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The production of thyroid hormones depends on adequate amounts of tyrosine symptoms menopause discount gabapentin express, a non-essential amino acid synthesized in the body from the essential amino acid phenylalanine medicine zoloft purchase gabapentin 600mg fast delivery, and dietary iodine medications given before surgery 300 mg gabapentin with amex. Tyrosine may be conditionally essential in the absence of phenylalanine (Whitney and Rolfes 183) symptoms nerve damage buy online gabapentin. Approximately 90 to 95% of all available iodine in the body is located in the thyroid gland (Norman and Litwack 172). T4 contains 4 atoms of organically bound iodine and T3 contains three atoms of organically bound iodine. Iodine deficiency is the most common cause of hypothyroidism worldwide, but it is rare in the U. We get iodine from foods (Table 2) and it is found in commercially processed iodized salt and preservatives used in bread products. Soy and seaweeds may decrease the absorption of levothyroxine (Synthroid) (Rybacki 1306). Drugs that may interfere with the absorption of levothyroxine include antacids containing aluminum hydroxide, bile acid sequestrants, calcium carbonate, and ferrous sulfate (Ananthakrishnan and Pearce 27). Some foods contain substances known as goitrogens that interfere with the body’s ability to use iodine. Goitrogens can induce iodine deficiencies by binding to iodine and making it unavailable (Appendix B). Cyanogenic compounds, found in cruciferous vegetables, flax seeds and soy isoflavones, particularly genistein, break down to isothiocyanates. Isothiocyanates decrease thyroid function by blocking thyroid peroxidase, the enzyme responsible for transporting iodine into the cell. Fermentation may reduce these effects, especially if eaten with foods high in iodine, and may even increase the levels of B vitamins, particularly B6 (Kohlstadt 112, Daniel 49). L-carnitine is an antagonist of thyroid hormone in peripheral tissues – it can prevent it’s entry into the cell (Murray and Bongiorno “Hyperthyroidism” 1775). Selenium is deficient in about 50% of the population and selenium deficiency can degrade cellular thyroid activity, even though hormone levels are normal (Murray and Bongiorno “Hypothyroidism” 1795). Selenium content in foods depends on the selenium content of the soil where those foods were grown (Milner 4). Adequate iron is also required for thyroid metabolism, as are zinc and copper (Liska et al. Vegetarian diets are high in copper, which can contribute to zinc deficiency (Billica and Willner). Zinc also plays a role in ridding the body of excess estrogens, balances adrenals, and lowers stress (Hedberg April 2009). Shari Lieberman advises to make note of the amount of elemental zinc in our supplements (190). Vitamin A, Vitamin C, Vitamin D, Vitamin E, bioflavonoids, B vitamins, and balanced essential fatty acids (2:1 to 1:1, Omega 6 to Omega 3) are required for optimal thyroid hormone production. B vitamins, cofactors in enzyme metabolism required for every bodily function, help the liver metabolize estrogen, balance hormones, and reduce the effects of stress. B vitamins, especially Vitamin B12 and folic acid, are depleted by mercury and environmental toxins. Vitamin C is an iodine transporter and protects against free radical damage caused by stress. Vitamins A and D support immunity and, therefore, the thyroid gland (Hedberg April 2009, Fallon 38, Kitchen, Liska et al. Suboptimal levels of Vitamin D and ferritin, high or low levels of cortisole, and dysfunction of cell receptors can cause thyroid hormone resistance, as can excessive amounts of essential (Omega 6) fatty acids, vitamin D or progesterone. One study showed reduced incidence of hypothyroidism with supplemental Vitamin A in Vitamin A and iodine-deficient children in developing countries, suggesting that Vitamin A supplementation improves iodine efficacy (Zimmerman et al. Others Imbalances in digestive function, overactive immune system, blood sugar dysregulation, adrenal malfunction, food allergies and sensitivities, particularly to gluten, and poor detoxification processes can upset optimal thyroid health (Hedberg April, June 2009, Kharrazian 88, Shames and Shames 9). Excess cortisol inhibits the production of 5fi deiodinase, decreases peripheral T3 receptors, and increases the production 4 of rT3 (Hedberg April 2009, Paoletti 3, Brady 4). Tyrosine prevents excessive rises in cortisol levels (Paul) and has been used therapeutically in the treatment of depression (Braverman et al. Infection compromises the adrenals and the immune