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# Thyroid Disease Manager

Thyroid Disease Manager

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- [Test rest](https://www.thyroidmanager.org/2026/06/18/test-rest-2/) - Test rest
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- [Home](https://www.thyroidmanager.org/) - CME credits for reading THYROIDMANAGER-- Click here Smart Phone App---Endocrinology and Endocrine Emergencies If you want to learn all about Clinical Thyroid Disease, this is the place to visit. LOGIN | REGISTER THYROID MANAGER REQUIRES A FREE REGISTRATION CHAPTERS ANATOMY AND PHYSIOLOGY 1. Ontogeny, Anatomy, Metabolism and Physiology of the Thyroid Jacques Dumont,
- [feb 2020 new Home - copy](https://www.thyroidmanager.org/feb-2020-new-home-copy/) - CME credits for reading THYROIDMANAGER-- Click here Smart Phone App---Endocrinology and Endocrine Emergencies If you want to learn all about Clinical Thyroid Disease, this is the place to visit. LOGIN | REGISTER THYROID MANAGER REQUIRES A FREE REGISTRATION CHAPTERS ANATOMY AND PHYSIOLOGY 1. Ontogeny, Anatomy, Metabolism and Physiology of the Thyroid Jacques Dumont, MD, Carine
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- [About Thyroid Disease Manager](https://www.thyroidmanager.org/about/) - Thyroid Disease Manager© was developed by Leslie J. De Groot, M.D. and a Group of Thyroid Experts from around the world. It is owned and copyrighted in its entirety by Endocrine Education, Inc., a Massachusetts not-for-profit corporation. James DelGrande is the Web designer. We do not use "cookies" to record information from readers. Current usage
- [Comments by Readers](https://www.thyroidmanager.org/comments-by-readers/) - I just want to thank you for a really well informed and well updated site. I was looking all over the internet for textbook knowledge on the thyroid that was updated. PubMed was not able to answer my basic questions, so your site has been a lifeline for my analytical research. Thanks and keep up the
- [Country Associates](https://www.thyroidmanager.org/country-associates/) - We are most fortunate to have the collaboration of a group of physicians from around the world who are helping to bring to the attention of physicians in their home country. Our COUNTRY ASSOCIATES develop demonstrations of THYROIDMANAGER at endocrine meetings, provide information on access to THYROIDMANAGER, pass our brochures, and in any way possible
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- [Guidelines for Diagnosis and Management of Thyroid Disease ](https://www.thyroidmanager.org/guidelines/) - Summaries of most of these guidelines are available at www.guidelines.gov. Complete versions for down-loading can be obtained electronically using the hyperlinks indicated below, but some of these seem to work erratically. Management of thyroid dysfunction during pregnancy and postpartum: an Endocrine Society clinical practice guideline. De Groot L, Abalovich M, Alexander EK, Amino N, Barbour
- [TKI Therapy of Aggressive Differentiated Thyroid Cancer](https://www.thyroidmanager.org/tki-therapy-of-aggressive-differentiated-thyroid-cancer/) - SPECIAL ENDOTEXT AND THYROIDMANAGER SYMPOSIUM TYROSINE KINASE INHIBITORS IN MANAGEMENT OF AGGRESSIVE DIFFERENTIATED THYROID CANCER CME Credits are available for Symposium readers--Click here--http://www.cvent.com/d/24q4qp PLEASE TAKE A SHORT EVALUATION SURVEY AFTER YOU VISIT/READ THIS SYMPOSIUM---CLICK HERE INTRODUCTION James Hennessey, MD Harvard Medical School, Boston, MA S1- CONTEMPORARY MANAGEMENT OF DIFFERENTIATED THYROID CANCER Furio Pacini, MD
- [Instructions for Authors ](https://www.thyroidmanager.org/instructions-for-authors/) - Citing a Reference to a Chapter in www.thyroidmanager.org Please be sure to add your THYROIDMANAGER publication to your own CV, and to cite it in your lectures and publications. The format for citations is: List Authors, Title, in www.thyroidmanager.org, Date (usually the current date), and you may list the specific Section Editor. Published by ENDOCRINE
- [Introduction -Special Symposium on TKIs](https://www.thyroidmanager.org/introduction-special-symposium-on-tkis/) - The contemporary treatment of thyroid cancer has evolved greatly in the past 30 years. This advancement in knowledge has been more rapid than in the preceding century and continues to be a challenge to the practicing endocrinologist. This symposium on advances in the diagnosis and treatment of thyroid cancer was developed to summarize the current
- [HIGHLY SENSITIVE TG ASSAYS IN FOLLOW-UP OF CANCER PATIENTS   20 February 2014](https://www.thyroidmanager.org/highly-sensitive-tg-assays-in-follow-up-of-cancer-patients-20-february-2014/) - Unstimulated Highly Sensitive Thyroglobulin in Follow-up of Differentiated Thyroid Cancer Patients: A Meta-Analysis. Giovanella L1, Treglia G, Sadeghi R, Trimboli P, Ceriani L, Verburg FA. J Clin Endocrinol Metab. 2014 Feb;99(2):440-7 PMID: 24285679 Serum thyroglobulin (Tg) is an indicator of differentiated thyroid cancer (DTC) relapse. We conduced a meta-analysis of published data about the diagnostic
- [LOW TSH AND DEMENTIA](https://www.thyroidmanager.org/low-tsh-and-dementia/) - . Lower-But-Normal Serum TSH level Is Associated With the Development or Progression of Cognitive Impairment in Elderly: Korean Longitudinal Study on Health and Aging Moon JH1, Park YJ, Kim TH, Han JW, Choi SH, Lim S, Park do J, Kim KW, Jang HC. J
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- [Supporters](https://www.thyroidmanager.org/supporters/) - We are greatly indebted to readers who have generously contributed to ENDOCRINE EDUCATION, INC, in support of our website. THANK YOU Norman E. Andrews Dr Nancy Greep Dr Samuel Refetoff Nicola Antonio Lembo, MD, São Paulo, Brazil
- [Algorithms](https://www.thyroidmanager.org/algorithms/) - Managment of thyroid disease will always require your knowledge and your thought. The following algorithms are presented as guides to help direct investigation, diagnosis, and therapy. Click on one of the topics to identify a pathway that will be useful in managing your patient. We wish to acknowledge the generous permission given by Drs. Chester
- [Links](https://www.thyroidmanager.org/links/) - The following list provides addresses for other Websites which the viewer may find important and useful . Opening these links will move you to a new Webserver, but you may (usually) return by using the BACK button on your browser. Treatment guidelines for Physicians for management of thyroid carcinoma, thyrotoxicosis, and for thyroid function testing,
- [AGREEMENT COVERING USE OF THIS SITE](https://www.thyroidmanager.org/terms-of-use/) - October 1, 2009 This site is owned and operated by ENDOCRINE EDUCATION, INC. By entering this site you acknowledge and agree to all terms and conditions stated herein. If you do not agree to these terms, do not use this site. These Terms may be updated by ENDOCRINE EDUCATION, INC. in the future without notice
- [Case of the Month](https://www.thyroidmanager.org/cases/) - Check out your diagnostic skills versus the experts. If you disagree with the management of this case, wish to comment, or care to submit a case, please contact us. We solicit interesting cases for inclusion in this section. Please submit your case and any illustrations, electronically, to Geraldo Medeiros-Neto, MD, MACP, at medneto@uol.com.br All cases
- [Authors](https://www.thyroidmanager.org/authors/) - Our editors continuously review the thyroid literature, select important new material and add that to Thyroid Disease Manager. Each brings to our site great experience and expertise in their field. To them we are very indebted.
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## Algorithms

- [Managing Primary Hypothyroidism](https://www.thyroidmanager.org/algorithm/managing-primary-hypothyroidism-2/)
- [Single Thyroid Nodule Management](https://www.thyroidmanager.org/algorithm/single-thyroid-nodule-management/)
- [Management of a Thyroid Enlargement](https://www.thyroidmanager.org/algorithm/management-of-a-thyroid-enlargement/) - A scheme for evaluation of thyroid enlargments.
- [Congenital Hypothyroidism (Part C)](https://www.thyroidmanager.org/algorithm/congenital-hypothyroidism-part-c/)
- [Hyperthyroidism Management with Antithyroid Drugs](https://www.thyroidmanager.org/algorithm/hyperthyroidism-management-with-antithyroid-drugs/)
- [Postpartum Thyroiditis Diagnosis and Management](https://www.thyroidmanager.org/algorithm/postpartum-thyroiditis-diagnosis-and-management/)
- [Evaluating Metastatic Cancer Thyroid  ](https://www.thyroidmanager.org/algorithm/evaluating-metastatic-cancer-thyroid/) - A scheme for evaluation of patients who present with metastatic cancer thought possibly to be from the thyroid.
- [RAI Ablation and Therapy for Thyroid Cancer](https://www.thyroidmanager.org/algorithm/rai-ablation-and-therapy-for-thyroid-cancer/) - Note: This algorithm depends on availability of a TG assay sensitive to and specific at 1 ng/ml, with a normal range of approximately 5-20 ng/ml.
- [Deciding on Operation for Thyroid Cancer](https://www.thyroidmanager.org/algorithm/deciding-on-operation-for-thyroid-cancer/)
- [Possible Thyroid Cancer - Initial Decisions](https://www.thyroidmanager.org/algorithm/possible-thyroid-cancer-initial-decisions/)
- [Exophthalmos: What is the cause?](https://www.thyroidmanager.org/algorithm/exophthalmos-what-is-the-cause/)
- [What is the Correct Thyroxine Dosage?](https://www.thyroidmanager.org/algorithm/what-is-the-correct-thyroxine-dosage/) - Suggested guidelines for managing thyroxin therapy in patients with different thyroid conditions: The author (Leslie DeGroot, MD), believes that patients feel best on replacement therapy when TSH is at the lower end of the normal range, at which time FTE is usually just above normal, and T3 is in the normal range.
- [Possible Hypothyroidism: Diagnosis](https://www.thyroidmanager.org/algorithm/possible-hypothyroidism-diagnosis/) - A scheme for evaluation of patients thought to possibly have hypothyroidism.
- [Possible Hyperthyroidism: Diagnosis](https://www.thyroidmanager.org/algorithm/possible-hyperthyroidism-diagnosis/) - A scheme for evaluating ptients who are suspected to possibly have hyperthyroidism.
- [Painful or Tender Thyroid Gland Evaluation](https://www.thyroidmanager.org/algorithm/painful-or-tender-thyroid-gland-evaluation/)
- [Neonatal Thyroid Dysfunction and Genetic Defects in Hormone Supply - (See #18,19, 20)](https://www.thyroidmanager.org/algorithm/neonatal-thyroid-dysfunction-and-genetic-defects-in-hormone-supply/) - #18 - Neonatal Thyroid Dysfunction (Part A) #19 - Neonatal Thyroid Dysfunction (Part B) #20 - Congenital Hypothyroidism (Part C)
- [Strange Thyroid Function Tests](https://www.thyroidmanager.org/algorithm/strange-thyroid-function-tests/) - This scheme is intended to provide a general guide for interpretation of abnormal thyroid function test-- tests that are "abnormal " in the sense that they do not fit with typical hyper or hypo-thyroidism. Possible explanations are offered for consideration and investigation. IEF- refers to isoelectric focusing analysis, Alb.ppt- refers to albumin co-precipitation analysis, and
- [Protocol for Scanning with Thyrogen](https://www.thyroidmanager.org/algorithm/protocol-for-scanning-with-thyrogen/) - Thyrogen has been approved for use in preparation for 131-I scanning and TG testing. Avaliable data indicate it is nearly (93%) as effective as a standard hormone withdrawal preparation for detecting residual thyroid tissue (benign or malignant) by scan and TG assay. The protocol suggested for use has been developed using a standard dose of
- [Neonatal Thyroid Dysfunction (Part A)](https://www.thyroidmanager.org/algorithm/neonatal-thyroid-dysfunction-part-a/)
- [Neonatal Thyroid Dysfunction (Part B)](https://www.thyroidmanager.org/algorithm/neonatal-thyroid-dysfunction-part-b/)

## Questions

- [MANAGEMENT OF METASTATIC RAI NEGATIVE THYROID CANCER  8/11/207 ](https://www.thyroidmanager.org/question/management-metastatic-rai-negative-thyroid-cancer-811207/) - MANAGEMENT OF METASTATIC RAI NEGATIVE THYROID CANCER 8/11/207 QUESTION--The patient is a 53 year old Hispanic male diagnosed with a 5.7 cm papillary thyroid cancer in 7/2014. He had invasion of the trachea mucosa and 4/6 level 6 lymph nodes positive. He was treated with 157 mci I-131 8/26/14. He had recurrence in the larynx
- [MANAGEMENT  OF  RESISTANT  HYPERTHYROIDISM  IN  PREGNANCY  6/11/2017](https://www.thyroidmanager.org/question/management-resistant-hyperthyroidism-pregnancy-6112017/) - MANAGEMENT OF RESISTANT HYPERTHYROIDISM IN PREGNANCY Question-I would appreciate your help in management of 24 y/o female who is 28 weeks IUP. I have never seen the patient but the perinatologist called for an opinion. Hence, I felt it best to seek your advise. Patient has Grave’s disease which was treated prior to pregnancy with
- [POSSIBLE RTH-BETA?                  12/12/15](https://www.thyroidmanager.org/question/possible-rth-beta-121215/) - QUESTION- I recently saw a 68-year-old female who started experiencing shortness of breath and fatigue. She was evaluated by primary care provider who found her to be in atrial fibrillation with rapid ventricular rate. She was started on anticoagulation and metoprolol. Echocardiogram revealed ejection fraction 308 with mild left aortic enlargement and wall motion abnormalities
- [THYROID HORMONE RESISTANCE AND PERIODIC PARALYSIS—4 June 2015](https://www.thyroidmanager.org/question/thyroid-hormone-resistance-and-periodic-paralysis-4-june-2015/) - THYROID HORMONE RESISTANCE AND PERIODIC PARALYSIS— QUESTION--I am looking for assistance with the following case: 18yo male with a diagnosis of thyroid hormone resistance made in childhood, though per the patient's mother the disorder is reportedly not found in other family members Most recent thyroid labs: 5/17/15 TSH 0.86 (0.35-4) FT4 2.9 (0.8-1.5) T3 287
- [MORE  STRANGE THYROID TESTS-  2 March 2015](https://www.thyroidmanager.org/question/more-strange-thyroid-tests-2-march-2015/) - STRANGE THYROID TESTS QUESTION--I have seen this patient a week ago, came with many anxiety and panic symptoms. PCP did LAB, shows : ( not on known thyroid medication/supplements). clinically very anxious, has fine tremor. Thyroid gland 25 g, USG shows mild heterogenity with 2 sub centimeter nodules. She is a 33 YO WF.
