Thyroid symptoms

Based on subjective evaluation of thyroid symptoms and neurocognitive test results, there was no difference between a 16-week study of either desiccated thyroid extract (DTE) or levothyroxine in a randomised double-blind crossover study of 70 hypothyroid patients stabilised for 6 months on levothyroxine. However, a greater number of patients preferred DTE (48.6% DTE vs 18.6% levothyroxine) due to subjective judgement of better concentration, sleep and happiness... 

The symptoms of hypothyroidism and hyperthyroidism are given in Table 51-1. A severe form of hyperthyroidism, called thyrotoxicosis or tiiyroid storm, is characterized by high fever, extreme tachycardia, and altered mental status. Thyroid hormones are used to treat hypothyroidism and antithyroid... 

Thyroid hormone replacement therapy in patients with diabetes may increase the intensity of the symptoms or the diabetes. The nurse closely monitors the patient with diabetes during thyroid hormone replacement therapy for signs of hyperglycemia (see Chap. 49) and notifies the primary health care provider if this problem occurs. 

Thyroid-stimulating hormone (TSH) should be ordered when thyroid dysfunction is suspected. Hypothyroidism may be responsible for constipation and related symptoms. 

IVday, monitor urinalysis, osmolality, and specific gravity every 3 months. Thyroid function tests should be obtained once or twice during the first 6 months, then every 6-12 months monitor for signs and symptoms of hypothyroidism if supplemental thyroid therapy is required, monitor thyroid function tests and adjust thyroid dose every 1-2 months until thyroid function indices are within normal range, then monitor every 3-6 months. 

Discuss the prevalence of thyroid disorders, including subclinical (mild) and overt (typical signs and/or symptoms present) hypothyroidism and hyperthyroidism. 

The goals of treating hyperthyroidism are to relieve symptoms, to reduce thyroid hormone production to normal levels and achieve biochemical euthyroidism, and to prevent longterm adverse sequelae. 

The assessment of patients for thyroid disorders entails a history and physical examination. In many patients with subclinical or mild thyroid disease, there may be an absence of specific signs and symptoms, and the physical examination may be normal. Various diagnostic tests can be used, including serum thyroid hormone(s), TSH, and thyroid antibody levels and imaging techniques to evaluate patients for thyroid disorders. Normal values for selected laboratory tests are given in Table 41-1. 

What would you tell GD regarding the cause of her signs and symptoms, significance of her abnormal thyroid function tests, and therapeutic options ... 

Success of therapy for thyroid disorders must be based not only on short-term improvement of the patient s clinical status and abnormal laboratory values but also on achievement of a long-term euthyroid state. Maintaining the TSH level in the normal range improves symptoms and reduces the risk of long-term complications. 

Vasomotor symptoms, as well as other menopausal symptoms, occur in over 50% of perimenopausal women and over 80% of menopausal women.5 Menopausal symptoms tend to be more severe in women who undergo surgical menopause compared with natural menopause because of the more rapid decline in estrogen concentrations. Women who seek medical treatment should undergo laboratory evaluation to rule out other conditions that may present with similar symptoms, such as abnormal thyroid function or pituitary adenoma. Once other conditions have been excluded, HRT should be considered. 

Thyroid Disease. Hypothyroidism (myxedema) [169] and hyperthyroidism [170] alter small bowel motility. Although today these diseases are usually recognized before such symptoms develop, thyroid function must be examined in unexplained intestinal pseudoobstruction. 

The answer is d. (Hardman, p 1401.) In patients who are suspected of having hyperthyroidism, propranolol can be administered to provide temporary relief of the peripheral manifestations of the disease while the patient is further evaluated. Propranolol suppresses adrenergic symptoms such as tremors and tachycardia it has no effect on the release of thyroid hormones from the gland. 

Painless thyroiditis has a triphasic course that mimics that of painful subacute thyroiditis. Most patients present with mild thyrotoxic symptoms lid retraction and lid lag are present but exophthalmos is absent. The thyroid gland may be diffusely enlarged, but thyroid tenderness is absent. 

The therapeutic objectives for hyperthyroidism are to normalize the production of thyroid hormone minimize symptoms and long-term consequences and provide individualized therapy based on the type and severity of disease, patient age and gender, existence of nonthyroidal conditions, and response to previous therapy. 

Blockers have been used widely to ameliorate thyrotoxic symptoms such as palpitations, anxiety, tremor, and heat intolerance. They have no effect on peripheral thyrotoxicosis and protein metabolism and do not reduce TSAb or prevent thyroid storm. Propranolol and nadolol partially block the conversion of T4 to T3, but this contribution to the overall therapeutic effect is small. 

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