Thyroid Awareness Month

What is hyperthyroidism?

Hyperthyroidism develops when the body is exposed to excessive amounts of thyroid hormone. This disorder occurs in almost I% of all Americans and affects women 5 to 10 times more often than men. In its mildest form, hyperthyroidism may not cause recognizable symptoms. More often, however, the symptoms are discomforting, disabling, or even life-threatening.

What are the features of hyperthyroidism?

When hyperthyroidism develops, a goiter (enlargement of the thyroid) is usually present and may be associated with some or many of the following symptoms:

• Fast heart rate, often more than 100 beats per minute

• Anxious, irritable, argumentative

• Trembling hands

• Weight loss, despite eating the same amount or even more than usual

• Intolerance of warm temperatures and increased likelihood to perspire

• Loss of scalp hair

• Rapid growth of fingernails and tendency of fingernails to separate from the nail bed

• Muscle weakness, especially of the upper arms and thighs

• Loose and frequent bowel movements

• Smooth and thin skin

• Change in menstrual pattern

• Increased likelihood for miscarriage

• Prominent "stare" of the eyes

• Protrusion of the eyes, with or without double vision (in patients with Graves' disease)

• Irregular heart rhythm, especially in patients older than 60 years of age

• Accelerated loss of calcium from bones, which increases the risk of osteoporosis and fractures

What are the causes of hyperthyroidism?

GRAVES' DISEASE

Graves' disease (named after Irish physician Robert Graves) is an autoimmune disorder that frequently results in thyroid enlargement and hyperthyroidism. In a minority of patients, swelling of the muscles and other tissues around the eyes may develop, causing eye prominence, discomfort or double vision. Like other autoimmune diseases this condition tends to affect multiple family members. It is much more common in women than in men, and tends to occur in younger patients.

Toxic Multi-nodular Goiter

Multiple nodules in the thyroid can produce excessive thyroid hormone, causing hyperthyroidism. Often diagnosed in patients over the age of 50, this disorder is more likely to affect heart rhythm. In many cases, the person has had the goiter for many years before it becomes overactive.

Toxic Nodule

A single nodule or lump in the thyroid can also produce more thyroid hormone than the body requires and lead to hyperthyroidism. This disorder is not familial.

SUBACUTE THYROIDITIS

This condition of unknown cause is characterized by painful thyroid gland enlargement and inflammation, which results in the release of large amounts of thyroid hormones into the blood. Fortunately, this condition usually resolves spontaneously. The thyroid usually heals itself over several months, but often not before a temporary period of low thyroid hormone production (hypothyroidism) occurs.

POSTPARTUM THYROIDITIS

5% to 10% of women develop mild to moderate hyperthyroidism within several months of giving birth. Hyperthyroidism in this condition usually lasts for approximately 1-2 months. It is often followed by several months of hypothyroidism, but most women will eventually recover normal thyroid function. In some cases, however, the thyroid gland does not heal, so the hypothyroidism becomes permanent and requires lifelong thyroid hormone replacement

SILENT THYROIDITIS

Transient (temporary) hyperthyroidism can be caused by silent thyroiditis, a condition which appears to be the same as postpartum thyroiditis but not related to pregnancy. It is not accompanied by a painful thyroid gland.

EXCESSIVE IODINE INGESTION

Various sources of high iodine concentrations, such as kelp tablets, some expectorants, amiodarone (Cordarone, Pacerone - a medication used to treat certain problems with heart rhythms) and x-ray dyes, may occasionally cause hyperthyroidism in certain patients.

OVERMEDICATION WITH THYROID HORMONE

Patients who receive excessive thyroxine replacement treatment can develop hyperthyroidism. They should have their thyroid hormone dosage evaluated by a physician at least once each year and should NEVER give themselves "extra" doses.

How is hyperthyroidism diagnosed?

Characteristic symptoms and physical signs of hyperthyroid ism can be detected by a physician. In addition, tests can be used to confirm the diagnosis and to determine the cause.

TSH (THYROID-STIMULATING HORMONE OR THYROTROPIN TEST)

A low TSH level in the blood is the most accurate indicator of hyperthyroidism. The body shuts off production of this pituitary hormone when the thyroid gland even slightly overproduces thyroid hormone. If the TSH level is low, it is very important to also check thyroid hormone levels to confirm the diagnosis of hyperthyroidism.

OTHER TESTS

• Free T4 (thyroxine) and Free T3 (tri iodothyronine) - the active thyroid hormones in the blood. When hyperthyroidism develops, free T4 and T3 levels rise above previous values in that specific patient (although they may still fall within the normal range for the general population), and are often considerably elevated.