- [SUPPRESSED TSH WITHOUT CLEAR CAUSE?  TREATMENT?    10Jan2015](https://www.thyroidmanager.org/question/suppressed-tsh-without-clear-cause-treatment-10jan2015/) - SUPPRESSED TSH WITHOUT CLEAR CAUSE? TREATMENT? QUESTION--I would be thankful if you could kindly guide me on this clinical situation I come across so often. Patients of various age groups are frequently referred with persistent subclinical hyperthyroidism. TSH suppression can be mild or less than 0.2 mIU/l. Patients may be asymptomatic or having symptoms that
- [RECURRENT GRAVES’ THYROTOXICOSIS, AND  POSSIBLE PREGNANCY](https://www.thyroidmanager.org/question/recurrent-graves-thyrotoxicosis-and-possible-pregnancy/) - RECURRENT GRAVES’ THYROTOXICOSIS, AND POSSIB LE PREGNANCY QUESTION-I have a question regarding a 35 y/o with Graves’ relapse and decision for RAI therapy. She was diagnosed in 2009 and did not complete 18 months of anti-thyroid medication and took it intermittently. Went to remission with pregnancy and only took PTU in first trimester. I don’t
- [CLINICAL HYPERTHYROIDISM, LOW TSH, HIGH fT4, POSITIVE PERTECHNETATE SCAN, NEG  Ab](https://www.thyroidmanager.org/question/clinical-hyperthyroidism-low-tsh-high-ft4-positive-pertechnetate-scan-neg-ab/) - QUESTION-Could I have your input on this case. Thank you in advance. He is a 27 year old Psychologist who presented in September 2011 with 18 months history of poor concentration, fatigue, headaches, bloating, weight gain, constipation and dull pain at the back of his eyes. He had gained 10kg over last 4 months with
- [INTERVAL B ETWEEN TESTS,  AND,  HYPOTHYROIDISM IN PREGNANCY](https://www.thyroidmanager.org/question/interval-b-etween-tests-and-hypothyroidism-in-pregnancy/) - TIMING OF TESTS QUESTION-My question is regarding the timely checking of T3, T4 and TSH levels when changing medications for hyperthyroidism due to Graves disease. My doctor just informed me that due to new regulations, I cannot have bloodwork done more frequently than every two months. The reasoning is that significant changes will not show
- [ULTRASOUND DIAGNOSIS,  AND, NODULE IN THYROIDITIS](https://www.thyroidmanager.org/question/ultrasound-diagnosis-and-nodule-in-thyroiditis-2/) - ULTRASOUND DIAGNOSIS QUESTION I recently had an ultrasound of my thyroid, which revealed large cystic nodule, right lobe predominately superior. measures 3.2 x 2.5 x.2.3 cm. multiple septations, some of which are thick. also appearance of mural nodule with vascularity measuring .5 cm. also otherwise small cystic nodules, one of which shows inspissate colloid. larger
- [ULTRASOUND DIAGNOSIS,  AND NODULE IN THYROIDITIS](https://www.thyroidmanager.org/question/ultrasound-diagnosis-and-nodule-in-thyroiditis/) - ULTRASOUND DIAGNOSIS QUESTION I recently had an ultrasound of my thyroid, which revealed large cystic nodule, right lobe predominately superior. measures 3.2 x 2.5 x.2.3 cm. multiple septations, some of which are thick. also appearance of mural nodule with vascularity measuring .5 cm. also otherwise small cystic nodules, one of which shows inspissate colloid. larger
- [PAPILLARY CANCER](https://www.thyroidmanager.org/question/4140/) - PAPILLARY CANCER QUESTION I would be so grateful for your comments please –I am a 54 year old female who had a papillary carcinoma at age 16 which was treated with a thyroidectomy and removal of positive lymph nodes in the neck initially. Since the first diagnosis I had two subsequent malignant nodules within a
- [CYSTIC  NODULES](https://www.thyroidmanager.org/question/cystic-nodules/) - CYSTIC NODULES QUESTION Hi i got your email address from thyroidmanager.org,i hope you don't mind me emailing you a question? I had a ultrasound scan a few weeks ago and got a copy of the results sent to me(well the covering letter) that says the following: “There were changes of multiple cystic nodular areas involving
- [THYROIDITIS](https://www.thyroidmanager.org/question/thyroiditis/) - THYROIDITIS QUESTION--I'm having trouble finding stories/forums of thyroid issues for 20 or 30 something males, everything I read is female based. I'm a 28 year old male otherwise very healthy. I recently went to my GP as I was constantly sweating, off balance, ringing left ear, intolerant to hear and fatigued easily, I would also
- [POSTPARTUM  THYROID  DISEASE](https://www.thyroidmanager.org/question/postpartum-thyroid-disease/) - POSTPARTUM DISEASE Q My name is xxxx and I stumbled across your webpage while doing a google search. I don't know if you are able to answer any questions or give any advice but I am in desperate need of direction. A little over a year ago, I had a child. Eight days after his
- [RADIOIODINE  INDUCED  HYPOTHYROIDISM](https://www.thyroidmanager.org/question/radioiodine-induced-hypothyroidism/) - RADIOIODINE INDUCED HYPOTHYROIDISM Q Had a quick question on being hyper and hypo at the same time. I had RAI in 2004 and am on full replacement hormone, I take Naturethroid ( pig hormone) and my T4 levels are at or below the bottom of the range and my T3 levels stay at the top
- [HYPERTHYROIDISM](https://www.thyroidmanager.org/question/hyperthyroidism/) - HYPERTHYROIDISM Question My 77-year old mother has been diagnosed with a slightly over-active thyroid. She shows some of the effects (nervous, emotional, fidgeting etc), but is otherwise healthy. The only pill she has been taking in the past few years is for a slightly high blood pressure. She lives on her own and is very
- [INCIDENTAL THYROID MEDULLARY CARCINOMA:  27 March 2012](https://www.thyroidmanager.org/question/incidental-thyroid-medullary-carcinoma-27-march-2012/) - QUESTION-Age 63, female, Histopathological Sheet Clinical diagnosis: nodular goiter. Right thyroid lobe enlarged retro-sternal plunged. Macroscopic appearance: 5.5/4/2.5cm thyroid lobe. On sectioning to identify a 0.5cm diameter nodular formation, Cystic appearance, with slightly irregular walls, gray brown. Histopathological diagnose: Nodular goiter with nodules poorly demarcated, consisting of unequal follicles, colloid relaxed, dilated cystic, with effusion
- [THYROID NODULE AND POSITIVE ANTIBODY TESTS  18Oct 2012](https://www.thyroidmanager.org/question/thyroid-nodule-and-positive-antibody-tests-18oct-2012/) - QUESTION--I'm 35yrs old and found a lump in my thyroid so my GP advised me to go for ultrasound and blood test . The ultrasound result was-- There was a solitary well defined prominently solid mildly echogenic nodule with some cystic degeneration in the mid to lower aspect of left hemithyroid measuring 3.4 into 1.6
- [REQUIRED TREATMENT OF HYPERTHYROIDISM  BEFORE SURGERY](https://www.thyroidmanager.org/question/required-treatment-of-hyperthyroidism-before-surgery/) - PROPER T3 LEVEL IN PREPARATION FOR SURGERY 6 December 2011 QUESTION-I would like to get your opinion about a patient. I recently saw an 67 year old women referred for preoperative consultation for thyrotoxicosis. She has a valvular heart diease requiring surgical therapy. She has a history of toxic multinodular goitre for last six months. She is
- [Diffuse Lung Micro-mets with Residual Neck Nodes in Place](https://www.thyroidmanager.org/question/diffuse-lung-micro-mets-with-residual-neck-nodes-in-place/) - Question We received a woman 47 years old with diagnosis of papillary cancer that undergo total thyroidectomy 1 month ago, we do not have much information about the surgical procedure but we know that she had metastases in 2 lymph nodes and no neck dissection was done. We decided a RAI ablation with 150mci I131, post-therapy
- [Possible Thyroid Hormone Resistance](https://www.thyroidmanager.org/question/possible-thyroid-hormone-resistance-2/) - Question I have a patient who has had evidence of thyroid hormone resistance. He has had a thyroidectomy for a fib. He is now well but feels hyper at TSH of 3-5. I now keep his TSH about 5 with beta blockade this is tolerable for him. His mother and sister also had thyrotoxicosis treated
- [Radioactivity and Thyroid Cancer](https://www.thyroidmanager.org/question/radioactivity-and-thyroid-cancer/) - Question I am interested in what the proper length of time that should be made after receiving 50 mc of radioiodine i 131. I have had a total thyroid removal after the left lobe was found to be cancerous in may and the right side being removed in september. Also should a condom be used
- [Cancer and Radioiodine Therapy](https://www.thyroidmanager.org/question/cancer-and-radioiodine-therapy/) - Question I underwent a tt last week for what was found to be stage 1 papillary follicular variant carcinoma. Right lobe 1 lesion 9x5x3mm. Left lobe 2 lesions 1mm and 4mm. Negative nodes. Clear dissection/margins. 7year history of Hashimotos multinodular which was monitored annual by US. Endo discovered right lobe carcinoma on routine US followed by FNAB. I'm 41yrs
- [2008 Patient Questions](https://www.thyroidmanager.org/question/2008-patient-questions/) - Dear Andrea, Thank you for your email. You have Graves' disease with some eye problems which occur with Graves' disease. It is not clear whether you are still hyperthyroid (over active) but you certainly need your T3 and T4 checked carefully. Propanolol can sometimes interfere with the thyroid function test to a small degree. If
- [Topical Patient Questions 2008](https://www.thyroidmanager.org/question/topical-patient-questions-2008/) - Questions answered by Dr John Lazarus 1 Antithyroid drugs, Carbimazole I would like to ask a question for the thryoid disease manager web site. I am 58 and have Graves disease being controlled by carmbimazole 10mg daily. I am feeling very well and able to live a full and active life. Last test results l.4
- [2007 Patient Questions](https://www.thyroidmanager.org/question/2007-patient-questions/) - TREATING HYPERTHYROIDISM12/1/2007 Question My mother had been diagnosed as Hyperthyroidism and she is now having her medication to controlling her thyroid hormone for 3 months which will be continue for a year if her thyroid level still in high risk, what I want to ask are : 1.how to gain her weight since she is
- [Thyroxine Requirement During Pregnancy](https://www.thyroidmanager.org/question/thyroxine-requirement-during-pregnancy/) - Question One of my patients underwent total thyroidectomy because of failure of drug treatment of Graves disease. One month postoperative she was pregnant. Under 150 mcg T4 the TSH was 3.6 mU/L in the first trimester. After 2 months it rose to 26 mU/L (under 170 mcg/d) and it was necessary to give more T4:
- [Thyroid Hormone Treatment and Uric Acid Level](https://www.thyroidmanager.org/question/thyroid-hormone-treatment-and-uric-acid-level/) - Question Dear Doctor I have a patient with benign thyroid cyst on suppressive therapy with 150 micrograms thyroxine . H e r thyroid function tests on this are : Free T 4 23.2pmol/l range10-25 freeT3 6.8pmol/l range 3.3-7.2 S-TSH
- [Does This Person Have Thyroid Hormone Resistance?](https://www.thyroidmanager.org/question/does-this-person-have-thyroid-hormone-resistance/) - Question Case submitted by Dr Karen Kartun. History: This 54-year-old woman is referred for a thyroid evaluation. She was originally diagnosed as hyperthyroid about 20 years ago when she presented with complaints of irritability, feeling "hyper" and general malaise. That had been present for many years before her presentation to this physician. She was treated
- [Primary Vs Secondary Hypothyroidism, and Financial Problems](https://www.thyroidmanager.org/question/primary-vs-secondary-hypothyroidism-and-financial-problems/) - Question One of my patient is a 54 y.o., poor, medically uninsured female suffering evidently from hypothyroidism: since 2 years, she has become progressively fatter, weaker, has menorrhagia, hoarseness of her voice, decrease hearing, and feels depressed. She also complains of dry skin and water retention. Her condition has been attributed to premenopause and depression
- ["Hashimoto's Encephalitis"?](https://www.thyroidmanager.org/question/hashimotos-encephalitis/) - Question Dear Thyroid experts: I had a patient who was admitted to hospital with confusion. she is 39 yo with known Hashimotos found last month to present with tonic-clonic seizure. Not doing well for one month and problems with word finding. ct at outlying hospital reported as cerebral edema. EEG revealed bifrontal rhythms and polymorphic
- [Patient Seeks Counseling About the Possibility of Future Thyroid Exacerbations](https://www.thyroidmanager.org/question/patient-seeks-counseling-about-the-possibility-of-future-thyroid-exacerbations/) - Question In brief he is a 40 year old male who presented in his early 30s with hypothyroid symptoms and a modest goiter of several month's duration. A family history of transient hypothyroidism, possibly in the setting of pregnancy, was reported. An elevated TSH and low total T4 were found and corrected with Synthroid. His
- [How to Manage Fetal Hypothyroidism and Goiter](https://www.thyroidmanager.org/question/how-to-manage-fetal-hypothyroidism-and-goiter/) - Question Dear expert: Patient is a 29 yr old lady - 26 weeks intauterine pregnant. She has had an earlier miscarriage at 6 wks gestation - cause unknown. Not a consanguinous marriage. Routine ultrasound at 26 weeks revealed a fetal goiter - 3.5 x 2.5x 2.5 cms. Weeks of gestation by ultrasound corresponds to gestational
- [Do We Really Need to Do Both fT4 and TSH in Evaluating Patients?](https://www.thyroidmanager.org/question/do-we-really-need-to-do-both-ft4-and-tsh-in-evaluating-patients/) - Question Dear Sir, Sincere admiration for your great website. Regarding evaluation of thyroxine replacement therapy, it is always suggested to evaluate TSH and free T4. However except in the situation of pregnancy (where only depending on TSH could result in a retarded action), I don' t see much reason to determine both values. Is it
- [How Long to Wait After Operation Before RAI Ablation?](https://www.thyroidmanager.org/question/how-long-to-wait-after-operation-before-rai-ablation/) - Question Dear experts- In the literature it is always suggested that the radio iodine abalation is administered approx 4-6 weeks post operatively after total /near total thyroidectomy for ca. One of the reasons is for stimulation of TSH so it is at least above 30 mIU/L, but if this level of TSH is reached before
- [How to Manage Existing Hypothyroidism Perioperatively in a Patient NPO?](https://www.thyroidmanager.org/question/how-to-manage-existing-hypothyroidism-perioperatively-in-a-patient-npo/) - Question I was called to evaluate a 82 year old female with cholecystitis who had hypothyroidism and has been taking levothyroxine 125 mcg/day. Her last TFT was fT4- 1.3; TSH - 6.1 three days ago. Patient is NPO. Suction tube is in place. It is on constant suction. There is a plan for surgery in
