Hypothyroidism Holistic Treatments

The Hypothyroidism Revolution

During Phase 1 of the Hypothyroidism Revolution Program, the magic begins to happen as you begin to notice many positive changes occurring. You will begin your progressive transition towards the ideal thyroid healing diet that will give your thyroid the big boost that it needs to help your cells produce more than enough energy for you. By the end of Phase 1, your energy levels will be rapidly on the rise and you will feel amazingly satisfied with zero food cravings. You will feel in control again as your mood drastically improves and any sign of depression and anxiety begin to disappear. Your family and friends are going to notice some major positive changes in you. You will also begin to experience many of the outer changes that come with improved thyroid function. Youre skin will begin to clear up and glow while your hair and nails will begin to look healthy again. As you ease into the thyroid healing diet, you will progressively remove the foods that suppress your thyroid, disrupt your hormone pathways, cause digestive upset and irritation, and cause toxic byproducts that congest your liver. At the same time, you will be progressively adding the foods that will be supplying your cells with the right balance and combination of nutrients that they need to thrive and produce endless amounts of energy. Continue reading...

The Hypothyroidism Revolution Summary

Rating:

4.8 stars out of 18 votes

Contents: Ebooks
Author: Tom Brimeyer
Official Website: www.hypothyroidismrevolution.com
Price: $97.00

Access Now

My The Hypothyroidism Revolution Review

Highly Recommended

This is one of the best books I have read on this field. The writing style was simple and engaging. Content included was worth reading spending my precious time.

Purchasing this book was one of the best decisions I have made, since it is worth every penny I invested on it. I highly recommend this to everyone out there.

CASE 1 Recurrent Painful Hashimotos Thyroiditis Case Description

Case 1 presented to us in 1982, at age 67, after taking levothyroxine (T4) for 10 yr. Her thyroid was nontender, quite firm, and diffusely enlarged, with an estimated size of 50 g. Her antithyroid microsomal antibody titer was 1 1 600,000 and her antithyroglobulin antibody level was 50 radioimmunoassay (RIA) units*. On a T4 dose of 150 g daily, her serum thyrotropin thyroid stimulating hormone (TSH) level was 3.5 mU L (normal 0.5-5.2). The presumed diagnosis was chronic lymphocytic (Hashimoto's) thyroiditis. T4 was continued. In 1987, because her thyroid size had not decreased, she had a fine-needle aspiration biopsy (FNAB), that produced only a few groups of oxyphilic follicular cells (Hurthle cells), consistent with Hashimoto's thyroiditis, but insufficient for a definite diagnosis. Her goiter was stable until May 1995, when she reported 2 wk of severe anterior neck pain that radiated to her ears and jaw. Thyroid size was still about 50 g, the erythrocyte sedimentation rate (ESR)...

Hypothyroidism and Weight Loss

Weight loss is uncommon in hypothyroidism, although appetite is usually reduced. Most patients manifest a gain in weight due to retention of fluid by hydrophilic glycoprotein deposits in the tissues. The effect of hypothyroidism on energy metabolism is opposite to that of hyperthyroidism and is characterised by a general decrease of energy metabolism and heat production. This is reflected in a reduced BMR, decreased appetite, cold intolerance, and slightly lower basal body temperature 18 . Some cases of weight loss associated with hypothyroidism have been reported, most frequently in elderly patients. In these cases, weight loss can also be induced by malabsorption 18,24 or hypothalamic or pituitary insufficiency in the case of central hypothyroidism. In these cases, the hyposecretion of TSH is accompanied by a decrease in the secretion of other pituitary hormones, with combined gonadal and corticoid insufficiency.

Hypothyroidism

A detainee who is being adequately treated for myxedema poses no particular problem for the physician assessing fitness for interview. However, an individual with undiagnosed or undertreated hypothyroidism may exhibit mental manifestations that are as important as the physical. The typical picture is of mental lethargy, general dulling of the personality, and slowing of all cognitive functions. In particular, the patient with hypothyroidism shows deficits in memory, abstraction, conceptual organization, and mathematical ability (95).

The Spectrum of Malnutrition

Nearly 30 of humanity - infants, children, adolescents, adults and older persons in the developing world - are currently suffering from one or more of the multiple forms of malnutrition. This remains a continuing travesty of the recognised fundamental human right to adequate food and nutrition, and freedom from hunger and malnutrition, particularly in a world that has both the resources and knowledge to end this catastrophe. The tragic consequences of malnutrition include death, disability, stunted mental and physical growth and as a result, retarded national socioeconomic development. Some 49 of the 10.7 million deaths each year among children aged under 5 in the developing world are associated with malnutrition. Iron-deficiency anaemia affects 2 billion people, especially women and children. Iodine deficiency is the greatest single preventable cause of brain damage and mental retardation worldwide 740 million are affected. PEM affects 150 million children aged under 5. Intrauterine...

The Antigen Specificity of Naturally Arising TR

The presence of the corresponding organ, as adoptive transfer of T cells from male mice were more effective at preventing neonatal thymectomy-induced autoimmune prostatitis than oophoritis, and vice versa for T cells from female mice (Taguchi et al. 1994). Studies from Mason's group extended this observation by demonstrating that ablation of the thyroid gland resulted in the selective functional loss of T cells within the CD4+ population capable of preventing radiation-induced autoimmune thyroiditis, but not diabetes (Seddon and Mason 1999). Curiously, thyroid ablation did not result in the loss of protective thymic CD4+ T cells. Although the CD4+ T cell population was not fractionated in these studies to ensure that the suppressing cells were indeed CD25+ TR, these data support the hypothesis that tissue-specific antigen recognition by TR is necessary for their survival, development, and or expansion in the periphery, as the tissue-protective CD4+ T cell population is functionally...

