Your Hypothyroidism: A diagnosis with serious implications for your family.

Your Hypothyroidism: A diagnosis with serious implications for your family.

Your Hypothyroidism: A diagnosis with serious implications for your family.
  1. 90% of patients with a diagnosis of hypothyroidism have Chronic Hashimoto’s thyroiditis CHT as the cause.
  2. The rest are due to surgery or radioiodine therapy.
  3. Did your primary physician evaluate you for CHT or just diagnose hypothyroidism without exploring the cause?
  4. CHT is a condition with a long latent period where the disease is slowly destroying your thyroid over years before you develop hypothyroidism, goiter or nodules.
  5. First degree relatives are at risk if they are not examined and tested for CHT.
  6. This is case finding not screening as the finding of a member of the family with CHT is a cause for evaluation of all the first degree relatives.
  7. What is the evaluation? To an endocrinologist the first clue is a small firm thyroid gland with irregular surface.
  8. TSH and FT4 may be normal , the TPO and or TG antibodies will be positive. TSH may be slightly elevated but FT4 will still be normal and the patient will be euthroid.
  9. Even in this early stage before hypothyroidism occurs the ultrasound may show changes of CHT and even nodules. Many patients with CHT may also present during case finding with a significant nodule needing a biopsy.
  10. While most biopsies will be negative for cancer some will be suspicious or even positive for cancer.
  11. It is the beginning of treatment with T4 for CHT even before hypothyroidism occurs that will alter the course of CHT, and prevent nodules and even cancer occurrence.
  12. It may take years from the onset of the positive antibodies until the patient becomes hypothyroid.
  13. Prior to antibody testing most patient’s first diagnosis was at 30-40 years old with hypothyroidism, goiter and nodules.
  14. If your physician’s diagnosis for you is hypothyroidism and you did not have thyroid surgery, you need to insist on referral to an endocrinologist for neck examination antibody testing.
  15. Your family deserves to know if you have CHT as it has implications for their health as well as yours.
  16. Case example: 4 Y/O male with childhood obesity was tested for thyroid disease by the family pediatrician. The TSH and FT4 were normal but the TPO antibody was positive. The mother had hypothyroidism. No T4 treated was given to the child. At 8 Y/O he had a goiter, a nodule and hypothyroidism. The FNA was positive for papillary thyroid cancer. The family history and the positive antibodies should alerted the primary to refer the child to an endocrinologist at age 4, not at 8. Untreated Hashimoto’s with rising TSH can stimulate nodule formation and in this case thyroid cancer.
  17. Call 310-393-8860 or email to [email protected]
  18. Ask for Alicia.
  19. Dr.G.
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