• TSI (thyroid-stimulating immunoglobulin) - a substance often found in the blood when Graves' disease is the cause of hyperthyroidism. This test is ordered infrequently, since it rarely affects treatment decisions or helps in the diagnosis.

• Radioactive iodine uptake (RAIU - a measurement of how much iodine the thyroid gland can collect) and thyroid scan (a thyroid scan that shows how the iodine is distributed throughout the thyroid gland). This information can be useful in determining the cause of hyperthyroidism and ultimately its treatment.

Sometimes a general physician can diagnose and treat the cause of hyperthyroidism, but assistance is often needed from an endocrinologist, a physician who specializes in managing thyroid disease.

How is hyperthyroidism treated?

Before the development of current treatment options, the death rate from hyperthyroidism was as high as 50%. Now several effective treatments are available, and with proper management, death from hyperthyroidism is rare. Deciding which treatment is best depends on what caused the hyperthyroidism, its severity, and other conditions present. A physician who is experienced in the management of thyroid diseases can confidently diagnose the cause of hyperthyroidism and prescribe and manage the best treatment program for each patient.

ANTITHYROID DRUGS

In the United States, two drugs are available for treating hyperthyroidism: propylthiouracil (PTU) and methimazole (Tapezole). These medications control hyperthyroidism by slowing thyroid hormone production, and are frequently used for several months after the initial diagnosis of hyperthyroidism to normalize the thyroid hormone levels. Some patients with hyperthyroidism caused by Graves' disease experience a spontaneous or natural remission of hyperthyroidism after a I 2 to I 8 month course of treatment with these drugs, and may sometimes avoid permanent under-activity of the thyroid (hypothyroidism), which often occurs as a result of using the other methods of treating hyperthyroidism. Unfortunately, the remission is frequently only temporary, with the hyperthyroidism recurring after several months or years off medication and requiring additional treatment, so relatively few patients are treated solely with anti-thyroid medication in the United States.

Anti-thyroid drugs may cause an allergic reaction in about 5% of patients who use them. This usually occurs during the first six weeks of drug treatment. Such a reaction may include rash, hives, fever, or joint pain, but after discontinuing use of the drug, the symptoms resolve within one to two weeks, and there is no permanent damage.

A more serious effect, but occurring in only about I in 250-500 patients during the first four to eight weeks of treatment, is a rapid decrease of white blood cells in the bloodstream. This could increase susceptibility to serious infection. Symptoms such as a sore throat, joint aches, infection, or fever should be reported promptly to your physician, and a blood cell count should be done immediately. In nearly every case, when a person stops using the medication, the white blood cell count returns to normal. Anti-thyroid drugs may very rarely cause liver problems, which can be detected by monitoring blood tests. Your physician should be contacted if there is yellowing of the skin ("jaundice"), fever, loss of appetite, or abdominal pain.

RADIOACTIVE IODINE TREATMENT

Iodine is an essential ingredient in the production of thyroid hormone. Each molecule of thyroid hormone contains either 4 (T4) or 3 (T3) molecules of iodine. Since most overactive thyroid glands are quite hungry for iodine, it was discovered in the 1940's that the thyroid could be "tricked" into destroying itself by simply feeding it radioactive iodine. The radioactive iodine is given by mouth, usually in capsule form, and is quickly absorbed from the bowel. It then enters the thyroid cells from the bloodstream and gradually destroys them. Maximal benefit is usually noted within three to six months.

It is not possible to reliably eliminate "just the right amount" of the diseased thyroid gland, since the effects of the radioiodine are slowly progressive on the thyroid cells. Therefore, most endocrinologists strive to completely destroy the diseased thyroid gland with a single dose of radioiodine. This results in the intentional development of an underactive thyroid state (hypothyroidism), which is easily, predictably and inexpensively corrected by lifelong daily use of oral thyroid hormone replacement therapy. Although every effort is made to calculate the correct dose of radioiodine for each patient, not every treatment will successfully correct the hyperthyroidism, particularly if the goiter is quite large, and a second dose of radioactive iodine is occasionally needed.

In the 50+ years and hundreds of thousands of patients (including a former President of the United States and his wife!) in which radioiodine has been used no serious complications have been reported. Since the treatment appears to be extraordinarily safe, simple, and reliably effective, it is considered by most thyroid specialists in the United States to be the treatment of choice for those types of hyperthyroidism caused by overproduction· of thyroid hormones.