CASE 1 Tshsecreting Pituitary Adenoma Case Description

Two weeks later, the patient presented for an evaluation. Since starting on atenolol 50 mg twice daily, her palpitations had resolved. She denied nervousness, tremor, hyper-defecation, insomnia, weakness, shortness of breath, chest pain, or symptoms of ophthal-mopathy. she had not noticed anterior neck discomfort, dysphagia, hoarseness, or neck swelling. she also denied headaches, visual changes, or a personal or family history of thyroid disease. Repeat laboratory testing of thyroid function was as follows fT4 1.9 ng dL (n 0.8-1.5), T3 265 ng dL, TSH 1.6 mU L. A 24-h radioiodine uptake was elevated at 42 (normal 10-30 ). Other tests that were done included estradiol 4 pg mL, LH 26 mlU L (postmenopausal 40-103), follicle stimulating hormone (FSH) 43 mlU L (postmenopausal 34-96), prolactin 7.8 ng mL, a subunit 1.5 ng mL (n < 1.0 < 3.6 for postmenopausal women), insulin-like growth factor (IGF)-1 269 ng mL (90-360), morning cortisol 17 lg dL. Sex hormone binding globulin (SHBG) was...

CASE 4 Thyroid Storm Case Description

A 25-yr-old woman presented to her physician two yr previously with weight loss, palpitations, and tremulousness. She was diagnosed with hyperthyroidism due to Graves' disease and started on therapy with an antithyroid drug. Because of a variety of circumstances, including an inability to afford the medication, she became increasingly symptomatic. Over the next two yr, she lost approximately 40-50 lbs, and developed significant proximal muscle weakness. When referred to the Endocrine Clinic, she was severely debilitated. The patient had no other medical problems. There was a positive family history of thyroid disease her mother had had an overactive thyroid treated surgically many years earlier. She smoked two packs of cigarettes daily and was unemployed. While in the recovery room, she became more tachycardic and was treated with 5 mg of intravenous propranolol, which reduced the heart rate from 140 bpm to 95 bpm. Her blood pressure and temperature were normal, and she was...

Late Effects In Survivors

As noted earlier, patients who survive the first five years after HCT are likely to survive long-term with mortality rates eventually approaching that of the general population (5). However, some survivors experience late complications of HCT. Baker et al. (67) studied the long-term risks and benefits of HCT for CML. Two hundred forty-eight recipient of HCT for CML who had survived at least two years post-HCT were compared to 317 normal siblings. Subjects completed a 238-item survey on medical late effects. When compared with sibling controls, survivors had higher risks of ocular, oral health, endocrine, gastrointestinal, musculo-skeletal, neurosensory, and neuromotor impairments. Multivariate analysis of the allograft recipients identified chronic GVHD as a major risk factor for hypothyroid-ism, osteoporosis, cardiopulmonary, neurosensory, and neuromotor impairments. These data show the need for continued monitoring and medical intervention in these patients. The CIBMTR and EBMT...

CASES 3 AND 4 Malabsorption Of Levothyroxine Case Descriptions

A 49-yr-old female with primary hypothyroidism had been euthyroid for several years, taking 200 g T4 daily, until March 2000, when her free T4 was normal at 1.6 ng dL, but her TSH level was elevated at 33 mU L. Questioning revealed that she had started ingesting two 330-mg calcium tablets with magnesium, chromium picolinate, vitamin E, and a high potency multivitamin tablet simultaneously with her T4. She was instructed to separate her daily T4 dose from her vitamin and mineral supplements by 4 h. Six weeks later, her free T4 was high-normal at 2.2 ng dL and her TSH was 0.06 mU L. A 45-yr-old female had a 3-yr history of hypothyroidism. For the past year she had taken 300 g T4 tablets 6 d a week. She was intermittently fatigued and sometimes needed excessive sleep. She took no other medication. On examination, her height was 66 in and her weight was 198 lb. Her thyroid gland was small. Her serum free T4 was 1.7 ng dL (normal 0.8-1.8) and her TSH was 4.0 mU L, both normal. T4 was...

Investigating the pathogenesis of problematic hypoglycaemia

It is important to avoid carrying out hypoglycaemia studies on people with ischaemic heart disease, epilepsy, hypertension, untreated hypothyroidism, hypoadrenalism or unstable diabetic retinopathy. It is crucial not to carry out studies on women of childbearing age if radioisotopes or potentially teratogenic or fetotoxic drugs are to be used, because of the potential risk to any future fetus.

Factors That Shape the Repertoire of CD25 Suppressor T Cells in the Periphery

For several reasons, it is unlikely that the composition of the suppressor T cell pool as it exists in a normal immune system is a linear projection of the intrathymically generated pool. First, extrathymic conversion of conventional, naive CD4 T cells into suppressor T cells may modulate the composition of the peripheral suppressor T cell pool. Although this has at present only been demonstrated in certain experimental systems (see preceding section), it appears reasonable to assume that the normal immune system in the steady state exploits similar pathways. Furthermore, there is accumulating evidence that the repertoire of suppressor T cells undergoes dynamic changes that are dictated by competition for survival factors such as access to cognate antigen or niches in the immune system. Among polyconal (non-TCR-transgenic) model systems, the most straightforward evidence in favor of interplay between an intra- and extrathymic encounter of self-antigen in the shaping of the repertoire...

CASE 1 Child With Sclerosing Papillary Cancer Case Description

A 9-yr-old girl was referred to an endocrinologist in November 1995 after her pediatrician found a goiter. Her paternal grandmother and paternal uncle (who also had Down syndrome) both had thyroidectomies by age 20 yr for unknown reasons. The endocrinologist found the patient had high titers of antithyroid peroxidase antibodies, diagnosed Hashimoto's thyroiditis, and initiated thyroxine suppression therapy.

