Question

- Assessment and Management of Patients with Thyroid Disorders
In table format compare and contrast Hypo and Hyperthyroidism. Include the following elements in the table:

• Causative Agent
• Risk Factors
• Pathophysiology
• Manifestations
• Treatment

Answer 1

Hypothyroidism	Hyperthyroidism
Definition: Hypothyroidism is a condition in which the thyroid gland doesn’t produce enough thyroid hormone and thereby disrupting all the metabolism in the body.	Definition: Hyperthyroidism is the condition in which there will an over-production of thyroid hormone.
Etiology: • Autoimmune disorder such as Hashimotos’ thyroiditis	Etiology for hyperthyroidism includes •Graves’ disease
• Exposure to any radiation therapy	• Presence of thyroid nodules
• Any pituitary disorders or surgery in the pituitary glans	• Thyroiditis
• Pregnancy	• Ingestion of thyroid hormone
• Iodine deficiency	• Thyroid adenoma
• Previous surgeries in the thyroid glands	• High dietary iodine intake
• Over drug consumption in the hyperthyroidism treatment	• Ingestion of food containing thyroid hormone
	• Genetic factors
	• Too much thyroid medicine intake
Risk factors: • Age more than 60 years	Risk factors: • Age more than 60 years
• Women are affecting more likely than men	• Women are affecting more
• Family history of thyroid disease	• Family history of thyroid disease
• Previously treated with radioactive iodine or anti-thyroid medications	• History of Graves’ disease
• Previous thyroid surgery	• Previous thyroid surgery
• Presence of any autoimmune disorders	• Presence of other autoimmune disorders
Previous thyroid surgeries	• Most probably in pregnancy or delivery within the past six months
• Most probably in pregnancy or delivery within the past six months
Pathophysiology: In hypothyroidism, mainly the hypothalamus and pituitary glands disorders will result in decreased thyroid production. In normal mechanisms, there will increase the production of T4 and a small amount of T3 production. During the early stage of the disease, there will be a decrease in the production of T4 which causes increased production of TSH by the pituitary gland and this TSH stimulates hypertrophy and hyperplasia of the thyroid gland which leads to increased T3 production. These changes will lead to cardiac enlargement, pericardial effusion, decreased pulse, and decreased heart rate.	Pathophysiology: In hyperthyroidism, there will be an alteration in the normal control of thyroid hormone secretion by increasing the thyroid hormone level in the body will results in hypermetabolism in the body. This hypermetabolism will increase the sympathetic nervous system activity and there will be an alteration in the hypothalamic-pituitary and gonadal hormone metabolism and secretion. The increased thyroid hormone secretion will stimulate the cardiac system and will lead to tachycardia, increased cardiac output, stroke volume, peripheral blood loss, etc. There will be a negative nitrogenous balance and nutritional deficiency that will lead to hyperthyroidism.
Clinical manifestations: • Fatigue	Clinical manifestations: • Palpitations and tachycardia
• Constipation	• Weight loss or gain
• Weight gain	• Increased sweating
• Mood swings	• Tremor
• Puffy face	• Lower leg swelling
• Thinning hair	• Shortness of breath
• Slow heart rate	• Increase in appetite
• Depression	• Diarrhea
• Muscle weakness	• Decreased menstrual flow
• Pain and swelling in joints	• Insomnia
• Dry skin	• Hair loss
• Increased sensitivity to cold	• Mood swings
• Elevated cholesterol level	• Vision troubles including double vision, photophobia
Treatment: • Thyroid hormone replacement by medications such as Eltroxin, Levothyroxine.	Treatment: • Radioactive Iodine absorption will help to shrink the thyroid glands and to subside the symptoms.
• Promote nutritional therapy to reduce weight gain.	• Anti-thyroid medications such as propylthiouracil and methimazole to prevent the excess production of thyroid hormone.
• Monitor the thyroid hormone levels once in a month and adjust the medication doses according to the values.	• Beta-blockers will helps to reduce the signs and symptoms of hyperthyroidism.
	• Surgical management includes thyroid lobectomy, subtotal thyroidectomy, and total thyroidectomy.