Preventive Services

Heart / Stroke Prevention

Prevention Continuum

heart disease prevention medical center kuala lumpur
Adapted from Healthlink 2005.

CVD Risk Factors: Large Potential for Prevention

heart disease prevention

Cardiovascular Risk Factors

  • Hypertension.
  • Cigarette smoking.
  • Obesity (body mass index ≥30 kg/m2).
  • Physical inactivity.
  • Dyslipidemia.
  • Diabetes mellitus
  • Microalbuminuria or estimated GFR < 60 mL/min.
  • Family history of premature cardiovascular disease.

Heart Disease Prevention

Heart disease is the leading cause of death and disability.

The risk of heart disease increases as you age.

There are many things you can do reduce your chances of getting heart disease:-

  • Know your blood pressure and keep it under control.
  • Exercise regularly.
  • Don't smoke.
  • Get tested for diabetes and if you have it, keep it under control.
  • Know your cholesterol and triglyceride levels and keep them under control.
  • Eat a lot of fruits and vegetables.
  • Maintain a healthy weight.

Regular medical check up is advisable for early detection and control of cardiovascular risk factor.

Stroke Prevention

  • Blood pressure - have it checked at least once a year, and, if it is elevated, work with your doctor to keep it under control; - Find out if you have atrial fibrillation, which encourages the formation of blood clots that could cause a stroke;.
  • If you smoke - Stop.
  • If you drink alcohol - do so in moderation;
  • Find out if you have high cholesterol;
  • Diabetes- follow your physician's recommendations to control the condition;
  • Regular exercise.
  • Eat a low-salt, low-fat diet;
  • Ask your physician if you have circulation problems that could increase the risk of stroke.
  • Seek immediate medical attention if you experience any stroke symptoms, including sudden weakness of the face or a limb, a blurring of vision, dizziness, or an intense headache.

Cancer Prevention

At least one-third of all cancer cases are preventable. Prevention offers the most cost-effective long-term strategy for the control of cancer. (Adapted from WHO cancer control programmes)

What are the major causes of cancer?

  • Tobacco.
  • Inadequate intake of fruit and vegetables.
  • Excess alcohol intake.
  • Obesity.
  • Too much sun. Click to show/hide.

Cancer risk can be reduced 60-70% by:-

  • Sensible food choices.
  • A healthy weight.
  • Physical activity.
  • Not smoking.

Less Common Causes of Cancer:-

  • Genetics.
  • Pollution.
  • Radiation.
  • Occupational hazards.
    • Tobacco: Tobacco is the single largest preventable cause of cancer in the world today. It causes 80-90% of all lung cancer deaths, and about 30% of all cancer deaths in developing countries, including deaths from cancer of the oral cavity, larynx, oesophagus and stomach.
    • Diet, physical activity and health: Dietary modification is another important approach to cancer control. There is a link between overweight and obesity to many types of cancer such as oesophagus, colorectum, breast, endometrium and kidney. Diets high in fruits and vegetables may have a protective effect against many cancers. Conversely, excess consumption of red and preserved meat may be associated with an increased risk of colorectal cancer. In addition, healthy eating habits that prevent the development of diet-associated cancers will also lower the risk of cardiovascular disease. Regular physical activity and the maintenance of a healthy body weight, along with a healthy diet, will considerably reduce cancer risk.
    • Infectious diseases: Infectious agents are responsible for almost 22% of cancer deaths in the developing world and 6% in industrialized countries. Viral hepatitis B and C cause cancer of the liver; human papilloma virus infection causes cervical cancer; the bacterium Helicobacter pylori increases the risk of stomach cancer. Preventive measures include vaccination and prevention of infection and infestation.
    • Ionizing radiation: Exposure to ionizing radiation is also known to cause to certain cancers. Excessive solar ultraviolet radiation increases the risk of all types of cancer of the skin. Avoiding excessive exposure, use of sunscreen and protective clothing are effective preventive measures.
    • Occupational hazards: Asbestos can cause lung cancer; aniline dyes have been linked to bladder cancer; and benzene can lead to leukaemia. The prevention of certain occupational and environmental exposure to these and other chemicals is another important element in preventing cancer.
    • Extensive sun exposure: Prolong exposure under the sun can lead to skin cancer such as malignant melanoma. The condition worsens following climate change and depletion of the ozone layer, over the past decades.

