Thyroid is one of the
largest endocrine glands found in the neck, below the Adam’s Apple
with the function of regulating the body use of energy, make of
proteins by producing its hormones as a result of the stimulation of
thyroid-stimulating hormone (TSH) produced by the anterior pituitary.
Thyroid disease is defined as a condition of malfunction of thyroid. Hyperthyroidism is a condition in which the thyroid gland is over active and produces too much thyroid hormones. Hypothyroidism is a condition in which the thyroid gland is under active and produces very little thyroid hormones. Thyroid cancer is defined as condition in which the cells in the thyroid gland have become cancerous.
Postoperative hypothyroidism
Hypothyroidism is not a rare
condition, since it represents about 10% of thyroid diseases. It is
more frequent in women (F/M = 5/1), and in patients older than 60 years
of age. Postoperative hypothyroidism is secondary to thyroidectomy,
and the incidence varies, with a reported range between 14% and 75%.
(a).
A. Symptoms
Symptoms may be related to the amount of
thyroid removed, the experience of the surgeon, age of patient, the
function of remaining thyroid, and duration of postoperative
observation, according to the study by the Università degli Studi di
Roma La Sapienza(a), including the below but not limit to
1. Weight gainand fatigue
In
a prospective observational research design where 198 consecutive
breast cancer patients receiving adjuvant chemotherapy were monitored
from start to end and 6 months post-therapy on changes in
anthropometics, fatigue, nutritional intake, physical activity, thyroid
and steroid hormones, found that a weight gain over >5 lb in 22.2% of this patient population with a significant and progressive gain
of 6.7 lb (P < 0.0001) at 6 months. Ninety four percent of all
patients reported fatigue and 56% of patients reported lowered physical
activity. A significant reduction in serum free and total estradiol (P
< 0.0001) was observed indicative of reduction in ovarian function
with 86% amenorrehic at the end of treatment. A significant reduction in
mean serum triiodothyronine uptake levels (P < 0.05), in addition
to a significant increase in TBG (P < 0.0001) from baseline to end
of chemotherapy, was observed. In addition 20-25% of this patient group
was already diagnosed with clinical hypothyroidism at diagnosis
and treated. Changes in fatigue frequency and serum sex-hormone-binding
globulin (SHBG) were variables significantly predictive of weight gain (P < 0.0001)(1).
2. Vitiligo and alopecia areata
There is a report of the
parents of an 18-year-old woman had noticed white hair while combing
their daughter’s hair 12 years ago. They found tiny white spots on her
scalp, but she was asymptomatic. The spots have since progressed.
Examination of the affected skin on the scalp was marked by the presence
of a chalky/ivory white macule, 8 to 10 cm in diameter, conforming to
that of segmental (zosteriformis) vitiligo (Figure 1). The lesions were
located on the temporoparietal region of the scalp. The hair over the
macules was white (leukotrichia) and dry, coarse, and brittle. The
patient’s nails were thin and dull. Her thyroid profile revealed the
following: triiodothyronine, 1.12 nmol/L (0.95-2.5 nmol/L); thyroxine,
69.21 nmol/L (60.0-120.0 nmol/L); and thyroid-stimulating hormone, 6.26
microIU/mL (0.25-5.00 microIU/mL), indicative of primary hypothyroidism(2).
3. Chronic constipation
Geriatric
patient educational material and a general practice review suggest
insufficient dietary fiber intake, inadequate fluid intake, decrease
physical activity, side effects of drugs, hypothyroidism, sex hormones and colorectal cancer obstruction may play a role in the pathogenesis of constipation, according to the study by the University of California at Los Angele(3).