- [How to Treat Sub-clinical Hypothyroidism?](https://www.thyroidmanager.org/question/how-to-treat-sub-clinical-hypothyroidism/) - Question Hello. One of my patients is a lady aged 48 years. She has most signs and symptoms that correlate with hypothyroidism. Her TSH is 9.7 mlu/L ( range 0.27-4.2), T4 is 13 pmol/L (range 12-22), T3 is 4.7 pmol/L (range 2.8-7.1) . There is no relevant history. She is having menorrhagia (severe) , shortness
- [When is a Pentagastrin Test Advised in Following MTC?](https://www.thyroidmanager.org/question/when-is-a-pentagastrin-test-advised-in-following-mtc/) - Question I would like to see more information about the use of pentagastrin-stimulated CT secretion as a test to determine whether thyroidectomy is to be recommended in persons with the C609Y (or other relevant location) mutant RET proto-oncogene on chromosome 10. It appears that some physicians recommend thyroidectomy in such a case without ordering the
- [Is This Graves' Disease?](https://www.thyroidmanager.org/question/is-this-graves-disease/) - Question I recently saw a 25 year old male law student with hyperthyroidism. He came with a diagnosis of Graves disease made about 3 years previously (solely on clinical grounds as far as I can tell). He was treated with PTU with control of symptoms for about 1 and 1/2 year after which he stopped
- [Hashimoto's, Transient Hypothyroidism, and an Elevated RAIU](https://www.thyroidmanager.org/question/hashimotos-transient-hypothyroidism-and-an-elevated-raiu/) - Question May I get your opinion on the following case: 22 year old woman with presents to her primary provider with complaints of amenorrhea times 6 months. Additional concerns include cold intolerance, dry skin, hair loss and an 18lb weight gain over the past year. In March of this year TSH 2.54.. On 8/14/02 TSH
- [Therapy of Thyroid Cancer with Known Positive Neck Nodes, Elevated TG, and Negative Scan?](https://www.thyroidmanager.org/question/therapy-of-thyroid-cancer-with-known-positive-neck-nodes-elevated-tg-and-negative-scan/) - Question I am writing to seek your opinion on a patient who has been treated and followed up by one of my colleagues and recently I was involved in his management. A detailed medical report is attached but briefly he is a 33-year-old man who had papillary thyroid cancer of 4.5 cm size with lymph
- [What to Do with an Incidental 1mm Papillary Cancer?](https://www.thyroidmanager.org/question/what-to-do-with-an-incidental-1mm-papillary-cancer/) - Question What is the appropriate workup and treatment plan for a 41 yo female who underwent right total thyroidectomy for what was initially felt to be a single hot nodule with symptoms of hoarseness, localized pain and enlargement? Path report revealed 1 large encapsulated adenoma as well as several smaller nodules. An incidental finding unrelated
- [Infant with Chylothorax and Apparent Hypothyroidism](https://www.thyroidmanager.org/question/infant-with-chylothorax-and-apparent-hypothyroidism/) - Question I would be greatful for advice over management of this case. A one month old girl with Down Syndrome was admitted in the PICU due to respiratory distress 20 days ago and bilateral chylothorax was diagnosed. Bilateral drainages tubes were placed and fluid analysis confirmed chylothorax. Debt is more or less 500 ml/day and
- [Managing Hashimoto's in Pregnancy](https://www.thyroidmanager.org/question/managing-hashimotos-in-pregnancy/) - Question What are the current recommendations regarding > treating Hashimoto's during pregnancy? How frequently should the woman be monitored with thyroid tests? Should she be followed a high risk OBGYN? Thank you. Dr. Amy Handler, Katonah, NY Response This question demands an answer subdivided in several parts. Concerning thyroid function, most patients (but not all)
- [T4 Suppression Therapy Post Radiation Exposure](https://www.thyroidmanager.org/question/t4-suppression-therapy-post-radiation-exposure/) - Question A 65 year old white female with history of irradiation as an infant, apparently as a treatment for an enlarged thymus. The patient has been on T4 suppression therapy since age 20. Thyroid function tests show normal T4 and suppressed TSH, compatible with her treatment goals. Thyroid gland is non-palpable and the latest thyroid
- [What Condition Does This Person Suffer From?](https://www.thyroidmanager.org/question/what-condition-does-this-person-suffer-from/) - Question HISTORY: Mrs. M is an 87-year-old woman who is referred for treatment of hyperthyroidism. The patient was recently admitted to our institution for chest pain and shortness of breath resulting from CHF. During evaluation of this illness, the patient had thyroid function studies drawn (see laboratory section below). The patient gives a history of
- [Amiodarone Induced Thyrotoxicosis](https://www.thyroidmanager.org/question/amiodarone-induced-thyrotoxicosis-2/) - Question I am a 67year old cardiologist. I recently had a succesful pulmonary vein ablation for paroxysmal AF. Prior to the ablation I ceased taking Amiodarone which had been administered for two years. Approximately 6 weeks after stopping Amiodarone I had lost 14kg in weight and had a tremor and heat intolerance and other symptoms.
- [Add Recombinant TSH to Endogenous TSH for Ablation?](https://www.thyroidmanager.org/question/add-recombinant-tsh-to-endogenous-tsh-for-ablation/) - Question I am a family physician in Toronto, Ontario. I am also unfortunately the patient. I will be undergoing I131 treatment following my near total thyroidectomy last month for a mulitcentric follicular variant papillary thyroid carcinoma. It was completely resected. The primary nodule was 2.4 cm with capsular invasion nut no extrathyroidal spread and no
- [Invasive Papillary Cancer and Enlarged Node](https://www.thyroidmanager.org/question/invasive-papillary-cancer-and-enlarged-node/) - Question 35 yo male patient with 8.5 cm tumor of the right lobe of thyroid. Pathology reports poorly differentiatedpapillary, Hurthle, and Follicular cell types. Extensive lymphovascular invasion, 9 out of 15 nodes positive. Modified radical neck dissection was performed and 7/54 nodes positive. Patientreceived 151mc dose of RAI,scan showed no uptake. Followup Thyrogen stimulated scan
- [Adverse Effect of Iodine Treatment of Drinking Water](https://www.thyroidmanager.org/question/adverse-effect-of-iodine-treatment-of-drinking-water/) - Question I've read your article regarding iodine and the thyroid gland. I hope you can advise us regarding our problem. I am a 37 years old man. My entire family (father,mother, sister, wife and myself) developed thyroid illness because we have been using a pentaiodide water purification device that had been producing water with toxic
- [Thyroxin Absorption Test](https://www.thyroidmanager.org/question/thyroxin-absorption-test/) - Question In patients with suspected T-4 malabsorption, is there a "standardized" T-4 absorption test during which time patients are given their T-4 dose supervised in the office, and have their labs monitored at intervals? I have done this in the past, and have derived useful information; however, I am uncertain as to the best time
- [Hyperthyroidism in the Truly Elderly](https://www.thyroidmanager.org/question/hyperthyroidism-in-the-truly-elderly/) - Question I would appreciate your input on the following case: a 103 yrsold white female, was first diagnosed with hyperthyroidism 6 month ago, but she was followed up w/t therapy. There is no known thyroid disorder in the family.Thyroid was normal in size. Since the beginning of January are clinicallypresent diarrhea,nervousness, palpitations, breathlessness. Geriatric physician
- [Thyroid Tissue in a Lateral Mass, with Thyroiditis; is It Cancer?](https://www.thyroidmanager.org/question/thyroid-tissue-in-a-lateral-mass-with-thyroiditis-is-it-cancer/) - Question I am taking the liberty to write to you because of a management dilemma which Iam having difficulty to solve using the available published data.A 34-year-old womanwas referred to ourInstitutionafter she had undergonetotal thyroidectomy andright modified neck dissection.The surgery was performed because FNAof a lateral neck mass (presumed to be a lymph node) revealed
- [Thyroxin Dose After Thyroidectomy for Papillary Cancer](https://www.thyroidmanager.org/question/thyroxin-dose-after-thyroidectomy-for-papillary-cancer/) - Question Following a complete thyroidectomy 18mo ago (papillary CA) I am now on 250ug thyroxine. Key question is: If I am exercising more, (trying to run 7kms, 3x/w) should I be raising my thyroxine dose. I would imagine that under normal circumstances, metabolic needs would rise hence a greater need for thyroxine.Compared to pre-thyroidectomy running,
- [Iodine Supplements in Hashimoto's Thyroiditis](https://www.thyroidmanager.org/question/iodine-supplements-in-hashimotos-thyroiditis/) - Question Patients with Hashimoto’s thyroiditis are more susceptible to developing a Wolf-Chaikoff reaction to iodine excess than patients without thyroid disease. Yet pregnant women are all being recommended by some to take 250 mcg of iodine during pregnancy and lactation. If you make sure pre-pregancy hypothyroid patients are treated to assure TSH
- [Subclinical Hyperthyroidism and Conception](https://www.thyroidmanager.org/question/subclinical-hyperthyroidism-and-conception/) - Question I am following a 39 y/o woman with 1ry infertility found by her fertility GYN to have a low tsh and diagnosed by myself as having a subclinically hyperthyroid multinodular goiter[-ve fna]. Her TSH has fluctuated between .04 and .15 or so with normal free T4 and T3total. She has no overt hyperthyroid symptoms.
- [Thyroiditis, or GRTH?](https://www.thyroidmanager.org/question/thyroiditis-or-grth/) - Question I would like to ask your opinion regarding 10,5 years old Caucasian girl. She was referred to me after series of doctors. Anamnesis and complaints. 6 mo ago she lost a lot of hair on the head, shortly after her parents told her about the family moving to another country. Very similar episodes had
- [RAI Treatment While Pregnant](https://www.thyroidmanager.org/question/rai-treatment-while-pregnant/) - Question I am an endocrinologist in Maryland. I have a 35 y/o woman with hx Grave's just had RAI in mid Jan 2006, had negative pretreatment pregnancy test and now came in today and is pregnant. I had previously counseled the couple multiple times about avoiding this issue. Anyway, what would be your advice as
- [Management of a Mediastinal Mass](https://www.thyroidmanager.org/question/management-of-a-mediastinal-mass/) - Question I would like your opinion regarding a 63 year old lady with well differentiated follicular variant papillary carcinoma (3.7cm) with mediastinal metastases. She presented in August 2005 with thyrotoxicosis (TSH
- [Normal T4 Ranges in Pregnancy](https://www.thyroidmanager.org/question/normal-t4-ranges-in-pregnancy/) - Question All along,I thought that free hormone levels (ft4/ft3) are better initialparameters (vs t4) in monitoring treatment in pregnant patients with toxic goiter. In the march 2006 issue of Endocrinology and met clinics of NA, the authors, recommend measuring total t4 concentration for dose titration of anti thyroid drug. Can you comment on this. Thanks
- [Hot Nodule with Indeterminate Histology](https://www.thyroidmanager.org/question/hot-nodule-with-indeterminate-histology/) - Question A 45 years lady presented with STN.TSH-0.1,Tc uptake at 20 min-39%.FNAC-? follicular neoplasm. She was managed with carbimazole for 2 months.now her TSH is 10.8,Tc uptake is still 31%.FNAC -colloid with sheets of follicular cells.Is she a candidate for surgery? Regards, Dr. Sailesh Lodha 759 Ganeshpath, Mahaveernagar, Tonkroad Jaipur 302004 Response I presume that
- [Microcarcinoma in Teenager with Dyshormonogenesis](https://www.thyroidmanager.org/question/microcarcinoma-in-teenager-with-dyshormonogenesis/) - Question I’d like to tap into the expertise of this forum (Thyroid Manager) regarding an unusual situation in a pediatric patient. Patient was a non-adherent young, obese 14 yo teen with an original diagnosis of congenital hypothyroidism secondary to dyshormonogenesis. He’d been lost to follow-up for more than a year. Upon return, he presented with
- [Hyperthyroidism, Low Uptake, Negative Ab](https://www.thyroidmanager.org/question/hyperthyroidism-low-uptake-negative-ab/) - Question 1 Thanks for you site.I will greatly appreciate your --.Clinical problems PATIENT 1. Young female.Symtoms of thyrotoxicosis , no eye signs ,no grossly enlarged thyroid gland , or bruit,T4 = 50 ;TSH = < 0.03 Referred for I-131.Thyroid scan done = Uniform uptake of TC. Calculated uptake = 2 % , Gland not grossly
- [Twin Pregnancy, Low TSH, Normal T4 and T3](https://www.thyroidmanager.org/question/twin-pregnancy-low-tsh-normal-t4-and-t3/) - Question I am taking care of a 32 year old lady, first pregnancy, at 18 weeks with a twin gestation who comes in with the following thyroid numbers: TSH=0.02 (NV=.30-5.00), Total T4=15.7 (NV=4.5-12.0), Free T4=1.5 (NV=0.71-1.85), free T3=4.1 (NV=2.4-4.2) I repeated the blood work 10 days after the first set of numbers: TSH=0.02, Total T4=15.5,
- [Papillary CA, AITD, Neg Ab, Pos TG](https://www.thyroidmanager.org/question/papillary-ca-aitd-neg-ab-pos-tg/) - Question I am a board certified pediatric endocrinologist in private practice in Tampa, FL.I would like to ask your expert opinion on a 18 years old young lady I am following for Papillary thyroid carcinoma diagnosed when she was 13 years of age. She also has type 1 DM and hypothyroidism due to autoimmue thyroid
- [Thyroiditis, Hypothyroidism, Pregnancy](https://www.thyroidmanager.org/question/thyroiditis-hypothyroidism-pregnancy/) - Question Thank you for giving us such quality input at such convenience. This is a 37 yr old white female who had a normal TSH in Aug 2005. In Jan'06 her TSH was noted to be elevated at 7.92 with normal FT4 of 0.88 and free T3 of 3.52(2.3-4.2). She was started on Synthroid 50mcg
- [Mild Hyperthyroidism, Questionable Cause](https://www.thyroidmanager.org/question/mild-hyperthyroidism-questionable-cause/) - Question F 40+yrs, history of hypothyroidism on variable combination of T4 and T3 replacement (prescribed by GP, not seen by us or any endocrine specialist) for >10 years. The only retrievable TFT around that time (5/1999) : fT4 10.1 pmol/L (10-24), TSH 5.62 mU/L(0.4-4). Early 2005, given herbal treatment for tiredness for 1-2mths then stopped.