Specific Cancer Prevention Methods

Cancer Risk
Recommended Screening
Preventive Recommendations
Breast cancer
Mammography annually or biennially
1. Breast self-examination monthly
2. Clinical breast examination annually
Cervical cancer
1. Annual Pap smear
2. HPV test
HPV Vaccination
Colorectal cancer
1. Carcinoembryonic Antigen (CEA) annually
2. Colonoscopy every 3-5 years
High-fiber diet
Gastric cancer
Endoscopy annually
Eradication of Helicobacter pylori
Leukaemia cancer
Peripheral blood smear
 
Liver cancer
1. Hepatitis screening
2. Alpha-fetoprotein (AFP)
3. USG abdomen
1. Hepatitis B vaccination
2. Clear fatty liver
Lung cancer
1. Chest X-ray
2. CT lung every 3 years
Smoking cessation programme
Nasopharyngeal cancer
1. Nasopharyngoscopy
2. ELISA against EBV specific IgA
 
Oral cancer
Laryngoscopy
 
Ovarian cancer
1. CA 125 annually
2. Ultrasound Pelvis annually
 
Prostate cancer
1. Ultrasound Pelvis annually
2. Prostate Specific Antigen (PSA) annually
 
Thyroid cancer
1. Ultrasound of thyroid
2. Thyroid scan
 
Skin cancer
Skin examination annually
Precautions in the sun

Preventive recommendations for all cancer types:
  • Dietician referral (BMI >25 kg/m2 or dietary habits risk factor for cancer)
  • Smoking cessation programme
References:
  • American Cancer Society: Cancer Facts and Figures 2010. Atlanta, Ga: American Cancer Society, 2010.
  • Management of Breast Cancer 2010. Malaysian Clinical practice Guidelines.
  • Management of Cervical Cancer. 2003. Malaysian Clinical Practice Guidelines.
  • National Cancer Institute (U.S. National Institute of Health). Retrieved from World Wide Web 26 May 2011: http://www.cancer.org

Heart Disease Risk Assessment (Annual)

Treatment Services

Hypertension

Treatment of Hypertension



Classification and management of blood pressure for adults.

BP CLASSIFICATION SBP* MMHG DBP* MMHG LIFESTYLE MODIFICATION INITIAL DRUG THERAPY
WITHOUT COMPELLING INDICATION WITH COMPELLING INDICATION
(See Table1)
NORMAL < 120 and
< 80
Encourage No antihypertensive drug indicated. Drug(s) for compelling indications.‡
PREHYPERTENSION 120-139 or 
80-89
Yes
STAGE 1 HYPERTENSION 140-159 or 
90-99
Yes Thiazide-type diuretics for most. May consider ACEI, ARB, BB, CCB, or combination. Drug(s) for the compelling indications.‡
Other antihypertensive drugs (diuretics, ACEI, ARB, BB, CCB) as needed.
STAGE 2 HYPERTENSION ≥ 160 or  
≥ 100
Yes Two-drug combination for most † (usually thiazide-type diuretic and ACEI or ARB or BB or CCB).

DBP, diastolic blood pressure; SBP, systolic blood pressure.
Drug abbreviations: ACEI, angiotensin converting enzyme inhibitor; ARB, angiotensin receptor blocker;
BB, beta-blocker; CCB, calcium channel blocker.


* Treatment determined by highest BP category.
† Initial combined therapy should be used cautiously in those at risk for orthostatic hypotension.
‡ Treat patients with chronic kidney disease or diabetes to BP goal of < 130/80 mmHg.


Table1: Clinical trial and guideline basis for compelling indications for individual drug classes.

