The duct should close in the first hours after birth. If it does not, the blood begins to shunt from the aorta into the pulmonary artery and hyperperfuse the lungs. The left side of the heart will have an increase in blood return and become volume overloaded. Too much blood is going to the lungs. RA – RV – Lungs _ LA – LV – Aorta now blood shunts backwards because pressure in L side higher than R so pressure in aorta in higher it backflows (it is already oxygenated) and prevents the blood that needs to be oxyenate doesn’t get there. Dispalces blood that needs to be oxygenated. Mixed blood in oxygenation. L sided heart failure. L to R shunt. THIS IS CALLED A LEFT-TO-RIGHT SHUNT.

-1 Patent ductus arteriosus (PDA).

Simply put, this is a hole in your baby’s aorta that doesn’t close.

Aorta is the largest artery in the body, the aorta arises from the left ventricle of the heart, goes up (ascends) a little ways, bends over (arches), then goes down (descends) through the chest and through the abdomen to where ends by dividing into two arteries called the common iliac arteries that go to the legs which is called the femoral artery than.

Anatomically, the aorta is traditionally divided into the ascending aorta, the aortic arch, and the descending aorta. The descending aorta is, in turn, subdivided into the thoracic aorta (that descends within the chest) and the abdominal aorta (that descends within the belly).

The aorta gives off branches that go to the head and neck, the arms, the major organs in the chest and abdomen, and the legs. It serves to supply them all with oxygenated blood. The aorta is the central conduit from the heart to the body. A hole in the aorta causes many problems.

During pregnancy, the hole allows your baby’s blood to bypass his lungs and get oxygen from your umbilical cord. After he’s born, he starts to get oxygen from his own lungs, and the hole has to close.

If it doesn’t, it’s called patent ductus arteriosus, or PDA. Small PDAs may get better on their own. A larger one could need surgery.

 -2Truncus arteriosus.

This is when your baby is born with one major artery instead of two that carry blood to the rest of his body. He will need surgery as an infant to repair the defect, and may need more procedures later in life.

I-transposition of the great arteries. This means that the right and left chambers of your baby’s heart are reversed. His blood still flows normally, but over time, his right ventricle doesn’t work as well because it must pump harder.

D-transposition of the great arteries. In this condition, the two main arteries of your baby’s heart are reversed. His blood doesn’t move through the lungs to get oxygen, and oxygen-rich blood doesn’t flow throughout his body. He will have to have surgery to repair this condition, usually within the first month of his life.

Single ventricle defects. Babies are sometimes born with a small lower chamber of the heart, or with one valve missing. Different types of single ventricle defects include:

• Hypoplastic left heart syndrome: Your baby has an undeveloped aorta and lower left chamber, or ventricle.
• Pulmonary atresia/intact ventricular septum: Your baby has no pulmonary valve, which controls blood flow from the heart to the lungs.
• Tricuspid atresia: Your baby has no tricuspid valve, which should be between the upper and lower chambers of the right side of his heart.

In some cases, your doctor can spot congenital heart problems when your baby is still in the womb. But he can’t always diagnose the defect until after birth and until your baby shows signs of a problem.

Many mild congenital heart defects are diagnosed in childhood or even later because they don’t cause any obvious symptoms. Some people don’t find out they have them until they’re adults.

Whatever the type of congenital heart defect, rest assured that with advances in diagnostic tools and treatments, there’s a much greater chance of a long, normal life than ever before.

Heart transplants are recommended for children who have serious heart problems. These children are not able to live without having their heart replaced. Illnesses that affect the heart in this way include complex congenital heart disease, present at birth at times. They also include heart muscle disease (cardiomyopathy).

“Every 4.5 minutes a baby is born with a condition that affects the structure or function of their body—collectively, these conditions are referred to as birth defects. They can vary widely in how and where they affect the body, and include things from cleft lip to heart disease problems. While medical advancements have greatly improved the health and survival of these individuals, many of these conditions are lifelong and require lifelong care.  While medical advancements have greatly improved the health and survival of these individuals, many of these conditions are lifelong and require lifelong care.”

Centers for Disease Control and Prevention-CDC (https://www.cdc.gov/ncbddd/birthdefects/esophagealatresia.html)

Your heart has 4 chambers=

2 uppers=atriums & 2 lowers=ventricles.

Congenital heart defects:

1.  Types of Hole Defects in the heart:

This a problem with your heart that you’re born with.

-They’re the most common kind of birth defect.

There are at least 18 different types of congenital heart defects. Most affect the walls, valves, or blood vessels of your heart. Some are serious and may need several surgeries and treatments.

This means you’re born with a hole in the wall, or septum of the heart that separates the left and right sides of your heart. The hole lets blood from the two sides mix.  This allows more oxygenated (L side of the heart) and more carbon dioxide blood (Rt side of the heart) mix together causing many problems.

An ASD is a hole in the wall between the upper chambers or the right and left atrium, of your heart.

Some ASDs close on their own. Your doctor may need to repair a medium or large ASD with open-heart surgery or another procedure.

The cardiology surgeon might seal the hole with a minimally invasive catheter procedure. The MD inserts a small tube, or catheter, in your blood vessel all the way to your heart. Then he can cover the hole with a variety of devices.

A VSD is a hole in the part of your septum that separates your heart’s lower chambers that we call ventricles. If you have a VSD, blood gets pumped back to your lungs instead of to your body.

A small VSD may also close on its own. But if yours is larger, you may need surgery to repair it.  Similar to ASD surgery, just a different spot on the chambers.

This is the most serious septal defect. It’s when you have a hole in your heart that affects all four chambers.

Complete atrioventricular canal (CAVC) defect is a severe congenital heart disease in which there is a large hole in the tissue (the septum) that separates the left and right sides of the heart. The hole is in the center of the heart, where the upper chambers and lower chambers meet.

As the heart formed abnormally, the valves that separate the upper and lower chambers also developed abnormally. In a normal heart, two valves separate the upper and lower chambers of the heart: the tricuspid valve separates the right chambers and the mitral valve the left chambers. In a child with a complete atrioventricular canal defect, there is one large valve, and it may not close correctly.