CASE 2 Graves Disease And Papillary Cancer Case Description

In June 1999, when her care was transferred to one of us (RTK), her thyroid stimulating immunoglobulin (TSI) was 22 (normal 0-9). In September, her chest X-ray demonstrated progression of the lung nodules, the largest of which was 9 mm. In December, she underwent hypothyroid whole body imaging and dosimetry after therapy with retinoic acid (Accutane, 1.3 mg kg in divided doses twice daily) and lithium to promote 131I uptake and retention. A diagnostic whole-body scan was negative despite her elevated Tg. Dosimetry studies indicated an upper limit of 200 rads to blood would be delivered by

Endocrine Disorders Associated with Myofascial Pain

It is not uncommon to find dozens of patients who present with muscle pain, spasm, and TrPs that are secondary to a primary endocrine disorder. The two most common are hypothyroidism and menopause. It is a good practice to perform a confirmatory lab test, and if your suspicions are correct, the patient may need to see an endocrinologist. Hypothyroidism is secondary to a lack of thyroid hormone production levothyroxine (T4) and liothyronine (T3) secondary to a problem with the hypotha-lamic-pituitary-thyroid (HPT) axis. Clinically, the patients are frequently overweight. Their eyelids may be puffy, their voice hoarse. The thyroid gland may be enlarged. Their muscles are stiff, tender, and, on occasion, weak. They may display muscle hypertrophy. TrPs are common. Their primary complaint may be diffuse muscle tenderness. The Achilles reflex may show delayed relaxation. Laboratory testing typically shows low serum thyroxine (T4), free thyroxine index, and a high thyroid-stimulating hormone...

Laboratory Evaluation of Depression

Laboratory evaluation of the elderly patient with clinically significant depression is aimed at ruling out endogenous etiological or contributing factors, such as hypothyroidism and adrenal insufficiency, and establishing the pretreatment baseline status of physiological systems likely to be affected by psychoactive med-

Dimension of the Nutritional Problem in the World

Superimposed upon the energy intake spectrum is the global problem of micronutrient malnutrition. Iron deficiency anaemia affects approximately 1.5 billion people, mostly women and children. Iodine deficiency disorders affect about 740 million people worldwide. Vitamin A deficiency-

CASE 3 Persistent Papillary Cancer Case Description

A 45-yr-old woman who had been treated for primary hypothyroidism from age 29 noted a thyroid mass in August 1994 that was cold by 123I scan and yielded indeterminate cytology by fine-needle aspiration (FNA) biopsy. At surgery done shortly after the FNA, frozen section biopsy revealed PTC and total thyroidectomy was performed. The final histologic sections showed this to be a multifocal bilateral PTC, the largest focus of which was 1.8 cm in the left lobe amidst a background of severe Hashimoto's thyroiditis.

Pharmacokinetics and toxicity

IFN-a side effects can be separated into acute and chronic toxicity (35). Acute toxicity is represented by a flu-like syndrome, characterized by fever, chills, bone pain, and headache. These side effects usually appear 2 to 4 h application IFN-a after. Acute side effects can be attenuated significantly by prophylactic application of acetaminophen at a dose of 500 to 1000 mg orally (po) taken 2 h before and 2 h after subcutaneous injection of IFN. Side effects are generally dose related but tend to disappear within days due to tachyphy-laxis. A less common side effect is gastrointestinal toxicity, such as nausea, vomiting, and diarrhea. Cardiovascular toxicity, such as hypotension, angina pectoris, or tachyarrhythmia, is also rarely observed. The chronic toxicity of IFN generally manifests as fatigue, depression, polyneuropathy, and asthenia. Autoimmune phenomena, such as autoimmune hepatitis or hypothyroidism, may also be observed during prolonged IFN-a therapy. Occlusion of retinal...

CD4CD25 Regulatory T Cells

That using the 'S-word' became a certain way of having one's paper rejected. However, during the mid-1990s this slowly began to change when Sakaguchi and co-workers described a subset of immunosuppressive T cells capable of preventing autoimmune disease in mice. These cells were characterized by the expression of CD4 and CD25, the interleukin-2 (IL-2) receptor a chain 10 . Rather than calling them suppressor T cells, these cells are now referred to as CD4+CD25+ regulatory T cells (Tregs). When stimulated in vitro, the CD4+CD25+ Tregs were found to be anergic and suppressive 11 . In vivo depletion of this subset by day-3 thymectomy resulted in the spontaneous development of organ-specific autoimmunity such as gastritis and thyroiditis, and reconstitution of the mice with CD4+CD25+ Tregs prevented disease 10, 12, 13 . Since then, many groups have investigated the presence and function of these cells in both rodents and humans, and this is accompanied by a steep increase in the number of...

Thymic Generation of CD4CD25 Regulatory T Cells

Sakaguchi and co-workers demonstrated that CD4+CD25+ regulatory T cells could be detected in the thymus as well as in peripheral lymphoid organs 10, 12, 13 . Thymectomy on day 3 led to the spontaneous development of organ-specific autoimmunity such as gastritis and thyroiditis however, thymectomy at day 0 or day 7 did not result in disease. This was explained either by a lack of peripheral CD4+CD25- effector T cells at day 0, or by sufficient influx of suppressive CD4+CD25+ T cells into the periphery at day 7. Importantly, reconstitution of the mice with CD4+CD25+ Tregs from either the thymus or peripheral lymphoid organs such as spleen or lymph nodes prevented disease 10, 12, 13 . These data demonstrated that CD4+CD25+ Tregs can be found in both the thymus and the periphery. Furthermore, these studies provided evidence for thymic generation but did not exclude the possibility that CD4+CD25+ Tregs can be generated in the periphery. A later study by the same group showed that CD4+CD25+...

Balancing the Risk and Benefits of RT in Adolescent and young adult Patients

Spinal RT (CrSp) in this group are considerable, and include secondary hypothyroidism, growth hormone deficiency, and in girls, either precocious puberty or incomplete pubertal development, as well as risking infertility from irradiation of the hypothalamus, pituitary, and ovaries. Irradiation to the vertebrae will result in failure of these bones to grow during the adolescent growth spurt, causing loss of up to 5 cm in height this is unresponsive to growth hormone therapy.