Compelling Indications* Recommended Drugs †
Diuretic BB ACEI ARB CCB Aldo ANT
Heart Failure
Postmyocardial Infarction
High Coronary Disease Risk
Diabetes
Chronic Kidney Disease
Recurrent Stroke Prevention
Postmyocardial infarction

* Compelling indications for antihypertensive drugs are based on benefits from outcome studies or existing clinical guidelines; the compelling indication is managed in parallel with the BP.
† Drug abbreviations; ACEI, angiotensin converting enzyme inhibitor; ARB, angiotensin receptor blocker;
Aldo ANT, aldosterone antagonist; BB, beta-blocker; CCB, calcium channel blocker.


Treatment of Hypertension

Goals of Therapy

The ultimate public health goal of antihypertensive therapy is the reduction of cardiovascular and renal morbidity and mortality. Since most persons with hypertension, especially those age >50 years, will reach the DBP goal once SBP is at goal, the primary focus should be on achieving the SBP goal. Treating SBP and DBP to targets that are <140/90 mmHg is associated with a decrease in CVD complications. In patients with hypertension and diabetes or renal disease, the BP goal is <130/80 mmHg.


Lifestyle Modifications

Adoption of healthy lifestyles by all persons is critical for the prevention of high BP and is an indispensable part of the management of those with hyper-tension. Major lifestyle modifications shown to lower BP include weight reduction in those individuals who are overweight or obese, adoption of the Dietary Approaches to Stop Hypertension (DASH) eating plan which is rich in potassium and calcium, dietary sodium reduction, physical activity, and moderation of alcohol consumption. Lifestyle modifications reduce BP, enhance antihypertensive drug efficacy, and decrease cardiovascular risk. For example, a 1,600 mg sodium DASH eating plan has effects similar to single drug therapy. Combinations of two (or more) lifestyle modifications can achieve even better results.


Pharmacologic Treatment

There are excellent clinical outcome trial data proving that lowering BP with several classes of drugs, including angiotensin converting enzyme inhibitors(ACEIs), angiotensin receptor blockers (ARBs), beta-blockers (BBs), calcium channel blockers (CCBs), and thiazide-type diuretics, will all reduce the complications of hypertension. Thiazide-type diuretics have been the basis of antihypertensive therapy in most outcome trials. In these trials, including the recently published Antihypertensive and Lipid Lowering Treatment to Prevent Heart Attack Trial(ALLHAT), diuretics have been virtually unsurpassed in preventing the cardiovascular complications of hypertension. The exception is the Second Australian National Blood Pressure trial which reported slightly better outcomes in White men with a regimen that began with an ACEI compared to one starting with a diuretic. Diuretics enhance the antihypertensive efficacy of multidrug regimens, can be useful in achieving BP control, and are more affordable than other antihypertensive agents. Despite these findings, diuretics remain underutilized.

Thiazide-type diuretics should be used as initial therapy for most patients with hypertension, either alone or in combination with one of the other classes (ACEIs, ARBs, BBs, CCBs) demonstrated to be beneficial in randomized controlled outcome trials. The list of compelling indications requiring the use of other antihypertensive drugs as initial therapy. If a drug is not tolerated or is contraindicated, then one of the other classes proven to reduce cardiovascular events should be used instead.


Lifestyle Modifications to Manage Hypertension

Modification
Recommendation
Approximate SBP
Reduction (Range)
Weight reduction
Maintain normal body weight.
(body mass index 18.5−24.9 kg/m2).
5–20 mmHg/10 kg
weight loss
Adopt DASH eating plan
Consume a diet rich in fruits, vegetables, and lowfat dairy products with a reduced content of saturated and total fat.
8−14 mmHg
Dietary sodium reduction
Reduce dietary sodium intake to no more than 100 mmol per day.
(2.4 g sodium or 6 g sodium chloride).
2−8 mmHg
Physical activity
Engage in regular aerobic physical activity such as brisk walking
(at least 30 min per day, most days of the week).
4−9 mmHg
Moderation of alcohol
Limit consumption to no more than consumption 2 drinks (1 oz or 30 mL ethanol; e.g., 24 oz beer, 10 oz wine, or 3 oz 80-proof whiskey) per day in most men and to no more than 1 drink per day in women and lighter weight persons.
2−4 mmHg

DASH, Dietary Approaches to Stop Hypertension.