As a result of the abnormal passageway between the two sides of the heart, blood from both sides mix, and too much blood circulates back to the lungs before it travels through the body. This means the heart works harder than it should have to, often becoming enlarged and damaged if the problems aren’t repaired.

A CAVC prevents oxygen-rich blood from going to the right places in your body. Your doctor can repair it with patches. But some people need more than one surgery to treat it.

Valves control the flow of blood through your heart’s ventricles and arteries. And some minor heart defects can involve the valves.  Your heart has four valves  aortic, pulmonic, tricuspid, and mitral valve.  All four of them can develop different kinds of heart valve disease, this would include stenosis, regurgitation, and atresia.

a Stenosis.

When your cardiac valves become involved with stenosis where they narrow or stiffen, and won’t open or allow properly from a little amount to completely closed.  Ranging the blood to pass easily to not at all depending on the extent of the stenosis to the valve.  This makes treatment range from none and just medication if needed at all to surgery later in life or immediately born, again depending on the extent of cardiac valvular stenosis.

Aortic Valve Stenosis:

Aortic valve stenosis is most common in the world and in elderly, becoming more and more common after age 65. Several diseases can also cause it to develop in people when they reach middle age. The bicuspid aortic valve is the most common cause of aortic stenosis in patients less than the age of 70 years in developed countries. Rheumatic valve disease is the most common cause in developing countries.  Although some people have aortic stenosis because of a congenital heart defect called a bicuspid aortic valve, this condition more commonly develops during aging as calcium or scarring damages the valve, that is a common cause for this condition in elderly pts since it takes time to develop calcium build up in causing the stenosis.  This in turn restricts the amount of blood flowing getting through the aorta to deliver that oxygenated blood to the body.  The calcium build up takes time to put an affect on the aorta with symptoms as well; so this is why this is commonly seen in elders.

Aortic stenosis is one of the most common and serious valve disease problems. Know the aorta is the main artery bringing blood from the heart to the body’s tissues/organs. Aortic stenosis is a narrowing of the aortic valve opening, and can sometimes be referred to as a failing heart valve. Aortic stenosis restricts the blood flow from the left ventricle to the aorta and may also affect the pressure in the left atrium due to the blood flow regurgitating backwards from the stenosis to the L Ventricle up to the L atrium.

The condition may range from mild to severe; the longer you have it the more severe the symptoms and intensity it would have on the heart, especially left untreated.

Over time, aortic valve stenosis causes your heart’s left ventricle to pump harder to push blood through the narrowed aortic valve. The extra effort may cause the left ventricle to thicken, enlarge and weaken. If not addressed, this form of heart valve disease may lead to heart failure known as CHF.  This heart failure would start on the Left Side of the Heart first=L CHF and if left untreated it would in time effect the Right Side of the Heart=R CHF as well.  The symptoms of L CHF versus R CHF would be different at first and in another topic later this year (over extends this topic for today).

Pulmonary Valve Stenosis:

Pulmonary valve stenosis is a heart valve disorder that involves the pulmonary valve. This is the valve separating the right lower chamber or the right ventricle (one of the chambers in the heart) and the pulmonary artery.  Pulmonary artery is one of the few arteries with high carbon dioxide and low oxygen level in the blood stream. This blood flow normally is being sent to the lungs for more oxygen where it will send the blood flow to the left side of the heart to go through the aorta and sent throughout the body to give high oxygen to all organs.  This is how we survive; with out oxygen we would be going through cellular starvation and die.   The pulmonary artery carries oxygen-poor blood to the lungs  as its ending function. Stenosis, or narrowing in the pulmonary valve occurs when the valve cannot open wide enough to its normal capacity or in some cases completely stenosis, not able to open or close at all.

Treatment surgery at some time in the person’s lifetime.  It would all depend on the severity of the stenosis condition.

Mitral Valve Stenosis:

Mitral valve stenosis — sometimes called mitral stenosis — is a narrowing of the valve between the two left heart chambers. The narrowed valve reduces or blocks blood flow into the heart’s main pumping chamber. The heart’s main pumping chamber is the lower left heart chamber, also called the left ventricle.

There are two types of mitral valve regurgitation:

• Degenerative mitral regurgitation: This occurs when the mitral valve itself is dysfunctional. The flaps may droop or bulge and do not close tightly.
• Functional mitral regurgitation: Functional mitral regurgitation happens when an issue outside of the valve (such as diseases of the left ventricle) causes the leakage. You may have normal valve flaps and still be diagnosed with functional mitral regurgitation.

Mitral valve stenosis can make you tired and short of breath. Other symptoms may include irregular heartbeats, dizziness, chest pain or coughing up blood. Some people don’t notice symptoms.

Mitral valve stenosis can be caused by a complication by a sore throat with strep throat called rheumatic fever. Rheumatic fever is now rare in the United States.

Treatment for mitral valve stenosis may include medication or mitral valve repair or replacement surgery.  Some people only need regular health checkups. Treatment depends on the severity of the condition and whether it’s getting worse. Untreated, mitral valve stenosis can lead to serious heart complications.

Tricuspid Valve Stenosis:

Tricuspid stenosis (TS) is narrowing of the tricuspid orifice that obstructs blood flow from the right atrium to the right ventricle. Almost all cases result from rheumatic fever. Symptoms include a fluttering discomfort in the neck, fatigue, cold skin, and right upper quadrant abdominal discomfort. Jugular pulsations are prominent, and a presystolic murmur is often heard at the left sternal edge in the fourth intercostal space and is increased during inspiration. Diagnosis is by echocardiography. TS is usually benign, requiring no specific treatment, but symptomatic patients may benefit from surgery.

b Regurgitation.

A damaged or diseased valve can severely compromise the ability of the heart in inefficiently which in turn does not let  oxygen or carbon dioxide to be used or removed from the body in the way its suppose to be and in time effects the heart and can lead to heart failure if left untreated. Instead of the valve having stenosis it is now not closing completely when it should allowing regurgitation to occur.