system, and therefore, thyroid function. Hormonal changes such as puberty, perimenopause and menopause stress the adrenal glands (Shomon 4). Insulin is the chief hormone regulating intermediary metabolism in which proteins, carbohydrates and fats are utilized by the metabolic processes involved in glucose homeostasis, the delicate balance throughout the body that results in either mobilization of stored glucose, glycogen, or storage of excess glucose as glycogen in response to changes in calorie intake and degree of physical activity (Norman and Litwack 194 – 221). Since this mechanism is responsible for mobilizing fat as an energy source for muscles and the brain, amino acid uptake into skeletal muscle, and the incorporation of amino acids into proteins by the liver, insulin resistance can affect this balance and contribute to nutrient deficiencies (Greenstein and Wood 83). Physicians are advised to look at the patient’s symptoms, medical history, and risk factors, such as family history. The best way to test thyroid function is to measure the serum levels of thyroid hormones. Conventional treatment for subclinical or mild hypothyroidism may include administration with T4, levothyroxine, a bioidentical synthetic hormone that must be converted in the liver and kidneys to T3. Synthetic T3 (Cytomel and Thyrolar) is four times more biologically active than T4 and exerts its effects more rapidly and vigorously. Persons are more likely to experience side effects from synthetic T3 than from compounded slow released T3, including tachycardia, arrhythmia, anxiety, nervousness, agitation, irritability, sweating, headaches, increased bowel motility, menstrual irregularities, and aggravation of conditions such as angina, congestive heart failure, and atrial 5 Milli-International Units per milliliter. Alternative Approach the alternative approach is to look at symptoms, related conditions, family history and physical signs. Signs include fatigue, lethargy, sleepiness, mental impairment, depression, cold intolerance, slow movements and speech, inadequate reflex response, hoarseness, dry skin, decreased perspiration, weight gain, decreased appetite, constipation, joint pain, slow heart rate, dry skin, myxedema, paresthesia, diminished or delayed reflexes, shortness of breath, impaired kidney function, loss of libido in men and menstrual disturbances. Hair loss in women is a cardinal sign of hypothyroidism but hair loss can be attributed to other conditions. Fatigue and depression are generally the first clinical signs, with difficulty concentrating and forgetfulness developing later as the condition progresses (Murray and Bongiorno “Hypothyroidism” 1793. Martin Milner, “The most common complaints include fatigue, impaired concentration, and persistent difficulty losing weight in spite of adequate exercise and reasonable caloric restrictions. The axillary (armpit) basal body temperature test, a functional test developed by the late Dr. The generally accepted temperature range for normal thyroid hormone function is between 97. Milner’s patients were asked to record their first morning axillary basal body temperature, they revealed values consistently below 98fi F (2). Many factors can affect the basal body temperature (Murray and Bongiorno “Hypothyroidism” 1794). Unless the reading is consistently below normal, a sluggish metabolism may not be a consideration – how you feel may be the most accurate assessment (Shames and Shames 52-4). Alternative medicine practitioners may also use conventional serum thyroid hormone levels to assess thyroid function. The rT3-to-T3 ratio is used to assess Wilson’s Syndrome (Murray and Bongiorno “Hypothyroidism” 1792). Jim Paoletti compares fT4 to fT3 (free T3) to determine if a patient is converting normally and recommends assessing adrenal function with saliva testing four times a day. Supporting metabolism with proper nutrients, instead of increasing T4, is recommended when the problem is converting T4 to T3 (Hedberg April 2009). Because serum tests may miss cases of mild hypothyroidism, and because adrenal and thyroid function are interdependent, urinary excretion of thyroid and adrenal metabolites and electrolytes may be used to assess thyroid and adrenal function (Brady 3). Prescription desiccated thyroid hormone extract from porcine sources, such as Armour Thyroid, Naturethroid, and Westhroid, is typically used in conjunction with nutritional and supplement protocols and lifestyle interventions. The belief is that these are less toxic and provide a better clinical and symptomatic response than synthetic compounds, particularly in persons having difficulty converting T4 to T3 (Brady 5). Practitioners may recommend supplemental T3 thyroid hormone for person’s with Wilson’s Syndrome. Excessive thyroid glandular concentrates may trigger autoimmune thyroid disorders (Brady 6) and, because the T3 is released immediately, may cause side effects, including antioxidant depletion, anxiety, tremor and palpitations (Murray and Bongiorno “Hypothyroidism” 1797). Some experts recommend using compounded slow release T3 in combination with T4, while monitoring serum hormone levels (Milner 7), and lowering T4 gradually (Paoletti 4, 7).
