormone because it must be converted to triiodothyronine (T3) to exert its biological effects.

• T4 is highly protein bound, for example, 99.96% is bound to thyroxine-binding globulin (TBG), albumin, transthyretin, and lipoproteins.

• Half-life of T4 is 7 days.

• T3 is also highly protein bound (99.3%).

• Half-life of T3 is 24 hours.

• TSH controls the secretion of T4 and T3 from the thyroid gland. TSH is a glycoprotein hormone with two subunits, A (common to follicle-stimulating hormone [FSH], luteinizing hormone [LH], and human chorionic gonadotropin [HCG]) and B (unique to TSH). The half-life of TSH is 50 minutes, and its secretion is facilitated by thyrotropin-releasing hormone (TRH) secreted from the hypothalamus.

• Primary factor inhibiting TSH synthesis and secretion is T3.

Prevalence of Thyroid Dysfunction

• Hypothyroidism is present in 2% of the adult population.

• Subclinical hypothyroidism likely accounts for an additional 5% to 17%.

• Hyperthyroidism is present in <0.2% of the adult population.

• Subclinical hyperthyroidism likely accounts for an additional 0.1% to 6.0%.

Risk of Developing Thyroid Dysfunction

• Previous thyroid dysfunction

• Goiter

• Surgery or radiotherapy involving the gland or neck

• Diabetes mellitus, type 1

• Vitiligo

• Pernicious anemia

• Medications (lithium, amiodarone, interferon)

• Leukotrichia

• Family history of thyroid disease, pernicious anemia, type 1 diabetes mellitus, or primary adrenal insufficiency

Abnormal Laboratory Tests that Accompany Hypothyroidism

• Hypercholesterolemia

• Hyponatremia

• Anemia

• Increased creatine phosphokinase (CPK)

• Increased lactic dehydrogenase (LD)

• Hyperprolactinemia

Abnormal Laboratory Tests that Accompany Hyperthyroidism

• Hypercalcemia

• Increased alkaline phosphatase

• Hepatocellular enzyme elevation

• Abnormal electrocardiogram (ECG) (atrial fibrillation, atrial flutter, or supraventricular tachycardia [SVT])

• Low cholesterol

• Increased ferritin

• Increased angiotensin-converting enzyme

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