Your valves don’t close tightly, the valve affected will allow regurgitation due to the valve not working efficiently with opening and closing the way it should during your heart beat (lub dub-the sound you hear of the heart when auscultating through the stethoscope, the RN or doctor uses.) Instead this lets your blood flow or leak backward r/t the valve partially open or to completely opened when the valve should be closely closed at that time and results into regurgitation.  Remember the cardiac valves open and close as their function to allow blood flowing with a heart pumping to deliver oxygen to the blood from red blood cells that carry O2 and remove carbon dioxide blood through red blood cells carrying it out of the blood stream back to the lungs to get more O2 for the RBCs to carrying it to organs / tissues that need it to survive.  Depending on the extent of valvular regurgitation will decide on treatment which ranges from surgery later in life or immediately when born.

It does the opposite of valve stenosis in that stenosis is a narrowing of the vessel whereas regurgitation is due to a valve remaining open partially or completely when the valve is suppose to be closing to allow blood fill up in the chamber of the heart and common one is mitral valve regurgitation but there are others like tricuspid, pulmonary and ventricular valve regurgitation.

Mitrial Valve Regurgitation:

Mitral valve regurgitation is the most common type of heart valve disease. In this condition, the valve between the left heart chambers doesn’t close fully. Blood leaks backward across the valve. If the leakage is severe, not enough blood moves through the heart or to the rest of the body. Mitral valve regurgitation can make you feel very tired or short of breath.

Other names for mitral valve regurgitation are:

• Mitral regurgitation (MR).
• Mitral insufficiency.
• Mitral incompetence.

Treatment of mitral valve regurgitation may include regular health checkups, medicines or surgery. You may not need treatment if the condition is mild.

Severe mitral valve regurgitation often requires a catheter procedure or heart surgery to repair or replace the mitral valve. Without proper treatment, severe mitral valve regurgitation can cause heart rhythm problems or heart failure.

Tricuspid Valve Regurgitation:

Tricuspid valve disease is a type of heart valve disease (valvular heart disease). The valve between the two right heart chambers (right atrium and right ventricle) doesn’t work properly. As a result, the heart must work harder to send blood to the lungs and the rest of the body.

Tricuspid valve disease often occurs with other heart valve problems.

Symptoms and treatments of tricuspid valve disease vary, depending on the specific valve condition. Treatment may include monitoring, medication, or valve repair or valve replacement.

The most common cause of tricuspid regurgitation is enlargement of the right ventricle. Pressure from heart conditions, such as heart failure, pulmonary hypertension and cardiomyopathy, cause the ventricle to expand. The result is a misshapen tricuspid valve that is leaky and cannot close properly.

Aortic Valve Regurgitation:

Aortic valve regurgitation — also called aortic regurgitation — is a type of heart valve disease. The valve between the lower left heart chamber and the body’s main artery doesn’t close tightly. As a result, some of the blood pumped out of the heart’s main pumping chamber, called the left ventricle, leaks backward.

The leakage may prevent the heart from doing a good enough job of pumping blood to the rest of the body. You may feel tired and short of breath.

Aortic valve regurgitation can develop suddenly or over many years. Once the condition becomes severe, surgery often is needed to repair or replace the valve.

Pulmonary Valve Regurgitation:

Pulmonary valve disease affects the valve between the heart’s lower right chamber and the artery that delivers blood to the lungs. That artery is called the pulmonary artery. The valve is called the pulmonary valve.

A diseased pulmonary valve doesn’t work properly. Pulmonary valve disease changes how blood flows from the heart to the lungs.

The pulmonary valve usually acts like a one-way door from the lower right heart chamber to the lungs. Blood flows from the chamber through the pulmonary valve. It then goes to the pulmonary artery and into the lungs. Blood picks up oxygen in the lungs to take to the body.

Many types of pulmonary valve disease are due to heart conditions present at birth. Treatment depends on the type and severity of pulmonary valve disease.

c Atresia.

Tricuspid Atresia:

This happens when your valve isn’t formed right or has no opening to let your blood pass through. It causes more complicated heart problems. Tricuspid atresia (pronounced try-CUSP-id uh-TREE-zhuh) is a birth defect of the heart where the valve that controls blood flow from the right upper chamber of the heart to the right lower chamber of the heart doesn’t form at all.  In babies with this defect, blood can’t flow correctly through the heart and to the rest of the body.

Aortic Atresia:

Aortic valvular atresia is a congenital condition in which the aortic valvular cusps are fused at birth. It frequently forms as a spectrum of malformations of the left ventricular outflow tract (LVOT). The atresia can be characterized as sub-valvular, valvular, or supra-valvular, depending on the site of the anomaly. Most commonly, the defect presents as aortic stenosis, though in rare cases, it can manifest as complete atresia.

Pulmonary Atresia

Pulmonary atresia is a birth defect of the pulmonary valve, which is the valve that controls blood flow from the right ventricle (lower right chamber of the heart) to the main pulmonary artery (the blood vessel that carries blood from the heart to the lungs). Pulmonary atresia is when this valve didn’t form at all, and no blood can go from the right ventricle of the heart out to the lungs. Because a baby with pulmonary atresia may need surgery or other procedures soon after birth, this birth defect is considered a critical congenital heart defect (critical CHD). Congenital means present at birth.

In a baby without a congenital heart defect, the right side of the heart pumps oxygen-poor blood from the heart to the lungs through the pulmonary artery. The blood that comes back from the lungs is oxygen-rich and can then be pumped to the rest of the body. In babies with pulmonary atresia, the pulmonary valve that usually controls the blood flowing through the pulmonary artery is not formed, so blood is unable to get directly from the right ventricle to the lungs.

In pulmonary atresia, since blood cannot directly flow from the right ventricle of the heart out to the pulmonary artery, blood must use other routes to bypass the unformed pulmonary valve. The foramen ovale, a natural opening between the right and left upper chambers of the heart during pregnancy that usually closes after the baby is born, often remains open to allow blood flow to the lungs. Additionally, doctors may give medicine to the baby to keep the baby’s patent ductus arteriosus open after the baby’s birth. The patent ductus arteriosus is the blood vessel that allows blood to move around the baby’s lungs before the baby is born and it also usually closes after birth.

d Ebstein’s anomaly.

This is a defect in another heart valve, the tricuspid valve-between the top and bottom of the right side of the heart, which may keep it from closing tightly. Ebstein anomaly is a rare heart problem present at birth. This means it’s a congenital heart defect. The tricuspid valve is incorrectly formed and located lower than usual in the heart. The condition may occur with a hole between the two upper chambers of the heart, called an atrial septal defect.Babies who have Ebstein’s also often have an atrial septal defect (ASD).