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Current therapy for hepatts C treatment urticaria proven 600mg gabapentin, though efectve symptoms 37 weeks pregnant cheap gabapentin 600mg line, is associated with numerous side efects that either preclude many patents from startng treatment or prevent them from completng therapy symptoms high blood pressure discount gabapentin online amex. Nevertheless medicine lake mt generic 100 mg gabapentin otc, new questons in access to care, therapeutc regimens, adverse events, and antviral mutatons will emerge. Develop global collaboratons for the conduct of basic research and clinical trials and for monitoring adverse events and antviral mutatons. Surveillance data enable natonal, state, and local public health professionals to measure and monitor trends in the burden of disease, detect epidemics, identfy and address health disparites, guide and evaluate public health programs and policies, and monitor changes in health-care practces (1,2). Public health surveillance requires standardized, systematc, ongoing collecton and management of reliable data. In additon, certain informaton about potental exposures and other characteristcs. Health jurisdictons also lack the staf required to collect pertnent informaton from laboratory and clinical records, which results in inaccurate case countng and erroneous estmaton of the true burden of disease. All of these sources of viral-hepatts–related data help provide insight into current disease prevalence and incidence at the state and local levels. However, because most persons living with viral hepatts are unaware that they are infected, employing actve surveillance and serologic surveys targetng priority populatons. Increases in resources also would enable case defnitons to be revised to refect the advent of new laboratory technologies and meet new data needs of preventon programs. Strengthen the capacity of state and local health departments to collect a core set of viral hepatts surveillance data. Case surveillance is a key source of informaton regarding disease outbreaks, changes in transmission paterns, and morbidity and mortality. All state and local surveillance programs should be capable of collectng a core set of surveillance data to include a variety of demographic and risk-related informaton. However, the number of viral hepatts case reports received by health departments is large; the sheer volume of reports overwhelms most health departments, limitng their ability to make meaningful use of viral hepatts data. Develop state and local Viral Hepatts Centers of Excellence charged with collectng an enhanced set of viral hepatts surveillance data. The creaton of Viral Hepatts Centers of Excellence within state and local health departments would help them evaluate methods for collectng surveillance data; set best practces for other state and local surveillance programs; and collect enhanced data regarding transmission paterns, burden of disease, and viral characteristcs. Initally, 10 such centers will be established, and additonal centers will be added based on the availability of funds. Electronic reportng of laboratory data ensures tmely reportng of laboratory-confrmed cases of infectous disease, including viral hepatts. Conduct natonal and multstate surveys to monitor health disparites in large populaton sub-groups in the United States. With sustained support, these surveys can reveal health disparites associated with viral hepatts. Collect data at the community level to help state and local programs identfy and address viral-hepatts–related health disparites. These populatons ofen are underrepresented in large natonal surveys, necessitatng the development and use of specifc behavioral and serologic surveys targetng populatons at the community level. Census data, clinical data sets, counseling and testng databases, and health records from correctonal setngs). Document and monitor provision and impact of preventve services for viral hepatts. A central role of public health is to ensure delivery of preventon, care, and