The essential role of supportive care

With more aggressive interventions in controlling locoregional and recurrent disease, patients require close surveillance. The importance of a teamwork approach to treating HNC patients cannot be underestimated. The expertise of a radiation oncologist, speech therapist, pathologist, otolaryngologist, nurse, and oncologist is fundamental in the care of these patients. Evaluating the quality of life in these patients is also essential when determining the nature of such aggressive chemoradiotherapy that may alter the daily lifestyle of these patients physically, including physical appearance and loss of their voice, and psychologically patients may have to sacrifice simple capabilities such as their swallowing ability and appreciation of the texture of food. Additionally, the lifestyle of these patients has placed these patients at increased risk of developing a second malignancy of the aerodigestive tract. Consequently, we encourage monthly clinical exams on our patients following the...

CASE 3 Acute Hyperkalemia Case Description

Her past medical history is notable for obesity, recurrent urinary tract infections, and COPD. There was no history of hypertension. Her current medications include albuterol (inhaled), long-acting glipizide, ibuprofen as needed, and trimethaprim sulfamethoxa-zole as prophylaxis for recurrent urinary tract infections. She has no known allergies to any medication. There is a prior history of tobacco use, last noted 20 yr ago. Her family history is notable for diabetes mellitus and hypothyroidism.

Reasons For Triggerpoint Injection Failure

There are a number of reasons one may encounter persistence of MTrP activity post injection. Lack of recognition and treatment of hypothyroidism, folic acid deficiency, or low levels of iron in patients with MPS may cause continued difficulty. Similarly, structural disorders such as a leg length discrepancy or pelvic asymmetry may be reason enough for perpetuation of MPS.

Thyroid Disorders Thyrotoxicosis

Thyrotoxicosis factitia Chronic thyroiditis Subacute thyroiditis Celiac disease may occur more frequently in patients with autoimmune thyroid disease and represents an associated cause of malabsorption and weight loss 24 . Recent evidence suggests that the association between autoimmune thyroid diseases and celiac disease is quite similar to that between diabetes mellitus type 1 and celiac disease 24 . In an earlier series, about 5 of patients with celiac disease were found to suffer from hyper- or hypothyroidism even though the percentages are highly variable, with clinical hyperthyroidism in celiac disease ranging from 0 up to 7 in different studies 24 . Moreover, gastric achlorydria and autoantibodies against gastric parietal cells are detectable in about one-third of patients with Graves' disease 18,24 . Hepatic dysfunction also occurs, particularly when TS is severe hypoproteinaemia and increase of AST and ALP may be present 18 .

Toxicities of radioimmunotherapy

The major complications of radioimmunotherapy are infusional reactions during the administration of the cold antibody, especially the rituximab, and myelo-suppression that occurs around 7-9 weeks after therapy. Febrile neutropenia or infections that require hospitalization are uncommon events. There is little in the way of alopecia, nausea, vomiting, or mucositis. Because of the radioactive iodine, I-131 tositumomab therapy is associated with hypothyroidism in fewer than 10 of patients.

Diagnosis and clinical Presentation

The MTC cells have great biosynthetic activity and secrete calcitonin (CTN) and carcinoembryonic antigen (CEA), both of which are excellent tumor markers for the disease. CTN, in particular, provides a high degree of diagnostic sensitivity, specifically in the long-term follow up of MTC. Occasionally, MTC can lose its ability to produce CTN, which is usually indicative of a more aggressive tumor and hence a poorer prognosis. Intravenous calcium and pentagastrin are potent CTN secretagogues that stimulate production of the hormone within minutes of injection. Measurement of basal and stimulated plasma CTN levels is especially useful in the evaluation of patients following thyroid-ectomy. Elevated levels post-operatively indicate the presence of metastatic MTC, even though it may not be evident clinically. Furthermore, a pre-operative diagnosis can also be made by measuring basal or stimulated levels of plasma CTN. Considering the rarity of MTC and the possibility of false-positive...

Differential Diagnosis

Mood and anxiety disorders, learning disorders, mental retardation, pervasive developmental disorders, organic mental disorders, and psychotic disorders may all present with impairment of attention, as well as hyperactive impulsive behaviors. The diagnosis of ADHD in DSM-IV-TR requires that the symptoms of inattention cognitive disorganization and impulsivity hyperactivity are not better accounted for by one of the above conditions. Differentiating ADHD from bipolar disorder in childhood is complicated by the low base rate of bipolar disorder and the variability in clinical presentation. Even though there are phenomenological similarities between the two disorders, there is little evidence to suggest that most children with externalizing symptoms are at risk for bipolar disorder. A positive family history of bipolar disorder is especially helpful in diagnosing bipolar disorder in children. In addition, a variety of medical conditions such as epilepsy, Tourette's disorder, thyroid...

Disease Features Pathology

Autoimmune processes Helicobacter pylori gastritis, Hashimoto's thyroiditis, and Sj gren syndrome.8 Sequence analysis of the immunoglobulin genes expressed by the MALT lymphoma B cells shows a pattern of somatic hypermutation and intraclonal variation, suggesting that the tumor cell has undergone antigen selection in germinal centers and that they continue to be at least partially driven by direct antigen stimulation.9-12

Definition and Diagnosis

Cachectic heart-failure patients are weaker and fatigue earlier, which is due to both reduced skeletal muscle mass and impaired muscle quality. A simple and fast applicable definition of 'clinical cardiac cachexia' is the following in CHF patients without signs of other primary cachectic states (e.g. cancer, thyroid disease, or severe liver disease), cardiac cachexia can be diagnosed when weight loss of > 6 of the previous normal weight is observed over a period of > 6 months 4 . The previous normal weight of a heart-failure patient would be the average weight prior to the onset of heart disease (before the diagnosis). It is important to document dry weight loss measured in a non-oedematous state to prove the diagnosis.