In people with Ebstein anomaly, the heart can grow larger. The condition can lead to heart failure.

Treatment of Ebstein anomaly depends on the symptoms. Some people without symptoms only need regular health checkups. Others may need medicines and surgery.

Keep in mind a baby can be born with more than one cardiac defect depending on the pt’s heart formation during pregnancy or at birth or in some cases symptoms arise later in life and that could be the time the patient is diagnosed with the heart condition they have.  Symptoms help tell the doctor there is a problem so diagnosing gets involved until the etiology is found.  If it is your heart your MD will find the defect no problem.

Part II tomorrow on other defects!

“The thyroid is a small gland at the front of your neck that makes the thyroid hormone that regulates your metabolism, says Dr. Thomas J. Fahey III,  Chief of Endocrine Surgery, and Director of the Endocrine Oncology Program. “The thyroid has a wide-ranging effect throughout the body. It contributes to how fast your heart beats, how fast your hair grows, and how fast things pass through your intestines,” Dr. Fahey says.

The thyroid gland commonly malfunctions, typically by over- or under-producing hormones. An over-functioning thyroid gland can trigger “hyperthyroidism,” which can cause your body to race and your heart to pound, as well as weight loss, sleep trouble, muscle weakness, frequent or loose bowel movements, nervousness, or irritability. The most common cause of hyperthyroidism in the U.S. is Graves’ disease, an autoimmune disorder in which the immune system attacks the thyroid gland. An under-functioning thyroid, which frequently stems from the autoimmune disorder Hashimoto’s disease, may lead to “hypothyroidism” and resulting fatigue, weight gain, depression, constipation, heavy or irregular menstrual periods, or problems conceiving. Family history increases the risk for both Hashimoto’s and Graves’.”

Weill Cornell Medicine (https://weillcornell.org/news/understanding-thyroid-problems-disease)

Diagnostic Tools for Hypothyroidism:

History: The doctor will take a detailed history, evaluating both past and present medical problems. If the patient is younger than 20 or older than 70 years, there is increased likelihood that a nodule is cancerous. Similarly, the nodule is more likely to be cancerous if there is any history of radiation exposure, difficulty swallowing, or a change in the voice. It was actually customary to apply radiation to the head and neck in the 1950s to treat acne! Significant radiation exposures include the Chernobyl and Fukushima disasters. Although women tend to have more thyroid nodules than men, the nodules found in men are more likely to be cancerous. Despite its value, the history cannot differentiate benign from malignant nodules. Thus, many patients with risk factors uncovered in the history will have benign lesions. Others without risk factors for malignant nodules may still have thyroid cancer.

Physical examination: The physician should determine if there is one nodule or many nodules, and what the remainder of the gland feels like. The probability of cancer is higher if the nodule is fixed to the surrounding tissue (unmovable). In addition, the physical exam should search for any abnormal lymph nodes nearby that may suggest the spread of cancer. In addition to evaluating the thyroid, the physician should identify any signs of gland malfunction, such as thyroid hormone overproduction (hyperthyroidism) or underproduction (hypothyroidism).

Blood tests: Initially, blood tests should be done to assess thyroid function. These tests include:

• The free T4 and thyroid stimulating hormone (TSH) levels. Elevated levels of the thyroid hormones T4 or T3 in the context of suppressed TSH suggests hyperthyroidism
• Reduced T4 or T3 in the context of high TSH suggests hypothyroidism
• Antibody titers to thyroperoxidase or thyroglobulin may be useful to diagnose autoimmune thyroiditis
• (for example, Hashimoto’s thyroiditis).
• If surgery is likely to be considered for treatment, it is strongly recommended that the physician als determine the level of thyroglobin. Produced only in the thyroid hormone in the blood. Thyroglobulin carries thyroid hormone in the blood. Thyroglobulin levels should fall quickly within 48 hours in the thyroid gland is completely remobed. If thyroglobulin levels start to climb.

Ultrasonography: A physician may order an ultrasound examination of the thyroid to:

• Detect nodules that are not easily felt
• Determine the number of nodules and their sizes
• Determine if a nodule is solid or cystic
• Assist obtaining tissue for diagnosis from the thyroid with a fine needle aspirate (FNA)

Despite its value, the ultrasound cannot determine whether a nodule is benign or cancerous.

Radionuclide scanning: Radionuclide scanning with radioactive chemicals is another imaging technique a physician may use to evaluate a thyroid nodule. The normal thyroid gland accumulates iodine from the blood and uses it to make thyroid hormones. Thus, when radioactive iodine (123-iodine) is administered orally or intravenously to an individual, it accumulates in the thyroid and causes the gland to “light up” when imaged by a nuclear camera (a type of Geiger counter). The rate of accumulation gives an indication of how the thyroid gland and any nodules are functioning. A “hot spot” appears if a part of the gland or a nodule is producing too much hormone. Non-functioning or hypo-functioning nodules appear as “cold spots” on scanning. A cold or non-functioning nodule carries a higher risk of cancer than a normal or hyper-functioning nodule. Cancerous nodules are more likely to be cold, because cancer cells are immature and don’t accumulate the iodine as well as normal thyroid tissue. However, cold spots can also be caused by cysts. This makes the ultrasound a much better tool for determining the need to do an FNA.

Fine needle aspiration: Fine needle aspiration (FNA) of a nodule is a type of biopsy and the most common, direct way to determine what types of cells are present. The needle used is very thin. The procedure is simple and can be done in an outpatient office, and anesthetic is injected into tissues traversed by the needle. FNA is possible if the nodule is easily felt. If the nodule is more difficult to feel, fine needle aspiration can be performed with ultrasound guidance. The needle is inserted into the thyroid or nodule to withdraw cells. Usually, several samples are taken to maximize the chance of detecting abnormal cells. These cells are examined microscopically by a pathologist to determine if cancer cells are present. The value of FNA depends upon the experience of the physician performing the FNA and the pathologist reading the specimen. Diagnoses that can be made from FNA include:

• Benign thyroid tissue (non-cancerous) can be consistent with Hashimoto’s thyroiditis, a colloid nodule, or a thyroid cyst. This result is reported from approximately 60% of biopsies.
• Cancerous tissue (malignant) can be consistent with diagnosis of papillary, follicular, or medullary cancer. This result is reported from approximately 5% of biopsies. The majority of these are papillary cancers.
• Suspicious biopsy can show a follicular adenoma. Though usually benign, up to 20% of these nodules are found ultimately to be cancerous.
• Non-diagnostic results usually arise because insufficient cells were obtained. Upon repeat biopsy, up to 50% of these cases can be distinguished as benign, cancerous, or suspicious.