4. Urticaria and puffiness of hands and feet, yellow ivory skin, coarse rough dry skin, alopecia periorbital edema, amenorrhe, dysparunia, PCO, PMS and Breast tenderness, menstrual irregularities and infertility
In the study to
study is to highlight the presenting dermatologic and gynecologic
manifestations of firstly-diagnosed hypothyroid females, showed that Compared
to euthyroid cases, hypothyroid ones were presenting mostly with
amenorrhea (OR=7.76). Other gynecologic manifestations that were
prominent in hypothyroid cases were dysparunia, PCO, PMS and Breast
tenderness. On the other hand, rate of menstrual irregularities and
infertility were non-significantly different in both groups.hypothyroid
women showed also significantly higher frequency of urticaria and
puffiness of hands and feet (both were present in 16.7% in hypothyroid
vs. 3.3% of euthyroid cases, p =0.007, OR=5.8). Hypothyroid cases
showed also significantly higher frequency of yellow ivory skin (OR=5.4) and coarse rough dry skin
(OR=3.8). On the other hand, alopecia and periorbital edema were
observed only among cases of hypothyroidsm and none of euthyroid
cases(4).
5. Depression
In the study to investigate the depression-like behavior performances of subclinical hypothyroidism
(SCH) rat. SCH rat model induced by hemi-thyroid electrocauterization,
and the behavior performances were measured by sucrose preference
test, force swimming test (FST), and tail suspension test (TST). SCH
rat model was established successfully by hemi-thyroid
electrocauterization, found that SCH could result in depression-like
behavior, accompanied with subtle hyperactivity of HPA axis. The
reduced hippocampal T3 prior to the reduction of thyroid hormone in
serum might be taken as an early sign of hippocampus impairment in the
progression from SCH to CH(5).
6. Mood, declarative memory, motor learning and working memory
In
a double-blinded, randomized, cross-over study of usual dose l-T(4)
(euthyroid arm) vs. higher dose l-T(4) (subclinical thyrotoxicosis arm)
in hypothyroid subjects, showed that The Profile of Mood States (POMS)
confusion, depression, and tension subscales were improved during the
subclinical thyrotoxicosis arm. Motor learning was better during the
subclinical thyrotoxicosis arm, whereas declarative and working memory
measures did not change. This improvement was related to changes in
the SF-36 physical component summary and POMS tension subscales and
free T(3) levels(6).
B. Causes of Risk factors
B.1. Causes
Postoperative hypothyrosis was diagnozed in 76 (6.17%) out of 1231 patients operated upon for various diseases of the thyroid gland. Among causes of this complication the authors point to lymphoid infiltration of tissue and changes in autoimmune processes. Adequate operative methods, leaving sufficient quantity of the gland tissue with special reference to cellular and humoral immunity are considered as prophylactic measures, according to the study by Volokh IuA, Pak VP and Osipov DP(7).
B.2. Risk Factors
In the study to assess the incidence of
hypothyroidism after hemithyroidectomy and to identify risk factors
for the development of hypothyroidism including 90 patients who
underwent a hemithyroidectomy from 1999 to 2004, found that the
incidence of hypothyroidism developing during follow-up among the Hashimoto thyroiditis and multinodular goiter
groups was 59% and 50%, respectively. Also, the patients who developed
hypothyroidism were noted to have statistically significant higher preoperative serum thyrotropin levels
(3.15 mIU/L vs 1.95 mIU/L; P< .001) than those who remained
euthyroid(8). For more information of Complications, diseases
associated, misdiagnosis, diagnosis, preventions and treatments, please
visit General Health section of hypothyroidism
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Sources
(a) http://www.ncbi.nlm.nih.gov/pubmed/9072668
(1) http://www.ncbi.nlm.nih.gov/pubmed/14997046
(2) http://www.ncbi.nlm.nih.gov/pubmed/21675503
(3) http://www.ncbi.nlm.nih.gov/pubmed/17219073
(4) http://www.ncbi.nlm.nih.gov/pubmed/21475555
(5) http://www.ncbi.nlm.nih.gov/pubmed/23794115
(6) http://www.ncbi.nlm.nih.gov/pubmed/18285414
(7) http://www.ncbi.nlm.nih.gov/pubmed/3232287
(8) http://www.ncbi.nlm.nih.gov/pubmed/16415427
Health Researcher and Article Writer. Expert in Health Benefits of Foods, Herbs, and Phytochemicals. Master in Mathematics & Nutrition and BA in World Literature and Literary criticism. All articles written by Kyle J. Norton are for information & education only.
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