Oral Antihypertensive Drugs

Class
Drug (Trade Name)
Thiazide diuretics
Hydrochlorothiazide
Loop diuretics
Furomide
Potassium-sparing diuretics
Amiloride
Aldosterone receptor blockers
Spironolactone
BBs
Atenolol
Betaxolol
Bisoprolol
Metoprolol
Sotalol
Propranolol
Conbined alpha-and BBs
Carvedilol
Labetalol
ACEIs
Captopril
Enalapril
Fosinopril
Lisinopril
Perindopril
Ramipril
Angiotensin II antagonists
Candersartan
Eprosartan
Irbesartan
Losartan
Olmesartan
Telmisartan
Valsartan
CCBs − non-dihydropyridines
Diltiazem extended release
Verapamil long acting
Verapamil nifedipine
CCBs − dihydropyridines Amlodipine
Felodipine
Nicardipine sustained release
Nifedipine long-acting
Alpha-1 blockers
Doxazosin
Prazosin
Central alpha-2 agonists and other centrally acting drugs
Methyldopa
Direct vasodilators
Minoxidil

Combination Drugs for Hypertension

Combination Type
Fixed-Dose Combination, mg
ACEIs and diuretics
Captopril-hydrochlorothiazide
ARBs and diurectics
Candesartan-hydrochlorothiazide
Irbesartan-hydrochlorothiazide
Losartan-hydrochlorothiazide
Olmesartan-hydrochlorothiazide
telmisartan-hydrochlorothiazide
valsartan-hydrochlorothiazide
BBs and diuretics
Atenolol-chlorthalidone
bisoprolol-chlorthalidone
Diuretic and diuretic
Amiloride-hydrochlorothiazide
spironolactone-hydrochlorothiazide
ARBs and CCBs
Amlodipine-valsartan

* Drug abbreviations:
BB, beta-blocker;
ACEI, angiotensin converting enzyme inhibitor;
ARB, angiotensin receptor blocker;
CCB, calcium channel blocker.


Alogorithm for Treatment of Hypertension

hypertension

Hyperlipidemia

Treatment of Hyperlipidemia



STEP 1: Determine lipoprotein levels - obtain complete lipoprotein profile after 9- to 12-hour fast.

ATP III Classification of LDL, Total, and HDL Cholesterol (mg/dL)

LDL Cholesterol - Primary Target of Therapy

<100
Optimal
100-129
Near Optimal/Above Optimal
130-159
Borderline High
160-189
High
190
Very high

Total Cholesterol

<200
Desirable
200-239
Borderline High
240
High
160-189
High
190
Very high

HDL Cholesterol

<40
Low
≥60
High

STEP 2: Identify presence of clinical atherosclerotic disease that confers high risk for coronary heart disease (CHD) events (CHD risk equivalent):

  • Clinical CHD.
  • Symptomatic carotid artery disease.
  • Peripheral arterial disease.
  • Abdominal aortic aneurysm.

STEP 3: Determine presence of major risk factors (other than LDL):

Major Risk Factors (Exclusive of LDL Cholesterol) That Modify LDL Goals

  • Cigarette smoking.
  • Hypertension (BP ≥140/90 mmHg or on antihypertensive medication).
  • Low HDL cholesterol (<40 mg/dl)*.
  • Family history of premature CHD (CHD in male first degree relative <55 years; CHD in female first degree relative <65 years).
  • Age (men ≥45 years; women ≥55 years).
HDL cholesterol 60 mg/dL counts as a "negative" risk factor; its presence removes one risk factor from the total count.
Note: in ATP III, diabetes is regarded as a CHD risk equivalent.

STEP 4: If 2+ risk factors (other than LDL) are present without CHD or CHD risk equivalent, assess 10-year (short-term) CHD risk.

Three levels of 10-year risk:

  • >20% -- CHD risk equivalent.
  • 10-20%.
  • <10%.

STEP 5: Determine risk category:

  • Establish LDL goal of therapy.
  • Determine need for therapeutic lifestyle changes (TLC).
  • Determine level for drug consideration.

LDL Cholesterol Goals and Cutpoints for Therapeutic Lifestyle Changes (TLC) and Drug Therapy in Different Risk Categories.

