Done Should combine the last "see also" into the text and get rid of that section.
The only way to include that would be with a lengthy context discussion. I've removed it completely for now.
JFW |
T@lk 20:33, 9 January 2014 (UTC)reply
Would be nice to have a picture of the conditions. There is a great one here
[1]. Wonder if they would release it?
Doc James (
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I might have found some.
[2] They have higher quality images that they are willing to release to use and I will ask.
Doc James (
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Thanks for adding the image of congenital hypothyroidism. Unfortunately the CNX.org images are of doubtful quality.
JFW |
T@lk 13:39, 9 January 2014 (UTC)reply
I have requested high quality images from them. They have donated a lot in the past. These are from them
[4] One just needs to ask.
Doc James (
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Great. Looking forward to the product!
JFW |
T@lk 19:32, 9 January 2014 (UTC)reply
Unfortunately they are uninterested in releasing more images. I am not sure why the change in heart.
Doc James (
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Diagnosis
We have ""Subclinical hypothyroidism" is said to exist when serum TSH levels are high but serum free thyroxine is within normal limits." and "In subclinical hypothyroidism, TSH is elevated but below the limit representing overt hypothyroidism." Should this be combined into a single statement?
Doc James (
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Agree. Second (imprecise) sentence dumped.
JFW |
T@lk 20:15, 9 January 2014 (UTC)reply
Overt hypothyroidism has a specific meaning. It is not just symptomatic hypothyroidism. This ref gives " overt hypothyroidism (defined as TSH >20 mIU/L or free T4 below the normal range)"
[5] But we of course need a better one.
Doc James (
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The article cited on Medscape is 10 years old. Since then (see e.g. Garber), "overt hypothyroidism" has been defined as raised TSH and low T4. Subclinical hypothyroidism has been defined as mild (TSH<10) and severe (TSH>10). In pregnancy, TSH>10 is "overt" even if the T4 is normal, at least according to the consensus guidelines currently cited.
JFW |
T@lk 20:15, 9 January 2014 (UTC)reply
Continue
I will continue next week. Sorry for the delay.
Doc James (
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Sounds good. I was wondering where we had landed on the GA nomination. Looking forward to seeing this as GA.
TylerDurden8823 (
talk) 06:16, 18 January 2014 (UTC)reply
We're back on track. Thanks Tyler for taking care of some of James' points.
JFW |
T@lk 14:14, 26 January 2014 (UTC)reply
Lead
We mention "subclinical hypothyroidism" in the lead but do not define it.
Done if you want to tweak what I added, that's fine, but there's an associated definition with it in the lead now courtesy of the Fatourechi paper from Mayo Clinic Proceedings.
TylerDurden8823 (
talk) 22:32, 25 January 2014 (UTC)reply
Signs and symptoms
This may be better under diagnosis "There are a number of symptom rating scales; they provide a degree of objectivity but have limited use for diagnosis."
And data on how often certain medications cause the problem?
The sources are silent on exactly how many cases of hypothyroidism are thought to be medication-induced; the problem becomes even bigger if you accept that immunomodulatory drugs cause hypothyroidism by inducing Hashimoto's (e.g. interferon). There are not many proper case series of hypothyroidism. A lot of associations are based on case reports (e.g. the tyrosine kinase inhibitors).
JFW |
T@lk 14:14, 26 January 2014 (UTC)reply
Pathophysiology
Good
Diagnosis
Wondering we "Subclinical hypothyroidism" is in quotes and we use "said to exist"?
Done. Removed the unnecessary quotation marks and the phrase "said to exist".
TylerDurden8823 (
talk) 00:28, 26 January 2014 (UTC)reply
We call the section "subclinical" yet the first line discusses overt primary hypothyroidism. Wondering if we should change the name of that section? Maybe to "types" and add in the table and the central hypothyroidism definitioon?
The section needs to define "overt hypothyroidism" before explaining the counterintuitive concept of subclinical hypothyroidism. I see no massive problem here.
JFW |
T@lk 14:14, 26 January 2014 (UTC)reply
Prevention
"This public health measure has effectively eliminated childhood hypothyroidism." Has it eliminated all of it or just much of it?
Considering there are other reasons why children develop hypothyroidism, I have rephrased this.
JFW |
T@lk 14:14, 26 January 2014 (UTC)reply
Screening
Good
Management
What is the "by the free T4 index"
It is a slightly outmoded part of specialist thyroid function testing. I have added a link to a section in the thyroid function testing article.
JFW |
T@lk 14:14, 26 January 2014 (UTC)reply
What does "the results are sensitive to the stage of the pregnancy" mean?
Rephrased.
JFW |
T@lk 14:14, 26 January 2014 (UTC)reply
Epidemiology
This is strange "1:20,0000 to 1:80,0000"
Done. Fixed, it was just a typographical error. The referenced paper said 1:20,000 to 1:80,000.
TylerDurden8823 (
talk) 22:38, 25 January 2014 (UTC)reply
Silly mistake on my part. Heavens know how that happened.
JFW |
T@lk 14:14, 26 January 2014 (UTC)reply
Would move this to screening "If T4 determination is included in the screening done at birth, this will identify cases of congenital hypothyroidism of central origin in 1:16,000 to 1:160,000 children. Considering that these children usually have other pituitary hormone deficiencies, early identification of these cases may prevent complications."
I separated them because I wanted to avoid the impression that these are sources of similar reliability and quality.
JFW |
T@lk 14:14, 26 January 2014 (UTC)reply
Review
Looks good. Passed. Many thanks to Jfd and all who worked on this article.
Doc James (
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