HYPO AND HYPER SUBCLIN

Views:
 
Category: Entertainment
     
 

Presentation Description

No description available.

Comments

Presentation Transcript

PowerPoint Presentation:

DIAGNOSIS AND MANAGEMENT OF SUBCLINICAL HYPOTHYROIDISM AND HYPERTHYROIDISM FRANKY RENATO ANTHONIUS ARI SUTJAHJO REVIEW ARTICLE DEPARTMENT OF INTERNAL MEDICINE AIRLANGGA UNIVERSITY SCHOOL OF MEDICINE-Dr SOETOMO HOSPITAL SURABAYA 2012

PowerPoint Presentation:

Subclinical Thyroid Disease : asymptomatic thyroid abnormalities found on laboratory tests or imaging Introduction Subclinical Hypothyroidism (Shypo) serum TSH above ref range serum FT4 normal USA : 4%-8,5% of adults Subclinical Hyperthyroidism (Shyper) serum TSH below ref range serum FT4 and T3 normal USA : 0,5%-6,3% of adults

PowerPoint Presentation:

Best approach and management Whom to be screened Clinical consequences of the untreated Monitoring Costs and benefits .....Introduction STILL IN DEBATE

PowerPoint Presentation:

Definitions and Epidemiology SUBCLINICAL HYPOTHYROIDISM US 4% - 8% Afro : White = 1:3 20% in ♀ older than 65 NHANES III TSH increased in 4,6% US population Among them 4,3% is subclinical

PowerPoint Presentation:

postpartum family history of autoimmune thyroid disease other autoimmune endocrine disorders history of head and neck surgery and radiation hyperthyroidism on treatment treatment with amiodaron or lithium HIGHER RISK Definitions and Epidemiology SUBCLINICAL HYPOTHYROIDISM

PowerPoint Presentation:

Etiology SUBCLINICAL HYPOTHYROIDISM TREATMENT OF HYPERTHYROIDISM AUTOIMMUNE THYROID DISEASE (TPOAb in up to 80% cases) POSTPARTUM SUBCLINICAL HYPOTHYROIDISM DRUGS (eg. amiodaron, contrast media, lithium, IFN α , etc)

PowerPoint Presentation:

DIAGNOSIS AND DIFFERENTIAL DIAGNOSIS SUBCLINICAL HYPOTHYROIDISM TSH above normal FT4 and T3 are normal Other causes of elevated TSH excluded Recovery from severe illness Adrenal insufficiency R/ domperidone or metoclopramide Presence of heterophilic Ab against mouse proteins Central hypothyroidism DD

PowerPoint Presentation:

RISKS vs BENEFITS MANAGEMENT AND EVALUATION SUBCLINICAL HYPOTHYROIDISM Concequences of the untreated (CV, lipid profile, cognitive and neuropsychiatric, mild systemic symptoms) Risk of progression to overt disease Special condition (pregnancy, elderly)

PowerPoint Presentation:

MANAGEMENT AND EVALUATION SUBCLINICAL HYPOTHYROIDISM Left ventricle diastolic abnormality (Vitale et al, 2002; Yasici et al, 2004; Aghini-Lombardi, 2006) Improved systemic vascular resistance and arterial stiffness in treated individual (Danzi, 2003; Owen et al, 2006) Improved myocardial contractility and diastolic function in treated individual (McDermott, 2001) CV ABNORMALITIES IN SHypo

PowerPoint Presentation:

MANAGEMENT AND EVALUATION SUBCLINICAL HYPOTHYROIDISM Dyslipidemia had no association with SHypo (Whickham Survey) Mean cholesterol level was higher in SHypo population (NHANES III) Better lipid profile in treated SHypo (Meier et al, 2001; Caraccio et al, 2002; Monzani et al, 2004; Razvi et al, 2007) LIPID PROFILE IN SHypo

PowerPoint Presentation:

MANAGEMENT AND EVALUATION SUBCLINICAL HYPOTHYROIDISM 4,3% risk in TPOAb+ vs 2,6% in TPOAb- (Whickham Survey) Higher TSH was strong predictor (Diez, 2004) RISK OF PROGRESSION PREGNANCY Higher preterm labour, placental abnormality and NICU admission in SHypo (Casey, 2006) Decrease abortion and preterm labour in treated pregnant TPOAb+ (Negro, 2005)

PowerPoint Presentation:

Summary

PowerPoint Presentation:

Summary

PowerPoint Presentation:

Summary

PowerPoint Presentation:

Summary

PowerPoint Presentation:

Summary

PowerPoint Presentation:

Summary

PowerPoint Presentation:

Summary

PowerPoint Presentation:

THANK YOU

authorStream Live Help