Thyroid disorders: overcoming the challenges of diagnosis and management

Abstract

Management of thyroid disease can be a difficult enterprise and can be profoundly influenced by the age, sex and comorbidities of the patient. In this era of heightened recognition of the consequences of subclinical disease and increased awareness of the importance of euthyroidism during pregnancy, optimum management of thyroid disease has become increasingly challenging, even for thyroidologists. Additional challenges are presented by a highly educated and proactive patient population and an ever-increasing number of levothyroxine formulations.Thyroid Disease is a delightful and readable book for primary care physicians. It nicely presents individual patient cases and discusses their diagnosis and management. It is simple, logically organized and presents a full spectrum of thyroid disorders. Sufficient thyroid physiology and background regarding thyroid testing and diagnostic procedures are provided to supply a frame of reference. However, there is not so much detail that it would be overwhelming to busy primary care physicians. This text should be very helpful to such physicians who are trying to come to grips with difficult or perplexing thyroid cases.One of the strengths of this book is the wealth of interesting cases of thyroid disorders presented by the author, drawn from his own professional experiences. Each case is described as it might present in the physician's office, and there is a logical progression through diagnosis to treatment. The discussion of each of these cases is refreshing and candid. It is indeed remarkable that such a wealth of illustrative cases, spanning the full spectrum of thyroid disorders, has been collected together in one book.The admonition to ‘think thyroid’ is certainly one that endocrinologists or thyroidologists, who are definitely not the intended audience of this book, would applaud. The frequently made point that symptoms of thyroid disease are nonspecific and can lead to considerable delay in diagnosis is worthy of its emphasis. The point that there are generally no pathognomonic symptoms of hypothyroidism or hyperthyroidism cannot be overemphasized. Another helpful feature of this guide is its devotion of separate chapters to the complex issues of thyroid disorders in children and pregnant women, thyroid cancer and iatrogenic hyperthyroidism.Many of the cases in this guide certainly merit a deeper discussion of different management options. More than one management approach could have been taken in many of the patients presented. Examples would be the decision to treat or not to treat subclinical thyroid disease in patients with relevant medical conditions and the optimal management of Graves disease patients to avoid oscillations between profound hyperthyroidism and profound hypothyroidism. Choice of branded or generic levothyroxine preparations is not addressed. Certainly many such discussions would be beyond the scope of this book and would have made it less salient to its intended audience.In summary, Thyroid Disease is an interesting book, which takes the primary care physician on a memorable tour through a wide spectrum of thyroid disorders. The discussion is well-reasoned and should furnish practical help to a busy primary care practitioner.