1. HYPOTHYROIDISM VIP Patient Education 1.17.18
My Health Onsite
HYPOTHYROIDISM
VIP
Patient Education

2. Vital Investment Program (VIP)
Education Goals
Basic Disease Understanding
Disease Triggers & Smart Choices
Treatment & Technique
Warning Signs & Action Plans
Patient Responsibilities

3. Vital Investment Program (VIP)
VIP Education Goals
Basic Disease Understanding
Disease Triggers & Smart Choices
Treatment & Technique
Warning Signs & Action Plans
Patient Responsibilities

4. Hypothyroidism: Basic Disease Understanding
The thyroid gland is a small but powerful, butterfly-shaped, hormone-releasing gland located in the front of your neck. It plays an essential role in metabolism, growth, and maturation of the human body.

5. What does it do?
The thyroid gland releases thyroid hormones called Thyroxine (T4) and Triiodothyronine (T3). These hormones control the way the body uses energy, so they affect nearly every organ in your body. Abnormal thyroid levels can cause serious problems with heart, bones, muscles, menstrual cycle, fertility, and fetal health. Keeping these hormone levels within normal ranges is essential.

6. As with all hormones, we can have
too much thyroid hormone (hyperthyroidism) or
too little thyroid hormone (hypothyroidism) or
just the right amount (euthyroid).

7. Hypothyroidism Too little thyroid hormone is (Underactive Thyroid)
which can cause many of the body’s functions to slow down.

9. How is it diagnosed?
medical history
family history of thyroid disease or any
autoimmune problems
physical exam

10. How is it diagnosed? – cont. Blood
Total T4 – Thyroxine - a thyroid hormone; Total T4 is the total amount of T4 found in the blood, most of which is bound to protein; high levels may mean hyperthyroidism; low may mean hypothyroidism; if pregnant or on oral contraceptives may have high T4; if on corticosteroids, may have low T4
Free T4 – the amount of T4 in blood not bound to protein
Total T3 – Triiodothyronine – a thyroid hormone; Total T3 is the total amount of T3 found in the blood, most of which is bound to protein; if Provider thinks you may have hyperthyroidism but T4 is normal, may order T3; high may mean hyperthyroidism
Free T3 – the amount of T3 in blood not bound to protein

11. How is it diagnosed? – cont.
Blood
TBG levels – Thyroxine Binding Globulin - a protein that moves thyroid hormone throughout your body
T3 Uptake – how much T3 is taken up by TBG
Reverse T3 – a thyroid hormone
TSH - Thyroid Stimulating Hormone or Thyrotropin - hormone made in the pituitary gland that tells the thyroid how much T3 and T4 to make; high may mean hypothyroidism; low may mean hyperthyroidism; if TSH is normal, you will need at least one other test to help find the cause of the problem
TSI - Thyroid Stimulating Immunoglobulin - may help diagnose autoimmune thyroid disorders like Graves’ or Hashimoto’s.; however in mild graves, TSI may be negative.
TPO - ThyroPeroxidase Antibodies (TPO); almost all people with Hashimoto’s have these

12. Thyroid Hormones Normal T4 ↓ free T4 (hypo) ↑ TSH Normal TSH ↓ TSH
Things in Flux
Primary
Hypo
Normal TSH
Normal
Secondary Hypo
↓ TSH

13. How is it diagnosed? – cont.
Imaging
Thyroid Ultrasound
most often to look at thyroid nodules (lumps) in your neck
for this test you will lie on a table while a transducer is moved over your neck; the transducer bounces safe, painless sound waves off your neck to make pictures of your thyroid
the ultrasound usually takes about 30 minutes

14. How is it diagnosed? – cont. Imaging
Thyroid Scan
looks at the size, shape, condition, and position of the thyroid gland
you will be asked to swallow a small amount of radioactive iodine in liquid or capsule form, or it may be injected into your vein; the thyroid is the ONLY organ in the body that stores, accumulates and excretes iodine; by using radioactive iodine, the thyroid is forced to uptake it allowing the Provider can see how and where iodine is distributed in the thyroid; with hyperthyroid Graves’, the entire thyroid is involved; in other causes like nodules, iodine shows up in a different pattern; you may be asked to avoid foods high in iodine for a week prior
during the exam you will lie on an exam table while a special camera takes pictures of your thyroid
the scan takes place 30 minutes after the iodine is given and usually takes about 30 minutes