treatment services. Document and monitor the provision and impact of viral hepatts care and treatment services. Providing care and treatment to persons infected with viral hepatts can prevent complicatons, including liver cirrhosis and liver cancer. Data on disease severity and the provision and outcomes of recommended clinical interventons (including antviral therapy) are integral to monitoring access to and impact of care and treatment services. Build the capacity for state public health laboratories to support outbreak investgatons and other surveillance actvites. Develop electronic infrastructure with the ability to capture results of existng and future laboratory markers of viral hepatts infecton. There is limited efciency and accuracy in laboratory reportng of viral hepatts cases to health departments, primarily because of the passive nature of the current reportng system. Electronic monitoring, laboratory reportng through a centralized database, and applicaton of standard laboratory-based case defnitons can yield accurate reports that are ready for review, verifcaton, and analysis. United States Department of Health & Human Services Combatng the Silent Epidemic of Viral Hepatts: 33 4. Comprehensive hepatts B vaccinaton recommendatons, which include all children aged fi18 years, have resulted in similar reductons in hepatts B infectons. Vaccinaton contributed to an 82% natonal decline in hepatts B incidence between 1990 and 2007; the decline was seen most dramatcally among persons aged <24 years, in whom incidence fell by 93%–98% (10). United States Department of Health & Human Services background rates of hepatts B are at risk for perinatal transmission and transmission through infected household contacts. Vaccinaton coverage rates remain low for neonates (55% by the third day of life) (13). Hepatts B vaccinaton programs for adults have been less successful than those targetng children. Despite these recommendatons, vaccinaton coverage among adults in priority populatons remains low (45% in adults with high-risk behaviors) (15). Barriers to vaccinaton include the lack of 1) vaccine afordability for the patent and inadequate provider reimbursement for vaccine administraton; 2) vaccine availability in public health setngs; 3) alternatve vaccinaton sites; 4) data collecton and tracking systems available to all providers; 5) public health infrastructure for care coordinaton of hepatts B-infected pregnant women, their newborn infants, and their household contacts; and 6) vaccinaton coverage estmates for adults in priority populatons. Development of new, more efectve vaccines that provide long-term protecton and reduce the number of doses required for immunoprotecton could improve existng hepatts A and hepatts B vaccinaton coverage levels in the United States. The development of vaccines that induce protectve immunity in those with reduced immune response rates, such as persons in older age groups and adults with co-morbidites, is equally important. Potentally, research can also yield new vaccines to prevent hepatts C and hepatts E infecton. Ensure that hospitals and birthing centers administer a “birth dose” of hepatts B vaccine to all neonates prior to discharge. Administraton of a dose of hepatts B vaccine to all newborns before discharge from hospitals or birthing centers provides a safety net for preventng perinatal and household transmission of hepatts B. Including the provision of a birth dose of hepatts B vaccine as a quality measure provides an incentve for routne administraton to all newborns. Ensure that children who were not vaccinated at birth and who have parents born in countries with high rates of hepatts B are tested and vaccinated as needed. Children born to parents from highly endemic countries who were not vaccinated at birth are at increased risk for acquiring hepatts B perinatally or from contact with infected household contacts. If infected, 25%–50% of children <5 years of age will develop chronic infecton, and 25% Combatng the Silent Epidemic of Viral Hepatts: 37 of those children will later die of cirrhosis, liver failure, or liver cancer. These high-risk children should be tested for hepatts B infecton and referred for care and treatment as needed. Increase availability and utlizaton of hepatts A and hepatts B vaccines for adults, including those in priority populatons. The cost of vaccine, along with inadequate reimbursement of providers for vaccinaton, is a barrier to hepatts A and hepatts B vaccinaton among adults. Provision of free or low-cost vaccine to targeted priority populatons will increase vaccine access and improve vaccinaton