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Alexander EK et al Timing and magnitude of increases in levothyroxine requirements during pregnancy in women with hypothyroidism N Engl J Med 2004 Jul 15;351(3):241 9 [PMID: 15254282] Appelhof BC et al Combined therapy with levothyroxine and liothyronine in two ratios, compared with levothyroxine monotherapy in primary hypothyroidism: a double-blind, randomized, controlled clinical trial J Clin Endocrinol Metab 2005 May;90(5): 2666 74 [PMID: 15705921] Hennessey JV Levothyroxine dosage and the limitations of current bioequivalence standards Nat Clin Pract Endocrinol Metab 2006 Sep;2(9):474 5 [PMID: 16957756] Roos A et al The starting dose of levothyroxine in primary hypothyroidism treatment: a prospective, randomized, double-blind trial Arch Intern Med 2005 Aug 8 22;165(15): 1714 20 [PMID: 16087818] Wekking EM et al Cognitive functioning and well-being in euthyroid patients on thyroxine replacement therapy for primary hypothyroidism Eur J Endocrinol 2005 Dec;153(6): 747 53 [PMID: 16322379]

Exercise 4-1. Write a program that assigns the value 25 to variable x, and 5 to variable y. Output the sum, difference, product, quotient, and modulus of x and y. Exercise 4-2. What will be the output of the following method Why

HYPERTHYROIDISM (THYROTOXICOSIS)

Sweating, weight loss or gain, anxiety, loose stools, heat intolerance, irritability, fatigue, weakness, menstrual irregularity Tachycardia; warm, moist skin; stare; tremor

In Graves disease: goiter (often with bruit); ophthalmopathy Suppressed TSH in primary hyperthyroidism; increased T4, FT4, T3, FT3

Multiprogramming, a technique based on memory partitioning, allows a single processor to interleave and execute two or more computer programs. Spool is an acronym for Simultaneous Peripheral Operation Online. This technique minimizes processing delays when moving data between peripherals and the CPU (see Tanenbaum 1997, 9).

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static void Main( ) { int varA = 5; int varB = ++varA; int varC = varB++; Console.WriteLine( "A: {0}, B: {1}, C: {2}", varA, varB, varC ); }

seen with interleukin-2 therapy and after neck surgery for hyperparathyroidism Patients taking lithium may rarely experience thyrotoxicosis due to silent thyroiditis Symptoms mimic a manic episode such that the diagnosis is often missed

The term thyrotoxicosis refers to the clinical manifestations associated with serum levels of T4 or T3 that are excessive for the individual (hyperthyroidism) Serum TSH levels are suppressed in primary hyperthyroidism However, laboratory tests can be affected by certain conditions and drugs that may lead to the erroneous diagnosis of hyperthyroidism in euthyroid individuals (Table 26 5) The causes of hyperthyroidism are many and diverse, as described below

Jodbasedow disease, or iodine-induced hyperthyroidism, may occur in patients with multinodular goiters after intake of large amounts of iodine in the diet or in the form of radiographic contrast materials or drugs, especially amiodarone

Exercise 4-3. Imagine an amusement park ride that holds two passengers. Because of safety restrictions, the combined weight of the two passengers must be more than 100 pounds, but no more than 300 pounds. Now imagine a family of four who want to ride this ride. Abby weighs 135 pounds, Bob weighs 175 pounds, their son Charlie weighs 55 pounds, and their daughter Dawn weighs 45 pounds. Write a program that calculates whether the weight of the two combined passengers falls within the accepted range. Use constants for the maximum and minimum weights, and for the weight of each family member. The output should look something like this, for Abby and Dawn:

Thyrotoxicosis factitia is due to ingestion of excessive amounts of exogenous thyroid hormone Isolated epidemics of thyrotoxicosis have been caused by consumption of ground beef contaminated with bovine thyroid gland

Graves disease (known as Basedow s disease in Europe) is the most common cause of thyrotoxicosis It is an autoimmune disorder affecting the thyroid gland, characterized by an increase in synthesis and release of thyroid hormones; the thyroid gland is typically enlarged Graves disease is much more common in women than in men (8:1), and its onset is usually between the ages of 20 and 40 years It may be accompanied by infiltrative ophthalmopathy (Graves exophthalmos) and, less commonly, by infiltrative dermopathy (pretibial myxedema) The thymus gland is typically hyperplastic and enlarged Graves disease may also be associated with other systemic autoimmune disorders such as pernicious anemia, myasthenia gravis, and diabetes mellitus It has a familial tendency, and histocompatibility studies have shown an association with group HLA-B8 and HLA-DR3 The pathogenesis of the hyperthyroidism of Graves disease involves the formation of autoantibodies that bind to the TSH receptor in thyroid cell membranes and stimulate the gland to hyperfunction Antibodies increased in most patients include TSH-R Ab[stim], antinuclear antibody (ANA), and antithyroperoxidase or antithyroglobulin antibodies Patients with Graves disease have an increased risk of developing Addison s disease, alopecia areata, celiac disease, diabetes mellitus type 1, myasthenia gravis, cardiomyopathy, and hypokalemic periodic paralysis

Thyroid tissue is contained in about 3% of ovarian dermoid tumors and teratomas This thyroid tissue may autonomously secrete thyroid hormone due to a toxic nodule or in concert with the woman s thyroid gland in Graves disease or toxic multinodular goiter

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