Food Poisoning Overview
Food poisoning is a common, usually mild, but sometimes deadly illness. Typical symptoms include nausea, vomiting, abdominal cramping, and diarrhea that come on suddenly (within 48 hours) of consuming a contaminated food or drink. Depending on the contaminant, fever and chills, bloody stools, dehydration, and nervous system damage may follow. These symptoms may affect one person or a group of people who ate the same thing (this would be called an outbreak).
The Centers for Disease Control and Prevention (CDC) estimates that in the United States alone, food poisoning causes about 76 million illnesses, 325,000 hospitalizations, and up to 5,000 deaths each year. One of the most common bacterial forms of infection, the salmonellae organisms, account for one billion dollars in medical costs and lost work time.
Worldwide, diarrheal illnesses are among the leading causes of death. Travelers to developing countries often encounter food poisoning in the form of traveler's diarrhea or "Montezuma’s revenge." Additionally, there are new global threats to the world's food supply through terrorist actions using food toxins as weapons.
Food Poisoning Causes
More than 200 known diseases can be transmitted through food. Those are just the ones we know about. The CDC estimates unknown or undiscovered agents cause 81% of all food–borne illnesses and related hospitalizations. Many cases of food poisoning are not reported because people suffer mild symptoms and recover quickly. Also, doctors do not test for a cause in every suspected case because it does not change the treatment or the outcome.
The known causes of food poisoning can be divided into two categories: infective agents and toxic agents.
Infective agents include viruses, bacteria, and parasites.
Toxic agents include poisonous mushrooms, improperly prepared exotic foods (such as barracuda), or pesticides on fruits and vegetables.
Food usually becomes contaminated from poor sanitation or preparation. Food handlers who do not wash their hands after using the bathroom or have infections themselves often cause contamination. Improperly packaged food stored at the wrong temperature also promotes contamination.
Food Poisoning Symptoms
Symptoms of food poisoning depend on the type of contaminant and the amount eaten. The symptoms can develop rapidly, within 30 minutes, or slowly, worsening over days to weeks. Most of the common contaminants cause nausea, vomiting, diarrhea, and abdominal cramping. Usually food poisoning is not serious, and the illness runs its course in 24–48 hours.
Viruses account for most food poisoning cases where a specific contaminant is found.
Norwalk virus: Causes a mild illness with nausea, vomiting, diarrhea, abdominal pain, headache, and low–grade fever. These symptoms usually resolve in two to three days. It is the most common viral cause of adult food poisoning and is transmitted from water, shellfish, and vegetables contaminated by feces, as well as from person to person.
Rotavirus: Causes moderate to severe illness with vomiting followed by watery diarrhea and fever. It is the most common cause of food poisoning in infants and children and is transmitted from person to person by fecal contamination of food and shared play areas.
Hepatitis A: Causes mild illness with sudden onset of fever, loss of appetite, and feeling of tiredness followed by jaundice, which is a yellowing of the eyes and skin. It is transmitted from person to person by fecal contamination of food.
Bacteria can cause food poisoning by two different ways. Some bacteria infect the intestines, causing inflammation and problems with normal absorption of nutrients and water that leads to diarrhea. Other bacteria produce chemicals in foods (known as toxins) that are poisonous to the human digestive system. When eaten, these chemicals can lead to nausea and vomiting, kidney failure, and even death.
Salmonellae: Salmonellae are bacteria that may cause food poisoning; the illness itself is often referred to as Salmonella or Salmonella infection. Salmonellae cause a moderate illness with nausea, vomiting, crampy diarrhea, and headache, which may come back a few weeks later as arthritis (joint pains). In people with impaired immune systems (such as people with kidney disease or HIV/AIDS or those on chemotherapy for cancer), Salmonellae can cause a life–threatening illness. The illness is transmitted by undercooked foods such as eggs, poultry, dairy products, and seafood.
