From an overview and call-to-action perspective, can you discuss the importance of screening, diagnosis and assessment of hypothyroidism? What is the unique metabolic role and impact of T3 on target organs, especially the cardiovascular system and CNS?
Hi, my name is Christine Kessler. I'm a nurse practitioner in general endocrinology practice and I have been speaking and treating and writing on the subject of fire disorders since 19 late 1970s. been a while well, we're looking into canopy. These are indifferent disorders. The most the second most common out there worldwide is thyroid, our thyroid disorders and among the thyroid open. These the most common is hypothyroidism, primarily primary hyperthyroidism. And in this country it is autoimmune thyroid eyes, hashimoto's. I say that because if you look on the World wide scale, it's actually iodine deficiency the biggest cause of hypothyroidism. But in this country it's going to be autoimmune hypothyroidism is the cause and what's interesting about this particular disorder. It is so prevalent and even among those who might be watching this among you among your patients, it is so prevalent that I fear it may become somewhat of a wallpaper diagnosis, not quite taken as seriously as we should take it and that will be talking about, it's very important. We take this seriously and look at a hypothyroidism. Now, when you're looking at the problem and why this is so impactful on the body and health care cost is understanding what thyroid hormone does and the thyroid hormone affects every tissue in the body. So if you have any disruption in the production and delivery of thyroid hormone, it's going to affect widespread systemic health. And to look at and when you're looking at the consequences for our patients, well, we have to understand what thyroid hormone does to the major systems that your patients and my patients complain mostly about. I like to start off by saying, I always consider hypothyroidism, particularly primary hypothyroidism as a cardio metabolic disorder is a cardiac disease. The greatest impact we see when it comes to long term morbidity and the mortality is due to cardiovascular Kuala from a deficiency. And certainly in thyroid hormone, Thyroid hormone affects three. A number of major systems with the one I want to focus on is cardiac cardiovascular system. The cns and fertility as well as fat mass and many others. The most metabolically active of the thyroid hormones is try I doth Iranian or T. Three, which has profound effects on all major systems in the body, especially the cardiovascular system where it affects contract, tell you the heart heart rate when it affects in ethereal function, systemic vascular resistance and also lipid metabolism. Now this is important because as you get a reduction insufficiency of thyroid or T. Three output, you're going to have a decrease in myocardial, contract ill itty which increases the risk of heart failure. You're going to have a decrease in heart rate. Which is going to lead to bradycardia and actually a lot of prolonging of intervals looking at E. K. G. Changes. You're going to have increases in systemic vascular resistance. You're going to have in the field of dysfunction and increases the risk of cardiovascular disease, coronary heart disease with heart attacks and stroke. And you're going to have an increased risk of hard to treat this like anemia. So that's probably the most common thing I look for and gives me greatest concern and getting these patients treated. The other thing with hypothyroidism and the one that brings a lot of patients to us is the effect on the cns. You cannot understate this. It affects profoundly mood and it affects called neural cognition. So what you're gonna end up getting is problems with fatigue depression, sufficient significant Depression. And then you're going to have problems with thermo genesis is T. three plays a big role in maintaining body temperature in times of greater need. The other one that's gonna bring patients to you due to their hypothyroidism is infertility and changes in the menstrual cycle if they're premenopausal. So that is a those are probably the biggest things you see as well as a deposit. E and I won't go into that for this talk, but I cannot minimize the impact of thyroid hormone on fat mass. And when you're in the presence of hypothyroidism, you're going to get increased central etapa city and you're gonna have increased a visual at a posse with uh nonalcoholic fatty liver, which colleagues is one of the biomarkers of cardio metabolic impairment or metabolic syndrome. Again, I focus on this as being the big reason we must pay attention now when we treat these patients, it's most important to understand the patient has a problem and when they're coming to you with very ubiquitous symptoms, that's hard. The majority of patients with hypothyroidism are managed in primary care unless they have a concomitant endocrine apathy that endocrinology is measuring, or they have an underlying condition that makes treating or thyroid hormone replacement very difficult, like a scheme of heart disease. The majority of these patients are in the purview and in the ballpark of primary care. And so that's why it's important that we we look at this and understand how first to identify these patients at risk, how to treat them efficiently, effectively and safely. And it can be very confusing when you're seeing guidelines coming out there, they don't quite meet what your patients show, and we'll be talking about that further.