User:Aemorrison/sandbox

- Review references

- Update the intro to have pictures of the thyroid and the other names of the condition

- Add epidemiology section '''- Update signs and symptoms. Add pictures of patient presentations and any diagrams that show the whole body and how it is affected'''

-- Signs and symptoms are variable and based on the clinical course. Early stages of autoimmune thyroiditis may have a normal physical exam with or without a goiter. As lymphocytic infiltration progresses, patients may exhibit signs of hypothyroidism in multiple bodily systems, including, but not limited to, a larger goiter, weight gain, cold intolerance, fatigue, myxedema, constipation, menstrual disturbances, dry skin and hair, depression, and muscle weakness. (Washington Manual endocrine)

- '''Combine the causes and mechanism category. Causes should be changed to associations for the title and can be its own subcategory.'''

Mechanism

-The mechanism of autoimmune thyroiditis is a result of a complex interaction of genetics, and environmental factors. The two antibodies most commonly implicated in autoimmune thyroiditis are antibodies against thyroid peroxidase (TPOAb) and thyroglobulin (TgAb). They are hypothesized to develop as a result of thyroid damage, where T-cells are sensitized to residual thyroid peroxidase and thyroglobulin, rather than as the cause of thyroid damage. However, they may exacerbate further thyroid destruction by binding the complement system and triggering apoptosis of thyroid cells. (de groots). Environmental factors that may predispose patients to this type of immune dysregulation include toxins, medications, dietary factors, and infectious agents. (werner and ingbars)

'''- Description of antibodies in mechanism to summarize. Add pictures of pathology'''

'''- Diagnosis - hard to follow at the moment. Update category and potentially add a flow chart with the diagnostic steps'''

'''- Treatment - add full spectrum of drugs such as, triiodothyronine; add surgical options, radioactive ablation, etc with descriptions. And side effects for medications'''

The standard of care is levothyroxine therapy, which is an oral medication structured like endogenous T4. Levothyroxine can be dosed based upon weight, most commonly, or TSH elevation. It should be administered on a consistent schedule. Some patients elect combination therapy with both levothyroxine and liothyronine, which is a synthetic T3, however studies of combination therapy are limited.(De groots)

Side effects of thyroid replacement therapy are associated with iatrogenic hyperthyroidism. More worrisome symptoms include atrial fibrillation and bone density loss.

-Add section under treatment for follow up monitoring of TSH levels after initiation of therapy

- Review for readability and change language away from doctor-speak when appropriate