E d u c a t i o n , R e s e a r c h a n d S e r v i c e i n W o m e n ' s H e a l t h
The Thyroid and Your Health
The thyroid is a small butterfly-shaped gland located just below the Adam’s apple in theneck. The thyroid makes thyroid hormone, well known to affect metabolism and energylevel. Thyroid hormone has other important effects, however, such as regulation of themenstrual cycle, bowel function, heart rate, and quality of our skin and hair. Thyroidhormone has these varied effects due to the presence of receptors for thyroid hormonenearly everywhere in the body.
Problems with the thyroid are more common in women than men. This may involve anunderactive thyroid called “hypothyroidism” or an overactive thyroid called“hyperthyroidism”. Hypothyroidism usually results from inflammation of the thyroid glandfrom a process known as thyroiditis. Thyroiditis is frequently painless with few symptomsand can result from autoimmunity (the body produces antibodies to the thyroid leading toinflammation), viral infection, or exposure to concentrated forms of iodine (contrast dye,certain medications such as amiodarone). Hypothyroidism resulting from thyroiditis maybe temporary at first, but if thyroiditis is ongoing, the thyroid can become permanentlyunderactive. A time in a woman’s life when she may be most at risk for developing
thyroiditis is 3 to 4 months after delivering a baby. This is called “post partum thyroiditis”
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and usually causes temporary hypothyroidism that resolves with no intervention.
A few of the changes in the body that suggest hypothyroidism include: weight gain, fatigue, brittle hair/nails, dry skin, anenlargement of the thyroid (goiter), constipation, slow heart rate, cold intolerance, and heavy menses. A blood test forthyroid hormones in combination with a history and physical examination are used by your primary care provider to confirm
hypothyroidism. Fortunately, hypothyroidism is easily treatedwith synthetic oral thyroid replacement with medication such as
I n t h i s i s s u e
Synthroid, Levothroid, or Levoxyl. In the past, animal-derived thyroid hormone replacement was used with a
Volume 8, Issue 4; October 2003
preparation called Armour’s thyroid from cow thyroid gland.
This medication has fallen out of favor due to inconsistent amountsof thyroid hormone found in the prescriptions.
Hyperthyroidism is less common than hypothyroidism. Like
hypothyroidism, hyperthyroidism may result from an inflammation
of the thyroid from thyroiditis, exposure to concentrated iodine(contrast, amiodarone), or uniquely from an autoimmune process
Omaha Women’s Health & Wellness Conference
called Graves’ disease. Graves’ disease occurs when the body
A quarterly newsletter provided by the
Olson Center for Women’s Health.
Message from the Chairman .
Carl V. Smith, MD, FACOG
The mission of the Olson Center for Womens Health
There are many milestones in medicine and it would be
is to provide a national comprehensive health science
extremely difficult to agree upon which has had the most
center at the University of Nebraska Medical Center.
impact on the health of women. Near the top of this list
Based in the Department of Obstetrics and Gynecology,
has to be the discovery of insulin. The story of its use
the center enables UNMC to make distinctive strides
parallels the story of women’s health care.
in education, research, and service through innovativeapproaches to womens health issues.
In the summer of 1921, Canadian biochemists, Frederick Banting and Charles
Best, reported the discovery of insulin and the outcomes of pregnant diabetics
were forever changed. In the early 1900’s pregnancy in diabetics was almost
unheard of. Quite simply, women with diabetes died before they reached
reproductive age. Those few that conceived had extraordinary rates of miscarriage
and fetal death. As insulin use became routine, women survived longer, conceived
at a rate equal to non-diabetics, and had fewer miscarriages. A problem that
remained for these women and their fetuses was a high rate of stillbirth.
McClure L. Smith, MDGail Walling-Yanney, MD
It is human nature to seek simple solutions to medical problems and the stillbirthrate is no exception. If the environment of the womb was unsafe, the solutionappeared clear: deliver the infant. Furthermore, since the more severe the disease
the higher the pregnancy loss rates and the earlier in pregnancy the loss occurred,
persons with more advanced disease were delivered earlier and earlier.
