Presentation (Final) Ppt

7/31/2019 Presentation (Final) Ppt

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Thyroid DiseaseEmily Culvern Jocelyn Reddy Sarah Fecco Colin Fuqua Karly Childress


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Types of Thyroid

Disease

There are two different types of Thyroid disease:

Hyperthyroidism & Hypothyroidism

Hypothyroidism: thyroid is under-productive

Often caused by Hashimotos thyroiditis

Hyperthyroidism: thyroid is overactive

Often caused by Graves disease


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Hashimotos Disease

Hypothyroidism

It is an autoimmune disease that is caused by inflammation of

the thyroid gland

Symptoms include difficulty concentrating, fatigue frequent

bowel movements, goiter, heat intolerance, increased

appetite, and sweating among others

It tends to occur in families and is associated with other

autoimmune condition such as type 1 diabetes and celiac

disease


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Graves Disease

Hyperthyroidism

Graves disease is an autoimmune disease caused by thyroid

autoantibodies that activate the TSH receptor

It usually presents itself in early adolescence and affects 2%

of the female population

Symptoms include constipation, depression, fatigue, heavier

menstrual periods, joint and muscle pain, weakness, and

weight gain among others


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Who is at risk?

Females

Pregnant women and neonates

Ages 50 and over pose the highest risk of thyroid disease

Family history of thyroid/autoimmune disease

Removal of thyroid or radioactive treatment

Current or former smoker

Iodine or herbal supplements containing iodine

Over-consumption of soy foods


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Prevalence

can be close to 20 million cases of global thyroid conditions

over 1.5 million adults & more than 200,000 children in USA

had Hashimotos thyroiditis in the year 1996 alone

over 3 million people in USA in 1996 had Graves disease

4 out of 100 women have some type of autoimmune thyroid

disease

1 per 3,000-4,000 newborns are affected by congenital

hypothyroidism


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Methods of TreatmentTreatment depends on the type and the severity of the

disease

Treatment of Hashimotos disease/hypothyroidism:

no definitive cure

hormone replacement by medication

replacing one or more can alleviate the symptoms

Treatment of Graves disease/hyperthyroidism:

3 treatments:

1. Anti-thyroid medication

2. Beta blockers

3. Surgery


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Nutritional Interactions

Over the past thirty years, research has been conducted to

find new preventions or reverse of various types of diseases.

Many tests have been focused on the identification of

bioactive food components, which is why vitamins and

minerals showed particular promising results

We have decided to talk about vitamin D and Iodine and theirinteraction with Thyroid Disease


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Why Vitamin D?

Vitamin D has been shown to prevent bone loss associated

with hyperthyroidism


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The Objective of the Study

on Vitamin D

The objective of this study was to investigate the association

of hyperthyroidism and bone loss and its correlation with

Vitamin D


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Materials & Methods

80 consecutive patients (62 female an 18 males) with Graves disease were

tested for biochemical, thyroid functions, serum vitamin D levels, and BMD(bone mass density). They were treated and rendered euthyroid. Diagnosis

was based on clinical features of thyrotoxicosis, serum T4, and TSH levels

in hyperthyroid range, readio-iodine uptake, and diffuse thyromegaly

Healthy controls were used that composed mainly of hospital employees,students, and nurses where a low vitamin D status has been reported.

Extensive questioning with a detailed history and clinical examinations were

used


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Materials & Methods

continued...

Statistical methods such as mean, standard deviation were

applied to summarize the variables. Proportions and

percentages were used to summarize the categorical

variables

For comparison of baseline continuous variables between

groups was done by applying independent T-test

For comparison of categorical variables, chi square or fishers

exact test was applied


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Results

The mean radioactive uptake at 2 hours was 38.56 and at 24 hours was 65.89%

Serum creatine, BMI, and TSH were lower in Graves patients compared to healthy

controls

Serum T4, ALP, duration of sun exposure and serum calcium were higher in people with

hyperthyroid Graves patients compared to healthy euthyroid controls

those patients were treated with carbimazole and all became euthyroid

In 2-4 months those patients began having a normal T4 range

Mean serum T4 levels at baseline were 20.94

Mean levels increased as months progressed. The TSH levels at baseline increased from