S URGICAL REMOVAL OF THE THYROID

Although seldom used now as the preferred treatment for hyperthyroidism, operating to remove most of the thyroid gland may occasionally be recommended in certain situations, such as a pregnant woman with severe disease in whom radioiodine would not be safe for the baby, removal of a clinically suspicious thyroid nodule coexisting with hyperthyroidism, or for rare patients with Graves' disease who have severe protrusion of their eyes. In such patients, permanent hypothyroidism usually results, and lifelong thyroxine replacement is required.

OTHER TREATMENTS

A drug from the class of beta-adrenergic blocking agents (which decrease the effects of excess thyroid hormone) may be used temporarily to control hyperthyroid symptoms while one of the abovementioned treatments becomes effective. In cases where hyperthyroidism is caused by thyroiditis or excessive ingestion of either iodine or thyroid hormone, this may be the only type of treatment required. Of course, taking too much of either substance should also be corrected.

Appropriate management of hyperthyroidism requires careful evaluation and ongoing care by a physician experienced in the treatment of this complex condition.

For more information please

visit www.thyroidawareness.com

Western Washington Medical Group has two offices for Endocrinology

and you can learn more at our website.

Prepared by the American Association of Clinical Endocrinologists (AACE), a not-for-profit national organization of highly qualified specialists in hormonal and metabolicdisorders whose primary professional activities focus on providing high-quality specialty care to patients with endocrine problems such as thyroid disease.

Supported by an unrestricted educational grant from Abbott Laboratories.

© 2006 AACE- Permission is granted for reproduction of this publication.

A COLONOSCOPY SAVED MY LIFE!

It Could Save Yours, Too!

March is Colon Cancer Awareness Month and Western Washington Medical Group’s (WWMG) Gastroenterology Department and Endoscopy Center are getting the word out early this year and encouraging the public to get screened for colorectal cancer not only in March but all throughout the year.

Barbara Holmes-Erickson and Dr. Mu



When Barbara Holmes-Erickson was 45, she was diagnosed with colon cancer.  She was absolutely shocked that she could have it, but has been very grateful to Dr. Mu who found the disease.



"I am so glad that Dr. Mu of Western Washington Medical Group requested that I have a colonoscopy," she said, "At the age of 45, I thought I was too young to worry about colon cancer."

In fact, a colonoscopy is not a normal procedure for someone as young as Barbara.  "That procedure saved my life," Barbara continued. Ten years later, Barbara's cancer treatments are completed and she is now cancer free.  "If there is one thing I learned and can pass on, there are few symptoms. Schedule your colonoscopy today," she said. "The disease can be 100 percent curable if it is caught at an early stage and treated."



March 2nd is Dress in Blue Day



Colon cancer is the second largest killer among all cancers, and the third most common cancer.

The goals of a screening colonoscopy are to detect colon cancer at an early and curable stage, when there are no symptoms; and to prevent colon cancer by removing precancerous polyps.

Dr. Mu is one of eight gastroenterologists at Western Washington Medical Group's Gastroenterology Department. They perform over 4,000 colonoscopies each year at their Endoscopy Center in Silver Lake. The Center is the only Accredidation Association for Ambulatory Health Care (AAAHC) accredited Endoscopy unit in Snohomish County.  They are also an ASGE Recognized Endoscopy Unit.

January is Thyroid Awareness Month

What is Hashimoto’s Thyroiditis?

Hashimoto’s thyroiditis (also called autoimmune or chronic lymphocytic thyroiditis) is the most common thyroid disease in the United States.  It is an inherited condition that affects approximately 14 million Americans and is about 7 times more common in women than in men.  Hashimoto’s thyroiditis is characterized by the production of immune cells and autoantibodies by the body’s immune system, which can damage thyroid cells and compromise their ability to make thyroid hormone.  Hypothyroidism occurs if the amount of thyroid hormone which can be produced is not enough for the body’s needs. The thyroid gland may also enlarge in some patients, forming a goiter.

What are the symptoms of Hashimoto’s thyroiditis?

Many patients with Hashimoto’s thyroiditis may have no symptoms for many years, and the diagnosis is made incidentally when an enlarged thyroid gland or abnormal blood tests are discovered as part of a routine examination.  When symptoms do develop, they are either related to local pressure effects in the neck caused by the goiter itself, or to the low levels of thyroid hormone.  The first sign of this disease may be painless swelling in the lower front of the neck.  This enlargement may eventually become easily visible and may be associated with an uncomfortable pressure sensation in the lower neck.  Left untreated, a person may begin to have trouble swallowing or even breathing.