Obstetricians thereby shifted an obstetric problem into the hands of the
pediatricians. This shift created as many problems as it solved and changed the
reasons for pregnancy loss. The most common cause of death among infants of
diabetic mothers was lung failure due to prematurity. With the advent of
biochemical tests of lung maturity and fetal heart rate monitoring, we were able tosignificantly reduce the rate of death. Those fetuses with immature lungs and
reassuring fetal heart rates were left in the womb longer. In a properly monitored
For more information on womens health, as well as
pregnancy, fetal death is remarkably rare. The story does not end there.
information on the faculty, research, and programs
available in the Department of Obstetrics and
At the present time, the leading cause of mortality in infants of diabetic mothers
Gynecology at the University of Nebraska Medical
is congenital birth defects. The rate of birth defects is directly related to how
Center, we invite you to visit the Olson Center for
tightly the blood sugars have been controlled at the time of conception. This
Womens Health website. Specific womens health
usually occurs well before the patient’s first visit with her obstetrician. Reducing
the rate of abnormalities and secondarily the rate of death requires cooperation
between the patient and the health care provider. Both need to assure adequate
contraception if pregnancy is not desired and tight control of blood sugars if it is.
Specialists in high-risk obstetrics welcome the opportunity to prevent rather than
treat disease. A team approach is more likely to be successful. Family physicians,
endocrinologists, diabetic educators and dieticians can work together to reinforce
◊ Reproductive Endocrinology/Infertility
the need for glucose control and develop strategies that assist the patient in
becoming compliant. Once the woman is pregnant this team approach is helpful
in controlling glucose levels during pregnancy, monitoring the well-being of the
Womens Health Overview is published quarterly
fetus, and deciding upon the best time for delivery.
for health care professionals and the general public withspecial interest in womens health issues. Address all
In the ideal world every woman of reproductive age should be offered
comments to Lana Molczyk, Olson Center for Womens
preconception counseling. Diseases, other than diabetes, that could be affected
Health, UNMC, 983255 Nebraska Medical Center,
by pregnancy, or affect the pregnancy, should be identified. The rate of
Omaha, NE 68198-3255; call (402) 559-6345 or (800)
unintended pregnancy in this country is at least 40%. In patients with medical
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illnesses and family or personal histories of adverse pregnancy outcomes, this
of this newsletter may be reproduced provided credit
rate should be far lower. The use of safe and effective contraception is possible
is given to the Olson Center for Womens Health. The
and in most situations contraception use is safer than unintended pregnancy.
information provided by the Olson Center for
In those patients who wish to conceive, treatment using drugs or therapies
Womens Health is for educational purposes only
thought to be low risk in pregnancy could be initiated and the outcomes
and should not take the place of advice and guidance
from your own health-care providers.
improved. Patients should demand this of their health care providers andproviders should be prepared to respond.
The Thyroid and Your Health (Continued from page 1)
produces an antibody that stimulates the thyroid to produce too much thyroid hormone. Hyperthyroidism may also occur ifthere is an overactive or “autonomous” nodule of the thyroid. The latter cause of hyperthyroidism is more common inwomen over the age of 50. Changes in the body that suggest hyperthyroidism include anxiousness, weight loss, tremor of thehands, insomnia, increased frequency of bowel movements, goiter, lighter menses or absence of menses, and dryness orgrittiness of the eyes. Just as with hypothyroidism, a blood test for thyroid hormone along with a history and physical examinationfrom your primary care provider are used to confirm hyperthyroidism. Depending on the cause of the hyperthyroidism, varioustreatments are used to restore a normal thyroid state. The treatments range from oral “antithyroid” medication to radioactiveiodine to make the thyroid nonfunctional. Removal of the thyroid or thyroidectomy may be a treatment option if there is anallergy to the antithyroid medications or if radioactive iodine cannot be used such as in pregnancy.
Routine screening for thyroid problems is not usually done unless patients have complaints that suggest that there is a thyroidproblem. Individuals who should be screened at least every 1 to 2 years for thyroid dysfunction, regardless of whether theyhave symptoms or not, include those with type 1 diabetes mellitus (formerly known as juvenile diabetes). This is recommendedbecause the autoimmunity that caused the type 1 diabetes mellitus may likewise cause thyroiditis and hypothyroidism.
Women with strong family histories of thyroid dysfunction may be screened at anytime if they have complaints, particularlyafter age 50. It is important to point out, however, that other health problems may exist that can produce similar complaintsseen with hypothyroidism, when the thyroid is actually normal. This emphasizes the need for a good history and physicalexamination by your primary care provider to help identify the true source of your complaints.
Contributed by Lynn Mack-Shipman, MD, Assistant Professor, UNMC Department of Internal Medicine,Section of Diabetes, Endocrinology and Metabolism
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