Hyperthyroidism Awareness

It is important to remember that hyperthyroidism can occur at any age. While most may present with a rather typical constellation of symptoms, many may present with exacerbation of pre-existing conditions which may make the diagnosis initially elusive. Worsening anxiety, insomnia, fatigue, panic attacks, palpitations, hypertension or diarrhea may not initially signal that the thyroid is involved. Clinicians must have a low threshold to check thyroid function early to rule out a component of hyperthyroidism.

Once a suppressed thyrotropin (TSH) has been detected, further investigation with serum triiodothyronine (T3) and free thyroxine (free T4) can help delineate overt from subclinical disease. A thorough history of past thyroid disease, as well as current medications and supplements, can help detect any pre-existing diagnoses or exogenous sources of thyroid hormone or over supplementation with iodine. More commonly, hyperthyroidism is due to either Graves diseasetoxic multinodular goiter or toxic adenoma. Distinction between these can usually be made with the assistance of a thyroid uptake scan, TSH receptor antibody measurement, and thyroid ultrasound. An additional physical exam finding of exophthalmos can further support the diagnosis of Graves’ disease. Understanding the etiology can help guide patient expectations. A small percentage of patients with Graves’ Disease may undergo spontaneous remission after 1 to 2 years, which may prompt patients to wait before considering a definitive treatment option.

With confirmation of the diagnosis of hyperthyroidism, focus is on hormonal control with an antithyroid medication (ATM, most commonly Methimazole in the United States). This may be augmented with beta-blockade, steroids, cholestyramine or SSKI for those who are difficult to control.

Many patients may need further consideration for definitive management with either radioactive iodine ablation (RAI) or thyroidectomy. Your local resources may also influence these options, but it is critical to understand that all three treatments (ATM, RAI and thyroidectomy) are possible options. Certain patient factors and priorities may alter the preferred definitive treatment. Smaller gland size, easy to control hormones, and lack of eye symptoms are factors that may favor continued ATM management. A large goiter with compressive symptoms, difficult to control hormones requiring high dose medications/ multiple modalities, pregnancy, severe eye disease, multiple nodules within the thyroid with or without thyroid cancer, or desire for rapid and reliable hormone control may favor thyroidectomy. RAI is a good option for patients with a smaller gland size, and a desire to pursue definitive management but avoid surgery.

There are also relative contraindications for treatment options. ATMs may have serious side effects, like agranulocytosis or liver failure, which prevent further use, or may cause skin eruptions making long term use intolerable. Additionally, high dose requirements or fluctuating doses may make long term use of ATMs not reliable. Women who are pregnant, wanting to become pregnant in the next 6 months to 1 year, breast feeding or have small children in the home will want to avoid RAI. Patients with severe eye involvement, have a large goiter with compressive symptoms, or are smokers should also avoid RAI. Thyroidectomy will be a poor option for patients with multiple previous neck operations on or around the thyroid due to internal scarring, or who are high risk for general anesthesia. Additionally, if they have a history of previous gastric bypass surgery, they are higher risk for major complications from hypocalcemia/hypoparathyroidism after thyroidectomy.

To help the patient navigate these decisions, it is important to allow them the opportunity to discuss each treatment option with respective physician experts – medical management with endocrinology, RAI with endocrinology and potentially nuclear medicine as well, and thyroidectomy with the thyroid surgeon.

In summary, patients with hyperthyroidism require medical control, as well as a clear understanding of the etiology of their hyperthyroidism. Patients with Graves disease, toxic multinodular goiter and toxic adenoma have more than one treatment option, and it is important for patients to be educated and engaged in treatment decisions.

For Further Reference:
American Thyroid Association Guidelines for Diagnosis and Management of Hyperthyroidism and other causes of Thyrotoxicosis| by the American Thyroid Association

“What is the difference between Blogging and Journalism?”

Before we continue we must first of all find out what the two really are and then we will be able to identify the difference between them.

So then, what is blogging?  Blogging was actually created by Justin Hall. It all started in 1994 when many witness the   birth of the first blog. According to creative blog,  It was  called  Links.net  – a place where  creator  Justin Hall could share his musings and  his favorite  links  with the world .  It was a page where he could express himself, share his ideas and content on the web (Creative blog).

As years went by and technology progressed   in 1997 ,  many people started using their own personal websites as a place  to spotlight their ideas, the term “ weblog” was coined and  shortened to “ blog”   in 1999( Creative blog) .

People needed a place to share ideas, thoughts, express their feelings, and experiences. They found that having a place where you could share ideas and express yourself was an ideal way to share intimate information with people who are very close to you, friends and family.

According to creative blog,   when people first started blogging   they did not have to share it on Facebook or join a content network   or outwardly promote it. It was actually private   and people shared it with people they knew and they knew where to find them.

Before, blogging grew to what we know it today,   early blogger’s hosted contents on sites like Xanga. It was founded in 1998, and live journal in 1999.  Both were simple to use,  but  were  mostly  only able  to swap  out colors schemes  and minor  layout pieces, but very  effective  at allowing users to publish  quickly  and easily( Creative blog).