- [Struma Ovarii with Malignancy](https://www.thyroidmanager.org/question/struma-ovarii-with-malignancy/) - Question I would appreciate your opinion on a very unusual case I encountered in my practice recently. My patient is a 63 year old, WF, PMH of ovarian cyst removed 30 years ago. 10-12 years ago, she began growing a mass/cyst on her incision line.She saw her Physician who recommended she not do anything until
- [Follow-up of an Incidentally Found Papillary CA](https://www.thyroidmanager.org/question/follow-up-of-an-incidentally-found-papillary-ca/) - Question I have a 43 year-old asymptomatic white male with a multinodular goiter and a 3.1 cm dominant nodule on the right thyroid lobe diagnosed in 11/2005. He has no family history of thyroid cancer and no history of head and neck radiation exposure. Thyroid function tests within normal limits. A subsequent FNA revealed a
- [Lump in the Neck](https://www.thyroidmanager.org/question/lump-in-the-neck/) - Question My 28-year-old daughter has been diagnosed with a thyroid problem just three days ago. At her annual physical, the doctor noticed an enlarged lobe of the thyroid, referred her to an endocrinologist and after a biopsy was performed, the results were as follows. The cells presented as "normal but in an abnormal pattern". She
- [Hashimoto](https://www.thyroidmanager.org/question/hashimoto/) - Question I was diagnosed with Hashimoto's hypothyroidism over 20 years ago and for the past 10 to 15 years I have had over 6 endocrinologist's and have had a constant struggle with weight gain and getting my thyroid levels to be consistant. My current endocrinologist has come to the conclusion that I have been overmedicated
- [Hypothyroidism and Pregnancy](https://www.thyroidmanager.org/question/hypothyroidism-and-pregnancy/) - Question My husband and I are trying to conceive and I have Hypothyroidism-I was diagnosed shortly after birth (at 29 weeks) and have been on a regimine of eltroxin ever since (ranging from 0.1 to 0.137 at present-Synthroid didn't agree with me and made me retain more water). There have been several changes with my
- [Possible Thyroid Hormone Resistance](https://www.thyroidmanager.org/question/possible-thyroid-hormone-resistance/) - Question Your thoughts regarding this generally healthy 65 yo man would be most appreciated.He presented with non-specific but suspicious symptoms: hyperkinetic, emotional irritability, weight loss despite intentional high calorie intake (nickname of "Joe Donuts" by his family). Exam: Equivocal tremor, normal reflexes, no lid lad. Thyroid exam enlarged, consistent with the ultrasound. Lab (all serum
- [Repeated Miscarriages in a Young Woman with Hashimoto’s Thyroiditis and Antibodies](https://www.thyroidmanager.org/question/repeated-miscarriages-in-a-young-woman-with-hashimoto’s-thyroiditis-and-antibodies/) - Question This is a 32 yr old female who first saw me 3/7/7 when she was 8 weeks IUP, G4M3. First pregnacy was 5yrs ago FTND. Subsequent 3 miscarriages at 6-8wks IUP. Hypothyroidism diagnosed 3yrs ago, not treated for reasons unclear. 6/06 she was started on LT4 50 mcg, gradually increased to 100mcg by 2/07.
- [Treatment of 2.3cm Unifocal Follicular Variant of Papillary Cancer](https://www.thyroidmanager.org/question/treatment-of-2-3cm-unifocal-follicular-variant-of-papillary-cancer/) - Question I would like to ask you about encapsulated follicular variant of papillary thyroid cancer. I have a young female 28 yo recently diagnosed with a 2.3 cm nodule left lobe with the above pathology confirmed by Dr. LiVolsi. She will have completion thyroidectomy and my question is how aggressive one should be with this
- [Hurthle Cells in an FNA of a Hashimoto’s Gland](https://www.thyroidmanager.org/question/hurthle-cells-in-an-fna-of-a-hashimoto’s-gland/) - Question A patient of mine with euthyroid Hashimoto's thyroiditis was noted to have a single nodule on sonogram; FNAB showed follicular cells with Hurthle cell change and colloid, consistent with Hurthle cell metaplasia within a nodular goiter. As a pediatric endocrinologist, I am not particularly experienced with analyzing these results. Is this just Hashimoto's or
- [Prior Radiation to Bone and Use of Teriparatide](https://www.thyroidmanager.org/question/prior-radiation-to-bone-and-use-of-teriparatide/) - Question Is the amount of irradiation received by the underlying rib cage in a woman who receives radiation to the breast/axilla after a lumpectomy for breast carcinoma enough to make the use of teriparatide contraindicated? Edward Biederman, MD, FACE Response Yes, any amount of radiation would be considered a contraindication. Pam Taxel, MD
- [Residual Papillary Cancer: RAI vs Surgery??](https://www.thyroidmanager.org/question/residual-papillary-cancer-rai-vs-surgery/) - Question I would appreciate your input. This is a 51 year-old lady who was diagnosed with papillary cancer of the thyroid (4 cm , right lobe), s/p total thyroidectomy on 2/2005.Her primary MD gave her a 30 mCi RAI ablative dose. Themetastatic search showed increase uptake in the thyroid bed. The baseline thyroglobulin was 87.1
- [Pregnant (Post RAI on T4) Woman with Elevated TSAb](https://www.thyroidmanager.org/question/pregnant-post-rai-on-t4-woman-with-elevated-tsab/) - Question I have a pregnant lady with history of Grave's dse s/p RAI before her first pregnancy. This is her second pregnancy and she is on her 2nd trimester. I have her on Synthroid and her TSH levels have been at 1-1.5uiu/ml. I ordered a TSI and it is mildly elevated at 146 %(
- [Pet-scan Positive Mediastinal ? Met After RAI and Prior Nediastinal Operation](https://www.thyroidmanager.org/question/pet-scan-positive-mediastinal-met-after-rai-and-prior-nediastinal-operation/) - Question I would like your advice on the following case. A 28 year old female underwent total thyroidectomy and central neck dissection in 2004, for a classic papillary thyroid carcinoma (T2 (unifocal 2,5 cm), N1a, M0, EI). Afterwards she received 150 mCi radioiodine (under low iodine diet). The post dose scan showed uptake only in
- [rhTSH vs Hormone Withdrawal in RAI Therapy](https://www.thyroidmanager.org/question/rhtsh-vs-hormone-withdrawal-in-rai-therapy/) - Question An 18 year old girl with diffuse miliary metastases of papillary thyroid cancer in lungs has had 200mc of I131 and we plan repeat doses every 6 months until no more uptake in lungs. This first dose was given after withdrawal of thyroid hormone. Would future doses after Thyrogen be as effective and less
- [Fna "Positive" Contralateral Node Following Hemithyroidectomy](https://www.thyroidmanager.org/question/fna-positive-contralateral-node-following-hemithyroidectomy/) - Question I have a 21 year old who presented with a 3.6 cm Left thyroid mass, TFT's were normal, TG and TPO antibodies were negative. The right lobe did not show any nodules but she had a calcified LN measuring 1.8 cm with no fatty hilum. She underwent left hemithyroidectomy and final pathology was reviewed
- [Ovarian Mass and Hyperthyroidism](https://www.thyroidmanager.org/question/ovarian-mass-and-hyperthyroidism/) - Question A 24 yr old unmarried girl with H/O hyperthyroidism for last 12 year now presented with non-specific lower abdominal mild pain. USG and CT abd.suggestive of B/L complex ovarian mass.NO other finding in abdomen NO ascies present. CA-125is 151. B HCG, AFP, LDH are normal. What are the chances of some abnormal stimulation of
- [Iodine Deficiency and Hypothyroidism in Early Pregnancy](https://www.thyroidmanager.org/question/iodine-deficiency-and-hypothyroidism-in-early-pregnancy/) - Question I am an practising endocrinologist in India a relatively Iodine deficienct region. Wide spread availbility of Thyroid funciton testing has brought many patients with mild hypothyroidism in the 1st trimister with TSH of 10 to 15 and a low free T4. What will be the plan of mamagent and if at all termination of
- [Therapy of Probable (?) Sporadic MTC](https://www.thyroidmanager.org/question/therapy-of-probable-sporadic-mtc/) - Question I have a woman who is 51 with a 1.9 cm left lobe thyroid nodule. The radiologist noted multiple sub centimeter hypoechoic nodules on the right lobe and "multiple probable Reactive lymph nodes." On FNA the one left lobe nodule is a spindle cell carcinoma --favor medullary carcinoma--the other nodules were not biopsied. She
- [Follicular Neoplasm in a 19yr Old Female](https://www.thyroidmanager.org/question/follicular-neoplasm-in-a-19yr-old-female/) - Question 19yr old unmarried female has come to me with history of a slowlygrowing swelling in the neck for 6 months. Clinically it is a thyroid cyst replacing whole of the left lobe. no history in family, exposureto radiation etc. is present. US shows a cyst with size 1.5cmx1.8cm with no wall irregularity, no mixed
- [Thyroid Replacement Therapy](https://www.thyroidmanager.org/question/thyroid-replacement-therapy/) - Question Dr. Lazarus: Thyroid is a very confusing issue and I, after taking thyroid meds for almost ten years am still confused. I have a doctor that only uses tsh to calculate. Six months ago I had a tsh at of .27 and doc was concerned that I was too low. Cut my Armour back
- [Steroids in Graves’ Eye Disease](https://www.thyroidmanager.org/question/steroids-in-graves’-eye-disease/) - Question I have a question regarding standard protocols for IV glucocorticoid therapy for Graves ophthalmopathy w/ constant diplopia. Is there a "best practices" protocol now established? I've just completed pulse IV therapy of 3 days, every other day, 1000 mg Solumedrol each session. I'm wondering if this is typically repeated, is followed by oral prednisone,
- [Use PTU After MMI Induced LFT Abnormalities?](https://www.thyroidmanager.org/question/use-ptu-after-mmi-induced-lft-abnormalities/) - Question I am writing to request your advice on a pt with hyperthyroidism who developed and elev alk phosph on Tapazole. This is a 70 yo male with subclinical hyperthyroidism due to a MNG. His TSH ranges between .07-.13, with normal freet4 of .8 and normal free T3 of 2.5. He is asx except has
- [Low T4 and T3 but Normal TSH](https://www.thyroidmanager.org/question/low-t4-and-t3-but-normal-tsh/) - Question I would appreciate your comments on this case. This is a 24-year-old man who was referred for low normal values of T4 and T3 with normal TSH. He noted easy fatigability and a bit of weight gain during the last year. Otherwise he is a healthy young man who is studying medicine. His past
- [Thyroid Cyst, What to Do?](https://www.thyroidmanager.org/question/thyroid-cyst-what-to-do/) - Question I found a lump in my neck back in september, but at the time I was sick so all the other glands in my throat were swollen. But a couple of months go by and I still felt in my neck. So I went back to the doctor who suggested that I have a
- [Hypergonadotropic Hypogonadism and Congenital Rubella](https://www.thyroidmanager.org/question/hypergonadotropic-hypogonadism-and-congenital-rubella/) - Question I am an endocrinologist from India. The cases are 2 male patient, both are a known case of congenital rubella syndrome with deaf mutism. case-1 presented to us at 23 yrs with concern of lack of secondary sexual character. He was 168cm tall(target height was 166) with enuchoid proportions. His pubertal status being P3,A2.
- [Thyrotoxicosis with Low RAIU](https://www.thyroidmanager.org/question/thyrotoxicosis-with-low-raiu/) - Question I would appreciate your input regarding a management issue in a 45y/o lady sent to me for thyrotoxicosis evaluation and management.She started with hyperthyroid symptoms a few weeks after her abdominal surgery for radiation induced entrocolitis(has had a significant weight loss over 25 lbs besides other symptomatology.)She has had several iv contrast studies(Optiray) in
- [Thyroid Hormone Resistance Vs. TSH-oma](https://www.thyroidmanager.org/question/thyroid-hormone-resistance-vs-tsh-oma-2/) - Question My new case is a 49yr old white male referred by cardiology for abnormal TFT in July 2006. In March he had an episode of PAT/A fib which reverted to NSR.His Sx were anxiety, palpitations and dizziness. This is a summary of his tests: 4/06 7/06 8/06 10/06 11/06 12/06 2/07 TSH(.35-5.5) 0.961 0.92
- [Radiation and Possible Thyroid Malignancy](https://www.thyroidmanager.org/question/radiation-and-possible-thyroid-malignancy/) - Question I am 51 years old male with some previous radiation exposure from Chernobyl disaster (I live in Kiev, until 1990, about 100 km from Chernobyl) but until recently my health worries were limited to dental fillings and a slightly elevated blood pressure. About two years ago, after annual check up and blood tests, my
- [Thyroid CA, Invasion, Positive Nodes, and TG Antibodies](https://www.thyroidmanager.org/question/thyroid-ca-invasion-positive-nodes-and-tg-antibodies/) - Question I am an argentine Endocrinologist at the German Hospital in Buenos Aires, Argentina. I would appreciate your advice on the following clinical case. We are treating a 28 years old man, who underwent a total thyroidectomy and radical neck limphadenectomy due to thyroid carcinoma and elevated antithyroglobulin antibodies levels (245.5 IU/ml (normal: 0.0-115) ) in
- [Primary Hypothyroidism and Worsening Exophthalmos](https://www.thyroidmanager.org/question/primary-hypothyroidism-and-worsening-exophthalmos/) - Question I have a 63 year old lady with hx of hypothyroidism for at least 8 years and on 50 to 75 ug of generic LT4. Since August ' 06 she noticed left eye proptosis and double vision. Her hypothyroidism is NOT postablative from previous Grave's disease. Reviewing her chart ( since I have only
- [Treatment for Progressive Hurthle Cell Thyroid Carcinoma](https://www.thyroidmanager.org/question/treatment-for-progressive-hurthle-cell-thyroid-carcinoma/) - Question I would like to ask your expert opinion on a 64 years old lady with Hurthle cell thyroid carcinoma. She also has type 2 DM. She had initially sub-total excision of the thyroid gland without previous fine-needle aspiration biopsy in her local hospital. Histopatology had revealed Hurthle cell thyroid carcinoma (diameter of tumor: 4
- [Possible Effects of Amiodarone](https://www.thyroidmanager.org/question/possible-effects-of-amiodarone/) - Question A 64-year-old woman treating "arrythmia" with metoprolol 100mg bd (p.o.) has presented symptomatic ventricular extrasystoles and was treated with amiodarone acutely in the ER and released to continue metoprolol. In the ambulatory the cardiologist prescribed amiodarone but she used it for about 10 days only. In the mean time she had got these lab
- [Tracheal Invasion in Papillary Thyroid Carcinoma](https://www.thyroidmanager.org/question/tracheal-invasion-in-papillary-thyroid-carcinoma/) - Question I would appreciate your advice on the following clinical case. The patient is a 31 year old male who underwent total thyroidectomy and central neck dissection for papillary thyroid cancer, usual type (T3 N1aM0), in 2002. After that he received ablation with radioiodine. Apparently, he was considered with no evidence of disease until 2005,
- [Multiple Drugs for Schizophrenia, and Low T4 and T3 Levels](https://www.thyroidmanager.org/question/multiple-drugs-for-schizophrenia-and-low-t4-and-t3-levels/) - Question My question is regarding a young woman (19-year old) with shizofrenia. 4 months ago she overdosed herself with levothyroxine (500 ug/day) with intention to lose weight. She was admitted to the department of psychiatry in April 2007 and consequently diagnosed with shizofrenia. She had no thyroid history. Her current medications are lamotrigin, clonazepam, quetiapin,
- [Neonatal Goiter with Normal TFTs](https://www.thyroidmanager.org/question/neonatal-goiter-with-normal-tfts/) - Question I am a pediatric endocrinologist from Oman I like to ask a bout the newborn baby who is born to first blood related cousin with a huge goiter measuring 5.5 by 3.5 cm .mum not on any goitergen drugs and she is not having in thyroid diseeases, her tft and thyroid titre are normal.