Autoimmunity in chronic hepatitis C

Hepatic infection with HCV is known to induce several hepatic and extrahepatic autoimmune manifestations. Extrahepatic manifestations include mixed cryoglo-bulinaemia, membranoproliferative glomerulonephritis, porphyria cutanea tarda, Sjorgen syndrome and autoimmune thyroid disease 4 . Not surprisingly, numerous autoantibodies are found to be associated with chronic hepatitis C, i.e. antinuclear antibody (ANA), smooth muscle antibody (SMA), LKM-1 and antithyroid autoantibodies 5 . However, in the majority of cases, these antibodies are not markers of real autoimmune diseases. LKM1 autoantibodies, for example, are detected in patients with AIH-2 and in 0-7 of patients with chronic hepatitis C

The role of genetic predisposition in autoimmune diseases

AIH is detected with a mean annual incidence of 1.9 in 100000 patients 11 . When patients and their first-degree relatives were investigated, 30-40 of them were found to be affected by other autoimmune diseases. The most prevalent concurrent autoimmune diseases were autoimmune thyroiditis, Graves' disease, ulcerative colitis, insulin-dependent diabetes mellitus and vitiligo 12 . This finding indicates that patients with AIH and their first-degree relatives share a genetic predisposition for autoimmune diseases. To date, we know of several factors, such as specific human leucocyte antigen (HLA) alleles, which increase the risk of developing AIH. However, these risk factors cannot account for all patients with AIH and other pathogenic causes must be postulated. Most likely to be involved are other susceptibility genes regulating the immune responses and or the establishment and maintenance of tolerance. A model gene for such factors is the autoimmune regulator gene (AIRE). Defects in...

Classification of Diabetes Mellitus and the Metabolic Syndrome

Immune-mediated diabetes, previously referred to as insulin-dependent diabetes, type I diabetes, and juvenile-onset diabetes, accounts for 5-10 of all cases of diabetes. Immune-mediated diabetes typically develops in childhood and adolescence, but has a variable age of onset ranging from infancy to the eighth and ninth decades of life. Abnormalities in glucose homeostasis result from severe insulin deficiency due to cell-mediated autoimmune inflammation (insulitis) and subsequent destruction of the b-cells of the pancreas. In T1DM, daily exogenous insulin administration is a life-sustaining intervention, and the absence of insulin can result in a state of acute metabolic decompensation known as diabetic ketoacidosis (DKA). Individuals with T1DM are at increased risk for other autoimmune disorders such as Graves' disease, Hashimoto's thyroiditis, Addison's disease, vitiligo, celiac sprue, autoimmune hepatitis, myasthenia gravis, and pernicious anemia.

Other Conditions That Increase Natriuretic Peptides

Concentrations of BNP and NT-proBNP may be elevated in settings other than acute heart failure. Such increases do not represent analytic false positives but may cause false positive clinical diagnostic results, if other etiologies for abnormal BNP results are not considered. Disease processes other than heart failure (e.g., renal and thyroid function) have been shown to influence the concentration of natriuretic peptides (37). As an example, hyperthyroidism increases and hypothyroidism decreases natriuretic peptide concentrations (38). Renal impairment has been shown to increase NT-proBNP concentrations substantially and BNP to a lesser extent (39,40). In severe renal impairment (glomerular filtration rate of < 60 mL min1.73 m2 ) and end-stage renal diseases, testing of BNP or NT-proBNP may be difficult to interpret because decision limits for the diagnosis of heart failure or risk stratification were developed almost solely in patients without significant renal dysfunction....

CASE 1 Hirsutism Case Description

On examination, this patient was 65 in (1.67 m) tall and weighed 125 lbs (56.7 kg) (body mass index 21). She had 3+ out of 4+ facial hair noted on her chin, upper lip, and sideburn area. Hair growth was also noted on her midline chest and abdomen. There were no signs of thyroid disease or glucocorticoid excess. Breast development was Tanner stage 4 and there were no masses or galactorrhea. A pelvic exam revealed Tanner stage 5 pubic hair external and internal genitalia were normal, and there was no clitoromegaly. There were no other pertinent findings.

Assessment of Proptosis

Once thyroid disease and trauma have been excluded, the patient would require further investigations including systemic examination, full blood picture, orbital ultrasound, CT scan, magnetic resonance imaging (MRI) scan, possibly carotid angiography and sometimes orbital biopsy.

CASE 2 Amenorrhea And Pituitary Neoplasm Case Description

On examination, she had normal vital signs. She was 62 in tall and weighed 104 lbs. There were no signs of thyroid disease, glucocorticoid imbalance, or androgen excess. Breast development was Tanner stage 3 and there were no masses or galactorrhea. A pelvic exam revealed Tanner stage 3 pubic hair development. Her vagina was hypoestro-genic she had an unremarkable uterus and cervix. Neurologic exam was normal and there were no other pertinent findings.

Dementia Due to Other General Medical Conditions

Dementia also may be caused by other diseases with primarily central nervous system pathology, such as multiple sclerosis, amyotrophic lateral sclerosis, and various conditions (e.g., progressive subcortical gliosis, focal lobar atrophy) with mainly frontal lobe-type behavioral manifestations. Extracerebral pathology, both intracranial (brain tumor, subdural hematoma, hydrocephalus) and extracranial (hypothyroidism, hypercalcemia, hypoglycemia) processes, also can cause dementia via mechanical and biochemical effects on brain function. Accurate diagnosis usually depends on recognition of the characteristic clinical and laboratory features of the underlying illness. The battery suggested in Table 5-4 in Chapter 5 (Dementia and Alzheimer's Disease) is designed to have relatively high sensitivity for this purpose.