Campylobacter: Causes mild illness with fever, watery diarrhea, headache, and muscle aches. Campylobacter is the most commonly identified food–borne bacterial infection encountered in the world. It is transmitted by raw poultry, raw milk, and water contaminated by animal feces.
Staphylococcus aureus: Causes moderate to severe illness with rapid onset of nausea, severe vomiting, dizziness, and abdominal cramping. These bacteria produce a toxin in foods such as cream–filled cakes and pies, salads (most at risk are potato, macaroni, egg, and tuna salads, for example) and dairy products. Contaminated potato salad at a picnic is common if the food is not chilled properly.
Bacillus cereus: Causes mild illness with rapid onset of vomiting, with or without diarrhea and abdominal cramping. It is associated with rice (mainly fried rice) and other starchy foods such as pasta or potatoes. May also be used as a potential terrorist weapon.
Escherichia coli (E coli): Causes moderate to severe illness that begins as large amounts of watery diarrhea, and then turns into bloody diarrhea. There are many different types of this bacterium. The worst strain can cause kidney failure and death (about 3–5% of all cases). It is transmitted by eating raw or undercooked hamburger, unpasteurized milk or juices, or contaminated well water. Outbreaks of food poisoning due to E.coli have also occurred following ingestion of contaminated produce.
Shigella (traveler’s diarrhea): Causes moderate to severe illness with fever, diarrhea containing blood or mucus or both, and the constant urge to have bowel movements. It is transmitted in water polluted with human wastes.
Clostridium botulinum (botulism): Causes severe illness affecting the nervous system. Symptoms start as blurred vision. The person then has problems talking and overall weakness. Symptoms then progress to breathing difficulty and inability to move arms or legs. Infants and young children are particularly at risk. It is transmitted in foods such as home–packed canned goods, honey, sausages, and seafood.
Vibrio cholerae: Causes mild to moderate illness with crampy diarrhea, headache, nausea, vomiting, and fever with chills. It strikes mostly in the warmer months of the year and is transmitted by infected, undercooked, or raw seafood.
Parasites rarely cause food poisoning. When they do, they are usually swallowed in contaminated or untreated water and cause long–lasting but mild symptoms.
Giardia (beaver fever): Causes mild illness with watery diarrhea often lasting one to two weeks. It is transmitted by drinking contaminated water, often from lakes or streams in cooler mountainous climates.
Cryptosporidium: Causes moderate illness with large amounts of watery diarrhea lasting two to four days. May become a long–lasting problem in people with poor immune systems (such as people with kidney disease or HIV/AIDS or those on chemotherapy for cancer). It is transmitted by contaminated drinking water.
Toxic agents are the least common cause of food poisoning. Illness is often an isolated episode caused by poor food preparation or selection (such as picking wild mushrooms).
Mushroom toxins: Illness can range from mild to deadly depending on the type of mushroom eaten. Often there is nausea, vomiting, and diarrhea. Some types of mushrooms produce a nerve toxin, which causes sweating, shaking, hallucinations, and coma.
Ciguatera poisoning: Causes moderate to severe illness with numbness of the area around the mouth and lips that can spread to the arms and legs, nausea, vomiting, muscle pain and weakness, headache, dizziness, and rapid heartbeat. It is transmitted by eating certain large game fish from tropical waters—most specifically barracuda and jacks.
Scombroid: Causes mild to moderate illness with burning around the mouth and lips, a red rash to the upper body, dizziness, headache, and itchy skin. It is transmitted in seafood, mostly mahi–mahi and tuna, but can also be in Swiss cheese.
Pesticides: Cause mild to severe illness with weakness, blurred vision, headache, cramps, diarrhea, increased production of saliva, and shaking of the arms and legs. Toxins are transmitted by eating unwashed fruits or vegetables contaminated with pesticides.
When to Seek Medical Care
Contact your doctor if any of the following situations occur:
Nausea, vomiting, or diarrhea lasts for more than two days.