.08 to 1.67 at the end

BMI was shown to increase with therapy


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Discussion

Hyperthyroid state is associated with an increase in bone turnover with a possibly

direct effect of T4 on osteoclast, resulting in hypercalcemia with suppressed PTH

both patients and controls were vitamin D deficient

The high levels of PTH could be due to vitamin D deficiency associated with

secondary hyperthyroidism overwhelming T4 mediated PTH suppression

In a study of 34 untreated hyperthyroid patients, a mean 25(OH)D level of

23.4ng/ml was compared the to normal control level of 28ng/ml

In another study of 208 Graves patients, serum 25(OH)D value of less the 10ng/dlwas found in 40% of female and 18% of male patients

no healthy control was taken and thus cannot determine if the high vitamin D

deficiency was due to the high prevalence in general population or due to

hyperthyroidism itself


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Discussion continued...

A strong positive correlation between BMI and BMD at all sites was found

Lack of substantial increase in BMD after 2 years of treatment with attainment of

euthyroid state could occur because the bone turnover may not be normalized for asufficient length of time

Limitations to study:

area of sunlight exposure has not been recorded making it difficult to correlate sun

exposure and vitamin D status

clinical scoring was not done nor was history of menopause recorded

dietary calcium intakes of subjects and their socioeconomic status was notrecorded

urinary creatine ratio or phosphate excretion index could not be derived


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Why Iodine?

Iodine has been shown to be positively linked to the thyroid

Iodine is valuable in maintaining a proper thyroid function

3 iodine is added to make T3 and 4 iodine to make T4, whichare the two main hormones that the thyroid procuces

Deficiency has been shown to cause hypothyroidism

One particular study suggests a connection between iodine

deficiency in old age and the increase of thyroid

autoantibodies

In other words, an adequate intake of iodine can reduce the

presence of thyroid autoantibodies in the consumer


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The Objective

Thyroid disease - a common autoimmune disorder, which canbe detected by the presence of thyroid antibodies

To asses thyroid autoimmunity among elderly people in a

town with low iodine intake in comparison to a town with

sustained recommended iodine intake from a natural sources


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Materials & Methods

The study was carried out in the towns of Randers and Skagen inDenmark

the study was conducted on mostly elders as a representation of

long term iodine deficiencyPopulation, both men and women born in 1920 living in Randers, andpopulation both men and women born in 1918 through 1923 living inSkagen took part in the study

Questionnaire regarding treatment for thyroid disease use iodine

continuing vitamin and mineral preparations, duration of residence,smoking habits, and alcohol use

Iodine Deficiency - Randers

Iodine Replete (showing recommended levels) - Skagen


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Materials & Methods

continued...

A blood sample was drawn using minimal tourniquet and non fastingspot urine sample was collected in iodine free polyethylene containers

Dynotest RIA with functional sensitivity of 30 u/: used to measurethyroid antibodies

A functional sensitivity of 20 u/L used to measure thyroglobulinantibodies

The iodine content is urine was examined via Sandell - Kolthoffreaction modified

Urinary creatine was determined by kinetic Jaffe Method and used toestimate age and gender specific iodine/creatine ratio

The stats of each group and town recorded along with possibleinterfering variables: gender, smoking, alcohol, intake, and location ortown


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Results

Participation rate was 47%

More women then men took part in the study

75% of participants had been residents of one of the two

towns for over 40 years

The difference among towns was apparent in duration ofresidence as well as those abstaining from alcohol. Smoking

frequencies were similar


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Results continued...

Elders with a deficient Iodine intake - thyroid antibodies shown to be

more prevalent

Elders within recommended Iodine intake - thyroid antibodies not as

common

Those with moderate iodine deficiency (measured by urinary iodine

excretion below 50 u/24 hrs) had increased risk of harboring thyroid

antibodies

With Randers being an iodine deficient zone, the increase inoccurrence of thyroid antibodies directly coincided with length of

time as a resident

Skagen (iodine replete) did not have as strong of a correlation

between time as a resident and number of thyroid antibodies


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Iodine Intake Level

Hosting a thyroid antibody was more common in elders from

iodine deficient zone compared to those from iodine replete

zone

Thyroid antibodies were common in 75-80 year old men and

women from both iodine deficient and iodine replete levels

In short - more iodine deficient than iodine replete eldersharbored a thyroid autoantibody and differences increased

with duration of residence


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Variables to Consider

As age increases, immune system function is compromised.

