Understanding the most commonly billed diagnoses in primary care: Hypothyroidism.

ABSTRACT: This next article in the Most Commonly Billed Diagnoses series focuses on hypothyroidism and the significant role NPs play in identifying and managing patients with this condition and its associated comorbidities. Pathophysiology, systemic manifestations, screening, and treatment are discussed.

Hypothyroidism in Women.

Hypothyroidism, a disease in which the thyroid gland does not make enough thyroid hormone, is the second most common endocrine disorder among women. Symptoms of hypothyroidism include fatigue, weight gain, alteration in cognition, infertility, and menstrual abnormalities. The most common cause of hypothyroidism in the United States is Hashimoto's thyroiditis. The American Thyroid Association recommends an initial screening for thyroid disease at age 35years and every 5years thereafter. Thyroid-stimulating hormone is highly sensitive to thyroid dysfunction and is used to evaluate thyroid disorders. Monotherapy with levothyroxine is the standard for treating hypothyroidism. Diagnosing hypothyroidism requires appropriate diagnostic tests to facilitate prompt diagnosis and treatment.

Recognising hypothyroidism in the community: what can nurses and patients do?

Aysha Mendes discusses underactive thyroid and dispels commonly held myths that it is not serious and cannot be prevented-health professionals can play a vital role in the diagnosis, support and treatment of this misunderstood condition.

Metabolopatias. La importancia de una buena actuación enfermera / Metabolopathies. The importance of a good performance nurse

La detección precoz de las enfermedades metabólicas ha constituido un gran paso a lo largo de la historia médica científica, ya que realizando una buena técnica se pueden diagnosticar enfermedades mejorando su pronóstico. Algunas de ellas son: hipotiroidismo, hiperplasia suprarrenal congénita, hiperfenilalaninemia, hemoglobinopatías y fibrosis quística, entre otras. La muestra se puede recoger de dos modos: la llamada extracción única (al tercer día de vida) o la extracción doble (1ª muestra a las 48 horas de vida y la 2ª muestra a partir del cuarto día de vida). Se debe destacar la importancia de protocolizar una idónea técnica para obtener buenos resultados y no dar lugar a muestras erróneas o falsos positivos(AU)

The possibility for early detection of metabolic disorders has been a big step forward in medical history due to using a good technique by which diseases can be diagnosed, improving their outcome. The main disorders that these tests are designed to detect are hypothyroidism, congenital adrenal hyperplasia, hyperphenylalaninemia, hemoglobinopathies, and cystic fibrosis, among others. Samples can be collected by two methods: the single draw (taken on the third day of life) or the double draw (the first sample is taken at 48 hours of life and the second after the fourth day). It is important to institute a good technique in order to obtain good results and prevent erroneous samples or false positives(AU)

Levothyroxine and calcium interaction: timing is everything.

Are you aware that clients taking levothyroxine (Levoxyl, Synthroid, Unithroid) should also be taking a calcium supplement and that the calcium supplement should be spaced at least 4 hours apart from levothyroxine?

Hypothyroidism in elderly people.

Abnormal thyroid function tests are common for older adults, but the clinical significance of abnormal results and the need for treatment vary. Nonthyroidal illness (eg, low T3 and T4 syndromes) needs to be ruled out before making the diagnosis of hypothyroidism. Overt hypothyroidism and myxedema coma always require treatment, but treatment of subclinical hypothyroidism is not as clear. The purpose of this review article is to summarize existing data in the elderly population on the etiology, diagnosis, and management of overt hypothyroidism and subclinical hypothyroidism.

The thyroid gland: physiology and pathophysiology.

The thyroid gland contains many follicular cells that store the thyroid hormones within the thyroglobulin molecule until they are needed by the body. The thyroid hormones, often referred to as the major metabolic hormones, affect virtually every cell in the body. Synthesis and secretion of the thyroid hormones depend on the presence of iodine and tyrosine as well as maturation of the hypothalamic-pituitary-thyroid system. Interruption of this development, as occurs with premature delivery, results in inadequate production of thyroid-stimulating hormone and thyroxine, leading to a variety of physiologic conditions. Pathologic conditions occur in the presence of insufficient thyroid production or a defect in the thyroid gland. Laboratory tests are important in diagnosing conditions of the thyroid gland. A thorough history in combination with clinical manifestations and radiologic findings are also useful in diagnosing specific thyroid conditions. Nurses play an important role in identifying and managing thyroid disorders and in providing supportive care to infants and their families.

Hypothyroidism in cancer patients.

Hypothyroidism as a manifestation of malignancy, as a comorbid disorder in cancer patients, and its treatment are of significant importance to the advanced practice nurse. Considering that the incidence of hypothyroidism reaches 50% to 80% in some cancer patient populations, it is of concern that this problem is rarely addressed in standard oncology texts and journals. This article addresses the unique relationship of hypothyroidism to cancer patients and the important role of the advanced practice nurse in assessing and managing this complex disorder.