15. How is it diagnosed? – cont. Imaging
Radioactive Iodine Uptake Test (RAIU or thyroid uptake test)
measures amount of iodine the thyroid collects from bloodstream; if a large amount is found, may indicate hyperthyroid Graves’ disease or nodules
you will be asked to swallow a small amount of radioactive iodine in liquid or capsule form; the thyroid is the ONLY organ in the body that stores, accumulates and excretes iodine; by using radioactive iodine, the thyroid is forced to uptake it
during the test you will sit in a chair while a gamma probe is placed in front of your neck to measure how much of the radioactive iodine your thyroid takes up from your blood
measurements are often taken 4-6 hours after the iodine and again at 24 hours; each measurement usually takes only a few minutes

16. Diagnosing Thyroid Disease - Biopsy
if a nodule is found, you may have a fine needle aspiration biopsy to see if the lump is cancerous or not
for this test, you will lie on an exam table with your neck slightly bent backwards; your neck will be cleaned; you may be given a numbing agent; a specialist (endocrinologist or a specially trained radiologist) will place a needle through the skin and use ultrasound to guide the needle to the nodule; small samples of tissue from the nodule will be sent to a lab for testing
the biopsy usually takes about 30 minutes.

17. Vital Investment Program (VIP)
VIP Education Goals
Basic Disease Understanding
Disease Triggers & Smart Choices
Treatment & Technique
Warning Signs & Action Plans
Patient Responsibilities

18. Hypothyroidism: Disease Triggers & Smart Choices
Knowing the risk factors, causes, symptoms, and smart choices involved in managing hypothyroidism
results in having better control over the outcome.
Knowledge is power.

19. Hypothyroidism women are much more likely than men
Who’s at risk?
women are much more likely than men
people older than age 60
family history of thy disease
you have had a thyroid problem before

20. other health conditions (pernicious anemia,
Who’s at risk? – cont.
other health conditions (pernicious anemia,
type 1 diabetes, primary adrenal insufficiency,
Sjogrent’s syndrome, rheumatoid arthritis, l
upus, etc.); you have Turner syndrome, a genetic
disorder that affects females
pregnancy within the past 6 months
ingestion of excessive amounts of foods,
supplements, or medications containing iodine or
otherwise affecting thyroid levels

21. Many Foods Naturally Contain Iodine Percent DV
Seaweed/dried kelp — 1 whole sheet dried 11 -1,989
Cod (wild-caught) — 3 ounces 66
Yogurt (organic, grass-fed and ideally raw) — 1 c 50
Raw milk — 1 cup
Eggs — 1 large
Tuna — 1 can in oil/3 ounces 11
Lima beans — 1 cup cooked 10
Corn (organic) — 1/2 cup 9
Prunes — 5 prunes 9
Cheese (raw, unpasteurized) — 1 ounce 8
Green peas — 1 cup cooked 4
Bananas — 1 medium 2

22. Some Foods are Fortified with Iodine Percent DV
Iodized salt — ¼ teaspoon 45
Some baby formulas %, 25%, etc.

23. Some Vitamin Supplements Contain Iodine

24. Some Medications Contain Iodine
EXAMPLES
Cordarone/amiodarone
Synthroid/levothyroxine (but not added iodine)
Some Medications Alter Thyroid Hormones
Dilantin/phenytoin
Interferon
Interleukins
Selenium
Some chemo drugs
Certain antidepressants

25. What causes it?
thyroiditis - inflammation that causes stored thyroid hormone to leak out, initially causing hyperthyroidism; (hyperthyroidism may last up to 3 months, after which patient may become hypothyroid for months or sometimes permanently)
subacute thyroiditis – painfully inflamed and enlarged thyroid, possibly caused by a virus or bacteria
postpartum thyroiditis - develops after a woman gives birth
silent thyroiditis - painless, even though enlarged (probably autoimmune)
insufficient iodine or extremely high doses – the thyroid uses iodine to make thyroid hormone; the amount of iodine you consume affects the amount of thyroid you make; the thyroid gland is the ONLY organ in the body that stores, accumulates and excretes iodine; too little or too much of it can make us sick; it is very rare that anyone would get too little, as most table salt contains iodine.

26. What causes it? – cont.
congenital (present at birth) - some babies are born with a thyroid that is not fully developed or does not function properly (untreated, this can lead to intellectual disability and growth failure); most newborns in US are tested for this
medications - (like amiodarone, interferon alpha, lithium, interleukin -1) can interfere with thyroid hormone production and lead to hypothyroidism.