Studies in Experimental Animal Models

The suppressive effect of GA in EAE is a specific one, since GA lacked any suppressive effect on the immune response in several systems - humoral and cellular immune responses to a variety of antigens and vaccination against various induced infections. GA treatment also did not suppress other experimental autoimmune diseases, including myasthenia gravis, thyroiditis, diabetes, and systemic lupus erythematosus.5,17 However, it has been reported to inhibit another autoimmune disorder, namely experimental uveoretinitis,18 a disease interrelated with MBP and EAE. Recently, GA was also shown to be effective in the case of experimental colitis.19 In addition, GA also had an effect on a murine model for graft-versus-host disease, as well as in three systems of graft rejection.20

Signs and Symptoms of Pituitary Tumors

A primary deficit of a pituitary end organ's hormonal production (e.g., primary hypothyroidism) could cause a secondary swelling of the pituitary gland of sufficient size to make contact with the chiasm. In such cases, simple replacement of the missing hormone will lead to a reversal of the syndrome.

CD137 and Regulatory T Cells Treg

Consistent to these findings, Morris et al., also found that CD137 signaling interferes with CD4+CD25+ Treg-mediated tolerance in an experimental autoimmune thyroiditis (EAT) mouse model (Morris et al., 2003). In vivo depletion of CD25+ cells could abrogate established tolerance, indicating that CD4+CD25+ Treg cells are essential for the tolerance induction. Administration of CD137 mAb inhibited the tolerance induction and interfered with the established tolerance to EAT. In vitro CD137 signals also inhibited the suppression of mouse thyroglobulin-specific T cell proliferation by CD4+CD25+ Treg cells. In addition, CD137 stimulation did not increase Treg cells to proliferate. Thus, the authors suggested that signaling through CD137 on the autoreactive T cells directly overcomes suppression by CD4+CD25+ Treg cells.

Suppression of Autoimmune Disease by Regulatory Cells from Donors with or Without the Relevant SelfAg

In view of differential suppression of autoimmune prostatitis (AIP) and autoimmune thyroiditis by T cells from Ag-positive vs Ag-negative cell donors (described below), how do we explain their equal suppression of AOD Our interpretation is that even if the regulatory capacities of male and female CD4+CD25+ T cells for AOD suppression are different, they are equalized when the cells encounter the endogenous ovarian Ag in the young d3tx host. Indeed, we have shown that ovarian Ags (mater and ZP3) are expressed from birth and have the capacity to stimulate T cells on day 3 (Alard et al. 2001). This is also exemplified by the process of diversified autoAb response that depends on de novo B cell response to endogenous ovarian Ag. Immunized female mice with a ZP3 peptide that contains T but not native B epitope (in CFA) elicited Ab response to a distant native ZP3 B cell epitope within 7 days, 2 days after detectable response to the ZP3 T cell epitope (Lou et al. 1996). Other examples of...

Endocrinologically Silent Pituitary Adenomas

Hormonally inactive pituitary tumors (up to one third of all pituitary tumors) can with growth and displacement of surrounding tissues result in a hormonal deficit, hypopituitarism with a loss of gonadal function (often the first clinical sign) and hypothyroidism, weakness of the muscles, loss of body hair or with symptoms of hypothalamic disease, including diabetes insipidus, and disorders of sleep, body temperature, and poor motivation.

Thyroid And Gonadal Dysfunction

Subclinical and clinical thyroid disease is common after treatment of HL. In a series of 151 patients, 26 cases of subclinical, 12 cases of manifest clinical hypothyroidism, and 2 cases of hyperthyroidism were documented.14 Thyroid dysfunction was more frequent in patients who underwent mantle or neck radiotherapy. Hypothyroidism was often revealed after the sixth year of follow-up. A high incidence of thy-roiditis was also reported in this group of patients. Annual monitoring of thyroid function should be incorporated in follow-up patients with HL, particularly in those treated with radiation involving neck.

Other Endocrinopathies

Radiation may affect the thyroid gland. Patients that received radiation to the neck or craniospinal irradiation are at risk of thyroid dysfunction. This may take the form of hypothyroidism, thyrotoxicosis, or thyroid nodules, which may be malignant. Patients at risk should have regular thyroid function tests performed and their thyroid should be examined by palpation on an annual basis. Endocrine dysfunction of the thyroid should be managed as for any patient with hypo- or hyperthyroidism. The presence of nodules should be treated seriously and referral for thyroidectomy made where appropriate 88 .

Therapeutic Challenges

131I tositumomab is a radioimmunoconjugate comprising a murine anti-CD20 MoAb covalently linked through tyrosine amino acids in the immunoglobulin protein to iodine-131. Tositumomab does not require a linker due to direct covalent bonding between the MoAb and the radionuclide. 131I is more readily available than 90Y and is relatively inexpensive. However, 131I emits both p- and 7-irradiation, necessitating special radiation precautions for patients receiving this compound. Dehalogenation (cleaving of the radionuclide from the compound) can occur as well this results in potential uptake of free iodine by the thyroid and stomach. Oral thyroid blockade is recommended beginning 24 h before therapy and continuing for 14 days in order to prevent iodine uptake and subsequent hypothyroidism.47 The rate of dehalogenation varies significantly among patients, resulting in fluctuating rates of urinary clearance. Thus, dosimetry calculations incorporating total-body distribution and tissue uptake...

Challenging Cases in Endocrinology

In medicine, the difficult cases can yield valuable insights because they force physicians to think a little harder when making a diagnosis and to be creative when treating the patient. In Challenging Cases in Endocrinology, distinguished clinician-scientists describe in concise studies their most difficult cases and reveal what they did, how they did it, and why. The cases cover a wide range of medical problems, including pituitary and thyroid tumors, hypopituitarism, hyper- and hypothyroidism, metabolic bone disease, Cushing's syndrome, adrenal insufficiency and cancer, diabetes, and hypoglycemia. Other cases involve disorders of female reproduction, of water balance and lipoprotein metabolism, of puberty, and of growth and development. Each case study reviews how the patient was managed, details the reasons why various tests and treatments many only recently available were carried out, and provides references to ensure that these novel methodologies can be easily translated into...