Although many of the symptoms associated with thyroid hormone deficiency occur commonly in patients without thyroid disease, patients with Hashimoto’s thyroiditis who develop hypothyroidism are more likely to experience the following:

• Fatigue
• Drowsiness
• Forgetfulness
• Difficulty with learning
• Dry, brittle hair and nails
• Dry, itchy skin
• Puffy face
• Constipation
• Sore muscles
• Weight gain
• Heavy menstrual flow
• Increased frequency of miscarriages
• Increased sensitivity to many medications

The thyroid enlargement and/or hypothyroidism caused by Hashimoto’s thyroiditis tends to progress in many patients, causing a slow worsening of symptoms.  Therefore, patients with either of these findings should be recognized and adequately treated with thyroid hormone.  Optimal treatment with thyroid hormone will eliminate any symptoms due to thyroid hormone deficiency, usually prevent further thyroid enlargement, and may sometimes cause shrinkage of an enlarged thyroid gland.

What is the cause of Hashimoto’s thyroiditis?

Hashimoto’s thyroiditis results from a malfunction in the immune system.  When working properly, the immune system is designed to protect the body against invaders, such as bacteria, viruses, and other foreign substances.  The immune system of someone with Hashimoto’s thyroiditis mistakenly recognizes normal thyroid cells as foreign tissue, and it produces antibodies that may destroy these cells.  Although various environmental factors have been studied, none have been positively proven to be the cause of Hashimoto’s thyroiditis.

How is Hashimoto’s thyroiditis diagnosed?

A physician experienced in the diagnosis and treatment of thyroid disease can detect a goiter due to Hashimoto’s thyroiditis by performing a physical examination and can recognize hypothyroidism by identifying characteristic symptoms, finding typical physical signs, and doing appropriate laboratory tests.

ANTITHYROID ANTIBODIES

Increased antithyroid antibodies provide the most specific laboratory evidence of Hashimoto’s thyroiditis, but they are not present in all cases.

TSH (Thyroid-stimulating or thyrotropin) test

Increased TSH level in the blood is the most accurate indicator of hypothyroidism.  TSH is produced by another gland, the pituitary, which is located in the center of the head behind the nose.  The level of TSH rises dramatically when the thyroid gland even slightly under produces thyroid hormone so a normal level of TSH reliably excludes hypothyroidism in patients with normal pituitary function.

other tests

• Free T4 (thyroxine) – the active thyroid hormone in the blood.  A low level of free T4 is consistent with thyroid hormone deficiency.  However, free T4 values in the “normal range” may actually represent thyroid hormone deficiency in a particular patient, since a high level of TSH stimulation may keep the free T4 levels “within normal limits” for many years.

• Fine-needle aspiration of the thyroid – Usually not necessary for most patients with Hashimoto’s thyroiditis, but a good way to diagnose difficult cases and a necessary procedure if a thyroid nodule is also present.

How is Hashimoto’s thyroiditis treated?

For patients with thyroid enlargement (goiter) or hypothyroidism, thyroid hormone therapy is clearly needed, since proper dosage corrects any symptoms due to thyroid hormone deficiency and may decrease the goiter’s size.  Treatment consists of taking a single daily tablet of levothyroxine.  Older patients who may have underlying heart disease are usually started on a low dose and gradually increased, while younger healthy patients can be started on full replacement doses at once.  Thyroid hormone acts very slowly in the body, so it may take several months after treatment is started to notice improvement in symptoms or goiter shrinkage.  Because of the generally permanent and often progressive nature of Hashimoto’s thyroiditis, it is usually necessary to treat it throughout one’s lifetime and to realize that medicine dose requirements may have to be adjusted from time to time.

Optimal adjustment of thyroid hormone dosage, based on laboratory tests rather than symptoms, is critical, since the body is very sensitive to even small changes in thyroid hormone levels.  The tablets come in over 10 different strengths, and it is essential to take them in a consistent manner every day.  If the dose is not adequate, the thyroid gland may continue to enlarge and symptoms of hypothyroidism will persist.  This may be associated with increased serum cholesterol levels, possibly increasing the risk for atherosclerosis and heart disease.  If the dose is too strong, it can cause symptoms of hyperthyroidism, creating excessive strain on the heart and an increased risk of developing osteoporosis.