coverage. Public health eforts should be directed toward helping health plans implement viral hepatts vaccinaton for insured adults. Determine long-term protecton of the current hepatts A and hepatts B vaccine, and improve vaccine-related laboratory methodology. Although hepatts B vaccine provides immunity for more than 20 years, research is needed to determine whether a booster dose is necessary for contnuing immunity. Determining the duraton of vaccine-induced immunity is partcularly important for persons vaccinated as infants and for the minority of healthy persons and persons in certain populatons. Ensuring the success of vaccinaton programs requires eforts to increase detecton of viral variants that are resistant to vaccines and those that cause unusual clinical manifestatons. Assess efectveness of hepatts E vaccine candidates, and consider indicatons for use in the United States and globally.
Ensure that a daily due list is prepared for the patients expected to medications on carry on luggage cheap gabapentin on line visit and a follow up action is taken to treatment kidney infection order generic gabapentin canada contact the defaulting patients medicine 031 buy gabapentin with a mastercard. Pharmacist Qualifcation: the pharmacist should hold a Degree in Pharmacy from a recognized institute medicinenetcom purchase 400mg gabapentin mastercard. If candidate with degree is not available, diploma holder in pharmacy with 3 years of experience in health care institution can be considered. Advise the patients and family about the importance of adherence during each visit d. Counsel the patient on possible drug toxicities and report the same, if signifcant. Do pill count and report any adverse effects of drugs Also, confrm the next visit date and inform the patient f. In case pharmacist is not available/on leave, the nodal offcer in consultation with the head of institute will make any alternative arrangement so that the functioning does not suffer and regular staff of the facility must also be integrated for service delivery. S/he has to undergo training under the initiative in monitoring and evaluation tools (M & E) of the programme aimed to build the capacity of the person in recording data, preparing and sending reports and maintaining records properly. Maintain the attendance register for the centre staff and get it verifed by the nodal offcer everyday and by the Nodal Offcer at the end of the month 5. Prepare and send all the monthly reports prescribed by central unit after approval of Nodal Offcer 7. Peer supporter Qualifcation: the peer supporter should be a person preferably with or recovered from the disease (hepatitis B or hepatitis C), with a minimum of intermediate (12th) level education. S/he must also have sound knowledge of the local language and working knowledge of English. Be a peer educator for patients at centre and provide psycho-social support to newly registered patients. Follow up the patients and assist in patient retrieval, where necessary and as far as possible h. Ensuring that all job responsibilities are adhered to by all the laboratory personnel d. Management of funds with relation to laboratory National Guidelines for Diagnosis & Management of Viral Hepatitis 53. Candidates with PhD Medical Microbiology from recognized university with 3 months experience in clinical laboratory services will be preferred. Supervises the work of Laboratory technician under the guidance of the Laboratory In-charge. Maintaining and monitoring timely calibration / verifcation of all devices and ensuring that all monitoring and measurements are done with devices having valid verifcation / calibration status. Confrmation of reference samples from state medical college labs and compilation of reports. Indent for supplies to the Laboratory through Lab In charge and ensure suffcient stock of Laboratory consumables is available. To maintain cleanliness in and safety and follow proper biomedical waste disposals. S/he has to undergo training under the initiative in monitoring and evaluation tools (M & E) of the initiative aimed to build the capacity of the person in recording data, preparing and sending reports and maintaining records properly. S/he has to work under the guidance and supervision of nodal offcer (Microbiologist) 2. Ensure that all data recording and reporting is updated for all activities under the program, including surveillance of viral hepatitis, if the lab is also participating in the surveillance program for viral hepatitis 3. Print and share all circulars/information sent by central unit/States to the Nodal Offcer and maintain a fle for the important