• Virtual Rounds Session 5: Thyroid Disorders (Premed Shadowing)

Virtual Rounds Session 5: Thyroid Disorders (Premed Shadowing)

Throughout each premed virtual shadowing session, you will actively participate by answering and asking questions about the week’s proposed case. Like an in-person shadowing experience, we strive to stimulate students intellectually and ultimately reaffirm their interest in medicine.

 

Introduction – Thyroid Disorders

The thyroid is essential to the metabolic functions of a multitude of organs in the body. Besides thyroid cancer, there are two primary classifications for thyroid disorders: hypothyroidism and hyperthyroidism.

Case Highlights 

A 35 y/o F attorney presents to the clinic with worsening fatigue. She notes that for the past 2 months she has been experiencing lingering tiredness despite sleeping 8+ hours per night. She denies depression and states “I am too busy for that” but does report constipation, hair loss, and a 10-lb weight gain over two months despite not feeling very hungry. She notes at the firm, most of her co-workers are hot while she is bundled up with “as many clothes as I can find.” Her last normal period was “normal,” though she does admit there was a heavier flow than usual. She states previously she felt very well with a lot of energy but recently had “a cold and felt terrible” following this. No significant PMH.

Pathology 

Above: Hypothalamic-pituitary axis

There are primarily two ways to classify thyroid disorders:

  1. Hypothyroidism
    1. Insufficient production of thyroid hormone
      1. Ex. Hashimoto’s thyroiditis
    2. Symptoms include:
      1. Weight gain  
      2. Cold intolerance
      3. Fatigue
      4. Bradycardia
      5. Constipation
      6. Weakness/fatigue
      7. Hair loss
      8. Menstrual irregularities
      9. Edema 
  1. Hyperthyroidism 
    1. Increased or excess production of thyroid hormone
      1. Ex. Grave’s disease 
    2. Symptoms include:
      1. Weight loss
      2. Heat intolerance
      3. Anxiety /insomnia
      4. Palpitations / tachycardia
      5. Diarrhea
      6. Weakness / myopathy
      7. Menstrual abnormalities 

In terms of risk factors, etiologies, or exposures of which place one at risk for developing a thyroid disorder, we might consider the following:

To diagnose thyroid disorders, the gold standard test is the TSH. The TSH value in combination with the Free T3/T4 can point us in the direction of whether we are dealing with a hypothyroid or hyperthyroid state.

Treatment is directed towards whether we are dealing with hypothyroid or hyperthyroid state:

  1. Hypothyroidism:
    • Levothyroxine / synthroid (thyroid hormone supplementation) 
  2. Hyperthyroidism:
    • Radioactive Iodine Ablation / Surgical excision (definitive treatment)

THEN

    • Levothyroxine / synthroid (thyroid hormone supplementation) 
    • Propranolol (symptomatic relief)

 Take home points

    1. Thyroid disorders are divided into hypothyroid and hyperthyroid. 
    2. Hypothyroidism is insufficient thyroid hormone production while hyperthyroidism is excess or increased thyroid hormone production.
    3. Symptoms of hypothyroidism are consistent with slowing of metabolic function. Hyperthyroidism is reflective of increased metabolic function.
    4. TSH is the gold standard test for diagnosing thyroid disorders. 
    5. Treatment is directed at either supplementing thyroid hormone of which is missing (levothyroxine, synthroid) or eliminating the source of excess thyroid hormone (ablation/excision) and then supplementing thyroid hormone after (levothyroxine, synthroid).

Watch the virtual shadowing session here:

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