- [Therapy of Advance Follicular Thyroid Cancer](https://www.thyroidmanager.org/question/therapy-of-advance-follicular-thyroid-cancer/) - Question I am Endocrinologist from Buenos Aires, Argentina and I have a troublesome case.The patient is a 59 years old male. His thyroid cancer was diagnosed because of bone metastasis 9 years ago. At that time(1996) he underwent thyroidectomy (moderately differenTiated follicular thyroid carcinoma) and received 200 mC I 131. After 6 months the serum
- [RAI Treatment with Extensive Lung Metastases](https://www.thyroidmanager.org/question/rai-treatment-with-extensive-lung-metastases/) - Question I would really appreciate your advice about an 18-year-old girl with papillary carcinoma of thyroid and extensive miliary pattern of metastases throughout both lung fields. An added complication is that she was given contrast for a CT scan just before a total thyroidectomy. Since I have not treated someone with such extensive lung disease,
- [A Case of Galactorrhea](https://www.thyroidmanager.org/question/a-case-of-galactorrhea/) - Question I am an Internal Medicine Resident in Rio de Janeiro, Brazil. I have seen a 23 year old woman which has a history of galactorrhea started 5 years ago. Her prolactin at that time was around 50 ng/ml and a pituitary MRI showed a 5mm adenoma. She had normal menses and no other symptoms.
- [Gestational Hypertyroidism?](https://www.thyroidmanager.org/question/gestational-hypertyroidism/) - Question I would appreciate you comments on a young woman RDW age 35 years. I saw her first on June 13, 2003, when she was 33 weeks pregnant. On June 3, 2003, her free T4 was 11.3 pmol/L (7.5 ' 21.1). Her free T3 was 5.6 (2.3 ' 6.3), and her TSH was 0.16. At
- [Hot Nodule and Sub-clinical Hyperthyroidism](https://www.thyroidmanager.org/question/hot-nodule-and-sub-clinical-hyperthyroidism/) - Question May I pick your brain? I read Cooper's article on subclinical hyperthyroid. However I have a 44yo woman with nodule TSH 0.17 sent to me for Bx.I deferred the Bx and recommended a scan.The nodule was hypervascular on Doppler, however it was 2.8cm vs 1.5cm 3 years earlier.How do you approach hot nodules in
- [RAI Ablation in Stage 1 Papillary Thyroid Cancer?](https://www.thyroidmanager.org/question/rai-ablation-in-stage-1-papillary-thyroid-cancer/) - Question After reading Endocrine Practice last month: Hayes: no I 131 stage 1-2 Mazz: 30 mCi remnant ablation stage 1 disease My institution uses 150 mCi in this situation (I'm trying to change this) How would you treat this patient below? 51 yo woman with chronic hashimoto's, FNA + PTC, undergoes total thyroidectomy post op on
- [Interferon Therapy and Hyperthyroidism](https://www.thyroidmanager.org/question/interferon-therapy-and-hyperthyroidism/) - Question This is about a 40 year old male with CHRONIC HEPATITIS B. He started interferon tratment in 2004 until he developed weight loss, tremors, palpitations in Nov.2006.(He received a total of 44 doses of interferon).Past history showed no dx of any thyroid disease. On initial visit he clearly showed signs of hyperthyroidsm. His goiter
- [Thyroid Cancer with High TG Response to TSH but Negative Scan](https://www.thyroidmanager.org/question/thyroid-cancer-with-high-tg-response-to-tsh-but-negative-scan/) - Question He is a 37 yo man that I first saw in 2003 following excision of a thyroglossal duct cyst (he presented with a neck mass), which showed a 1cm papillary carcinoma focus within it. He then underwent a total thyroidectomy which showed papillary cancer in a right thyroid nodule. There was no neck dissection
- [Intermittent Hyperthyroidism and Hypothyroidism](https://www.thyroidmanager.org/question/intermittent-hyperthyroidism-and-hypothyroidism/) - Question A 48yr old man has hyperthyroidism. He had lymphoma in 1992 receiving chemotherapy and radiotherapy and is in remission. Shortly after he apparently had biochemical features of primary hypothyroidism and was placed on thyroxine. He also developed hypocortisolism, thought secondary to his cancer treatment and is on hydocortisone replacement. In 2005 he developed chronic
- [Possible Euthyroid Graves' Disease](https://www.thyroidmanager.org/question/possible-euthyroid-graves-disease/) - Question A case of hyperthyroidism, with NORMAL thyroid profile , borderline high TSI , abnormal nuclear studies and clinical picture of hyperthyroidism.A29 y/o Hispanic female who was referred to me by a cardiologist – because of tachycardia with normal cardiac work up and normal thyroid test .She was initially diagnosed with tachycardia - during her
- [Possible T4 Malabsorption and Abdominal Disease](https://www.thyroidmanager.org/question/possible-t4-malabsorption-and-abdominal-disease/) - Question 60 year old female, previous Cambridge university tutor, now works as a schoolteacher. Thyrotoxicosis 20 years ago and was treated with a course of medication although she cannot recall what it was and I cannot find out. She was subsequently hypothyroid and on 100mcg thyroxine for 20 years with normal thyroid function tests (TSH
- [Need for Iodine Supplementation During Pregnancy](https://www.thyroidmanager.org/question/need-for-iodine-supplementation-during-pregnancy/) - Question About 3 years ago, I asked this thyroid manager whether it thought that hypothyroid women with autoimmune thyroid disease receiving levothyroxine (in treatment during pregnancy with increased doses of levothyroxine from the very beginning of pregnancy) should receive iodine supplements or not. At the time I was worried about the risk of a prolonged
- [Hyperthyroidism and Increasing LFT Abnormalities, What Therapy?](https://www.thyroidmanager.org/question/hyperthyroidism-and-increasing-lft-abnormalities-what-therapy/) - Question My patient is a 40-year-old lady with recently diagnosed Grave's Disease. For 2 months she had been complaining of palpitations, heat intolerance, tremors, 15 lb. weight loss, and lower extremity weakness. Her initial labs done 6/3/2009showed Total T4 = 17.1 (NV = 4.5-10.9), TSH = 0.008 (NV = 0.350-5.50). However, she also had LFT's
- [Graves, Exophthalmos, Mediastinal Mass, Heart Disease?](https://www.thyroidmanager.org/question/graves-exophthalmos-mediastinal-mass-heart-disease/) - Question A 62 y/o white female wit hyperthyroidism , diagnosed in the last 2 months c/w graves disease with severe exophthalmos , positive TSI ( no able to get the thyroid uptake and scan since she had a CT scan with contrast in the last 8 weeks ) – she was also found to have
- [Graves’ Disease in Pregancy and Atd Allergy, Possible Treatment?](https://www.thyroidmanager.org/question/graves’-disease-in-pregancy-and-atd-allergy-possible-treatment/) - Question I would like to ask for help and advice on the management of a 22 y/o female with Graves' disease who is currently 33 weeks pregnant. She presented with severe symptoms of thyrotoxicosis and was diagnosed with Graves' disease last summer 6 months after she delivered her first child. Her T4 and T3 were
- [Invasive Papillary Thyroid Cancer in a 71 Yr Old](https://www.thyroidmanager.org/question/invasive-papillary-thyroid-cancer-in-a-71-yr-old/) - Question I wanted to run something by you. I have a 71 yo discovered to have a 3.5cm follicular-variant of papillary which extends past the "inked specimen margins" into soft tissue - but has no know nodal mets. The surgeon who referred her to me says he "looked" at the nodes - but did not
- [131-I Treatment and Risk to Later Pregnancy](https://www.thyroidmanager.org/question/131-i-treatment-and-risk-to-later-pregnancy/) - Question I would appreciate it if you could let me if a patient who has undergone radioactive iodine treatment for thyrotoxicosis and against the advice, she becomes pregnant with in 3months of treatment, what should be the exact advice given to her? If she say what is the risk to the baby and whether or
- [Lower Limit of TSH for Replacement T4 Treatment in Pregancy](https://www.thyroidmanager.org/question/lower-limit-of-tsh-for-replacement-t4-treatment-in-pregancy/) - Question In our daily routine practice forpregnant hypothyroid women, the T4 dosage istitrated tomaintain serum TSH concentrations of less than 2.5 mIU/ml in the first trimester (or 3 mIU/ml in the second and third trimesters) as suggested by Endo Society. However, I wonder what isthe lower limit of TSH in a pregnant women on T4
- [Oral T4 Causing a Rash?](https://www.thyroidmanager.org/question/oral-t4-causing-a-rash/) - Question I had a question about a patient of mine. She is a 10 yr old with a TSH of 211, FT 0.3, positive TPO and TG antibodies. I started her on 50 mcg of synthroid and she broke out into rash. A lower dose of 25 is also causing a rash. Do we have
- [Hypothyroidism and Ascites](https://www.thyroidmanager.org/question/hypothyroidism-and-ascites/) - Question I have an interesting case to discuss and hear your opinion about the patient management. 78 years old African American female referred to me for a follow up of status post surgical hypothyroidism due to Multinodular goiter with compressive symptoms. She has a complicated post operative stage with severe hyponatremia and severe ascitic myxedema.
- [Prolonged TSH Suppression After Antithyroid Therapy of Graves](https://www.thyroidmanager.org/question/prolonged-tsh-suppression-after-antithyroid-therapy-of-graves/) - Question Please give me your opinion for another patient: A 33 years old female with history of Hyperthyroidism since 2008. She had taken Neomercazole 5mg to10mg until she became pregnant in 2008. During her pregnancy she was prescribed PTU 100mg daily and she is continuing same medications for first 6months during pregnancy and later stopped
- [Amiodarone Induced Thyrotoxicosis](https://www.thyroidmanager.org/question/amiodarone-induced-thyrotoxicosis/) - Question I recently saw an 82 year old gentleman referred to my VA clinic for hyperthyroidism. This individual had been previously well up until a few months prior. His only significant medical history was the development of cardiomyopathy along w/ a h/o of paroxysmal VT and a-fib. For the latter, he was started on "low
- [Hyperthyroidism in Pregnancy; Cause and Treatment?](https://www.thyroidmanager.org/question/hyperthyroidism-in-pregnancy-cause-and-treatment/) - Question My wife is a 37 year old female with no significant past medical history. She is presently in the 15th week of a twin gestation which has been otherwise uneventful.The pregnancy is a natural conception. She is gravida 3 para 2 with a 9 week miscarraige during her first pregnancy. During routine screening for
- [Hyperthyroidism in Pregnancy](https://www.thyroidmanager.org/question/hyperthyroidism-in-pregnancy/) - Question I received your email address through thyroidmanager.org and have a case I would like help with from your group of thyroid experts. A 29 yo G5P1A3( none spontaneous) referred to me 3/06/03 at 12 wks gestation for hyperthyroidism. HX: Admitted for hyperemesis 2/26-3/3. Had a normal 8 wk u/s. Normal fetal heart rate. Asx
- [Hives, Angioedema, and Hashimoto's Thyroiditis](https://www.thyroidmanager.org/question/hives-angioedema-and-hashimotos-thyroiditis/) - Question I have a female patient 38 yo dx with hashimoto's in late adolescense. She suffered from hyperthyroidism in her early childhood and was tx with PTU until the age of 16. She was dx with hashimoto's thyroiditis after the delivery of her first chold at 23 yrs and has been on Synthroid .125 since
- [Hurthle Cell Nodule and Hyperthyroidism in Hashimoto’s Gland](https://www.thyroidmanager.org/question/hurthle-cell-nodule-and-hyperthyroidism-in-hashimoto’s-gland/) - Question W is a 44 yo woman referred 3/02 for a thyroid nodule 1.2 cm bx “c/w Hash thyroiditis with Hurthle cell proliferation” cannot r/o Hurthle cell neoplasm h/o ? partial Lt thyroidectomy in 1991 on Synthroid since. Saw PMD to have BW checked, fullness noted Rt. Lobe. Had u/s and BX of rt. Nodule.
- [Follow-up in Differentiated Thyroid Cancers Under 1cm](https://www.thyroidmanager.org/question/follow-up-in-differentiated-thyroid-cancers-under-1cm/) - Question I am very impressed by WWW.THYROIDMANAGER.ORG and wish there were more like this. I have a question about the treatment and f/u of incidental or minimal pap thyroid cancer. Do you have any literature sources you could recommend reading re: this common problem? As an example, I have a 47 yo female patient with
- [Thyroid Hormone and TSH Levels During Pregnancy](https://www.thyroidmanager.org/question/thyroid-hormone-and-tsh-levels-during-pregnancy/) - Question I am a reproductive endocrinology and infertility specialist in Quito Ecuador. First of all congratulation for your thyroid website. It is very good and a great help. Knowing your great experience in thyroid problems I want to know if you could please be so kind to comment about the new TSH reference range. Last
- [Positive Antibodies, and Growing Nodules](https://www.thyroidmanager.org/question/positive-antibodies-and-growing-nodules/) - Question I have a puzzling case. 37 M seen by PCP April last year, felt ?enlarged thyroid . TSH normal . No antibodies done . USG showed multiple nodules, on R there were 2 solid nodules about 17 mm and 10 mm respectively and on L , there was a 12 mm circumscribed nodule in
- [Thyroxine Dosage and Surgery, or After 131-I Treatment](https://www.thyroidmanager.org/question/thyroxine-dosage-and-surgery-or-after-131-i-treatment/) - Question I very much appreciate your answers to my questions. They have been quite helpful. May I ask you another clinical question? Would you recommend lowering the dose of thyroid hormone prior to thyroid surgery in patients with thyroid cancer who have suppressed TSH, normal FT4? Also, when do your recommend restarting thyroid hormone therapy
- [131-I Treatment in Renal Failure](https://www.thyroidmanager.org/question/131-i-treatment-in-renal-failure/) - Question Thank you so much for providing this service. My question is about the safety of I131 therapy in a patient renal dysfunction. Her serum creatinine runs from 220umol/L to 310umol/L. (2.5-3.5mg/dL). She is a 65 year old woman who is hyperthyroid on the basis of an autonomously functioning nodule in a longstanding multinodular goitre.