Other associated disorders

As noted above, Hashimoto’s thyroiditis is a common disorder of the immune system which affects the thyroid gland.  However, much less often, the immune system can also mistakenly target virtually any other part of the body, causing it to malfunction, and this tendency runs in families.  Although the majority of patients with Hashimoto’s thyroiditis and their genetic family members will never experience any other autoimmune condition, they do have a statistically increased risk of developing the following disorders:

• Type 1 Diabetes Mellitus (insulin-requiring)
• Graves’ disease (goiter and hyperthyroidism or overactive thyroid)
• Rheumatoid arthritis
• Pernicious anemia (inability to absorb vitamin B12, potentially causing anemia and neurologic problems)
• Addison’s disease (adrenal failure; the adrenal gland provides cortisone to handle stress and illness)
• Premature ovarian failure (early menopause)
• Vitiligo  (patchy loss of skin pigmentation)
• Thrombocytopenic purpura (bleeding disorder due to inadequate platelets in the blood)
• Lupus erythematosus (autoimmune disease that involves skin, heart, lungs, kidneys)

Appropriate management of Hashimoto’s thyroiditis requires continued care by a physician who is experienced in the treatment of this disease.

Western Washington Medical Group has two Endocrinology sites and
you can learn more at our website.


For more information please visit www.thyroidawareness.com

Do You Have a

Mediterranean Diet

on Your Mind?

 

Courtesy of Dr. Marissa Fernandez-Kiemele

Family Medicine Physician

Western Washington Medical Group

Following a "Mediterranean diet" — emphasizing fruits, vegetables and olive oil and little red meat — may be associated with not only a lower risk for Alzheimer’s disease, but also an increase in cognitive function.

According to a recent study in the Archives of Neurology, people who adhere to a Mediterranean diet are less likely to develop mild cognitive impairment. In addition, research indicates traditional Mediterranean eating may reduce your risk of heart disease and perhaps some cancers.

The Mediterranean diet typically features plenty of grain products, vegetables, legumes, nuts and fruits, fish, poultry and moderate amounts of wine. The fat in this diet is mostly monounsaturated from olive oil. Yogurt and cheese offer other sources of protein.

Virtually everyone can benefit from eating more fruits, vegetables, legumes and healthy oils. A registered dietitian can help you make healthful changes to your daily eating plan.

From the June 2, 2009 –American Dietetic Association-www.eatright.org

                                                

Happy New Year!

Good health isn't something that you start on

January first and forget about two weeks later.

It is a lifestyle and a way of life that comes from

determined and thoughtful consideration

of what is best for your body and your health.

This month, Western Washington Medical Group Family Medicine is starting a program for people who want to thoughtfully and with determination consider what is best for their bodies and their health. Their program of Lifestyle Medicine is one way that you can make the changes you want in your life whether you have chronic disease or are only a few pounds overweight.

According to the U.S. Center for Disease Control and Prevention, 1.7 million Americans die, and 25 million are disabled each year due to chronic diseases caused or made worse by unhealthy lifestyles. At the recent American College of Lifestyle Medicine conference in San Antonio, TX, the U.S. Surgeon General, Dr. Regina Benjamin, emphasized that it is time to change how we treat those with chronic illnesses. Her focus was toward Lifestyle Medicine, which she believes needs to be the priority treatment for chronic illnesses. When combined with Primary Care, it can drastically save and change lives.

So what is Lifestyle Medicine and how, on a practical level, does it work?

Lifestyle Medicine makes use of lifestyle interventions as the primary therapeutic tool in the prevention, treatment and management of disease. At Western Washington Medical Group Family Medicine, we focus on being proactive with the whole person, including the use of exercise, nutrition, stress reduction, and soul-care exercises in order to provide patients with the unique tools and personal encouragement they need to turn doctors’ suggestions into real, lasting lifestyle changes.

At WWMG the “group appointment” format is used, along with one-to-one visits with a Lifestyle Medicine physician. Physicians walk together with patients, breaking things down to small, manageable steps for lasting impact. WWMG firmly believes that small, slow, steady steps lead to lasting lifestyle changes. And that translates into healthier people and healthier communities.

Lifestyle Medicine classes start in January and include Weight Management, Chronic Disease Management, and Wellness Cuisine (gourmet cooking classes taught by a doctor who is a trained amateur gourmet cook). Lifestyle Medicine classes are perfect for people with diabetes, high cholesterol, hypertension, or chronic disease, and for those wanting to manage their weight.

To schedule an appointment, the public can call 425-317-8025 and they can also request a brochure to learn more about experiencing good health.

The Lifestyle Medical Group Visits are at the Silver Lake Medical Center at 12728 19th Avenue SE, Everett, WA 98208.

 

Are you ready to give up the resolutions and

change your lifestyle for good? Take the first

step and call Family Medicine.