CASE 1 Cushings Disease Difficulties In Diagnosis Case Description

Her past medical history is remarkable for a left oophorectomy 6 mo ago for a ruptured ovarian cyst. She has recently been receiving some counseling for depression. There is a family history of thyroid disease in her mother and diabetes in both maternal grandparents. She has had two pregnancies and two healthy children. There is no history of significant alcohol use and she does not smoke.

Kelly L Wirfel MD Douglas B Evans MD Jeffery E Lee MD Helmuth Goepfert MD and Robert F Gagel MD

An 80-yr-old white man who had been treated for primary hypothyroidism presented for evaluation of possible medullary thyroid carcinoma (MTC). His sister, diagnosed with thyroid cancer in the 1970s, had undergone thyroidectomy for MTC. When the MTC recurred in 1998, she was found to have a germline RET protooncogene mutation involving codon 618 (cys phe, TGC TTC). Her son and our patient were subsequently found to have the same mutation. Further family history included that of a maternal aunt who died of an unknown thyroid carcinoma.

Discussion

The treatment of TSHomas is transsphenoidal surgery. The chances of cure increase with smaller tumor size and absence of cavernous sinus invasion overall, about 35 of patients can be cured surgically. Patients should be prepared for surgery with antithyroid drugs and or P adrenergic blocking drugs. The criteria for cure are euthyroidism with a normal serum TSH and no residual tumor on MRI (3,4). For patients with residual tumor, radiation therapy should be considered. Octreotide in doses of 50-100 mcg bid or tid will normalize the serum TSH in most patients (5), but there may be escape from the effects of the drug in about 10 of cases (6). Long-acting somatostatin analogs have also been used effectively in TSHomas (7). Treatment with radioiodine or surgery to ablate the thyroid should be avoided if at all possible, since hypothyroidism could cause tumor growth.

Case Description

The patient was started on SSKI 2 drops three times a day and atenolol 50 mg bid. Her serum levels of fT4 and T3 declined to 2.3 ng dL and 225 ng dL, respectively, and she underwent shoulder surgery uneventfully. The SSKI was continued, but after 6 wk, thyroid function returned to baseline elevations and the medication was stopped. Two months later, she was still hyperthyroid, with fT4 2.4 ng dL and T3 550 ng dL. The thyroid was still two-threefold enlarged and firm. There was continuing mild ophthalmopathy, which had not progressed, and she was treated with a second 20 mCi dose of radioiodine without glucocorticoid coverage. Six weeks later, fT4 was 0.6 ng dL and T3 was 115 ng dL, but after an additional 6 wk, fT4 rose to 2.1 ng dL, and T3 was 350 ng dL. She remained persistently hyperthyroid for the next 6 mo. A third dose of radioiodine (20 mCi) was administered, and the patient developed hypothyroidism 2 mo later. When last seen, she was doing well in school and had normal thyroid...

Longterm Followup

(Table 14.5) would be to follow the patients monthly during the first year, every 2 to 3 months during the second and third years, and then at least every 6 months during the next 3 years. At 6 years and thereafter, patients can be monitored annually with history and physical examination, complete blood count with differential, and careful attention for second malignancies, heart failure, sterility, avascular necrosis, and hypothyroidism all potential sequelae of therapy. Assessment of minimal residual disease should preferably be associated with clinical trials.

Iodine

Iodine deficiency is one of the most common nutritional deficiencies. Worldwide, it is estimated that nearly 1 billion people are at risk of iodine deficiency disorders (IDD).1 Iodine deficiency, both in utero and during early childhood, can impair mental development and is the most prevalent cause ofpreventable

Graves Disease

A history of prior problems with hyper- or hypothyroidism may suggest an acquired restrictive mechanism, and if Graves' disease has been active in the past, there should be some evidence of proptosis, conjunctival erythema, che-mosis, or lid retraction. Forced duction testing (see above) will demonstrate restriction of movement, the intraocular pressure will rise with attempts to move the eye into the restricted field of gaze, and CT MRI ultrasound testing will confirm the presence of rectus muscle thickening (see Chap. 9).

Thyroid Hormone

BMD at the distal and 8-mm sites on the radius was measured with SPA (Nuclear Data ND 1100A) in 78 postmenopausal women who had been on thyroid hormone replacement for a minimum of 5 years (165). The average age of the women was 64 years. Hypothyroidism in these women was initially caused by idiopathic hypothyroidism or primary autoimmune hypothyroidism. Forty-four of these women had persistently suppressed thyroid stimulating hormone (TSH) values, whereas 34 did not. One hundred two women served as controls. The women with nonsuppressed TSH values had z-scores at the 8-mm and distal radial sites of -0.07 and -0.03, whereas the women with suppressed TSH had z-scores of -0.25 and -0.20, respectively. The differences between the three groups were not statistically significant. The authors estimated that a suppressed TSH was associated with at most a 5 decrease in BMD. Affinito et al. (166) also measured BMD at the distal radius in a study of 54 postmenopausal women with primary...

Management

Following total or completion thyroidectomy (if the initial surgery entailed only a lobectomy), the patient is rendered hypothyroid with plans to administer RAI therapy 4-6 weeks later. This treatment is based upon studies in adults that demonstrate a lower recurrence rate and subsequent lower cancer-related mortality rate in patients treated with 131I 51 . Although RAI therapy in low-risk patients is controversial, it is generally recommended that all patients less than 15 years who have been treated surgically for PTC or FTC receive additional therapy with 131I, both to ablate the normal thyroid gland remnant (hence making long-term follow up easier) and to treat any remaining thyroid cancer or metastases 52 . Although short-term triiodothyronine therapy (Cytomel 1-2 p,g kg day divided twice daily to three times daily) is used frequently in adolescents and young adults, younger children are often quite tolerant of hypothyroidism. Therefore, it is also reasonable to give no thyroid...