- [Thyroiditis: Relation to Sertraline, and Lack of Melanin](https://www.thyroidmanager.org/question/thyroiditis-relation-to-sertraline-and-lack-of-melanin/) - Question Dear Sirs, I am writing you from Italy about a patient who was diagnosed Hashimoto's Thyroiditis in July 2002 (no treatment was given). She's a 40 y.o. woman whose latest blood tests (may 17,2003) were as follows: Ab anti-thyroglobuline = 779.5 ku/l, Ab anti-tpo = >2000 ku/l, TSH = 5.6 mu/l .Ft3 and ft4
- [Atypical Graves’ Disease](https://www.thyroidmanager.org/question/atypical-graves’-disease/) - Question Dear Sir, I am a Family Physician from the UK. I am writing about the case of a 37 year old female patient, who was recently diagnosed with Graves' disease, but the presentation and clinical course to date have been most atypical. The patient first presented four months ago with an acute maculopapular rash,
- [Therapy of a Patient with a Solitary Vertebral Metastasis](https://www.thyroidmanager.org/question/therapy-of-a-patient-with-a-solitary-vertebral-metastasis/) - Question I have a patient who had a 3.5 cm follicular carcinoma reoccur as a solitary vertebral met 13 years later..Thyrogobulin rose to max of 63 during the reoccurrence-we treated with local externall radiation and high dose I131--one year later the thyroglobulin is 7 clinically she feels well- no major pain and neurologically intact-(it is
- [Amiodarone and Recurrent Graves’ disease](https://www.thyroidmanager.org/question/amiodarone-and-recurrent-graves’-disease/) - Dear Professor Hennemann, You may recall I previously wrote to you about a case of atypical Graves disease, and found your response and comments most helpful and interesting. First of all, I would like to thank you and your team once again for providing such an invaluable 'Ask an expert' service at the ThyroidManager.org site.
- [Nodules, Positive Antibodies, and Treatment?](https://www.thyroidmanager.org/question/nodules-positive-antibodies-and-treatment/) - Question Dear Doctors, I would appreciate your opinion concerning this case: 34 yr old female with multinodular goiter. She displays no symptoms and labs are TSH 2.02 ìIU/ml FT3 2.5 pg/ml FT4 1.01 ng/ml anti TPO 12.45 IU/ml anti TG 17.49 IU/ml TBG 194 ng/ml Ultrasound: 3.2 x 2.1 cm nodule L, 2.1 cm nodule
- [Sublinical Hyperthyroidism and Substernal Goiter](https://www.thyroidmanager.org/question/sublinical-hyperthyroidism-and-substernal-goiter/) - Question I would appreciate your or your panel of expert' s assistance with a patient. Patient is a 46 yo male with a multinodular goiter. He has no compressive symptoms and no symptoms of hyperthyroidism. At his lastvisit his pulse was 60. His TSH 0.09, FT4: 1.15, T3:120 T3RU: 33%. Recentultrasound multiple bilat nodules largest
- [Thyroid Carcinoma Diagnosed by Bronchoscopy](https://www.thyroidmanager.org/question/thyroid-carcinoma-diagnosed-by-bronchoscopy/) - Question I was asked to consult on a patient who felt well but went to his doc with hemoptsis. A lesion was biopsied through the bronchoscope-the diagnosis came back papillary cancer either metastatic or ectopic. The patient has been treated for several years for hypothyroidism-no local symptoms ever reported until this one episode of coughing
- [Neonate with Large Goiter](https://www.thyroidmanager.org/question/neonate-with-large-goiter/) - Question Full term newborn male with a hx of IUGR in utero born to a mother who smoked during pregnancy but who has no hx of thyroid problems, who at birth has some respiratory distress and is noted to have a large neck mass. TSH is 775mcIU/ml and free T4 is 0.39 ng/dl so he
- [Central Hypothyroidism?](https://www.thyroidmanager.org/question/central-hypothyroidism/) - Question I am presenting a patient who I need some advice as to how I can make a diagnosis. A 66 year old female with h/o primary hypothyroidism (TSH:7.103 in 6/01) started on synthroid 50 mcg/ day and repeat TSH was 3.318 on 8/01. Pt then was lost to f/u and the next TSH available
- [Malabsorption of Thyroxine?](https://www.thyroidmanager.org/question/malabsorption-of-thyroxine/) - Question I have a patient (I don't have her chart available to me tonight) whom, I suspect, is apparently simply not taking her oral thyroid medication at all for primary hypothyroidism. Despite increases in her dose of levothyroxine (Synthroid) from 150mcgs to 400mcgs over about a 4 month period of time, her thyroid levels never
- [Growing Hot Nodule](https://www.thyroidmanager.org/question/growing-hot-nodule/) - Question I would appreciate the advice of your experts on one of my patients. She is a 70 yo woman with a hot nodule which increased from 3 to 3.8 cm between 2000 and 2002. It has recently increased over the past year to 5 cm.I saw her first a year ago. She has no
- ["Incidental" Medullary Carcinoma](https://www.thyroidmanager.org/question/incidental-medullary-carcinoma/) - Question I have a patient who was operated for a benign goiter (colloid) -age 49-Mother had papillary thyroid cancer-My patient had total thyroidectomy -a 6 mm left lobe only medullary cancer was found in the specimen when the analysis was completed- My questions are 1. What do we know about the behavior of incidental medullary
- [Onset Long After](https://www.thyroidmanager.org/question/onset-long-after/) - Question This is a case of a 41 years-old woman whounderwent subtotal thyroidectomy 10 years agobecause of aGraves disease with mild palpebral edema.After surgery shehas beentreated with levothyroxineadjusted according to her plasmatic TSH levels. Ten years later, while she was taking 100 ug of levothyroxin, an ophtalmopathy appeared with proptosis. CT scan showed an enlargement
- [Thyrotoxicosis, Ventricular Fibrillation, Hypokalemia](https://www.thyroidmanager.org/question/thyrotoxicosis-ventricular-fibrillation-hypokalemia/) - Question I wonder what you think of the following patient I am in charge for: Caucasian male, 30years old, police man. He has never been ill before. After strenuous exercise (squash for some hours) the night before he is losing consciousness the next day in the morning in the office. The emergency doctor diagnoses ventricular fibrillation
- [Thyrotoxic Hypokalemic Paralysis and 131-I Therapy](https://www.thyroidmanager.org/question/thyrotoxic-hypokalemic-paralysis-and-131-i-therapy/) - Question I have a 28 yo white male with thyrotoxicosis and periodic hypokalemic paralysis. He is 5 days post RAI and seems to be having an exacerbation of the thyrotoxicosis and paralysis. I started him on Tapazole 30, have him well beta blocked and on 20 meq KCl daily. Is there anything else I can
- [Thyroid Cyst, and Mild Hyperthyroidism, in Pregnancy](https://www.thyroidmanager.org/question/thyroid-cyst-and-mild-hyperthyroidism-in-pregnancy/) - Question I am an endocrinologist in Salisbury, NC. I saw a 37yo WF in her first trimester with a distant history of solitary thyroid cyst. The pt was clinically euthyroid. On exam she had a readily palpable 3+ cm R sided thyroid nodule. Her tsh was
- ["Subclinical Hypothyroidism" with Normal freeT4 and TSH](https://www.thyroidmanager.org/question/subclinical-hypothyroidism-with-normal-freet4-and-tsh/) - Question Dear Sir, I am a GP in a rural area with little population migration. In the last 15 months, I have seen 10 patients with more than 5 symptoms each, suggestive of hypothyroidism. 9 were females, one 14 y, eight 39-58 years old, one 69 year old male patient. All had TSH 2-3 (0.15-3.5),
- [Thyrotoxicosis and Pregnancy](https://www.thyroidmanager.org/question/thyrotoxicosis-and-pregnancy/) - Question Dear Sir, What one would do with a 20 years old lady with a recently diagnosed graves disease who would like to get married next week. Her partner refused to delay the wedding and will not accept her to be on contraception. What would be the optimum management. Should we operate on her. Would
- [Hypothyroisim, Renal Insufficiency, and RAI Therapy](https://www.thyroidmanager.org/question/hypothyroisim-renal-insufficiency-and-rai-therapy/) - Question I am a physician with a 3.5 cm papillary thyroid cancer 5.5 weeks post total-thyroidectomy (no macroscopic extension, no known distant mets, but a few positive lymph nodes) about to undergo ablation with 150 mCi iodine next week. I was otherwise healthy, 43 years old, with no meds and no prior medical problems. Post
- [Liver Failure and Severe Thyrotoxicosis](https://www.thyroidmanager.org/question/liver-failure-and-severe-thyrotoxicosis/) - Question An 18 yo AA Male with Graves disease was transferred to our hospital for liver transplant b/o acute liver failure while taking PTU. This has been d/c five days before the admission although low compliance was suspected. The TFT were still reflecting a suppressed TSH, high FT4 and FT3. Clinically the pt was thyrotoxic
- [Normal Thyroid Tests Except for Elevated RT3](https://www.thyroidmanager.org/question/normal-thyroid-tests-except-for-elevated-rt3/) - Question I am a physician who practice in El Paso, TX. I just got a patient complaining of fatigue with the following thyroid panel results: TSH - 2.04 uIU/mL T4 Total - 8.55 ug/dL (4.87 - 11.72) T Uptake - 43.3 % (32 - 51) Free Tiroxine Index - 9.26 ug/dL (5.93 - 13.13) T3
- [Surgery with Adrenal Mass; "Incidental" Medullary Carcinoma](https://www.thyroidmanager.org/question/surgery-with-adrenal-mass-incidental-medullary-carcinoma/) - Question Thank you so much for responding to my e mails. I wish to get your views on these cases. 43 year old male diagnosed with NHLymphoma 1991,post surgery,post RT.Incidental finding of 1.3 cm adrenal adenoma right, serial ct/mri of the adrenals showed increase in size 2003 1.8 cm,2004 1.6 cm. He is clinically ok,
- [Congenital Thyroid Deficiency, No Raiu, and Thyroid Cancer](https://www.thyroidmanager.org/question/congenital-thyroid-deficiency-no-raiu-and-thyroid-cancer/) - Question Thanks for taking the time to read this. I am a registrar from South Africa with an interesting young patient in whom your opinion would be greatly Appreciated. This young male first presented as a neonate with congenital hypothyroidism. At that time a thyroid uptake scan showed no thyroid tissue anywhere and a diagnosis
- [Abnormal Thyroid Tests in Pregnancy](https://www.thyroidmanager.org/question/abnormal-thyroid-tests-in-pregnancy/) - Question Mrs. S is a 28 year old female with no significant past medical history, who is at 27 weeks gestation. Her pregnancy to date has been normal, some nausea during the first trimester, but she has put on an appropriate amount of weight and is tolerating foods well. Her thyroid function tests done are
- [Hashimoto’s, Urticaria, and Stomach Pains](https://www.thyroidmanager.org/question/hashimoto’s-urticaria-and-stomach-pains/) - Question 38 YOWF with Hashimoto's - she has subtotal thyroidectomy (elective) about 4 years ago and takes unithroid daily (85mcg).She has had bouts of Uticaria and Angioedema and I am relating this to the Hashimoto's.In addition she gets episodes of sever stomach pains with vomiting. I am suspicious that this too is related to the
- [Hurthle Cell Carcinoma, Residual Disease Post-op](https://www.thyroidmanager.org/question/hurthle-cell-carcinoma-residual-disease-post-op/) - Question 54 year old found to have a right sided nodule which, on biopsy, was felt to be Hurthle cell. Total thyroidectomy performed 4/04. Tumor was 7 x 3 x 2.5 cm with invasion of tumor through capsule. Although margins of excision were free of tumor. lymphatic invasion was present. An additional microscopic focus of
- [Chroic Urticaria, Thyroxine Treatment, Thyroid Cancer](https://www.thyroidmanager.org/question/chroic-urticaria-thyroxine-treatment-thyroid-cancer/) - Question I ask to you to help me for curing this patient. She is 48 years old women, in 1996 diagnized that she have papillary carcinoma of thyroid gland, and then she did total thyroidectomy operation in same year outside Iraq. And postoperatively she took radioactive iodine. And after 6 monthes she did scaning ,
- [Thyroid Hormone Resistance Vs. TSH-oma?](https://www.thyroidmanager.org/question/thyroid-hormone-resistance-vs-tsh-oma/) - Question Wonder if I might get an opinion on what you would do next: 74 year old male had routine physical exam and labs done by his primary care physician in May. As part of laboratory panel a TSH and free T4 were done. The TSH was 1.64 (0.4-4.0) and the free T4 was 2.03
- [Elevated Hormone Levels, Congenital Hypothyroidism, Psychiatric Problem](https://www.thyroidmanager.org/question/elevated-hormone-levels-congenital-hypothyroidism-psychiatric-problem/) - Question Hello, I'd appreciate your input on this patient's scenario: H41+ female, Hypothyroid since birth [uncertain of any presence of gland] Medicated from 18mths Oroxine medication monitored every few months. blood pathology indicating appropriate dose. Dose for many years: 400mg daily. No notable deformities, other than stunted thumbs. Patient treated for depression over past 12
- [Carbimazole Treatment and Hair Loss](https://www.thyroidmanager.org/question/carbimazole-treatment-and-hair-loss/) - Question Happy Thanksgiving. My question is about carbimazole.Many patients of mine complain of falling hair now that their hormones are better .They all have gained weight already and feeling much much better,but why the falling hair?Any thoughts. Thanks Sir for reading my e mail. lynnbilarmd@yahoo.com Response Dear Colleague, Falling hair is one of the acknowledged
- [Nodules After RAI Therapy of TMNG](https://www.thyroidmanager.org/question/nodules-after-rai-therapy-of-tmng/) - Question I believe RAI is the better option for toxic multinodular goiter. Can you comment on situations when 1) nodules become bigger year(s) post RAI, or minimal change if at all? 2) growth of new nodules post RAI. These patients are already on replacement doses of Lt4 for hypothyroidim(post ablation).I wonder if the kind of
- [Diagnosis and Treatment of NTIS](https://www.thyroidmanager.org/question/diagnosis-and-treatment-of-ntis/) - Question I am an intensivist and I'm very confused about the literature about NTSI or "euthyroid sick syndrome". As we now are used to use some kind of endocrine replacement therapy (fe. hydrocortisone, vasopressine) on a routine basis, we are currently reevaluating our approach to the NTSI. I read with great interest your article in
- [Preparation for Treatment of a Toxic Adenoma](https://www.thyroidmanager.org/question/preparation-for-treatment-of-a-toxic-adenoma/) - Question I am wondering what is the proper way to prepare a patient with toxic adenoma prior to rai. How long and how much t4 do we give? How about those patients who are clinically and biochemically toxic? Thanks so much Doctor for your generosity. L. W.Bilar, MD Response Usually in patients with a single
- [Possible Resistance to Thyroid Hormone](https://www.thyroidmanager.org/question/possible-resistance-to-thyroid-hormone/) - Question Dear Doctors: A 3 9/12 year old boy was referred to us because of elevated T3, T4 and positive microsomal antibodies. He has a history of developmental delay and hyperactive behavior. On 9/2/04: T4 = 14.3 (5-12.5) free T4 = 1.79 (.77-2.02) T3 = 353 (75-250) TSH = 1.26 (.4-8.1) antithyroglobulin ab (
- [Minimally Invasive Follicular Carcinoma](https://www.thyroidmanager.org/question/minimally-invasive-follicular-carcinoma/) - Question I am still confused on the staging and management of a minimally invasive follicular carcinoma. As an example, I have a patient who is 35 years old and had a 3.7cm minimally invasive follicular carcinoma resected with a total thyroidectomy. The remainder of the gland showed only thyroiditis. There was no vascular invasion noted.
