WHAT IS HYPOTHYROID AND WHAT ARE THE SYMPTOMS?
Hypothyroidism is a disease that occurs as a result of insufficiency or rarely ineffectiveness of thyroid hormone at the tissue level.
- Primary hypothyroidism: Due to causes arising from thyroid gland insufficiency
- Secondary hypothyroidism: Hypothyroidism due to TSH deficiency
- Tertiary hypothyroidism: Hypothyroidism due to TRH deficiency
Symptoms of hypothyroidism: weakness, fatigue, Weight gain, forgetfulness, difficulty concentrating, dry skin, hair loss, chills, constipation, deepening of the voice, irregular and heavy menstrual bleeding, infertility, muscle stiffness, muscle pain, depression, and dementia may occur.
2. WHAT IS HYPERTHYROID/THYROTOXICosis AND WHAT ARE THE SYMPTOMS?
Thyrotoxicosis: is a general term expressing excess thyroid hormone, regardless of its source.
Hyperthyroidism: caused by increased hormone production from the thyroid gland. It refers to excess thyroid hormone.
Symptoms of hyperthyroidism: weakness, irritability, palpitations, weight loss, shortness of breath, intolerance to heat, increased appetite, oligomenorrhea, sweating, diarrhea, eye symptoms.
3. WHAT IS THE TARGET OF THYROID FUNCTION TESTS DURING PREGNANCY AND WHEN SHOULD IT BE TREATED?
TEMD (Turkish Endocrinology and Metabolism Association) recommendation
1. trimester: TSH should be between 0.1mIU/L-2.5mIU/L
2. trimester: TSH should be between 0.2mIU/L-3mIU/L
3. trimester: TSH should be between 0.3mIU/L-3mIU/L
The most important reason for hypothyroidism during pregnancy is autoimmune thyroid disease in iodine-sufficient areas. In regions with iodine deficiency, it is iodine deficiency.
4. HOW ARE THYROIDITIS DIVIDED INTO?
- Chronic autoimmune thyroiditis
-Painful thyroiditis
1. subacute granulomatous thyroiditis
2. infectious thyroiditis
3. radiation thyroiditis
4. thyroiditis due to trauma
-Painless thyroiditis
1. subacute lymphocytic thyroiditis (silent thyroiditis)
2. postpartum thyroiditis
3. drug-induced thyroiditis (interferon, interleukin-6, amiodarone)
4. fibrous thyroiditis (Riedl struma)
5. WHAT IS HASHIMOTO THYROIDITIS AND WITH WHICH DISEASES IS IT SEEN WITH?
Hashim Autothyroiditis is a disease of the thyroid gland that progresses with chronic autoimmune destructive inflammation. It is very common in all societies. It begins with enlargement of the thyroid gland, resulting in hypothyroidism. It is usually asymptomatic.
HASHIMOTO THYROIDITIS; Addison's disease can be observed as a component of "type 2 autoimmune polyglandular syndrome" together with type 1 diabetes, hypogonadism, hypoparathyroidism, and pernicious anemia.
6. WHAT ARE THE SITUATIONS IN WHICH HASHIMOTO'S DISEASE MAY BE SUSPICIOUS?
1. Hypothyroidism not attributable to other causes
2. Anti-TPO or anti-Tg positivity without thyroid dysfunction/goiter
3. Cases with suspicion of thyroid lymphoma
4. Hypoechoic, heterogeneous appearance on ultrasonographic examination
7. WHAT ARE THE RISK FACTORS FOR THYROID DISEASE DURING PREGNANCY?
1. History of thyroid disease in the family or in oneself (hyperthyroidism or hypothyroidism, postpartum thyroiditis)
2. Having had thyroid surgery before
3. Presence of type 1 diabetes or other autoimmune diseases
4. Presence of clinical findings suggestive of thyroid disease, goiter
5. Presence of thyroid autoantibodies
6. Anemia, high cholesterol, hyponatremia
7. Women who received head and neck radiotherapy
8. Women who have received infertility treatment
9. Those with a previous history of miscarriage or stillbirth
8. HOW IS THE APPROACH TO THYROID NODULES?
In the follow-up evaluation of thyroid nodules, calcitonin level should be measured once in nodules with suspicious sonographic features, insufficient material detected in repeated biopsies, and long-term follow-up planned (in terms of thyroid medullary cancer)
Thyroid USG: It is not a recommended test for general population screening. Ultrasonographic examination should be performed on every patient whose thyroid abnormality is detected during examination. In addition, even if palpation is normal, ultrasonographic evaluation should be performed in every individual who is at risk of thyroid malignancy or has lymphadenopathy in the neck.
In the thyroid USG report; The location, shape, size, borders, content, echogenic structure and blood supply characteristics of the nodules should be evaluated. Ultrasonographic findings that increase the possibility of nodules being malignant are: hypo echogenic structure, irregular borders, microcalcifications, etc.
9. WHICH THYROID NODULES SHOULD BE PERFORMED?
-Solid: hypoechoic if over 10mm, or patients in the risk group or with suspicious ultrasonographic findings over 5mm
-Iso-hypoechoic: 1- Those between 1.5cm
-Mixed or spongy: Those between 1.5-2cm
-Pure cystic: no biopsy is required, if large, it should be evacuated.
-Multinodular: the largest nodule and other ultrasonographically suspicious nodules
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