27. What causes it? – cont.
thyroidectomy - surgery to remove part or all of the thyroid gland; when only part is removed, thyroid levels may remain normal or may become too low; when the entire thyroid is removed, thyroid hormone replacement therapy will be required for life
radiation - radiation therapy of the thyroid gland using radioactive iodine is a common treatment for hyperthyroidism; this gradually destroys the cells of the thyroid causing most patients to eventually develop hypothyroidism; radiation for head or neck cancers can also damage the thyroid

28. What causes it? – cont.
pituitary or hypothalamus disease - including tumors, Sheehan's syndrome, idiopathic hypopituitarism and infiltrative diseases, such as sarcoidosis, histiocytosis and lymphocytic hypophysitis. Radiation-induced central hypothyroidism is common in patients irradiated for pituitary tumors.
autoimmune - Hashimoto’s disease

29. Hashimoto’s disease
(also called “Hashimoto’s thyroiditis”, “chronic lymphocyctic thyroiditis”, and “autoimmune thyroiditis”)
What is it?
the most common cause of hypothyroidism
in the US (it affects about 5 in 100 people)
an autoimmune disorder (the immune system
attacks the thyroid, eventually causing it to make
too little thyroid hormones) ● ● ● ● ●

30. + Hashimoto’s disease – cont. What causes it?
the cause is unknown, but thought to be a combination of genetics and an outside trigger like a virus +

31. - Hashimoto’s disease – cont. Who’s at risk?
usual onset is between ages 40-60
affects 8 times more women than men
there is an increased risk if other family
members have it
people with other autoimmune disorders
are more likely to develop Hashimoto’s
(rheumatoid arthritis, pernicious anemia,
lupus, Addison’s disease, Celiac disease,
vitiligo, type 1 diabetes, autoimmune hepatitis, etc.) -

32. Hypothyroidism What are the symptoms? cold intolerance
extreme fatigue, lethargy
joint and muscle aches, weakness
depression, apathy, dull-blank expression

33. What are the symptoms? – Cont.
goiter
weight gain despite lack of hunger (anorexia)
puffy face & eyelids
thick tongue – slow speech

34. What are the symptoms? – Cont.
slowed heart rate
thick, dry, coarse, scaly skin (decreased sweating)
brittle nails
dry, thinning, brittle hair, receding hairline, thin eyebrows

35. What are the symptoms? – Cont.
heavy or irregular menstrual periods; fertility problems
constipation

36. Smart Choices Keys to minimizing complications of hyperthyroidism:
recognize symptoms early and let your Provider know or seek immediate medical attention (Emergency Room or Urgent Care)
closely follow your hyperthyroid treatment plan, and manage all known medical conditions within recommended guidelines)
make healthy lifestyle choices (diet, exercise, tobacco, alcohol, stress, etc.)
show up for routine labs and follow-ups with Providers & Specialists

37. Vital Investment Program (VIP)
VIP Education Goals
Basic Disease Understanding
Disease Triggers & Smart Choices
Treatment & Technique
Warning Signs & Action Plans
Patient Responsibilities

38. Hypothyroidism: Treatment & Technique
Treatment is aimed at
bringing thyroid hormone levels back to normal to prevent long-term problems
and at relieving uncomfortable symptoms.
No single treatment works for everyone.

39. Always take all medications exactly as prescribed.
Know exactly what you take - drug name, dosage, instructions, & what
it’s for; make sure ALL of your Providers know, too - all prescriptions,
OTCs, herbs, & supplements. Keep a list or snap pictures with your cell.
Do not use medications past the expiration date.
Do not break, crush, or chew extended release tablets.
Immediately inform your Provider of any concerning signs or symptoms.

40. Treatment
Medications
Thyroid Hormone Replacement
synthetic thyroid replaces the hormone that your own thyroid can no longer make; have regular labs 6-8 weeks after start of this hormone and each time dose adjusted; then 6 months; then annually.
EXAMPLES: Synthroid/levothyroxine
Iodides
iodine is a mineral found in some foods (seaweeds, cod, plain yogurt, iodized salts, etc.), medications, and supplements; the thyroid gland uses iodine to make thyroid hormone; the amount of iodine consumed affects the amount of thyroid made; people who don’t get enough iodine make insufficient amounts of thyroid hormone (this is rare, as most table salt contains iodine); ingestion of very large amounts of iodine, however, can cause a paradoxical lowering of thyroid hormone levels called Wolff-Chaikoff effect;
EXAMPLES: iopanoic acid, ipodate sodium

41. Treatment Other Watchful Waiting
for autoimmune Hashimoto’s, the Provider may choose to just monitor until symptomatic or hypothyroid; when the immune system attacks the thyroid, the thyroid becomes inflamed and unable to make enough thyroid hormones; there may be no symptoms at first, but as the condition slowly progresses, the thyroid usually gets larger (goiter) and may cause a feeling of fullness in throat; after many years/decades, damage to the thyroid causes it to shrink and the goiter to disappear, eventually causing symptomatic hypothyroidism.
Referrals to Specialist
because the thyroid gland plays an essential role in metabolism, growth, and maturation of the human body, it is vital to keep hormone levels within normal range; you may need the help of a doctor who specializes in hormones called an Endocrinologist; additionally, you may need the help of other specialists (cardiologist for the heart, ophthalmologist for the eyes, surgeon, radiologist, etc.).