One of the most difficult problems for the pathologist is to be confident that a follicular adenoma – usually a benign nodule – is not a follicular cell carcinoma or cancer. In these cases, it is up to the physician and the patient to weigh the option of surgery on a case-by-case basis, with less reliance on the pathologist’s interpretation of the biopsy. It is also important to remember that there is a small risk (3%) that a benign nodule diagnosed by FNA may still be cancerous. Thus, even benign nodules should be followed closely by the patient and physician. Another biopsy may be necessary, especially if the nodule is growing. Most thyroid cancers are not very aggressive; that is, they do not spread rapidly. The exception is poorly differentiated (anaplastic) carcinoma, which spreads rapidly and is difficult to treat.

Treatment  for Hypothyroidism:

Hypothyroidism happens when the thyroid gland doesn’t make enough hormones. Conditions or problems that can lead to hypothyroidism include:

• Autoimmune disease. The most common cause of hypothyroidism is an autoimmune disease called Hashimoto’s disease. Autoimmune diseases happen when the immune system makes antibodies that attack healthy tissues. Sometimes that process involves the thyroid gland and affects its ability to make hormones.
• Thyroid surgery. Surgery to remove all or part of the thyroid gland can lower the gland’s ability to make thyroid hormones or stop it completely.
• Radiation therapy. Radiation used to treat cancers of the head and neck can affect the thyroid gland and lead to hypothyroidism.
• Thyroiditis. Thyroiditis happens when the thyroid gland becomes inflamed. This may be due to an infection. Or it can result from an autoimmune disorder or another medical condition affecting the thyroid. Thyroiditis can trigger the thyroid to release all of its stored thyroid hormone at once. That causes a spike in thyroid activity, a condition called hyperthyroidism. Afterward, the thyroid becomes underactive.
• Medicine. A number of medicines may lead to hypothyroidism. One such medicine is lithium, which is used to treat some psychiatric disorders. If you’re taking medicine, ask your heath care provider about its effect on the thyroid gland.

Less often, hypothyroidism may be caused by:

• Problems present at birth. Some babies are born with a thyroid gland that doesn’t work correctly. Others are born with no thyroid gland. In most cases, the reason the thyroid gland didn’t develop properly is not clear. But some children have an inherited form of a thyroid disorder. Often, infants born with hypothyroidism don’t have noticeable symptoms at first. That’s one reason why most states require newborn thyroid screening.
• Pituitary disorder. A relatively rare cause of hypothyroidism is the failure of the pituitary gland to make enough thyroid-stimulating hormone (TSH). This is usually because of a noncancerous tumor of the pituitary gland.
• Pregnancy. Some people develop hypothyroidism during or after pregnancy. If hypothyroidism happens during pregnancy and isn’t treated, it raises the risk of pregnancy loss, premature delivery and preeclampsia. Preeclampsia causes a significant rise in blood pressure during the last three months of pregnancy. Hypothyroidism also can seriously affect the developing fetus.
• Not enough iodine. The thyroid gland needs the mineral iodine to make thyroid hormones. Iodine is found mainly in seafood, seaweed, plants grown in iodine-rich soil and iodized salt. Too little iodine can lead to hypothyroidism. Too much iodine can make hypothyroidism worse in people who already have the condition. In some parts of the world, it’s common for people not to get enough iodine in their diets. The addition of iodine to table salt has almost eliminated this problem in the United States.

• If you have had radiation therapy and have hypothyroidism, or if your thyroid gland has been removed, you will most likely need treatment from now on. If your hypothyroidism is caused by Hashimoto’s thyroiditis, you might also need treatment from now on. Sometimes, thyroid gland function returns on its own in Hashimoto’s thyroiditis.
• If a serious illness or infection triggered your hypothyroidism, your thyroid function most likely will return to normal when you recover.
• Some medicines may cause hypothyroidism. Your thyroid function may return to normal when you stop the medicines.
• If you have mild (subclinical) hypothyroidism, you may not need treatment but should be watched for signs of hypothyroidism getting worse. You and your doctor will talk about the pros and cons of taking medicine to treat your mild hypothyroidism. The dose of thyroid medicine must be watched carefully in people who also have heart disease, because too much medicine increases the risk of chest pain (angina) and irregular heartbeats (atrial fibrillation).

*****1.)If you have severe hypothyroidism by the time you are diagnosed, you will need immediate treatment. Severe, untreated hypothyroidism can cause myxedema coma, a rare, life-threatening condition.

            2.)Treatment during pregnancy is especially important, because hypothyroidism can harm the developing fetus.

• If you develop hypothyroidism during pregnancy, treatment should be started immediately. If you have hypothyroidism before you become pregnant, your thyroid hormone levels need to be checked to make sure that you have the right dose of thyroid medicine. During pregnancy, your dose of medicine may need to be increased by 25% to 50%.

• You are likely to need treatment for hypothyroidism from now on. As a result, you need to take your medicine as directed. For some people, hypothyroidism gets worse as they age and the dosage of thyroid medicine may have to be increased gradually as the thyroid continues to slow down.
• Most people treated with thyroid hormone develop symptoms again if their medicine is stopped. If this occurs, medicine needs to be restarted.

Treatment for Hyperthyroidism:

If your symptoms bother you, your doctor may give you pills called beta-blockers. These can help you feel better while you and your doctor decide what your treatment should be. Hyperthyroidism can lead to more serious problems. So even if your symptoms do not bother you, you still need treatment.