The ill person is younger than three years.
The abdominal symptoms are associated with a low–grade fever.
Symptoms begin after recent foreign travel.
Other family members or friends who ate the same thing are also sick.
You cannot keep any liquids down.
You do not improve within two days even though you are drinking large amounts of fluids.
You have a disease or illness that weakens your immune system (for example, HIV/AIDS, cancer and undergoing chemotherapy, kidney disease).
You cannot take your normal prescribed medications because of vomiting.
You have any nervous system symptoms such as slurred speech, muscle weakness, double vision, or difficulty swallowing.
Go to the nearest hospital's emergency department if any of the following situations occur:
You pass out or collapse, become dizzy, lightheaded, or have problems with your vision.
A fever higher than 101°F occurs with the abdominal symptoms.
Sharp or cramping pains do not go away after 10–15 minutes.
Your stomach or abdomen swells.
The skin and/or eyes turn yellow.
You are vomiting blood or having bloody bowel movements.
You stop urinating, have decreased urination, or have urine that is dark in color.
You develop problems with breathing, speaking, or swallowing.
One or more joints swell or a rash breaks out on your skin.
The ill person or caretaker considers the situation to be an emergency.
Exams and Tests
If you visit a doctor or a hospital emergency department because you think you may have food poisoning, a thorough examination will be performed, including measurements of blood pressure, pulse, breathing rate, and temperature will be done. The doctor will perform a physical exam, which screens for outward signs and symptoms of your illness. They will assess how dehydrated you are and examine your abdominal area to make sure your illness is not serious.
The doctor may need to do a rectal examination. The doctor performs this test by inserting a lubricated and gloved finger gently into your rectum. The purpose is to make sure there are no breaks in your rectal wall. A sample of your stool is taken and tested for blood and mucus. In some cases, a sample of stool or vomit can be sent to the laboratory for further testing to find out which toxin caused the illness. In a majority of cases, a specific cause is not found.
A urine sample helps assess how dehydrated you are and indicates possible kidney damage.
Blood tests may be performed to determine the seriousness of your illness. An x–ray of the abdomen or a CT scan may be taken if the doctor suspects your symptoms may be caused by another illness.
Food Poisoning Treatment
Self–Care at Home
Short episodes of vomiting and small amounts of diarrhea lasting less than 24 hours can usually be cared for at home.
Do not eat solid food while nauseous or vomiting but drink plenty of fluids.
Small, frequent sips of clear liquids (those you can see through) are the best way to stay hydrated.
Avoid alcoholic, caffeinated, or sugary drinks, if possible. Over–the–counter rehydration products made for children such as Pedialyte and Rehydralyte are expensive but good to use if available.
Sports drinks such as Gatorade and Powerade are fine for adults if they are diluted with water because at full strength they contain too much sugar, which can worsen diarrhea.
After successfully tolerating fluids, eating should begin slowly, when nausea and vomiting have stopped. Plain foods that are easy on the stomach should be started in small amounts. Consider eating rice, wheat, breads, potatoes, cereals (low–sugar cereals), lean meats, and chicken (not fried) to start. Milk can be given safely, although some people may experience additional stomach upset due to lactose intolerance.
Most food poisonings do not require the use of over–the–counter medicines to stop diarrhea, but they are generally safe if used as directed. It is not recommended that these medications be given to children. If there is a question or concern, you should always check with your doctor.
Medical Treatment
The main treatment for food poisoning is putting fluids back in the body (the process of rehydration) through an IV and by drinking. You may need to be admitted to the hospital. This depends on the severity of the dehydration, your response to therapy, and your ability to drink fluids without vomiting. Children, in particular, may need close observation.
Antivomiting and diarrhea medications may be given.
The doctor may also treat any fever to make you more comfortable.
Antibiotics are rarely needed for food poisoning. In some cases, antibiotics would worsen the condition. Only a few specific causes of food poisoning are improved by using these medications. The length of illness with traveler's diarrhea (shigellae) can be decreased with antibiotics, but this specific illness usually runs its course and improves without treatment.
