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THE ADENOHYPOPHYSIS, THYROTROPIN & THE REGULATION OF THYROXIN by Professor Fink

In this video lecture, Professor Fink reviews the role of the Hypothalamic Releasing Hormones on the Adenohypophysis (Anterior Lobe of the Pituitary Gland) i...  
YouTube
over 5 years ago
Www.bmj
2
72

Diagnosis and management of subclinical hypothyroidism in pregnancy

In prospective studies, the prevalence of undiagnosed subclinical hypothyroidism in pregnant women ranges from 3% to 15%. Subclinical hypothyroidism is associated with multiple adverse outcomes in the mother and fetus, including spontaneous abortion, pre-eclampsia, gestational hypertension, gestational diabetes, preterm delivery, and decreased IQ in the offspring. Only two prospective studies have evaluated the impact of levothyroxine therapy in pregnant women with subclinical hypothyroidism, and the results were mixed. Subclinical hypothyroidism is defined as raised thyrotropin combined with a normal serum free thyroxine level. The normal range of thyrotropin varies according to geographic region and ethnic background. In the absence of local normative data, the recommended upper limit of thyrotropin in the first trimester of pregnancy is 2.5 mIU/L, and 3.0 mIU/L in the second and third trimester. The thyroid gland needs to produce 50% more thyroid hormone during pregnancy to maintain a euthyroid state. Consequently, most women on levothyroxine therapy before pregnancy require an increase in dose when pregnant to maintain euthyroidism. Ongoing prospective trials that are evaluating the impact of levothyroxine therapy on adverse outcomes in the mother and fetus in women with subclinical hypothyroidism will provide crucial data on the role of thyroid hormone replacement in pregnancy.  
bmj.com
about 5 years ago
Preview
1
33

THE ADENOHYPOPHYSIS, THYROTROPIN & THE REGULATION OF THYROXIN by Professor Fink

In this video lecture, Professor Fink reviews the role of the Hypothalamic Releasing Hormones on the Adenohypophysis (Anterior Lobe of the Pituitary Gland) i...  
YouTube
about 5 years ago
Www.bmj
2
45

Airway obstruction after the development of Hashimoto’s thyroiditis

A 67 year old white woman presented to her family doctor in January 2013 with a small asymptomatic thyroid swelling. Her serum thyroid stimulating hormone (TSH) concentration was high (37 mIU/L; reference range 0.5-4.5) and serum free thyroxine was low (5.4 pmol/L; 10-21), consistent with a hypothyroid state. However, she had no clinical features of hypothyroidism. Ultrasonography of the neck showed diffuse hypoechoic enlargement of the thyroid gland, with no retrosternal extension. Her serum anti-thyroid peroxidase (anti-TPO) value was also high (>600 kU/L; <35 kU/L). These features were suggestive of autoimmune (Hashimoto’s) thyroiditis. She was advised to take thyroxine tablets (100 µg) daily, and after two months her neck swelling reduced in size and her serum TSH concentration normalised (1.2 mU/L).  
bmj.com
over 4 years ago
Www.bmj
1
30

An abnormality at the hepatic flexure

A 92 year old woman presented to the emergency department after collapsing at home. She recalled standing from her chair, feeling lightheaded, and then collapsing. She had felt generally weak for more than a year, with weight loss of 56 lb (25.2 kg) but no change in bowel habit, dysphagia, or gastrointestinal bleeding. Her medical history included hypertension, hypothyroidism, and anaemia (which was currently being investigated by her general practitioner). Among other drugs, she was taking lisinopril, bendroflumethiazide, and levothyroxine. Her son had died at 60 years of age from large bowel obstruction and perforation secondary to colon cancer.  
bmj.com
over 4 years ago
7
0
59

What is the advantage of 'block and replace' regime in managing grave's disease patient?

I am now doing a thyroid surgery rotation. This morning we had a tutorial regarding management of patient with grave's disease (hyperthyroid). We were asked about what are the options that available for them. One of the participants highlighted the so called "block and replace regime" in which we are giving patient with carbimazole (block) and thyroxine (replace). The problem is, despite giving carbimazole alone, why do we need to add on thyroxine in managing hyperthyroid patient since this thyroxine might worsen the condition. Any ideas?  
malek ahmad
about 7 years ago
Www.bmj
0
15

Airway obstruction after the development of Hashimoto’s thyroiditis

A 67 year old white woman presented to her family doctor in January 2013 with a small asymptomatic thyroid swelling. Her serum thyroid stimulating hormone (TSH) concentration was high (37 mIU/L; reference range 0.5-4.5) and serum free thyroxine was low (5.4 pmol/L; 10-21), consistent with a hypothyroid state. However, she had no clinical features of hypothyroidism. Ultrasonography of the neck showed diffuse hypoechoic enlargement of the thyroid gland, with no retrosternal extension. Her serum anti-thyroid peroxidase (anti-TPO) value was also high (>600 kU/L; <35 kU/L). These features were suggestive of autoimmune (Hashimoto’s) thyroiditis. She was advised to take thyroxine tablets (100 µg) daily, and after two months her neck swelling reduced in size and her serum TSH concentration normalised (1.2 mU/L).  
feeds.bmj.com
over 4 years ago
Preview
0
15