The diagnostic workup for hyperthyroidism includes measuring thyroid-stimulating hormone, free thyroxine (T₄), and total triiodothyronine (T₃) levels to determine the presence and severity of the condition, as well as radioactive iodine uptake and scan of the thyroid gland to determine the cause.

There are several treatments available for hyperthyroidism. The best approach for you depends on your age and health. The underlying cause of hyperthyroidism and how severe it is make a difference too. Your personal preference also should be considered as you and your health care provider decide on a treatment plan. Treatment may include:

• Anti-thyroid medicine. These medications slowly ease symptoms of hyperthyroidism by preventing the thyroid gland from making too many hormones. Anti-thyroid medications include methimazole and propylthiouracil. Symptoms usually begin to improve within several weeks to months.

  Treatment with anti-thyroid medicine typically lasts 12 to 18 months. After that, the dose may be slowly decreased or stopped if symptoms go away and if blood test results show that thyroid hormone levels have returned to the standard range. For some people, anti-thyroid medicine puts hyperthyroidism into long-term remission. But other people may find that hyperthyroidism comes back after this treatment.

  Although rare, serious liver damage can happen with both anti-thyroid medications. But because propylthiouracil has caused many more cases of liver damage, it’s generally used only when people can’t take methimazole. A small number of people who are allergic to these medicines may develop skin rashes, hives, fever or joint pain. They also can raise the risk of infection.

• Beta blockers. These medicines don’t affect thyroid hormone levels. But they can lessen symptoms of hyperthyroidism, such as a tremor, rapid heart rate and heart palpitations. Sometimes, health care providers prescribe them to ease symptoms until thyroid hormones are closer to a standard level. These medicines generally aren’t recommended for people who have asthma. Side effects may include fatigue and sexual problems.Regardless of the cause of hyperthyroidism, the adrenergic symptoms are controlled by beta blockers Propranolol has the theoretical advantage of also inhibiting 5′-monodeiodinase, thus blocking peripheral conversion of T₄ to T₃.
• Radioiodine therapy. The thyroid gland takes up radioiodine. This treatment causes the gland to shrink. This medicine is taken by mouth. With this treatment, symptoms typically lessen within several months. This treatment usually causes thyroid activity to slow enough to make the thyroid gland underactive. That condition is hypothyroidism. Because of that, over time, you may need to take medicine to replace thyroid hormones.
• Radioactive iodine and antithyroid medicine are the treatments doctors use most often. The best treatment for you will depend on a number of things, including your age. Some people need more than one kind of treatment.
• Thyroidectomy. This is surgery to remove part of or all of the thyroid gland. It is not used often to treat hyperthyroidism. But it may be an option for people who are pregnant. It also may be a choice for those who can’t take anti-thyroid medicine and don’t want to or can’t take radioiodine therapy.

  Risks of this surgery include damage to the vocal cords and parathyroid glands. The parathyroid glands are four tiny glands on the back of the thyroid. They help control the level of calcium in the blood.

  People who have a thyroidectomy or radioiodine therapy need lifelong treatment with the medicine levothyroxine (Levoxyl, Synthroid, others). It supplies the body with thyroid hormones. If the parathyroid glands are removed during surgery, medicine also is needed to keep blood calcium in a healthy range.

Thyroid eye disease

If you have thyroid eye disease, you may be able to manage mild symptoms with self-care steps, such as artificial tear drops and lubricating eye gels. Avoiding wind and bright lights can help too.

More-severe symptoms may need treatment with medicine called corticosteroids, such as methylprednisolone or prednisone. They can lessen swelling behind the eyeballs. The medicine teprotumumab (Tepezza) also may be used to control moderate to severe symptoms. If those medicines don’t ease symptoms, other medicines are sometimes used to treat thyroid eye disease. They include, tocilizumab (Actemra), rituximab (Rituxan) and mycophenolate mofetil (Cellcept).

In some cases, surgery may be needed to treat thyroid eye disease, including:

• Orbital decompression surgery. In this surgery, the bone between the eye socket and the sinuses is removed. This surgery can improve vision. It also gives the eyes more room, so they can go back to their usual position. There is a risk of complications with this surgery. If you have double vision before the surgery, it may not go away afterward. Some people develop double vision after the surgery.
• Eye muscle surgery. Sometimes scar tissue from thyroid eye disease can cause one or more eye muscles to be too short. This pulls the eyes out of alignment, causing double vision. Eye muscle surgery may correct double vision by cutting the muscle from the eyeball and attaching it again farther back.

The choice of treatment modality for hyperthyroidism caused by overproduction of thyroid hormones depends on the patient’s age, symptoms, comorbidities, and preference but also including what is the CAUSE of the hyperthyroidism determined by diagnostic tooling tests.

 “The main hormones your thyroid make and release in the body are triiodothyronine (T3) thyroxine (T4).

Hyperthyroidism is a condition in which your thyroid creates and releases more of these hormones than you need.

Hyperthyroidism, also called overactive thyroid, is when the thyroid gland makes more thyroid hormones than your body needs. The thyroid is a small, butterfly-shaped gland in the front of your neck. Thyroid hormones control the way the body uses energy, so they affect nearly every organ in your body, even the way your heart beats. With too much thyroid hormone, creating many of your body’s functions to speed up.

About 1 out of 100 Americans ages 12 years and older have hyperthyroidism  Hyperthyroidism is more common in women and people older than 60.”

National Institute of  Diabetes and Digestive and Kidney Disease –  NIDDH

Hyperthyroidism, also called overactive thyroid, is when the thyroid gland makes more thyroid hormones than your body needs. The thyroid is a small, butterfly-shaped gland in the front of your neck. Thyroid hormones control the way the body uses energy, so they affect nearly every organ in your body, even the way your heart beats.

Possible Causes of Hyperthyroidism:

Hyperthyroidism has several causes, including Graves’ disease, thyroid nodules, and thyroiditis—inflammation of the thyroid. Rarely, hyperthyroidism is caused by a noncancerous tumor of the pituitary gland located at the base of the brain. Consuming too much iodine or taking too much thyroid hormone medicine also may raise your thyroid hormone levels.

-Graves’ disease

Graves’ disease is the most common cause of hyperthyroidism. Graves’ disease is an autoimmune disorder. With this disease, your immune system attacks the thyroid and causes it to make too much thyroid hormone.