With mushroom poisoning or eating foods contaminated with pesticides, aggressive treatment may include pumping the stomach (lavage) or giving medications as antidotes. These poisonings are very serious and may require intensive care in the hospital.
Next Steps
Follow–up
After visiting your doctor or the emergency department, follow any specific directions and take any medications prescribed exactly as directed. Continue to drink extra fluids until the diarrhea stops completely. You may need to miss one to two days of work or school to let your body recover. If any symptoms change or continue to worsen, contact your doctor.
Prevention
Safe steps in food handling, cooking, and storage are essential to avoiding food–borne illness. You cannot see, smell, or taste bacteria, which may be on any food.
Follow these food safety guidelines to keep contaminants away.
Safe shopping
Buy cold foods last during your shopping trip. Get them home fast.
Never choose torn or leaking packages.
Do not buy foods past their "sell–by" or expiration dates.
Keep raw meat and poultry separate from other foods.
Place refrigerated or frozen items in the shopping cart last, right before heading for the checkout counter.
Safe storage of foods
Keep it safe; refrigerate.
Unload perishable foods first and immediately refrigerate them. Place raw meat, poultry, or fish in the coldest section of your refrigerator.
Check the temperature of your appliances. To slow bacterial growth, the refrigerator should be at 40°F, the freezer at 0°F.
Cook or freeze fresh poultry, fish, ground meats, and variety meats within two days.
Safe food preparation
Keep everything clean!
Wash hands before and after handling raw meat and poultry.
Sanitize cutting boards often in a solution of one teaspoon chlorine bleach in one quart of water.
Do not cross–contaminate. Keep raw meat, poultry, fish, and their juices away from other food. After cutting raw meats, wash hands, cutting board, knife, and counter tops with hot, soapy water.
Marinate meat and poultry in a covered dish in the refrigerator. Discard any uncooked/unused marinade.
Thawing food safely
Refrigerator: Allows slow, safe thawing. Make sure thawing juices do not drip on other foods.
Cold water: For faster thawing, place food in a leak–proof plastic bag and submerge in cold tap water.
Microwave: Cook meat and poultry immediately after microwave thawing.
Safe cooking
Use a meat thermometer.
Cook ground meats to 160°F; ground poultry to 165°F. Beef, veal, and lamb steaks, roasts and chops may be cooked to 145°F; all cuts of fresh pork, 160°F. Whole poultry should reach 180°F in the thigh; breasts 170°F.
Keep hot foods hot and cold foods cold.
Never leave food out more than two hours (or more than 1 hour in temperatures above 90°F).
Bacteria that cause food poisoning grow rapidly at room temperature.
Use cooked leftovers within four days.
Tuesday, November 6, 2007
Thyroid Problems
Thyroid Problems Overview
The thyroid gland is located on the front part of the neck below the thyroid cartilage (Adam's apple). The gland produces thyroid hormones, which regulate body metabolism. Thyroid hormones are important in regulating body energy, the body's use of other hormones and vitamins, and the growth and maturation of body tissues.
Diseases of the thyroid gland can result in either production of too much (hyperthyroidism) or too little (hypothyroidism) hormone.
Production of thyroid hormones: The process of hormone synthesis begins in a part of the brain called the hypothalamus. The hypothalamus releases thyrotropin-releasing hormone (TRH). The TRH travels through the bloodstream to the pituitary gland, also in the brain. In response, the pituitary gland then releases thyroid-stimulating hormone (TSH) into the blood. The TSH then stimulates the thyroid to produce the two main thyroid hormones, L-thyroxine (T4) and triiodothyronine (T3). The thyroid gland also needs adequate amounts of dietary iodine to be able to produce T4 and T3.