Risk Category
LDL Goal
LDL Level at Which to Initiate Therapeutic Lifestyle Changes (TLC)
LDL Level at Which to Consider Drug Therapy
CHD or CHD Risk Equivalents (10-year risk >20%)
<100 mg/dL
≥100 mg/dL
≥130 mg/dL (100-129 mg/dL: drug optional)*
2+ Risk Factors (10-year risk ≤20%)
<130 mg/dL
≥130 mg/dL
10-year risk 10-20%: ≥130 mg/dL
10-year risk <10%: ≥160 mg/dL
0-1 Risk Factor**
<160 mg/dL
≥160 mg/dL
≥190 mg/dL (160-189 mg/dL: LDL-lowering drug optional)

*  
Some authorities recommend use of LDL-lowering drugs in this category if an LDL cholesterol <100 mg/dL cannot be achieved by therapeutic lifestyle changes. Others prefer use of drugs that primarily modify triglycerides and HDL, e.g., nicotinic acid or fibrate. Clinical judgment also may call for deferring drug therapy in this subcategory.
 
**  
Almost all people with 0-1 risk factor have a 10-year risk <10%, thus 10-year risk assessment in people with 0-1 risk factor is not necessary.

STEP 6: Initiate therapeutic lifestyle changes (TLC) if LDL is above goal.

TLC Features

  • TLC Diet:
    • Saturated fat <7% of calories, cholesterol <200 mg/day
    • Consider increased viscous (soluble) fiber (10-25 g/day) and plant stanols / sterols (2g/day) as therapeutic options to enhance LDL lowering
  • Weight management
  • Increased physical activity

STEP 7: Consider adding drug therapy if LDL exceeds levels shown in Step 5 table:

  • Consider drug simultaneously with TLC for CHD and CHD equivalents.
  • Consider adding drug to TLC after 3 months for other risk categories.

Drugs Affecting Lipoprotein Metabolism.

Drug Class
Agents and Daily Doses
Lipid/Lipoprotein Effects
Side Effects
Contraindications
HMG CoA reductase inhibitors (statins)
Lovastatin (20-80 mg)
Pravastatin (20-40 mg)
Simvastatin (20-80 mg)
Fluvastatin (20-80 mg)
Atorvastatin (10-80 mg)
Cerivastatin (0.4-0.8 mg)
LDL-C 18-55%
HDL-C 5-15%
TG 7-30%
Myopathy.
Increased liver enzymes.
Absolute:
  • Active or chronic liver disease.
  • Concomitant use of certain drugs*.
Bile acid Sequestrants
Bile acid Sequestrants
Cholestyramine (4-16 g)
Colestipol (5-20 g)
Colesevelam (2.6-3.8 g)
LDL-C 15-30%
HDL-C 3-5%
TG No change or increase
Gastrointestinal distress.
Constipation.
Decreased absorption of other drugs.
Absolute:
  • dysbeta-lipoproteinemia.
  • TG >400 mg/dL.
Relative:
  • TG >200 mg/dL.
Nicotinic acid
Immediate release (crystalline) nicotinic acid (1.5-3 gm).
Extended release nicotinic acid (Niaspan ®) (1-2 g).
Sustained release nicotinic acid (1-2 g).
LDL-C 5-25%
HDL-C 15-35%
TG 20-50%
Flushing.
Hyperglycemia.
Hyperuricemia (or gout).
Upper GI distress.
Hepatotoxicity
Absolute:
  • Chronic liver disease.
  • Severe gout.
Relative:
  • Diabetes.
  • Hyperuricemia.
  • Peptic ulcer disease.
Fibric acids
Gemfibrozil (600 mg BID).
Fenofibrate (200 mg).
Clofibrate (1000 mg BID).
LDL-C 5-20% (may be increased in patients with high TG).
HDL-C 10-20%.
TG 20-50%
Dyspepsia.
Gallstones.
Myopathy
Absolute:
  • Severe renal disease.
Relative:
  • Severe hepatic disease.

Cyclosporine, macrolide antibiotics, various anti-fungal agents, and cytochrome P-450 inhibitors (fibrates and niacin should be used with appropriate caution).