Late Effects

Early and usually transient side effects of 131I may include nausea, vomiting, sialoadenitis, xerostomia, loss of taste, thyroiditis (if a sizable thyroid remnant remains after surgery), and, rarely, bone marrow suppression (leukopenia and thrombocytopenia) 54 . Some of these early side effects may be minimized by having the patient drink lots of water after therapy and suck on tart candies, such as lemon drops, to promote salivary flow. The long-term consequences of 131I therapy in children remain an area of concern, particularly in individuals who receive high cumulative doses in early childhood. Much remains to be learned about possible late effects, which can include infertility (particularly in men), permanent damage to the salivary glands resulting in chronic xerostomia or salivary duct stones, excessive dental caries, reduced taste, pulmonary fibrosis (in those with diffuse pulmonary metastases), and the possibility of the development of other cancers (stomach, bladder,...

Conclusion

Chen F, Day SL, Metcalfe RA, Sethi G, Kapembwa MS, Brook MG, Churchill D, De Ruiter A, Robinson S, Lacey CJ, and Weetman AP (2005). Characteristics of autoimmune thyroid disease occurring as a late complication of immune reconstitution in patients with advanced human immunodeficiency virus (HIV) disease. Medicine (Baltimore) 84(2) 98-106.

Laboratory Features

Endocrine abnormalities were found in two-thirds of our patients at presentation. Hypogonadism was the most common abnormality, and 71 of males had erectile dysfunction. Twenty-four of 28 patients who had serum testosterone levels measured had a reduction. Gynecomastia was found in 17 men. Prolactin levels were not increased. Hypothyroidism was found in 14 of patients. An additional 12 had a mild increase in the thyroid-stimulating hormone level but had normal thyroxin levels. Abnormalities of the adrenal-pituitary axis were present in 16 . In five additional patients, adrenal insufficiency developed during follow-up.

Chromosome

Protein have both been proposed as important genes in brain development. Crystalline a is linked to both a dominant and recessive form of cataract. Interferon-a and p, w receptors 1 and 2, 7 receptor 2 (integrin p-2), and an autoimmune regulator responsible for autoimmune polyglandular disease are all also found on chromosome 21. How might these genes interact to bring about immune suppression or the excess of thyroid disease seen in DS The answers are not yet available in the literature.

Multiple sclerosis

NAA is not specific to MS, reflecting as it does the bioenergetic status of neurones. Falls in WBNAA concentrations are therefore observed in a range of conditions in which either neurones die or in which there is mitochondrial dysfunction. These include the mitochondrial encephalomyopathies, Alzheimer's disease, acute intermittent porphyria, hypothyroidism and stroke. A range of other markers have

AntiCD52

Several mAbs are currently being investigated at various stages of clinical development (Table 13.1). Alemtuzumab (Campath-1H, Burroughs Wellcome Co., Research Triangle Park, NC) is a humanized anti-CD52 antibody that probably induces direct death of T cells upon binding to CD52 molecule. It was adapted from lymphoma therapy to MS trials, where it leads to long-lasting and sustained lymphocyte depletion, suppression of MRI evidence of inflammation, but no effect on atrophy. These data illustrate that axonal degeneration can proceed despite drastic suppression of inflammation. In the phase II trial, major side effects were the induction of cytokine release and autoimmune thyroid disease (Coles et al. 1999).

Thyroid Eye Disease

Dysthyroid eye disease is an autoimmune disease in which the manifestations can be notable in the hyperthyroid, euthyroid or hypothyroid phase. Although the ophthalmic features of thyroid disease are often diagnosed in the hyperthyroid phase, a significant number of patients may be euthyroid (i.e., have no other evidence of thyroid disease) or less often hypothyroid at the time of detection of the eye changes. Thus, the ophthalmic disease might precede, be coincidental or follow the systemic manifestations. Table 21.2. The 13 possible eye signs of thyroid disease. CQ The systemic features of hyperthyroidism include weight loss, high pulse rate, poor tolerance of warm weather and fine tremor. The eye signs of thyroid disease are eyelid retraction and lid lag, puffiness of the eyelids, chemosis, proptosis, exposure keratitis, double vision from muscle involvement and optic neuropathy (Tables 21.2 and 21.3).

Treatment Strategies

Anemia Hypogonadism Adrenal insufficiency Hypothyroidism Infections Malnutrition Depression Inactivity Primary adrenal insufficiency can be treated with oral hydrocortisone or dexamethasone replacement therapy (Dufour et al., 2005). Hypothyroidism improves with levothyroxine administration, which has also been found to improve quality of life and energy levels in HIV patients with no evidence of hypothy-roidism (Derry, 1995).

Depression

Include degenerative neurological illnesses (e.g. Parkinson and Huntington diseases), stroke, metabolic conditions (e.g. vitamin B12 deficiency), endocrine conditions (e.g. hyper- and hypothyroidism, hyper- and hypoadrenocorticism), autoimmune conditions (e.g. systemic lupus erythematosus), viral or other infections (e.g. hepatitis, mononucleosis, human immunodeficiency virus), and certain cancers (e.g. carcinoma of the pancreas). The associated physical examination findings, laboratory findings, and pattern of prevalence or onset reflect the aetiolog-ical general medical condition, the management of which is more complex and the prognosis less favourable if major depressive disorder is present.

Download The Hypothyroidism Revolution Now

The legit version of The Hypothyroidism Revolution is not distributed through other stores. An email with the special link to download the ebook will be sent to you if you ordered this version.

Download Now