Thyroid Disorders

By Smoot, Laura Carter | Drug Topics, July 2009 | Go to article overview

Thyroid Disorders


Smoot, Laura Carter, Drug Topics


AN ONGOING CE PROGRAM OFTHE UNIVERSITY OF FLORIDA COLLEGE OF PHARMACY AND DWG TOPICS

Introduction

Thyroid disease affects as many as 27 million Americans, many of whom remain undiagnosed. Women suffer from hypothyroidism about five times as often as men and account for about eight out of every 10 patients with thyroid disorders. It remains unclear as to which patients will eventually develop thyroid conditions, although age does appear to be a risk factor for hypothyroidism. Estimates are that 1 7 percent of women and 9 percent of men develop this condition by the age of 60. Research shows that there is a strong genetic link between thyroid disease and other autoimmune diseases, including type 1 diabetes, rheumatoid arthritis, and hemolytic anemia. Estimates are that 1 5 percent to 20 percent of people with diabetes and their siblings or parents are likely to develop thyroid disease. This compares to approximately 4.5 percent of the general population.

The thyroid gland produces hormones that influence essentially every organ, tissue, and ceil in the body, creating many disturbances if it is not functioning properly. If left untreated, thyroid disease can cause elevated cholesterol levels and subsequent heart disease, infertility, muscle weakness, osteoporosis, and, in extreme cases, coma or death.

Thyroid function review

The function of the thyroid gland is to make thyroid hormones thyroxine (T4) and triiodothyronine (T3) through conversion of iodine. Thyroid cells are the only cells in the body able to absorb iodine, an element found in many natural foods and food supplements. The iodine circulates in its ionic form of iodide before being absorbed by the thyroid gland and converted back to iodine. It is then combined with the amino acid tyrosine in a large glycoprotein called thyroglobulin to make T^sub 3^ and T^sub 4^. The production of these hormones in normal drcurnstances is about 80 percent to 90 percent T^sub 1^ and 10 percent to 20 percent T^sub 3^, although T^sub 3^ is approximately four times as active. Within the tissues, T^sub 4^, is converted to T^sub 3^. Both hormones are carried in circulation by three different carrier proteins: thyroxine -binding globulin, thyroxinebinding prealbumin, and albumin.

Overall, thyroid function is a highly regulated system. When signaled by thyroid-stimulating hormone (TSH), the thyroid gland produces and secretes T^sub 3^ and T^sub 4^, depending on the body's needs. This hormone is released from the anterior pituitary gland by a negative-feedback mechanism. The pituitary gland itself is regulated by the hypothalamus, which produces thyrotropin-releasing hormone (TRH). This hormone stimulates the pituitary gland to signal the thyroid gland by TSH release, again on the basis of the body's needs. Cir* cumstances such as exposure to cold, stress, or decreased T, levels increase release of TRH. Problems within any of these systems may lead to thyroid dysregulation.

Common thyroid problems

The thyroid gland is prone to several distinct problems: increased growth of the thyroid, altered hormone production, and me formation of nodules or lumps within the gland. Some of the more common thyroid problems this article discusses are goiters, hyperthyroidism, hypothyroidism, and thyroiditis.

A thyroid goiter is a remarkable enlargement of the thyroid gland. Goiters are sometimes removed for cosmetic reasons, but more often because they cause compression of other vital structures of the neck region. Compression may impair breathing or swallowing, creating potentially liie-threatening concerns. Only a small percentage of goiters produce excess thyroid hormone. Most actually become enlarged as a result of iodine deficiency. With decreased iodine intake, the thyroid gland becomes unable to make its essential hormones, creating a subsequent release of TSH that causes the gland to enlarge. In the United States, where diet is supplemented with iodine, goiters from this cause are rarely seen today. …

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