2019-5-22 PTA - Philippine Thyroid Summit
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The document discusses thyroid disorders globally and in the Philippines. Some key points: - The Philippine prevalence of thyroid dysfunction is 8.53%, with subclinical hyperthyroidism and hypothyroidism being most common. - Filipino patients tend to present with more advanced thyroid cancer at a younger age compared to other populations. - Thyroid problems are relatively common during pregnancy, with careful management of hypo- and hyperthyroidism needed to prevent maternal and fetal complications.
2019-5-22 PTA - Philippine Thyroid Summit
- 1. Global, Regional and National Prevalence of Thyroid Disorders Jeremy F. Robles, MD, FPCP, FPSEDM 2019 Thyroid Summit “Building Partnerships to Support Thyroid Disorder Prevention and Control in the Philippines” May 22, 2019 (Wednesday) Diamond Hotel, Manila, Philippines
- 2. SPECTRUM OF THYROID DISEASES Hyperthyroidism Hypothyroidism Thyroid Nodules Thyroid Malignancy Pregnancy related thyroid Disease
- 3. SPECTRUM OF THYROID DISEASES Hyperthyroidism Hypothyroidism Thyroid Nodules Thyroid Malignancy Pregnancy related thyroid Disease
- 4. The Philippine Thyroid Diseases Study (PhilTiDeS 1): Prevalence of Thyroid Disorders Among Adults in the Philippines The Philippine Thyroid Diseases Study (PhilTiDeS 1) JAFES Vol. 27 No. 1 May 2012 • First national survey in the Philippines on the prevalence of thyroid disorder based on thyroid function tests. • Sampling: Stratified multi-stage sampling design (17 regions, 80 provinces)
- 5. The Philippine Thyroid Diseases Study (PhilTiDeS 1): Prevalence of Thyroid Disorders Among Adults in the Philippines The Philippine Thyroid Diseases Study (PhilTiDeS 1) JAFES Vol. 27 No. 1 May 2012 • Philippine Prevalence of thyroid dysfunction = 8.53%. • Half of the hyperthyroid patients have goiter • Distribution based on thyroid Function Status Thyroid Function Status Prevalence, N (%) Normal 4480 (91.47) Subclinical Hyperthyroidism 258 (5.33) Subclinical Hypothyroidism 110 (2.18) True Hyperthyroidism 30 (0.61) True Hypothyroidism 19 (0.41) Total 4897 (100)
- 6. Demographic & Biochemical Characteristics of the Population The Philippine Thyroid Diseases Study (PhilTiDeS 1) JAFES Vol. 27 No. 1 May 2012
- 7. Characteristics of the sample population according to World Health Organization grading of goiter The Philippine Thyroid Diseases Study (PhilTiDeS 1) JAFES Vol. 27 No. 1 May 2012
- 8. • Philippine National Prevalence of thyroid disease 8.53% • Subclinical Hyperthyroidism (5.33%) and Subclinical Hypothyroidism (2.18%) are the most common thyroid dysfunctions • Hyperthyroidism (0.6%) and Hypothyroidism (0.4%) • Only half of the patients with hyperthyroidism had goiter • Among the adult Filipino population, 8.9% have goiters by physical examination The Philippine Thyroid Diseases Study (PhilTiDeS 1): Prevalence of Thyroid Disorders Among Adults in the Philippines The Philippine Thyroid Diseases Study (PhilTiDeS 1) JAFES Vol. 27 No. 1 May 2012
- 9. SPECTRUM OF THYROID DISEASES Hyperthyroidism Hypothyroidism Thyroid Nodules Thyroid Malignancy Pregnancy related thyroid Disease
- 11. • American Cancer Society’s estimates for thyroid cancer in the United States for 2019 are: • 52,070 new cases of thyroid cancer (14,260 in men & 37,810 in women) • 2,170 deaths from thyroid cancer (1,020 men and 1,150 women) • The death rate from thyroid cancer has increased slightly, but remains very low compared with most other cancers. • Thyroid cancer is commonly diagnosed at a younger age than most other adult cancers. • Women 3X more likely to develop thyroid cancer than men. • Thyroid cancer is the most rapidly increasing cancer in the US. It has tripled in the past three decades. (UTZ: detect nodules better) US Thyroid Cancer Statistics https://www.cancer.org/cancer/thyroid-cancer/about/key-statistics.html
- 12. WHO: International Agency for Research on Cancer Globocan 2018 (World Incidence) https://gco.iarc.fr/today/data/factsheets/populations/608-philippines-fact-sheets.pdf More common in Females Relatively lower mortality rate
- 13. WHO: International Agency for Research on Cancer Globocan 2018 (Philippine Data) https://gco.iarc.fr/today/data/factsheets/populations/608-philippines-fact-sheets.pdf • Thyroid Cancer is the #7 most common cancers reported in the Philippines. Overall incidence of 4.2 % among reported cancers.