Regulation of thyroid hormone production: To prevent the overproduction or underproduction of thyroid hormones, the pituitary gland can sense how much hormone is in the blood and adjust the production of hormones accordingly. For example, when there is too much thyroid hormone in the blood, the TRH does not work effectively to stimulate the pituitary gland. In addition, too much thyroid hormone will prevent the release of TSH from the pituitary gland. The sum effect of this is to decrease the amount of TSH released from the pituitary gland, resulting in less production of thyroid hormones in the thyroid gland. This then works to restore the amount of thyroid hormone in the blood to normal. Defects in these regulatory pathways may result in hypothyroidism or hyperthyroidism.
Hypothyroidism in pregnancy
Newly diagnosed hypothyroidism in pregnancy is rare because most women with untreated hypothyroidism have ovulatory problems, which make it difficult for them to conceive.
It is a difficult new diagnosis to make. Many of the symptoms of hypothyroidism (fatigue, poor attention, weight gain, numbness, and tingling of the hands or feet) are also prominent symptoms of a normal pregnancy.
Undiagnosed hypothyroidism during pregnancy increases the chance of stillbirth or growth retardation of the fetus. It also increases the chance that the mother may experience complications such as anemia, eclampsia, and placental abruption.
Probably the largest group of women who will have hypothyroidism during pregnancy are those who are currently on thyroid hormone replacement. The ideal thyroxine replacement dose during pregnancy may rise by 25-50% during pregnancy. It is important to have regular checks of T4 and TSH during pregnancy to make sure you are at the correct medication dose.
Hyperthyroidism in pregnancy
Newly diagnosed hyperthyroidism occurs in about 1 in 2,000 pregnancies. Graves disease accounts for 95% of hyperthyroidism newly diagnosed during pregnancy.
Like hypothyroidism, many symptoms of mild hyperthyroidism mimic those of normal pregnancy. However, anyone experiencing symptoms such as significant weight loss, vomiting, increased blood pressure, or persistently fast heart rate should have blood tests to look for hyperthyroidism.
Untreated hyperthyroidism does cause fetal and maternal complications similar to untreated hypothyroidism.
Treatment of hyperthyroidism during pregnancy is primarily medical. Propylthiouracil or methimazole are usual first-line agents to block the synthesis of thyroid hormone. They appear to be equally effective and have the same rate of side effects. The rate of side effects of each medication is not increased in pregnancy.
Iodine will cross the placenta, so its use in either a thyroid scan or in treatment with radioactive iodine is prohibited in pregnancy.
One positive note for women with hyperthyroidism is that those with Graves disease or Hashimoto thyroiditis may have improvement in their symptoms during pregnancy.
Postpartum thyroid disease
Some women may have thyroiditis that usually occurs within 3-6 months after birth. It also may occur after miscarriage. The classic clinical picture is a woman who will first have symptoms of hyperthyroidism, followed by hypothyroidism, culminating in normal thyroid function.
Women with insulin-dependent diabetes have a 25% risk of developing postpartum thyroid dysfunction.
Consult your doctor if you have symptoms of hypothyroidism or hyperthyroidism after pregnancy or miscarriage.
Thyroid Problems Causes
Hypothyroidism
Loss of tissue: Treatment of hyperthyroidism by radioactive destruction of thyroid tissue or surgical removal of thyroid tissue can result in hypothyroidism.
Antithyroid antibodies: These may be present in people who have diabetes, lupus, rheumatoid arthritis, chronic hepatitis, or Sjögren syndrome. These antibodies may cause decreased production of thyroid hormones.
Congenital: Hypothyroidism can be present from birth. This is commonly discovered early with nationwide newborn screening for this disease.
Defects in the production of thyroid hormone: Hashimoto thyroiditis occurs when there are defects in the production of thyroid hormone, resulting in an increased amount of TSH. The increased TSH results in a goiter (enlargement of the thyroid gland itself that can be seen as an obvious swelling in the front of the neck).
Medications: Some medications, particularly lithium, may cause a drug-induced hypothyroidism.