orders/communication 4. Maintain the attendance register for the program staff and get it verifed by the nodal offcer (daily/ end of the month) 5. Training Trainings are important for any new initiative as well as for building the capacity of the service delivery points for an effective implementation. To ensure standardized and uniform quality of service delivery, there will be capacity building of the different cadres of staff in the program, using standardized training modules and facilitator guides. It will be ensured that no stock out/expiry happens in any circumstance, once the center starts functioning. A provision of 10% buffer stock needs to be maintained all the time as per the laid down procedure. These drugs should be kept under safe custody and proper storage conditions shall be maintained. The nodal person of the center should undertake physical verifcation of the stocks periodically and the stock registers should be regularly updated and duly signed by the pharmacist and nodal offcer. Table 18A and 18B below details the pattern of assistance: Table 18A:Pattern of assistance for Model Treatment Centers. Follow up visits of the patient Enrollment of the patient: the patients who present to the center could either have a defnite diagnosis or might have suspected infection. Peer supporter guides the patient to laboratory Lab technician: draws the blood, performs the tests/ ensures transport and ensures that the reports are generated and sent to the clinician at the treatment center. Ensures that test results are updated in records Doctor reviews the case with clinical assessment and investigation, evaluates for the presence or absence of cirrhosis (using non-invasive criteria), prescribes the medicines as per the guidelines and send to pharmacist. Sequential entries for all the registration are to be maintained in the hepatitis C Treatment Register (Annexure 6). It is made in two sets: one to be kept at the center and other given to the patient. The confdentiality of the information provided by the patient is to be protected at all cost. Any divulgence of such information will have penal implication as per law for anyone responsible for such divulgence. The testing and treatment card will capture patient demographic information diagnosis and treatment details (Annexure 5). The sections on name and demographic details are flled by the peer supporter while enrolling. The section on the clinical parameters and the laboratory investigations are flled by the treating doctor. The follow up entries help in monitoring the disease progress, counseling of the patient for regular treatment, review of adherence of the patient to therapy. However, the pharmacist should ensure that the patient is given a follow-up day after 25 days. This will ensure that the patient does not land in a situation where s/he is out of drug stock. At every visit, the pharmacist should also count the remaining drugs (pill count) to have an idea if any doses have been missed. The uncomplicated cases, as defned in the technical guidelines, should be initiated treatment at the treatment center. Once the patient is stable and the treating doctor is confdent that the patient can be managed at the nearest treatment site, then the drug dispensation can be done at the nearest site. However, the patient should be referred back in case it is deemed necessary for appropriate management. However, in the event there is expiry of some medicines under the program, they should be discarded as per the hospital policy. The process should be documented with details on the quantity of drug, batch number and should be signed by three regular government employees including the nodal offcer of the center. Justifcations and reasons for the same must be recorded in writing and kept for review by supervising authorities Monitoring and Evaluation of the Treatment sites the treatment sites and the laboratory will be reviewed regularly by the nodal offcers for the site level day to day functioning. In addition, the district/state and National offcials will also undertake supervisory site visits for supportive supervision and mentoring. The suggested frequency of the monitoring and mentoring visits are: Table 20: Frequency of visit to the treatment sites. Recording tools the following recording tools are to be used under the program: 1. Reporting tools There will be a monthly report that each laboratory and treatment center will have to collate and submit to the state and national offcials. The reports at the state level should be compiled into a state report, the facility level reports have to be checked and feedback should be provided to centers. The responsibility of information collection, reporting, management and analysis rests at four levels: 1. Responsibility of reporting, fow of information and frequency of reporting is summarized below: 60 National Guidelines for Diagnosis & Management of Viral Hepatitis Table 21: Flow of information and frequency of reporting. Key gaps identifed during implementation of the program and innovative interventions would also be planned through operational research and will follow the established procedures under the guidance from the central unit.