- 14. Clinicopathological, Biochemical, and Sonographic Features of Thyroid Nodule Predictive of Malignancy among Adult Filipino Patients in a Tertiary Hospital in the Philippines Endocrinol Metab (Seoul). 2014 Dec 29;29(4):489-97. • . . physical findings of firm to hard thyroid nodules, and sonographic findings of microcalcifications and irregular margins were significantly predictive of thyroid malignancy.
- 15. Well-Differentiated Thyroid Cancer: The Philippine General Hospital Experience Endocrinol Metab (Seoul). 2016 Mar;31(1):72-9. • PTC among Filipinos was associated with a more aggressive and recurrent behavior. FTC among Filipinos appeared to behave similarly with other racial groups.
- 16. • Papillary Thyroid Cancer among Filipinos occur at a younger age, with larger tumors, higher degree of distant metastasis at presentation & higher recurrence rate (aggressive and recurrent) • Follicular Thyroid Cancer among Filipinos presents at a young age, with high recurrence rates, behaving similarly to other racial groups. (recurrent) • Overall prognosis and survival rates are excellent with well differentiated Thyroid Disease. • Timely diagnosis and treatment of thyroid cancer are therefore of the utmost importance to reduce recurrence rates. Well-Differentiated Thyroid Cancer: The Philippine General Hospital Experience Endocrinol Metab (Seoul). 2016 Mar;31(1):72-9.
- 17. Poorly Differentiated Thyroid Carcinoma: 10-Year Experience in a Southeast Asian Population Endocrinol Metab (Seoul). 2017 Jun;32(2):288-295. • PDTC Filipinos compared with other similar patients showed higher mean age and larger tumor size at presentation.
- 18. • Filipino PDTC median age was 62 years old, with the majority being females, goiter on presentation, and most were stage IV at the time of diagnosis. • 5-year survival rate was 83%. Surgery provided excellent 5- year survival rates, but the role of adjuvant therapy remains unclear. • Behavior of PDTC in this Southeast Asian population was found to be similar to patterns observed in other regions, and exhibited intermediate features between WDTC and ATC. Poorly Differentiated Thyroid Carcinoma: 10-Year Experience in a Southeast Asian Population Endocrinol Metab (Seoul). 2017 Jun;32(2):288-295.
- 19. SPECTRUM OF THYROID DISEASES Hyperthyroidism Hypothyroidism Thyroid Nodules Thyroid Malignancy Pregnancy related thyroid Disease
- 20. • Recommended patient profiles for targeted thyroid disease case finding in women seeking pregnancy or newly pregnant • Women over age 30 yr ; Women with a goiter ; Women with infertility • Familial history or autoimmune thyroid disease or hypothyroidism • With thyroid antibodies, primarily thyroid peroxidase antibodies • With symptoms or clinical signs suggestive of thyroid hypofunction • With type 1 DM or other autoimmune disorders • With a prior history of miscarriage or preterm delivery • With prior therapeutic head or neck irradiation or prior thyroid surgery • Women currently receiving levothyroxine replacement • Women living in a region with presumed iodine deficiency Management of Thyroid Dysfunction during Pregnancy and Postpartum: An Endocrine Society Clinical Practice Guideline The Journal of Clinical Endocrinology & Metabolism, Volume 97, Issue 8, 1 August 2012, Pages 2543–2565
- 21. • Thyroid problems during pregnancy • Management of hypothyroidism: maternal and fetal aspects • Management of hyperthyroidism: maternal and fetal aspects • Gestational hyperemesis and hyperthyroidism • Autoimmune thyroid disease and miscarriage • Thyroid nodules and cancer • Iodine nutrition during pregnancy • Postpartum thyroiditis • Screening for thyroid dysfunction during pregnancy Management of Thyroid Dysfunction during Pregnancy and Postpartum: An Endocrine Society Clinical Practice Guideline The Journal of Clinical Endocrinology & Metabolism, Volume 97, Issue 8, 1 August 2012, Pages 2543–2565