42. Vital Investment Program (VIP)
VIP Education Goals
Basic Disease Understanding
Disease Triggers & Smart Choices
Treatment & Technique
Warning Signs & Action Plans
Patient Responsibilities

43. Hypothyroidism: Warning Signs & Action Plans
For any concerning signs or symptoms, please see your Provider or Specialist for an evaluation, or call 911.

44. Hypothyroidism Complications
Untreated hypothyroidism can lead to a number of health problems:
Heart
hypothyroidism may be associated with an increased risk of heart disease, primarily because high levels of low-density lipoprotein (LDL) cholesterol — the "bad" cholesterol — can occur in people with an underactive thyroid; even subclinical hypothyroidism, a mild or early form of hypothyroidism in which symptoms have not yet developed, can cause an increase in total cholesterol levels and impair the pumping ability of your heart; hypothyroidism can also lead to an enlarged heart and heart failure; seek immediate medical attention.
Goiter
constant stimulation of your thyroid to release more hormones may cause the gland to become larger — a condition known as a goiter; Hashimoto's thyroiditis is one of the most common causes of a goiter; although generally not uncomfortable, a large goiter can affect your appearance and may interfere with swallowing or breathing; talk with your Provider or Specialist

45. Hypothyroidism Complications – cont.
Mental Health
depression may occur early in hypothyroidism and may become more severe over time; hypothyroidism can also cause slowed mental functioning; talk with your Provider or Specialist.
Nerves / Muscles
long-term, uncontrolled hypothyroidism can cause damage to your peripheral nerves — the nerves that carry information from your brain and spinal cord to the rest of your body, for example, your arms and legs; this is called peripheral neuropathy; signs and symptoms may include pain, numbness and tingling in the area affected by the nerve damage; it may also cause muscle weakness or loss of muscle control; talk with your Provider or Specialist.
Birth Defects
babies born to women with untreated thyroid disease may have a higher risk of birth defects than may babies born to healthy mothers; these children are also more prone to serious intellectual and developmental problems; infants with untreated hypothyroidism present at birth are at risk of serious problems with both physical and mental development; but if this condition is diagnosed within the first few months of life, the chances of normal development are excellent; talk with your Provider or Specialist

46. Hypothyroidism Complications – cont.
Infertility
low levels of thyroid hormone can interfere with ovulation, which impairs fertility; in addition, some of the causes of hypothyroidism — such as autoimmune disorder — can also impair fertility; talk with your Provider or Specialist
Myxedema
this rare, life-threatening condition is the result of long-term, undiagnosed hypothyroidism; its signs and symptoms include intense cold intolerance and drowsiness followed by profound lethargy and unconsciousness; a myxedema coma may be triggered by sedatives, infection or other stress on your body; if you have signs or symptoms of myxedema, you need immediate emergency medical treatment – call 911.

47. Vital Investment Program (VIP)
Education Goals
Basic Disease Understanding
Disease Triggers & Smart Choices
Treatment & Technique
Warning Signs & Action Plans
Patient Responsibilities

48. Hypothyroidism: Patient Responsibilities
You
are the leader of your healthcare team.

49. Patient Responsibilities
Lab Work and Follow-Up Visits with Provider
see your Provider/Specialists for any concerning signs or symptoms and for regular follow-ups and lab work
Medications
take medications as instructed, and report any concerning signs or symptoms to your Provider
Quit Tobacco
tobacco can make your condition worse; ask how we can help you quit!
Exercise
exercise in general will help you feel better and improve your muscle tone and cardiovascular system; exercise also can help reduce your appetite and increase your energy level.

50. Patient Responsibilities – cont.
Diet
a healthy diet in general will help you feel better and improve overall health
our in-house dietician can help!
Reduce Stress
many relaxation techniques can help you maintain a positive outlook, especially when coping with illness; it is well-documented that stress can make illness worse, so learning to relax and achieve balance in your life can help maintain physical and mental well-being

51. Hypothyroidism: Patient Responsibilities
Please reach out to us.
We are here for YOU.