There is also an average of one triiodothyronine molecule for every 10 molecules of thyroxine medicine rheumatoid arthritis cheap gabapentin 100mg with visa. In this way that is in combination with thyroglobulin daughter medicine order gabapentin with amex, the thyroid hormone 17 nail treatment gabapentin 400mg generic,18 medications given im discount gabapentin online,22,62-64 can be stored for several months. On the other hand the hormones are first cleaved from the thyroglobulin; follicular cells of the thyroid gland send pseudopod like extensions, which close around the thyroglobulin hormone complex. Now, the hormones diffuse through the base of the follicular cells and enter the capillaries. Albumin Regulation of secretion of thyroid hormone the secretion of thyroid hormone is controlled by anterior pituitary through the feedback mechanism. Anterior pituitary secretes thyroid stimulating hormone under the influence of thyrotropin releasing hormone from hypothalamus. This hormone is secreted by the nerve endings in the median eminence of the hypothalamus. From hypothalamus it is transported through the hypothalamic31 Disease Review hypophysial portal system to the anterior pituitary. This effect results from excitation of the anterior hypothalamus and pre optic area, which are the hypothalamic centers for body temperature regulation. Physiological Functions of the Thyroid Hormones the rate of secretion of thyroxine is about 90 mgs per day. Therefore, it is believed that the true intracellular hormone is principally T3 rather than T4. Thyroid hormones have two major effects on the body to increase the overall metabolic rate in the body and to stimulate growth in children. Effect on basal metabolic rate – thyroxine increases the metabolic activities of almost all tissues of the body except brain, retina, spleen, testes and lungs. Effect on protein metabolism – thyroid hormone increases the synthesis of protein in the cells. Effect on carbohydrate metabolism – It increases the absorption of glucose from the gastrointestinal tract, enhances the glucose uptake by the cells, increases the breakdown of glycogen into glucose it accelerates the breakdown of gluconeogenesis. Thyroxine is more important to promote growth and development of the brain during fetal life and during first few years of postnatal life. Thyroxine accelerates the process of erythropoiesis and increases the blood volume. The increased metabolic rate caused by thyroxine increases the utilization of oxygen and formation of carbon dioxide. These two factors stimulate the respiratory centers to increase the rate and force of respiration. It is a stimulating hormone for the central nervous system particularly the brain, thus the normal functioning of the brain needs the presence of thyroxine. Because of its effect on metabolism thyroxine increases the demand for secretion 17-22,62 of other endocrine glands. In Indian scenario these is premature occurrence by 10 to 20 years, while in North America it is observed in the age group of 50 to 60 years, acquired impairment of thyroid dysfunction, affects 2 percent of adult women and 0. Hypo means too little 51 thyroidism means a disease of too little thyroid activity, clinical condition resulting from decreased circulating level of thyroxine (T4) and triiodothyronine (T3) by the thyroid gland irrespective of the cause. Hypothyroidism is a hypo metabolic clinical state resulting from in adequate production of thyroid hormone for prolonged period 7or rarely from resistance of the peripheral tissues to the effects of thyroid hormones. Hypothyroidism is the clinical syndrome that results from decreased secretion of thyroid hormone from the thyroid gland. It most frequently reflects a disease of the gland itself (primary hypothyroidism) but can also be caused by pituitary disease 8(secondary hypothyroidism) or hypothalamic disease (tertiary hypothyroidism). While the fundamental aetiology is kidney Yang deficiency, complications may involve Yang deficiency of the spleen and heart. In correlation with western