- 22. • Overt hypothyroidism occurs in 0.3–0.5% of pregnancies, and SCH occurs in 2–3%. • The prevalence of hyperthyroidism in pregnancy ranges from 0.1 to 0.4%, with Graves' disease accounting for 85% of cases. • A 2- to 5-fold increased risk of miscarriage has been found in unselected populations of euthyroid women with autoimmune thyroid disease. • Thyroid nodule in pregnancy with limited data suggest that the malignancy rate is either similar to or possibly greater than that seen in the general population. Management of Thyroid Dysfunction during Pregnancy and Postpartum: An Endocrine Society Clinical Practice Guideline The Journal of Clinical Endocrinology & Metabolism, Volume 97, Issue 8, 1 August 2012, Pages 2543–2565
- 23. • Overt hyperthyroidism is relatively uncommon during pregnancy, occurring in 0.1 to 0.4 percent of all pregnancies. Most common cause is Grave’s Disease. • Clinical manifestations similar to non pregnant hyperthyroid. • Transient subclinical hyperthyroidism in the first trimester of pregnancy is considered a normal physiologic finding. • Need to differentiate Graves' disease from hCG-mediated hyperthyroidism in the first Trimester (self-limiting). • PTU preferred for 1st trimester then shift to Methimazole. Thyroid Disease in Pregnancy - Hyperthyroidism Uptodate 2019
- 24. • Iodine nutrition needs to be adequate. • Most common cause of hypothyroidism is Chronic Thyroiditis. • Universal screening of asymptomatic pregnant women for hypothyroidism during the first trimester of pregnancy is controversial. (Consider cost, Medical History) • TPO antibodies in euthyroid pregnant treatment with levothyroxine remain controversial. (No consensus) • Treat overt hypothyroidism in Pregnancy to prevent maternal and fetal complications. Thyroid Disease in Pregnancy - Hypothyroidism Uptodate 2019
- 25. • 12.5% of the patients had subclinical hypothyroidism (N=101) • No statistically significant difference among the group of levothyroxine treated hypothyroid patients versus euthyroid women in documented complications of pregnancy. • Preterm delivery occurred in 2 (10%) patients with TSH > 4 mIU/L and post-term delivery in 2 (2.5%) patients with TSH 2.5-4.0 mIU/L (p=0.010) • Seven (8.6%) small for gestational age (SGA) infants and two (2.5%) large for gestational age (LGA) infants were also delivered in patients with TSH 2.5-4.0 mIU/L Maternal and Perinatal Outcomes of Levothyroxine Treatment in Pregnant Patients with Subclinical Hypothyroidism: A Single- Center, Prospective Cohort Study (Unpublished) Lim-Pacoli M, et. Al. Maternal and Perinatal Outcomes of Levothyroxine Treatment in Pregnant Patients with Subclinical Hypothyroidism: A Single-Center, Prospective Cohort Study
- 26. Pregnancy Related Thyroid Disease
- 27. SPECTRUM OF THYROID DISEASES Hyperthyroidism Hypothyroidism Thyroid Nodules Thyroid Malignancy Pregnancy related thyroid Disease
- 28. Philippine Thyroid Disease Key Points • Thyroid Disease Prevalence 8.53%, Goiter Prevalence 8.9%. • Subclinical Thyroid Disease are more common than overt. • Thyroid nodules with high risk of malignancy are generally asymptomatic with firm or hard nodule, imaging with microcalcifications and irregular borders • Papillary Thyroid Cancer more aggressive among Filipinos. Differentiated thyroid cancer with excellent prognosis and survival rate when managed accordingly. • Poorly Differentiated Thyroid Cancer larger with higher mean age of presentation. 5 year survival rate >80%. • Thyroid Disease in Pregnancy are a significant subset of patients that require follow up and appropriate treatment.
- 29. Global, Regional and National Prevalence of Thyroid Disorders Jeremy F. Robles, MD, FPCP, FPSEDM 2019 Thyroid Summit “Building Partnerships to Support Thyroid Disorder Prevention and Control in the Philippines” May 22, 2019 (Wednesday) Diamond Hotel, Manila, Philippines