Many people became very interested in this new thing that they started looking beyond their intimate circle for more information to read. They started exploring, looking for the best blog and content on the web.    Blogging actually gained it roots when Charlotte Observer set up its blog and used it to share information in mainstream news something that had not been done before.  They used it and kept people informed. The Bonnie Blog set   records for page views on the observer’s site. They also set the stage along with Drudge reports breaking of the Clinton –Lewinsky scandal, for a major shift in the way blogging platform were used (Creative Blog).

Soon people started showing interest in blogging and online news.  They needed to find new ways on how to manage the content and share these ideas with the public.  According to creative blog, I n 2003 Google launch AdSense, this allowed bloggers to earn income for their work.  Soon many people were blogging. This gave them the opportunity to earn an income for the work that they do. Now it has become a profession for some people whereby they learn how to blog and make money. As we have seen what was once consider to be expression of people’s feelings , passion, ideas , thoughts and what was  going on around the world, like current events has evolve to a whole new phenomenon. Blog is abbreviated of “Weblog,”   it is used to describe websites that maintain an ongoing chronicle of information.  A blog is like a personal diary type commentary and links to articles on other websites.   It ranges from personal to political and can focus on concerns of the people. It is a place where most people feel very free to write and share their concerns.

Add context to a story by linking and commenting on other material found online.  Basically  when journalist blogs , they express their view about the issues surrounding whatever they are reporting on and even does it better because there are no restrictions  like when they are actually doing journalistic work.  To be a journalist one needs an academic training or formal training from a reputable school of journalism.  To be a blogger one needs a website and need to know how to express him or herself by writing.

Simply, blogging is viewed by many as unreliable because it’s someone’s opinion and the other one is viewed as reliable because one has to verify the source of the information before it can be broadcast the world. However, I think it is a perception issue of what the public view as reliable or unreliable and I say this because when we look at the evolvement of blogging over the years we can infer that blogging has become a huge deal that even major companies are using blogs to promote their businesses on their websites  and different forums. It has become one of the reliable sources that most people rely on to read and make decisions about whether they want to do business with the firm, purchase from them or inquire about what they do and what it entails.  As mentioned before, even journalist  and others have taken to blogs in order  to share information with others.

‘On Running after One’s Hat’ by G K Chesterton.

“I am done with it! I am irritated! This is frustrating! Why does it happen only to me?”

We face problems everyday and life for no reason keeps throwing something at us. Even when our toe gets hit by furniture, we start cursing and stressing. No matter how trivial or challenging a problem is, we constantly worry about it. But all these problems can be romanticized as adventures after reading G K Chesterton’s essay ‘On Running after One’s Hat’.

The essay starts with Chesterton envying people who were in London when it was flooded. He says that Battersea (a place in London) has always been beautiful and the addition of water has made it appear like Venice. He imagines the boat that bought the meat to have moved with the elegance and smoothness of a gondola (a long and narrow boat). 

“There is nothing so perfectly poetical as an island; and when a district is flooded it becomes an archipelago.”

The optimism of the essayist makes him romanticize the flood which we would normally think of as bringing misfortune, destruction and loss.

“The true optimist who sees in such things an opportunity for enjoyment is quite as logical and much more sensible than the ordinary.”

Most of the instances which we perceive as inconveniences are completely related to our mentality and outlook. The essayist gives an instance for example. When there is a delay in the arrival of the train, the grown-ups complain while the children never do. This is because for children, a railway station appears like a ‘cavern of wonder and a palace of poetical pleasure’. The red and green lights of the signal appear to them as the new sun and moon. So if we view such inconveniences as children do, we shall no more perceive them as inconveniences. All the so-called inconveniences depend on how we view it. 

The second instance the essayist gives is running after one’s hat. Many find it unpleasant to run after their hats after being blown away by wind. They run after a ball in a game but not after their own hat as they find it is humiliating.

“When people say it is humiliating they mean it is comic.”

People find it embarrassing as they are laughed at by other onlookers. Their fretful pursuit serves as a source of laughter. But it is all right because everything a human does is comical.

He also says that running after one’s hat has the potential of becoming a sport and it can be an alternative to poaching. “He might regard himself as a jolly huntsman pursuing a wild animal,…”. The essayist imagines it to be a common sport among the upper class. They would have their personal assistants run after the hat on a windy day and it would provide them a hearty laughter. This will be less painful than animal hunting too. The essayist says that we should be relieved of distress if our actions can provide laughter for others.

The essayist recalls how his friend struggled with a jammed drawer everyday. So, he points out to his friend that he is always finding the drawer troublesome because he always opens it while thinking that it should be easy to open the drawer. He says that the main problem lies with his friend’s outlook. Hence, he advises his friend to think of himself as “pulling against some powerful and oppressive enemy” or as participating in some fearsome tug war. If he imagines such situations when pulling the drawer, then it will no longer be an inconvenience but an adventure.

So, if we develop a positive outlook on everything that we encounter everyday, maybe life won’t be as hard as we think. After all,

“An adventure is only an inconvenience rightly considered. An inconvenience is only an adventure wrongly considered.”