-Overactive thyroid nodules

Thyroid nodules are lumps in your thyroid. Thyroid nodules are common and usually benign, meaning they are not cancerous. However, one or more nodules may become overactive and produce too much thyroid hormone. The presence of many overactive nodules occurs most often in older adults.

-Thyroiditis

Thyroiditis is inflammation of your thyroid that causes stored thyroid hormone to leak out of your thyroid gland. The hyperthyroidism may last for up to 3 months, after which your thyroid may become underactive, a condition called hypothyroidism. The hypothyroidism usually lasts 12 to 18 months, but sometimes is permanent.

Several types of thyroiditis can cause hyperthyroidism and then cause hypothyroidism:

• Subacute thyroiditis. This condition involves a painfully inflamed and enlarged thyroid. Experts are not sure what causes subacute thyroiditis, but it may be related to an infection caused by a virus or bacteria.
• Postpartum thyroiditis. This type of thyroiditis develops after a woman gives birth.
• Silent thyroiditis. This type of thyroiditis is called “silent” because it is painless, even though your thyroid may be enlarged. Experts think silent thyroiditis is probably an autoimmune condition.

-Too much iodine

Your thyroid uses iodine to make thyroid hormone. The amount of iodine you consume affects the amount of thyroid hormone your thyroid makes. In some people, consuming large amounts of iodine may cause the thyroid to make too much thyroid hormone.

Some medicines and cough syrups may contain a lot of iodine. One example is the heart medicine amiodarone. Seaweed and seaweed-based supplements also contain a lot of iodine.

-Too much thyroid hormone medicine:

Some people who take thyroid hormone medicine for hypothyroidism may take too much. If you take thyroid hormone medicine, you should see your doctor at least once a year to have your thyroid hormone levels checked. You may need to adjust your dose if your thyroid hormone level is too high.

Some other medicines may also interact with thyroid hormone medicine to raise hormone levels. If you take thyroid hormone medicine, ask your doctor about interactions when starting new medicines

– A noncancerous tumor of the pituitary gland causing too much release of the hormone for the thyroid to release T3 and T4.

This is done by the tumor causing the pituitary gland over release thyroid stimulating hormone-TSH.   Thyrotropinomas are pituitary adenomas that occur in the thyrotropic cells of the pituitary gland and secrete thyroid-stimulating hormone, or TSH. TSH, in turn, triggers the thyroid gland to become overly active and produce too much thyroid hormone, a condition known as hyperthyroidism.

It can also cause a wide variety of signs and symptoms:

• Hyperthyroidism (overactive thyroid) is a condition in which your thyroid gland produces too much of the hormone thyroxine. Hyperthyroidism can accelerate your body’s metabolism significantly, causing sudden weight loss, a rapid or irregular heartbeat, sweating, and nervousness or irritability.
• Sudden weight loss, even when your appetite and the amount and type of food you eat remain the same or even increase
• Rapid heartbeat (tachycardia) — commonly more than 100 beats a minute — irregular heartbeat (arrhythmia) or pounding of your heart (palpitations)
• Increased appetite
• Nervousness, anxiety and irritability
• Tremor — usually a fine trembling in your hands and fingers
• Sweating
• Changes in menstrual patterns
• Increased sensitivity to heat
• Changes in bowel patterns, especially more frequent bowel movements
• An enlarged thyroid gland (goiter), which may appear as a swelling at the base of your neck
• Fatigue, muscle weakness
• Difficulty sleeping
• Skin thinning
• Fine, brittle hair
• Graves’ ophthalmopathy=An autoimmune disease that is frequently associated with hyperthyroidism.
• Sometimes an uncommon problem called Graves’ ophthalmopathy may affect your eyes, especially if you smoke. In this disorder, your eyeballs protrude beyond their normal protective orbits when the tissues and muscles behind your eyes swell. This pushes the eyeballs forward so far that they actually bulge out of their orbits. This can cause the front surface of your eyeballs to become very dry. Eye problems often improve without treatment.Older adults are more likely to have either no signs or symptoms or subtle ones, such as an increased heart rate, heat intolerance and a tendency to become tired during ordinary activities. Medications called beta blockers, which are used to treat high blood pressure and other conditions, can mask many of the signs of hyperthyroidism.
• Protruding eyeballs
• Red or swollen eyes
• Excessive tearing or discomfort in one or both eyes
• Light sensitivity, blurry or double vision, inflammation, or reduced eye movementIf you experience unexplained weight loss, a rapid heartbeat, unusual sweating, swelling at the base of your neck or other symptoms associated with hyperthyroidism, see your doctor. It’s important to completely describe the changes you’ve observed, because many signs and symptoms of hyperthyroidism may be associated with a number of other conditions.Causes:  A number of conditions, including Graves’ disease, toxic adenoma, Plummer’s disease (toxic multi-nodular goiter) and thyroiditis, can cause hyperthyroidism.

When to be checked by the doctor:

Any of these signs or symptoms listed above you have that where never checked out by the doctor or if the new symptom (s) just recently started and where never diagnosed by the MD.  If you’ve been treated for hyperthyroidism or currently are being treated, see your doctor regularly as advised so that he or she can monitor your condition.  Also, if you are at a age that makes you in a age group that is more common to have this disease than have your MD check you out to see if you have the disease.

If hyperthyroidism isn’t treated, it can cause some serious health problems, including:

-an irregular heartbeat that can lead to blood clots, stroke, heart failure, and other heart-related problems

-an eye disease called Graves’ ophthalmopathy that can cause double vision, light sensitivity, and eye pain, and rarely can lead to vision loss

-thinning bones and osteoporosis

Risk factors:

Hyperthyroidism, particularly Graves’ disease, tends to run in families and is more common in women than in men. If another member of your family has a thyroid condition, talk with your doctor about what this may mean for your health with what you need to do.

Hyperthyroidism can be serious don’t ignore it, most people respond well once hyperthyroidism is diagnosed and treated. Hyperthyroidism can mimic other health problems, which may make it difficult for your doctor to diagnose.