STEP 8: Identify metabolic syndrome and treat, if present, after 3 months of TLC.


Clinical Identification of the Metabolic Syndrome - Any 3 of the Following:

Risk Factor
Defining Level
Abdominal obesity*
Men
Women
Waist circumference**
>102 cm (>40 in)
>88 cm (>35 in)
Triglycerides
≥150 mg/dL
HDL cholesterol
Men
Women
<40 mg/dl
<50 mg/dl
Blood Pressure
≥130/≥185 mmHg
Fasting Glucose
≥110 mg/dL

Overweight and obesity are associated with insulin resistance and the metabolic syndrome. However, the presence of abdominal obesity is more highly correlated with the metabolic risk factors than is an elevated body mass index (BMI). Therefore, the simple measure of waist circumference is recommended to identify the body weight component of the metabolic syndrome.
** 
Some male patients can develop multiple metabolic risk factors when the waist circumference is only marginally increased, e.g., 94-102 cm (37-39 in). Such patients may have a strong genetic contribution to insulin resistance. They should benefit from changes in life habits, similarly to men with categorical increases in waist circumference.

Treatment of the metabolic syndrome

  • Treat underlying causes (overweight/obesity and physical inactivity):
    • Intensify weight management.
    • Increase physical activity.
  • Treat lipid and non-lipid risk factors if they persist despite these lifestyle therapies:
    • Treat hypertension.
    • Use aspirin for CHD patients to reduce prothrombotic state.
    • Treat elevated triglycerides and/or low HDL (as shown in Step 9 below).

STEP 9: Treat elevated triglycerides.

ATP III Classification of Serum Triglycerides (mg/dL).

<150
Normal
150-199
Borderline high
200-499
High
≥500
Very high

Treatment of elevated triglycerides (≥150 mg/dL)

  • Primary aim of therapy is to reach LDL goal.
  • Intensify weight management.
  • Increase physical activity.
  • If triglycerides are ≥200 mg/dL after LDL goal is reached, set secondary goal for non-HDL cholesterol (total - HDL) 30 mg/dL higher than LDL goal.

Comparison of LDL Cholesterol and Non-HDL Cholesterol Goals for Three Risk Categories.

Risk Category
LDL Goal
(mg/dL)
Non-HDL Goal
(mg/dL)
CHD and CHD Risk Equivalent (10-year risk for CHD >20%)
<100
<130
Multiple (2+) Risk Factors and 10-year risk ≤20%
<130
<160
0-1 Risk Factor
<160
<190

If triglycerides 200-499 mg/dL after LDL goal is reached, consider adding drug if needed to reach non-HDL goal:

  • Intensify therapy with LDL-lowering drug, or
  • add nicotinic acid or fibrate to further lower VLDL.

If triglycerides ≥500 mg/dL, first lower triglycerides to prevent pancreatitis:

  • Very low-fat diet (≤15% of calories from fat).
  • Weight management and physical activity.
  • Fibrate or nicotinic acid.
  • when triglycerides <500 mg/dL, turn to LDL-lowering therapy.

Treatment of low HDL cholesterol (<40 mg/dL)

  • First reach LDL goal, then:
  • Intensify weight management and increase physical activity.
  • If triglycerides 200-499 mg/dL, achieve non-HDL goal.
  • If triglycerides <200 mg/dL (isolated low HDL) in CHD or CHD equivalent, consider nicotinic acid or fibrate.

Diabetes Mellitus

Treatment of Diabetes Mellitus



Lifestyle Modifications:

  1. Reduce weight if overweight.
  2. Physical activity most days of the week.
  3. Reduce dietary fat (<30%) and protein (10-20%).
  4. Increase dietary fibre (20-35 g/day).
  5. Limit carbohydrate intake (50-60%).
  6. Quit smoking.
  7. Limit alcohol consumption (<2 drinks/day in males and < 1 drink/day in females.)
  8. Diligent foot care.

Type 1 Diabetes Medication Use Guidelines

diabetes

Management of Hyperglycemia in Type 2 Diabetes

diabetes

Osteoporosis

Treatment of Osteoporosis



Osteoporosis which means 'porous bones' causes bones to become weak and brittle.