medicine, the lack of thyroid 69 hormone production is directly associated with Kidney Yang deficiency. In areas of adequate iodine supply, such as the United States, hypothyroidism occurs in 0. The incidence is also increased in areas exposed to waterborne goitrogens or where there is excessive consumption of goitrogens such as cassava. It occurs in 1-2% of women, 1,12,16,23,71 with a 5-10-fold lower prevalence in men. The prevalence of overt hypothyroidism varies according to different surveys between 0. Subclinical hypothyroidism is more prevalent and can be seen in as many as 15% of older women. Acquired impairment of thyroid function affects about 2% of adult women and about 2,16 0. The prevalence of previously diagnosed and treated hypothyroidism was 14 per 1,000 women, increasing to 19 per 1,000 women when possible, but unproven cases were 2,16 included. In the original Whickham survey, 8% of women and 3% of men had subclinical hypothyroidism. Similarly, in a study of Japanese people at least 40 years of age, the 2,73 prevalence of subclinical hypothyroidism was 6% in women and 3% in men. Hypothyroidism in Great Britain occurs at a rate of 3 cases per 1000 women per year. About one third of all cases resulted from surgical or radiation treatment for hyperthyroidism. In the United States hypothyroidism occurs in about 1%to 2%of the general population. Both hypothyroidism and hyperthyroidism are 5 or more times common in women than in men in the United States. Acquired impairment of thyroid function affects about 2% of adult women and 2,70,74-76 about 0. Prevalence rates for congenital hypothyroidism are well described, whereas acquired hypothyroidism in the young has been less well documented, particularly in recent years. Primary congenital hypothyroidism has a comparable incidence worldwide (1:3000– 1:4000 live births, with recent quoted figures in Holland of 1:3400 for primary congenital hypothyroidism and 1:25 000 for secondary 65,71,77,78 hypothyroidism. Permanent hypothyroidism also occurs about once in every 3500 to 4000 live births in 70 the United States. Of these approximately 2% (1:180 000 of all live births) have transient hypothyroidism secondary to maternal antibodies, and up to 5% may have transient hypothyroidism secondary to prematurity. Previous estimates of the prevalence of acquired hypothyroidism in children and adolescents, based on selected populations 77,79-81 with few population studies, have ranged between 0. Pathophysiology Hypothyroidism is a condition in which the body lacks sufficient thyroid hormone synthesis. Localized disease of gland resulting in decreased thyroid hormone production is the most common cause of hypothyroidism. Under normal circumstances, the thyroid releases 100-125 nmol of tetra-iodothyronine (T4) daily and only small amounts of tri-iodothyronine (T3). T4, a prohormone, is converted to T3, the active form of thyroid hormone, in the peripheral tissues by 5-deiodination. Hypothyroidism may reflect a malfunction of the hypothalamuspituitarythyroid axis, all of which are part of the same negative-feedback mechanism. Chronic autoimmune thyroiditis, also called chronic lymphocytic thyroiditis, occurs when autoantibodies destroy thyroid gland tissue. The cause of this autoimmune process is unknown, although heredity has a 39 Disease Review role, and specific human leukocyte antigen subtypes are associated with greater risk. Outside the thyroid, antibodies can reduce the effect of thyroid hormone in two ways. Primary idiopathic hypothyroidism (probably end stage Hashimoto’s disease) radiation to non-thyroidal malignancy. Post-ablative (iatrogenic) or surgery or therapeutic radiation to non-thyroidal malignancy. Tertiary (hypothalamic) hypothyroidism (idiopathic, traumatic, tumors, infiltrative disorders) Other forms of hypothyroidism Transient hypothyroidism fi Withdrawal of thyroid hormone treatment in patients with an intact thyroid. Risk factors Although anyone can develop hypothyroidism, it occurs mainly in women older than 50, and the risk of developing the disorder increases with age. You also have an increased risk if you: fi Have a close relative, such as a parent or grandparent, with an autoimmune disease fi Have been treated with radioactive iodine or anti-thyroid medications fi Received radiation to your neck or upper chest 86 fi Have had thyroid surgery (partial thyroidectomy) 41 Disease Review Classification Hypothyroidism can be classified into three main categories: I. Primary Hypothyroidism: Hypothyroidism due to the permanent loss or atrophy of thyroid tissue.
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