Complications:

Untreated, hyperthyroidism can cause serious health problems, including

• an irregular heartbeat that can lead to blood clots, stroke, heart failure, and other heart-related problems
• an eye disease called Graves’ ophthalmopathy
• thinning bones, osteoporosis NIH external link, and muscle problems
• menstrual cycle and fertility issues

“Women are much more likely than men to develop hypothyroidism. The disease is also more common among people older than age 60.¹

You are more likely to have hypothyroidism if you

• had a thyroid problem before, such as a goiter
• had surgery or radioactive iodine to correct a thyroid problem
• received radiation treatment to the thyroid, neck, or chest
• have a family history of thyroid disease
• were pregnant in the past 6 months
• have Turner syndrome NIH external link, a genetic disorder that affects women.”

National Institute of Diabetes, Digestive and Kidney Diseases – NIH

(https://www.niddk.nih.gov/health-information/endocrine-diseases/hypothyroidism#who)

Hypothyroidism

Hypothyroidism (under-active thyroid) is a condition that occurs when your thyroid produces too little thyroid hormone, a condition that is often linked to iodine deficiency.

Dr. David Brownstein, a board-certified holistic practitioner who has been working with iodine for the last two decades, claims that over 95 percent of the patients in his clinic are iodine-deficient.

In addition, 10 percent of the general population in the United States, and 20 percent of women over age 60, have subclinical hypothyroidism, a condition where you have no obvious symptoms and only slightly abnormal lab tests.

However, only a marginal percentage of these people are being treated. The reason behind this is the misinterpretation and misunderstanding of lab tests, particularly TSH (thyroid stimulating hormone). Most physicians believe that if your TSH value is within the “normal” range, your thyroid is fine. But as I always say, the devil is in the details. More and more physicians are now discovering that the TSH value is grossly unreliable for diagnosing hypothyroidism.

Hypothyroidism can cause a variety of signs and symptoms:

The most sensitive way to find out is to listen to your body. People with a sluggish thyroid usually experience:

Lethargy – Fatigue and lack of energy are typical signs of thyroid dysfunction. Depression has also been           linked to the condition. If you’ve been diagnosed with depression, make it a point that your physician checks your thyroid levels.

• • It’s essential to note that not all tiredness or lack of energy can be blamed on a dysfunctional thyroid gland. Thyroid-related fatigue begins to appear when you cannot sustain energy long enough, especially when compared to a past level of fitness or ability. If your thyroid foundation is weak, sustaining energy output is going to be a challenge. You will notice you just don’t seem to have the energy to do the things like you used to.

• • • Feeling like you don’t have the energy to exercise, and typically not exercising on a consistent basis
    • A heavy or tired head, especially in the afternoon; your head is a very sensitive indicator of thyroid hormone status
    • Falling asleep as soon as you sit down when you don’t have anything to do.
• Rough and scaly skin and/or dry, coarse, and tangled hair– If you have perpetually dry skin that doesn’t respond well to moisturizing lotions or creams, consider hypothyroidism as a factor.
• Hair loss– Women especially would want to pay attention to their thyroid when unexplained hair loss occurs. Fortunately, if your hair loss is due to low thyroid function, your hair will come back quickly with proper thyroid treatment.
• Sensitivity to cold– Feeling cold all the time is also a sign of low thyroid function. Hypothyroid people are slow to warm up, even in a sauna, and don’t sweat with mild exercise.
• Low basal temperature – Another telltale sign of hypothyroidism is a low basal body temperature (BBT), less than 97.6 degrees Fahrenheit averaged over a minimum of three days. It is best to get a BBT thermometer to assess this.
• Weight gain– Easy weight gain or difficulty losing weight, despite an aggressive exercise program and watchful eating, is another indicator.

Hypothyroidism in infants

Anyone can get hypothyroidism, including infants. Most babies born without a thyroid gland or with a gland that doesn’t work correctly don’t have symptoms right away. But if hypothyroidism isn’t diagnosed and treated, symptoms start to appear. They may include:

• Feeding problems.
• Poor growth.
• Poor weight gain.
• Yellowing of the skin and the whites of the eyes, a condition called jaundice.
• Constipation.
• Poor muscle tone.
• Dry skin.
• Hoarse crying.
• Enlarged tongue.
• A soft swelling or bulge near the belly button, a condition called umbilical hernia.

When hypothyroidism in infants isn’t treated, even mild cases can lead to severe physical and mental development problems.

Hypothyroidism in children and teens

In general, children and teens with hypothyroidism have symptoms similar to those in adults. But they also may have:

• Poor growth that leads to short stature.
• Delayed development of permanent teeth.
• Delayed puberty.
• Poor mental development.

When to see a doctor

See your health care provider if you’re feeling tired for no reason or if you have other symptoms of hypothyroidism.

If you’re taking thyroid hormone medicine for hypothyroidism, follow your health care provider’s advice on how often you need medical appointments. At first, you may need regular appointments to make sure you’re receiving the right dose of medicine. Over time, you may need checkups so that your health care provider can monitor your condition and medicine.

Causes:

“Your thyroid gland, as an endocrine gland, makes and secretes hormones. Your thyroid produces and releases the following hormones:

• Thyroxine (T4): This is the primary hormone your thyroid makes and releases. Although your thyroid makes the most of this hormone, it doesn’t have much of an effect on your metabolism. Once your thyroid releases T4 into your bloodstream, it can convert to T3 through a process called deiodination in the liver.
• Triiodothyronine (T3): Your thyroid produces lesser amounts of T3 than T4, but it has a much greater effect on your metabolism than T4.
• Reverse triiodothyronine (RT3): Your thyroid makes very small amounts of RT3, which reverses the effects of T3.
• Calcitonin: This hormone helps regulate the amount of calcium in your blood. It plays a role in regulating the level of calcium in your blood by decreasing it. The C-cells in your thyroid gland produce calcitonin.

Your thyroid’s main job is to control your metabolism — how your body uses energy. Sometimes, your thyroid doesn’t work properly. These conditions are common and treatable.

More than 12 percent of the U.S. population will experience a thyroid condition at some point in their lives.  Yet, thyroid disease often goes undetected: as many as 60% of people don’t know they have it, which is why regular screening is important.”

Cleveland Clinic (https://my.clevelandclinic.org/health/body/23188-thyroid)