Older age in some participants could play as much of a role

on thyroid disease as being iodine deficient

Alcohol consumption and smoking can play a contradicting

role against minerals and should be considered when

assessing iodine levels

The location of the iodine experiment degrades some

relevance to us


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Aging & Thyroid

The aging process affects the immune system that becomes lessresponsive to antigenic challenges and the incidence and morbidity ofinfections increase with age

Immune system is activated in elderly with increased concentration of

inflammatory cytokines causing a pro-inflammatory environment andcomplicates degenerative disease and increases incidence ofautoimmune disorders

Age influences the prevalence of TGAb and TPOAb

These antibodies increased with age from 7-9% in the young to 22-

20% for TGAb and TPOAb respectively in the 60-65 year old womenA higher prevalence rates of both TGAb and TPOAb of 37% and 28% inwomen irrespective of iodine intake level

Results suggest a peak in thyroid autoimmunity between age of 65 and100 years


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Aging continued...

Iodine intake did not influence the occurrence of thyroidautoantibody in those under age of 45 years in a largepopulation based survey

The findings that thyroid autoantibodies occurred morefrequently with iodine deficiency was dominated by adifference in TGAb. Iodine deficiency associated with a rise infrequency especially among men who rose almost to the level

of womenSuggests that iodine deficiency may increase pro-inflammatory environment in men in old age asthyroglobulin levels were elevated with iodine deficiency inboth men and women


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Conclusion

In Hyperthyroid Graves patients, BMD was found to be

significantly lower at hip, spine, and forearm compared to healthy,

euthyroid controls

When treated for hyperthyroidism, the absolute BMD improved,

but BMD corrected for BMI showed a decrease

Damage in BMD caused by thyroid hormone ecess is not made

up even after two years of patent being euthyroid

The impact of aging on the immune system is modified by iodine

Data suggests a peak in thyroid autoimmunity between the age of

65 and 100 years


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References

1.Andersen, Stig, Finn Iversen, Steen Terpling, Klaus M. Pedersen, Peter Gustenhoff, and Peter Laurberg. "Iodine Deficiency Influences

Thyroid Autoimmunity in Old Age - A Comparative Population-based Study. Thesis. Aalborg University Hospital, Denmark, 9

November 2011. Iodine Deficiency Influences Thyroid Autoimmunity in Old Age A Comparative Population. Science Direct, 9 Nov. 2011.

Web. 5 Apr. 2012.

2. Dar, Rayees A., Nisar A. Chowdri, Fazl Q. Parray, and Sabiya H. Wani. "An Unusual Case of Hashimoto's Thyroiditis with Four Lobed

Thyroid Gland. PubMed. North American Journal of Medical Sciences, 4 Mar. 2012. Web. 2 Apr. 2012.

3. Godbole, Madan M., Geeta Rao, By N. Paul, Vishwa Mohan, Preeti Singh, Drirh Khare, Satish Babu, Alok Nath, P. K. Singh, and

Swasti Tiwari. "Prenatal Iodine Deficiency Results in Structurally and Functionally Immature Lungs in Neonatal Rats." Thesis. Sanjay Gandhi

Postgraduate Institute of Medical Sciences, 2011. American Physiological Society. American Journal of Physiology, 12 Mar. 2012. Web. 2

Apr. 2012.

4. Jyotsna, Viveka P., Abhay Sahoo, Achouba Singh, V. Sreenivas, and Nandita Gupta. "Bone Mineral Density in Patients of Graves Disease

Pre- & Post-treatment in a Predominantly Vitamin D Deficient Population." Thesis. Department of Endocrinology & Metabolism, All India

Institute of Medical Sciences, 2009. Bone Mineral Density in Patients of Graves Disease Pre- & Post-treatment in a Predominantly Vitamin D

Deficient Population. Indian Journal of Medical of Research, 4 Nov. 2009. Web. 2 Mar. 2012.


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