Hyperthyroidism
Graves disease: This thyroid condition results from abnormal stimulation of the thyroid gland by a material in the blood termed the long-acting thyroid stimulator (LATS). LATS overstimulates the thyroid causing a goiter. It also causes Graves eye disease, including a "bug-eyed" look and "frightened stare." This can progress to severe eye pain or eye muscle weakness. It also causes raised, thickened skin over the shins or tops of the feet.
Toxic multinodular goiter: This occurs when part of the thyroid gland produces thyroid hormones all by itself, without regard to TSH stimulation. It usually occurs in people with a long-standing goiter—usually in the elderly. Toxic multinodular goiter is different from Graves disease because of the general lack of eye complications and less severe signs of hyperthyroidism.
Thyroiditis: This inflammatory disorder of the thyroid gland includes such conditions as de Quervain thyroiditis or Hashimoto thyroiditis. In these conditions, you may have periods of increased thyroid hormone release due to the inflammation, causing a hyperthyroid state. As thyroid failure occurs due to the inflammatory response, hypothyroidism may occur.
Pituitary adenoma: This tumor of the pituitary gland causes independent TSH production leading to overstimulation of the thyroid gland.
Drug-induced hyperthyroidism: This is most commonly caused by a heart medication called amiodarone. It may be prevented by monitoring this possible side effect and weighing it against the benefits of using the heart medication.
Thyroid Problems Symptoms
Hypothyroidism
Infants
Constipation
Poor feeding
Jaundice (yellow discoloration of the skin and eyes)
Excessive tiredness
Children
Similar to adult symptoms
Poor school performance
Adults
Early symptoms
Easy fatigue, exhaustion
Poor tolerance to cold temperatures
Constipation
Carpal tunnel syndrome (pain at the wrists and numbness of the hands)
Later symptoms
Poor appetite
Weight increase
Dry skin
Hair falls out
Intellectual ability worsens
Deeper, hoarse voice
Puffiness around the eyes
Depression
Hyperthyroidism
Children
Similar to adult symptoms
Declining school performance
Behavior problems
Adults
Insomnia
Hand tremors
Nervousness
Feeling excessively hot in normal or cold temperatures
Frequent bowel movements
Losing weight despite normal or increased appetite
Excessive sweating
Menstrual period becomes scant, or ceases altogether
Joint pains
Difficulty concentrating
Eyes seem to be enlarging
Elderly
Worsening of angina (chest pain) in person with heart disease
Worsening of shortness of breath in person with heart failure
Muscle weakness, especially in the shoulders and thighs
When to Seek Medical Care
The signs and symptoms of hypothyroidism and hyperthyroidism typically develop slowly over a period of weeks to months. If you have prolonged symptoms or signs of either condition, call your doctor to be evaluated.
Untreated hypothyroidism may have severe effects on the brain as well as cause intestinal obstruction and inability of the heart to beat effectively. An infection, exposure to cold, trauma, and certain medications may often cause a worsening of hypothyroidism.
Seek immediate attention at a hospital's emergency department if you have these signs and symptoms associated with thyroid problems.
Shortness of breath
Abdominal pain
Vomiting
Confusion
Coma
Severe hyperthyroidism, called thyrotoxic crisis, may be life threatening because of the effects it has on the heart and brain. It often occurs in people who are untreated or are receiving inadequate treatment for thyroid problems. A severe infection can also cause a thyrotoxic crisis.
Seek immediate attention at a hospital's emergency department if you have these signs and symptoms associated with thyroid problems.
Chest pain
Shortness of breath
Abdominal pain
Vomiting
Extreme agitation or irritability
Disorientation (person has no knowledge of the date or location)
Coma
Exams and Tests
The medical history and physical exam are important parts of the evaluation for thyroid problems. The doctor will focus on eye, skin, cardiac, and neurologic findings.
