Talk:Hypothyroidism/GA1

GA Review

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Reviewer: Jmh649 (talk · contribs) 18:12, 9 January 2014 (UTC)

Okay will review.

General comments

•  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)
• 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 (talk · contribs ·email) (if I write on your page reply on mine) 21:27, 7 January 2014 (UTC)

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 (talk ·contribs · email) (if I write on your page reply on mine) 21:43, 7 January 2014 (UTC)

There are also these [3] Doc James (talk ·contribs · email) (if I write on your page reply on mine) 22:01, 7 January 2014 (UTC)

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)

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 (talk · contribs ·email) (if I write on your page reply on mine) 14:01, 9 January 2014 (UTC)

Great. Looking forward to the product! JFW | T@lk 19:32, 9 January 2014 (UTC)

Unfortunately they are uninterested in releasing more images. I am not sure why the change in heart. Doc James (talk · contribs · email) (if I write on your page reply on mine) 08:50, 23 January 2014 (UTC)

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 (talk · contribs ·email) (if I write on your page reply on mine) 14:40, 9 January 2014 (UTC)
  • Agree. Second (imprecise) sentence dumped. JFW | T@lk 20:15, 9 January 2014 (UTC)

• 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 (talk · contribs ·email) (if I write on your page reply on mine) 17:49, 9 January 2014 (UTC)
  • 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)

Continue

I will continue next week. Sorry for the delay. Doc James (talk · contribs · email) (if I write on your page reply on mine) 02:03, 17 January 2014 (UTC)

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)

We're back on track. Thanks Tyler for taking care of some of James' points. JFW | T@lk 14:14, 26 January 2014 (UTC)

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)

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."
  •  Done TylerDurden8823 (talk) 22:36, 25 January 2014 (UTC)
• Should define goiter first time we use the term.
  •  Done TylerDurden8823 (talk) 00:22, 26 January 2014 (UTC)

Causes

• 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)

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)
• 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?
  • Sounds reasonable to me. TylerDurden8823 (talk) 00:29, 26 January 2014 (UTC)
  • 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)

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)

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)
• What does "the results are sensitive to the stage of the pregnancy" mean?
  • Rephrased. JFW | T@lk 14:14, 26 January 2014 (UTC)

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)
  • Silly mistake on my part. Heavens know how that happened. JFW | T@lk 14:14, 26 January 2014 (UTC)
• 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."
  •  Done.TylerDurden8823 (talk) 22:41, 25 January 2014 (UTC)

History

• Good

Other animals

• Good

Doc James (talk · contribs · email) (if I write on your page reply on mine) 11:49, 24 January 2014 (UTC)

Further reading and external links

Maybe combine as not many?

• 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)

Review

Looks good. Passed. Many thanks to Jfd and all who worked on this article. Doc James (talk · contribs · email) (if I write on your page reply on mine) 02:26, 27 January 2014 (UTC)