Symptoms:

  1. Back pain.
  2. Loss of height over time.
  3. A stooped posture
  4. Fracture of the vertebra, wrist, hip or other bone.

Risk factors :

  1. Low calcium intake.
  2. Smoking
  3. Eating disorders e.g anorexia neruosa
  4. Sedentary lifestyle
  5. Excessive alcohol consumption
  6. Corticosteroid medications

Test and diagnosis - Bone mineral density (BMD)

Treatment and Drugs :

Treatment of osteoporosis are based on a combination of bine mineral density and risk factors of the patient.
Indicated in patients with :

  • All postmenopausal women who have had on osteoporotic vertebral fracture.
  • BMD value consistent with osteoporosis (7-score worse than or equal to -2.5)
  • BMD values 7-score from -2.0 to -2.5 plus at least one of the following risk factors for fracture (other than skull, facial bone ankle, finger and toe) since menopause and history of hip fracture in a patient.

Drugs used are :-

  1. Biphosphonates
    • Alendronate (Fosamax)
    • Ibandronate (Bonviva)
    • Risedronate (Actonel)
    • Zoledronate (I/V Aclasta)
  2. Strontium Ranelate (Protaxos).
  3. Raloxifene (Evista) - It is a selective estrogen receptor modulotor (SERMS).
  4. Patient must also take calcium supplement and vitamin D while taking the medication for osteoprosis.

Hyperthyroidism and Hypothyroidism

Treatment and Management of Hyperthyroidism and Hypothyroidism



Treatment and Management of Hyperthyroidism

Hyperthyroidism (overactive thyroid) is a condition in which your thyroid gland produces too much of the hormone thyroxine.

 
Treatment and Management of Hypothyroidism

Hypothyroidism (underactive thyroid) is a condition in which thyroid gland doesn't produce enough of certain important hormones.

Symptoms :-

  1. Sudden weight loss, even when your appetite and diet remain normal or even increase.
  2. Rapid heartbeat (tachycardia), irregular heart beat (arrhythmia) or pounding of your heart (palpitations).
  3. Increased appetite.
  4. Tremor
  5. Changes in menstrual patterns
  6. Enlarged thyroid gland (goiter)
 

Symptoms :-

  1. Fatigue.
  2. Sluggishness.
  3. Unexplained weight gain.
  4. Constipation.
  5. Muscle weakness.
  6. An elevated blood cholestrol level.
  7. Heavier than normal menstrual periods.
  8. Brittle fingernails and hair.

Test and Diagnosis :-

  1. Diagnosis can be confirmed with blood tests that measure the levels of thyroxine and TSH in your blood
 

Test and Diagnosis :-

  1. Blood test - measures the level of TSH and thyroxine

Treatments and Drugs :-

  1. Anti-thyroid medications
    • These medications gradually reduce symptoms of hyperthyroidism.
    • Drugs used carbimazole, propylthiouracil
  2. Beta blockers
    • These drug is used to reduce av rapid heart rate and help prevent palpitations
  3. Radioactive iodine
  4. Surgical treatment (thyroiddectomy)
 

Treatments and Drugs :-

  1. Standard treatment for Hypothyroidism involves daily use of synthetic thyroid hormone - Levothyroxine.

Complications :-

  1. Heart problems :- These include a rapid heart rate, heart rhythm disorder (atrial fibrillation) and congestive heart failure.
  2. Brittle bones (osteoporosis).
  3. Eye problems (Grave's ophthalmopathy).
  4. Thyrotoxic crisis.
 

Complications :-

  1. Goiter.
  2. Heart problems e.g heart failure.
  3. Depression.
  4. Peripheral neuropathy.
  5. Myxedema (rare life threatening condition)

Disclaimer:

The information contained on this site is intended to support, not replace, discussion with your doctor or healthcare professionals. The authors of these consumer health information handouts have made a considerable effort to ensure the information is accurate, up to date and easily understood. HSC Medical Center accepts no responsibility for any inaccuracies, information perceived as misleading, or the success of any treatment regimen detailed in the handouts.