- [Positive I-131 Scan Post Therapeutic I-131](https://www.thyroidmanager.org/question/positive-i-131-scan-post-therapeutic-i-131/) - Question The patient is a hearty 85yo gentleman who presented with a right neck mass, subsequently diagnosed as metastatic papillary thyroid CA. The patient underwent total thyroidectomy with right modified radical neck dissection. He had Hashimoto's thyroiditis with Hurthle cell changes and a focal hyperplastic nodule. No primary CA found in the thyroid. He had
- [Rai Treatment After Lugol’s Iodine](https://www.thyroidmanager.org/question/rai-treatment-after-lugol’s-iodine/) - Question I have a young woman who recently presented with thyroid crisis due to graves' disease. She was successfully managed with beta blockade, propylthiouracil, dexamethasone and 10 days of lugol's iodine. She is now controlled on thionamide alone. I would be grateful for your advice as to how long to wait before administering radioiodine, given
- [Thyroid Patient with Asthma, Allergy to Carbimazole, Allery to Ptu?](https://www.thyroidmanager.org/question/thyroid-patient-with-asthma-allergy-to-carbimazole-allery-to-ptu/) - Question A female patient around 40 yrs old, developed thyroid toxic symptoms, her free T4 is around 50. She was given CMZ but developed urticaria, she was prescribed the anti-allergy med with PTU, but she developed bronchospasm the next day. Both meds were stopped now. 1. should PTU be tried? is the allergy due to
- [A Child with Non-Autoimmune Hyperthyroidism](https://www.thyroidmanager.org/question/a-child-with-non-autoimmune-hyperthyroidism/) - Question Dear Experts, I was recently asked for a second opinion about a child now aged 10yrs 7 mos who has non-autoimmune hyperthyroidism first diagnosed at 3 yrs age following investigation for tachycardia. Her initial FT4 was 77pmol/l and her TSH was
- [Neonate with Possible Hypothyroidism](https://www.thyroidmanager.org/question/neonate-with-possible-hypothyroidism/) - Question 2 month old baby,male, was born full term, birth weight 3.2kg. No neonatal complications. No hipoglicemia, jaundice or micropenis. Normal newborn screening (Normal TSH and Free T4). Maternal data: no medications during pregnancy or breastfeeding, no problems during pregnancy. Normal Thyroid function test.No hoarse cry, facial puffiness, umbilical hernia, hypotonia, mottling, cold hands and
- [Adiation and Breast Feeding](https://www.thyroidmanager.org/question/adiation-and-breast-feeding/) - Question I have a patient with papillary thyroid cancer with nodal metastasis. She was diagnosed when she was pregnant at 2 months. One month postpartum, she underwent total thyroidectomy, and is being evaluted for radioblation with suppressive therapy. She is currently breast feeding, and intends to breast feed her now 2 months old child. How
- [Cholestasis from MMI](https://www.thyroidmanager.org/question/cholestasis-from-mmi/) - Question I am a pediatric endocrinologist and I am seeing a girl of 10 years old otherwise healthy that presents to consultation with clinical and biochemical thyrotoxicosis. She began treatment with MMI 30 mg day and had an episode of cholestasis that remitted with withdrawal . As I did not see this episode myself and
- [Hurthle Cell Tumor, Mico-CA, Post-Lobectomy](https://www.thyroidmanager.org/question/hurthle-cell-tumor-mico-ca-post-lobectomy/) - Question I am presently managing a 74 year old Caucasian lady with past history of ASHDand breast cancer (1985) who was found to have thyroid nodules on a routine physical. She was and still is asymptomatic. Thyroid function tests within normal limits. Thyroid US revealed a mildly enlarged gland with a dominant 2.5 cm nodule
- [Infant with Genetic Problem and Hypothyroidism](https://www.thyroidmanager.org/question/infant-with-genetic-problem-and-hypothyroidism/) - Question Dear Sirs: First of all thank you very much for your help. I have been consulted for a 3 year old boy whowas born from un uneventfull pregnancy and delivery with an APGAR score of 1/8. TSH was informed as normal in neonatal screening and a TSH levelof 6.54 mu/l was foundat two months
- [Aggressive MTC with Post-op Elevated CT and CEA](https://www.thyroidmanager.org/question/aggressive-mtc-with-post-op-elevated-ct-and-cea/) - Question I hope you can help with this lady I saw recently. She is a 59 y/o who was initially diagnosed with papillary thyroid ca after FNA of mass on right thyroid. Surgical path surprisingly revealed medullary thyroid ca - initial pathology showed a dominant lesion in the right lobe 3.5 cm and a second
- [Thyroid Hormone Resistance?](https://www.thyroidmanager.org/question/thyroid-hormone-resistance/) - Question I have recently seen a young Caucasian girl, aged 20 years. Her family physician has referred her with persistently raised T3. She does not have any hyperthyroid symptoms at all and on other systemic enquiry she is asymptomatic. Her mother confirmed that she had a normal birth and normal childhood and pubertal developments, both physically and mentally. Physical examination
- [Borderline Elevated T3/Subclinical Hyperthyroidism?](https://www.thyroidmanager.org/question/borderline-elevated-t3subclinical-hyperthyroidism/) - Question I would appreciate your input on the following case: DD, a 9yrs and 7 month old white male, was first referred to me 3 months ago for a goiter. He has ADD and is on Concerta. He takes Claritin prn for allergies. He was recovering from an URTI, for which he had been on
- [Graves Disease and Incidental Thyroid Cancer](https://www.thyroidmanager.org/question/graves-disease-and-incidental-thyroid-cancer/) - Question A 17 years old girl was totaly thyroidectomized for Graves disease and histologic examination revealed a focus of papillary carcinoma of 8 mm. Post thyroidectomy the TRAB is 10,5U/l (normal values < 11), ATPO is >600 UI/ml( normal values <34), and ATGL is 51,43 UI/ml (normal values < 115). How do I best manage
- [Hyperthyroidism and Amenorrhea](https://www.thyroidmanager.org/question/hyperthyroidism-and-amenorrhea/) - Question My patient is 27 G1P1 desirous of pregnancy who stopped DepoProvera 1/05 and continues to be amenorrheic. 6/05 TSH =

## Chapters

- [Thyroid Regulation and Dysfunction in the Pregnant Patient](https://www.thyroidmanager.org/chapter/thyroid-regulation-and-dysfunction-in-the-pregnant-patient/) - Elizabeth N. Pearce, MD, MSc, Professor, Department of Medicine, Boston University Chobanian & Avedisian School of Medicine, Boston, MA. elizabeth.pearce@bmc.org ABSTRACT Thyroid dysfunction is common in pregnancy. This chapter reviews alterations in thyroid physiology during normal pregnancy. The interpretation of thyroid function tests in pregnancy is discussed. Preconception considerations for women with thyroid dysfunction and/or
- [Thyroid Cancer In The Elderly](https://www.thyroidmanager.org/chapter/thyroid-cancer-in-the-elderly/) - ABSTRACT This article provides reviews and updates of thyroid cancer, with particular emphasis on aspects related to advanced age. After analyzing epidemiology and anatomical pathology, it addresses novel developments in molecular biology and biological markers and their impact on diagnosis and therapeutic selection. The main histological subtypes affecting older patients are reviewed in detail,
- [Diagnosis and Treatment of Graves' Disease](https://www.thyroidmanager.org/chapter/diagnosis-and-treatment-of-graves-disease/) - ABSTRACT The diagnosis of Graves’ disease is mostly straightforward, depending on recognition of the cardinal features of the disease and confirmation by tests including serum TSH, free T4, and TSH receptor antibodies. The differential diagnosis includes other causes of thyrotoxicosis, such as secretory thyroid nodules, various forms of inflammatory or destructive thyroiditis, or thyrotoxicosis factitia.
- [Thermal Ablation for Thyroid Nodules](https://www.thyroidmanager.org/chapter/thermal-ablation-for-thyroid-nodules/) - ABSTRACT Thermal ablation (TA) of thyroid lesions has revolutionized the management of thyroid nodules over the past two decades. TA has emerged as an innovative, minimally invasive treatment modality for benign thyroid nodules and recurrent thyroid cancers. More recently, TA has been proposed as an alternative therapeutic option for selected cases of primary thyroid
- [Thyroid Hormones in Brain Development and Function](https://www.thyroidmanager.org/chapter/thyroid-hormones-in-brain-development-and-function/) - ABSTRACT Thyroid hormones are essential for normal brain development. They influence neurogenesis, neuronal and glial cell differentiation and migration, synaptogenesis, and myelination. Thyroid hormone deficiency may severely affect the brain during fetal and postnatal development, causing retarded maturation, intellectual deficits, and neurological impairment. Neural cells express the thyroid hormone nuclear receptors THRA and THRB,
- [Thyrotropin-Secreting Pituitary Adenomas](https://www.thyroidmanager.org/chapter/thyrotropin-secreting-pituitary-adenomas/) - ABSTRACT Thyrotropin-secreting pituitary tumors (TSH-omas or TSH-PitNET) are a rare cause of hyperthyroidism and account for about 1% of all pituitary adenomas. It is, however, noteworthy that the number of reported cases increased over the last few decades because of the improved awareness of this condition. Indeed, ultrasensitive TSH assays allow a clear distinction between
- [Assay of Thyroid Hormone and Related Substances](https://www.thyroidmanager.org/chapter/assay-of-thyroid-hormone-and-related-substances3/) - ABSTRACT This chapter reviews how improvements in the sensitivity and specificity of thyroid tests [total and free thyroid hormones (T4 and T3), TSH, thyroid autoantibodies (TRAb, TPOAb, and TgAb) and thyroglobulin (Tg)] have advanced the detection and treatment of thyroid disorders. The strengths and limitations of current methodologies [Radioimmunoassay (RIA), Immunometric assay (IMA) and
- [Graves' Disease and the Manifestations of Thyrotoxicosis](https://www.thyroidmanager.org/chapter/graves-disease-and-the-manifestations-of-thyrotoxicosis/) - ABSTRACT Graves' disease (GD) is an autoimmune disorder characterized by hyperthyroidism and various systemic manifestations, including thyroid eye disease (TED) and, less commonly, dermopathy. This chapter provides an in-depth review of GD, covering its history, epidemiology, risk factors, and the molecular mechanisms underlying autoimmune hyperthyroidism. Emphasis is placed on emerging insights into the genetic,
- [Impaired Sensitivity to Thyroid Hormone: Defects of Transport, Metabolism and Action](https://www.thyroidmanager.org/chapter/impaired-sensitivity-to-thyroid-hormone-defects-of-transport-metabolism-and-action-2/) - ABSTRACT Resistance to thyroid hormone (RTH), a syndrome of reduced responsiveness of target tissues to thyroid hormone (TH) was identified in 1967 (1). An early report proposed various mechanisms including defects in TH transport, metabolism and action (2). However, with the identification of TH receptor beta (THRB) gene mutations in 1989 (3, 4), the
- [Thyroid Nodules and Thyroid Cancer Prior to, During, and Following Pregnancy](https://www.thyroidmanager.org/chapter/thyroid-nodules-and-thyroid-cancer-pregnancy/) - ABSTRACT Thyroid cancer is the second most common malignancy to co-occur in pregnancy. Further, the rising prevalence of treated thyroid cancer in women of child-bearing age means that survivors of thyroid cancer are frequently presenting for obstetric care, occasionally in the setting of persisting structural disease. To ensure that optimal health outcomes are achieved
- [Defects of Thyroid Hormone Transport in Serum](https://www.thyroidmanager.org/chapter/defects-of-thyroid-hormone-transport-in-serum-2/) - ABSTRACT Inherited abnormalities of thyroid hormone-binding proteins are not uncommon and can predominate in some ethnic groups. They alter the number of iodothyronines present in serum and, although the concentration of free hormones remains unaltered, routine measurement can give erroneous results. With a single exception, inherited defects in thyroxine-binding globulin (TBG), are X-chromosome linked and
- [Acute and Subacute, and Riedel’s Thyroiditis](https://www.thyroidmanager.org/chapter/acute-and-subacute-and-riedels-thyroiditis-2/) - ABSTRACT The thyroid, like any other structure, may be the seat of an acute or chronic suppurative or non-suppurative inflammation. Various systemic infiltrative disorders may leave their mark on the thyroid gland as well as elsewhere. Infectious thyroiditis is a rare condition, usually the result of bacterial invasion of the gland. Its signs are the
- [PHYSIOLOGY OF THE HYPOTHALAMIC-PITUITARY-THYROID AXIS](https://www.thyroidmanager.org/chapter/physiology-of-the-hypothalamic-pituitary-thyroid-axis/) - ABSTRACT The activity of the thyroid gland is predominantly regulated by the concentration of the pituitary glycoprotein hormone, thyroid-stimulating hormone (TSH). In the absence of the pituitary or of thyrotroph function, hypothyroidism ensues. Thus, regulation of thyroid function in normal individuals is to a large extent determined by the factors which regulate the synthesis
- [test](https://www.thyroidmanager.org/chapter/thyroid-nodules-and-thyroid-cancer-prior-to-during-and-following-pregnancy-2/) - ABSTRACT Thyroid cancer is the second most common malignancy to co-occur in pregnancy. Further, the rising prevalence of treated thyroid cancer in women of child-bearing age means that survivors of thyroid cancer are frequently presenting for obstetric care, occasionally in the setting of persisting structural disease. To ensure that optimal health outcomes are achieved
- [Thyroid Hormone Serum Transport Proteins](https://www.thyroidmanager.org/chapter/thyroid-hormone-serum-transport-proteins-3/) - ABSTRACT Thyroid hormone (TH) effects are dependent on the quantity of the hormone that reaches the tissues, hormone activation, and the availability of unaltered TH receptors in the cell’s nuclei and cytoplasm. Since TH enters the cell unbound, the concentration of free rather than total hormone reflects more accurately the activity level of TH-dependent