An abnormality at the hepatic flexure

A 92 year old woman presented to the emergency department after collapsing at home. She recalled standing from her chair, feeling lightheaded, and then collapsing. She had felt generally weak for more than a year, with weight loss of 56 lb (25.2 kg) but no change in bowel habit, dysphagia, or gastrointestinal bleeding. Her medical history included hypertension, hypothyroidism, and anaemia (which was currently being investigated by her general practitioner). Among other drugs, she was taking lisinopril, bendroflumethiazide, and levothyroxine. Her son had died at 60 years of age from large bowel obstruction and perforation secondary to colon cancer.  
feeds.bmj.com
over 4 years ago
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0
16

A 56 year old woman with syncope, weakness, and refractory hypotension

A 56 year old woman with hypothyroidism after total thyroidectomy presented to the emergency department after an episode of near syncope. When she arrived she had hypotension and atrial fibrillation, with a rapid ventricular response. She reported a history of progressive weakness, weight loss, polyuria, polydipsia, anorexia, and fatigue. Urine analysis was positive for leucocyte esterase and pyuria. She was admitted to the intensive care unit with a diagnosis of severe sepsis of urinary source and atrial fibrillation with a rapid ventricular response. After aggressive fluid resuscitation and the administration of intravenous antibiotics, her heart spontaneously converted to a normal rhythm and she appeared well perfused but remained hypotensive. Review of her medical record showed that her therapeutic thyroxine replacement had recently been decreased because of low thyrotrophin. On perusal of her records from an another facility it was noted that she had undergone pituitary mass resection and irradiation 20 years earlier.  
feeds.bmj.com
over 4 years ago
Www.bmj
0
20

A 56 year old woman with syncope, weakness, and refractory hypotension

A 56 year old woman with hypothyroidism after total thyroidectomy presented to the emergency department after an episode of near syncope. When she arrived she had hypotension and atrial fibrillation, with a rapid ventricular response. She reported a history of progressive weakness, weight loss, polyuria, polydipsia, anorexia, and fatigue. Urine analysis was positive for leucocyte esterase and pyuria. She was admitted to the intensive care unit with a diagnosis of severe sepsis of urinary source and atrial fibrillation with a rapid ventricular response. After aggressive fluid resuscitation and the administration of intravenous antibiotics, her heart spontaneously converted to a normal rhythm and she appeared well perfused but remained hypotensive. Review of her medical record showed that her therapeutic thyroxine replacement had recently been decreased because of low thyrotrophin. On perusal of her records from an another facility it was noted that she had undergone pituitary mass resection and irradiation 20 years earlier.  
feeds.bmj.com
over 4 years ago
Www.bmj
0
17

A pain in the neck type of headache

A 29 year old right hand dominant chef presented to the emergency department with a four day history of feeling “not normal.” He was sent home from work because of a gradual onset of dull pain on the left side of his neck radiating up into his head, which was getting progressively worse, as well as “seeing two of everything.” The pain was not influenced by changes in posture. In addition, his right side felt numb and he was dropping things at work. He felt unsteady on his feet, which prompted him to seek medical advice. He thought all his symptoms had come on suddenly and were gradually getting worse. He denied any recent alcohol consumption, illicit drug use, seizure activity, head injury, or loss of consciousness. He had no medical history of note, apart from hypothyroidism, for which he was taking thyroxine.  
feeds.bmj.com
over 4 years ago
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1
48

Levothyroxine: Uses, Dosage, Side Effects - Drugs.com

Levothyroxine is used to treat low thyroid activity and to treat or suppress different types of goiters. Learn about side effects, interactions and indications.  
drugs.com
about 4 years ago
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0

No Thyroid-Function Benefits With T4/T3 Combo in Crossover Study

Despite anecdotal reports of improvement when patients with hypothyroidism take levothyroxine (T4) and triiodothyronine (T3) together, a new study testing a fixed-dose combination fails to impress.  
medscape.com
about 4 years ago
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6

AmeriCares Provides T4 Treatment for Thyroid Awareness Month

The global health and emergency-response organization AmeriCares partners with pharma to promote Thyroid Awareness Month and provide levothyroxine therapy to low-income patients across all 50 US states.  
medscape.com
almost 4 years ago
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0

Levothyroxine Replacement in Obese Hypothyroid Females

Obesity may factor into finding the optimal regimen for levothyroxine replacement in hypothyroid patients after thyroidectomy.  
medscape.com
over 3 years ago