- [Thyroid Nodules and Cancer in the Elderly](https://www.thyroidmanager.org/chapter/thyroid-nodules-and-cancer-in-the-elderly-tdm/) - ABSTRACT Thyroid nodules and thyroid cancer are common in elderly patients and demonstrate age-specific prevalence, malignancy risk, and clinical behavior. Improved risk stratification by ultrasound characteristics and molecular testing of thyroid nodules pre-operatively has reduced the need for diagnostic surgery in many individuals. In patients with differentiated thyroid cancer, total thyroidectomy and radioactive iodine
- [Thyrotropin-Secreting Pituitary Adenomas](https://www.thyroidmanager.org/chapter/thyrotropin-secreting-pituitary-adenomas-tdm/) - ABSTRACT Thyrotropin-secreting pituitary tumors (TSH-omas) are a rare cause of hyperthyroidism and account for less than 1% of all pituitary adenomas. It is, however, noteworthy that the number of reported cases increased over the last few years because of the routine use of ultrasensitive immunometric assays for measuring TSH levels. Contrary to previous RIAs, ultrasensitive
- [Ultrasonography of the Thyroid](https://www.thyroidmanager.org/chapter/ultrasonography-of-the-thyroid-tdm/) - ABSTRACT Thyroid ultrasonography (US) is the most common, extremely useful, safe, and cost-effective way to image the thyroid gland and its pathology. US has largely replaced the need for thyroid scintigraphy except to detect iodine-avid thyroid metastases after thyroidectomy and to identify hyper-functioning (toxic) thyroid nodules. This chapter reviews the literature; discusses the science
- [Clinical Strategies in the Testing of Thyroid Function](https://www.thyroidmanager.org/chapter/clinical-strategies-in-the-testing-of-thyroid-function-tdm/) - ABSTRACT In the past decades, emphasis has shifted from testing thyroid function in individuals who are likely to have clinically overt thyroid disorders to a broader population, an approach that includes also identification of so-called subclinical or mild thyroid dysfunctions. The key measurement methods used to detect thyroid dysfunction are still serum thyroid stimulating
- [Fine-Needle Aspiration of the Thyroid Gland](https://www.thyroidmanager.org/chapter/fine-needle-aspiration-of-the-thyroid-gland/) - ABSTRACT Thyroid nodules are common in clinical practice and the majority is benign with the risk of malignancy varying from 7 to 15%. Clinical evaluation includes careful history and physical examination, laboratory tests, neck ultrasound (US), and a fine-needle aspiration (FNA). Thyroid FNA or biopsy is an accurate test for determining malignancy in a
- [Hypothyroidism in Older Adults](https://www.thyroidmanager.org/chapter/hypothyroidism-in-older-adults/) - ABSTRACT Hypothyroidism is more common among elderly individuals due to the increasing incidence and prevalence of autoimmune thyroiditis that occurs with aging. Accurate diagnosis of this condition in the elderly may be challenging due to a number of factors including a relative paucity of referable symptoms, confounding findings that may be related to comorbid disorders,
- [Hyperthyroidism in Aging](https://www.thyroidmanager.org/chapter/hyperthyroidism-in-aging/) - ABSTRACT Hyperthyroidism in the elderly is a serious clinical condition that is associated with significant morbidity and excess mortality. It may be difficult to diagnose due to the confounding effects of drugs and acute or chronic illnesses on the interpretation of thyroid function tests. Hyperthyroidism is usually diagnosed when a suppressed TSH level is
- [Metabolism of Thyroid Hormone](https://www.thyroidmanager.org/chapter/metabolism-of-thyroid-hormone/) - ABSTRACT Thyroid hormone is indispensable for normal development and metabolism of most cells and tissues. Thyroid hormones are metabolized by different pathways: glucuronidation, sulfation, and deiodination, the latter being the most important. Three enzymes catalyzing deiodination have been identified, called type 1 (D1), type 2 (D2) and type 3 (D3) iodothyronine deiodinases. D1
- [Cellular Action of Thyroid Hormone](https://www.thyroidmanager.org/chapter/cellular-action-of-thyroid-hormone/) - ABSTRACT Thyroid hormones (THs) regulate growth, development, metabolism. This chapter aims to provide a comprehensive overview of the molecular and cellular mechanism(s) for intracellular signaling by TH. At the cellular level, THs bind to thyroid hormone receptors (TRs) that are members of the nuclear hormone receptor family. TRs act as ligand-activated transcription factors that bind
- [Graves' Disease: Complications](https://www.thyroidmanager.org/chapter/graves-disease-complications/) - ABSTRACT Thyroid storm is an acute and life-threatening worsening of hyperthyroidism, characterized by an exacerbation of symptoms and signs of hyperthyroidism, with high fever, dehydration, marked tachycardia or tachyarrhytmias, heart failure, hepatomegaly, respiratory distress, abdominal pain, delirium, possibly seizures. It may occur in patients submitted to thyroidectomy or radioactive iodine treatment while hyperthyroid, or as
- [The Iodine Deficiency Disorders](https://www.thyroidmanager.org/chapter/the-iodine-deficiency-disorders/) - ABSTRACT This chapter provides an overview of the disorders caused by iodine deficiency. Extensively referenced, it includes data on dietary sources of iodine, goitrogens, the effects of iodine deficiency throughout the lifecycle, the pathophysiology of iodine deficiency, as well as strategies for control and monitoring of the iodine deficiency disorders, such as iodized salt and
- [Genetic Defects in Thyroid Hormone Supply](https://www.thyroidmanager.org/chapter/genetic-defects-in-thyroid-hormone-supply/) - ABSTRACT Congenital hypothyroidism (CH) is the most frequent endocrine-metabolic disease in infancy, with an incidence of about 1/2500 newborns [1, 2]. In the last 20-30 years the incidence of congenital hypothyroidism in newborns has increased from 1:4000 to 1:2000 [3, 4]. This phenomenon could be explained by using a lower b-TSH cutoff, that allowed
- [Hashimoto's Thyroiditis](https://www.thyroidmanager.org/chapter/hashimotos-thyroiditis1/) - ABSTRACT Hashimoto's thyroiditis is characterized clinically as a commonly occurring, painless, diffuse enlargement of the thyroid gland occurring predominantly in middle-aged women. The patients are often euthyroid, but hypothyroidism may develop. The thyroid parenchyma is diffusely replaced by a lymphocytic infiltrate and fibrotic reaction; frequently, lymphoid germinal follicles are visible. Persons with Hashimoto's thyroiditis have
- [TSH Receptor Mutations and Diseases](https://www.thyroidmanager.org/chapter/tsh-receptor-mutations-and-diseases/) - ABSTRACT The thyroid-stimulating hormone (TSH) receptor (TSHR) is a member of the glycoprotein hormone receptors (GPHRs), a sub-group of class A G protein-coupled receptors (GPCRs). TSHR and its ligand thyrotropin are of essential importance for growth and function of the thyroid gland. The TSHR activates different G-protein subtypes and signaling pathways, of which Gs and
- [Chapter 2 Thyroid Hormone Synthesis And Secretion](https://www.thyroidmanager.org/chapter/chapter-2-thyroid-hormone-synthesis-and-secretion/) - ABSTRACT The main function of the thyroid gland is to make hormones, T4 and T3, which are essential for the regulation of metabolic processes throughout the body. As at any factory, effective production depends on three key components - adequate raw material, efficient machinery, and appropriate controls. Iodine is the critical raw material, because 65%
- [Disorders of the Thyroid Gland in Infancy, Childhood and Adolescence](https://www.thyroidmanager.org/chapter/disorders-of-the-thyroid-gland-in-infancy-childhood-and-adolescence/) - This chapter is, in part, based on the previous version written by Prof. Rosalind Brown. ABSTRACT Thyroid disorders in infancy, childhood and adolescence represent common and usually treatable endocrine disorders. Thyroid hormones are essential for normal development and growth of many target tissues, including the brain and the skeleton. Thyroid hormone action on critical genes
- [Ontogeny, Anatomy, Metabolism and Physiology of the Thyroid](https://www.thyroidmanager.org/chapter/ontogeny-anatomy-metabolism-and-physiology-of-the-thyroid/) - ABSTRACT This chapter presents an analysis and a summarized synthesis of our present knowledge of the biology of the thyroid gland, phylogeny ,ontogeny ,anatomy ,structure ,general metabolism ,regulatory factors and hormones , signalling cascades and their regulations , ( eg TSH ), functions including iodine metabolism and thyroid hormones synthesis , control of gene expression ,differentiation
- [Effects of the Environment, Chemicals and Drugs on Thyroid Function](https://www.thyroidmanager.org/chapter/effects-of-the-environment-chemicals-and-drugs-on-thyroid-function/) - ABSTRACT The sensitive and tightly regulated feedback control system, thyroid gland autoregulation, and the large intrathyroidal and extrathyroidal storage pools of thyroid hormone serve to provide a constant supply of thyroid hormone to peripheral tissues in the face of perturbations imposed by the external environment, chemicals and drugs, and a variety of diseases processes. The
- [Multinodular Goiter](https://www.thyroidmanager.org/chapter/multinodular-goiter/) - ABSTRACT Multinodular goiter (MNG) is the most common of all the disorders of the thyroid gland. MNG is the result of the genetic heterogeneity of follicular cells and apparent acquisition of new cellular qualities that become inheritable. Nodular goiter is most often detected simply as a mass in the neck, but sometimes an enlarging gland
- [Thyroid Nodules](https://www.thyroidmanager.org/chapter/thyroid-nodules/) - ABSTRACT Thyroid cancer accounts for only 0.4% of all cancer deaths, with an incidence of 11 cases and about 0.5-0.6 deaths per 100,000 population in the United States each year,according to the November 2011 SEER report (http://seer.cancer.gov/statfacts/html/thyro.html). Its clinical importance, by contrast, is out of all proportion to its incidence, because cancers of the thyroid
- [Cellular Uptake of Thyroid Hormones](https://www.thyroidmanager.org/chapter/cellular-uptake-of-thyroid-hormones/) - ABSTRACT The biological activity of thyroid hormone (TH) is regulated at the target tissue level by two important processes, i.e. deiodination and plasma membrane transport. The first process involves the expression of the deiodinase D2, which converts the prohormone T4 to bioactive T3, and/or of the deiodinase D3 which converts both T4 and T3 to
- [Autoimmunity to the Thyroid Gland](https://www.thyroidmanager.org/chapter/autoimmunity-to-the-thyroid-gland/) - ABSTRACT This discussion stresses the normal occurrence of immune self-reactivity, the genetic and environmental forces that may amplify such responses, the role of the antigen-driven immune attack, secondary disease-enhancing factors, and the important contributory role of antigen-independent immune reactivity. Research on thyroid autoimmunity has benefited greatly by knowledge of the specific target antigens and easy
- [Chapter 21  SURGERY OF THE THYROID](https://www.thyroidmanager.org/chapter/chapter-21surgery-of-the-thyroid/) - ABSTRACT Incidence rates of thyroid cancer have increased substantially worldwide in the past several decades. Thus, diseases of the thyroid gland and their treatment remain one of the most interesting and dynamic areas of study in medicine. This chapter presents a clear and concise description of current thought and practice concerning the surgical treatment of
- [Thyrotoxicosis of other Etiologies](https://www.thyroidmanager.org/chapter/thyrotoxicosis-of-other-etiologies/) - INTRODUCTION Thyrotoxicosis is defined as the clinical syndrome of hypermetabolism resulting from increased free thyroxine (T4) and/or free triiodothyronine (T3) serum levels (1). The term thyrotoxicosis is not synonymous with hyperthyroidism, the elevation in thyroid hormone levels caused by an increase in their biosynthesis and secretion by the thyroid gland (Table 1) (2). For example,
- [Evaluation of Thyroid Function in Health and Disease](https://www.thyroidmanager.org/chapter/evaluation-of-thyroid-function-in-health-and-disease/) - Archived This chapter has been superceded by newer chapters (See Homepage). However this Chapter, written originally by Dr Samuel Refetoff and updated by Drs Franklyn and Shephard, remains a treasure trove of information on many now-obscure thyroid tests, and references. For that reason we maintain it as a part of our Archive for use of
- [The Non-Thyroidal Illness Syndrome](https://www.thyroidmanager.org/chapter/the-non-thyroidal-illness-syndrome/) - ABSTRACT NTIS refers to a syndrome found in seriously ill or starving patients with low fT3, usually elevated RT3, normal or low TSH, and if prolonged, low fT4. It is found in a high proportion of patients in the ICU setting, and correlates with a poor prognosis if TT4 is
- [Adult Hypothyroidism](https://www.thyroidmanager.org/chapter/adult-hypothyroidism/) - 9.1 HISTORICAL The full-blown expression of hypothyroidism is known as myxedema. Adult myxedema escaped serious attention until Gull described it in 1874 1 . That it was a state resembling the familiar endemic cretinism, but coming on in adult life, was what chiefly impressed Gull. Ord 2 invented the term myxedema in 1873. The disorder
- [Thyroid Cancer](https://www.thyroidmanager.org/chapter/thyroid-cancer/) - Incidence and Distribution The annual incidence of thyroid cancer varies considerably in different registries, ranging from 1.2-2.6 per 100,000 individuals in men and from 2.0-3.8 per 100,000 in women (106,107). It is particularly elevated in Iceland and Hawaii, being nearly two times higher than in North European countries, Canada and the USA. In Hawaii, the

## Cases

- [Juvenile hypothyroidism](https://www.thyroidmanager.org/case/juvenile-hypothyroidism/) - Section 1 Mauris mauris ante, blandit et, ultrices a, suscipit eget, quam. Integer ut neque. Vivamus nisi metus, molestie vel, gravida in, condimentum sit amet, nunc. Nam a nibh. Donec suscipit eros. Nam mi. Proin viverra leo ut odio. Curabitur malesuada. Vestibulum a velit eu ante scelerisque vulputate. Section 2 Sed non urna. Donec et

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