Blood tests
Thyroid-stimulating hormone (TSH): In most cases, this is the single most useful lab test in diagnosing thyroid disease. When there is an excess of thyroid hormone in the blood, as in hyperthyroidism, the TSH is low. When there is too little thyroid hormone, as in hypothyroidism, the TSH is high.
L-thyroxine (T4): T4 is one of the thyroid hormones. High T4 may indicate hyperthyroidism. Low T4 may indicate hypothyroidism.
Triiodothyronine (T3): T3 is another one of the thyroid hormones. High T3 may indicate hyperthyroidism. Low T3 may indicate hypothyroidism.
TSH receptor antibody: This antibody is present in Graves disease.
Antithyroid antibody: This antibody is present in Hashimoto disease.
Thyroid scan: For this test, a small amount of radioactive iodine is given into the blood, and then an x-ray image of the thyroid is taken. Increased uptake of the radioactive material in the thyroid gland indicates hyperthyroidism, while decreased uptake is present in hypothyroidism. This test should not be done on pregnant women.
Thyroid ultrasound: This exam helps to differentiate between different types of nodules of the thyroid gland.
Fine-needle aspiration: For this test, a small needle is inserted into the thyroid gland in order to get a sample of thyroid tissue, usually from a nodule. The tissue is then observed under a microscope to look for any signs of cancer.
Thyroid Problems Treatment
Medications
Medications for hyperthyroidism
Beta-blockers: This class of medications works by blocking many of the body’s responses to hyperthyroidism. It decreases tremor, nervousness, and agitation. It also reduces the fast heart rate. It is given as tablets to the person with mild to moderate symptoms, and as an IV preparation to the person with the severe form of hyperthyroidism (thyrotoxic crisis).
Propylthiouracil: This antithyroid drug works by blocking thyroid hormone synthesis. It takes about a week after starting the medication for full therapeutic effect. Common mild side effects include rash, itching, and mild fever. More rare, serious side effects include a decrease in white blood cell count, which can decrease the ability to fight off infection. Therefore, a high fever should prompt a call to the doctor.
Methimazole (Tapazole): This antithyroid drug also works by blocking thyroid hormone synthesis. It may take slightly longer than propylthiouracil to achieve full effect. It has similar side effects as propylthiouracil and may also cause a decreased white blood cell count.
Iodide (Lugol’s solution, Strong iodine): This medication works by inhibiting the release of thyroid hormone from the overfunctioning thyroid gland. It must be used in conjunction with an antithyroid drug because the iodine can be used to increase the amount of thyroid hormone and worsen the hyperthyroidism. Common side effects include nausea and a metallic taste in the mouth.
Medications for hypothyroidism
L-thyroxine: This medication is the mainstay of thyroid hormone replacement therapy in hypothyroidism. This is a synthetic form of thyroxine. The body tissues convert it to the active product L-triiodothyronine. Side effects are rare, and it has an excellent safety record.
L-triiodothyronine: This is rarely used alone as thyroid hormone replacement, because it has less uniform potency than L-thyroxine. Its use can cause rapid increases in L-triiodothyronine concentration, which can be dangerous in the elderly and in people with cardiac disease. It may be used in combination with L-thyroxine for people who have poor symptomatic relief with L-thyroxine alone.
Surgery
Surgery for hyperthyroidism may involve removal of much of the thyroid tissue, leaving some intact to continue to produce thyroid hormone. Risks in this procedure include damage to nerves that control the vocal cords, damage to the parathyroid glands, which lie just behind the thyroid gland, and bleeding causing breathing problems. Hypothyroidism may also occur, but occurs less frequently than in radioactive iodine treatment. Persistent hyperthyroidism may also occur. If so, the entire thyroid gland is removed. In general, in the hands of an experienced surgeon, this is considered an effective and relatively safe procedure.
Next Steps
Follow-up
Anyone diagnosed with Graves disease should stop smoking immediately because smoking increases the risk of progression to Graves eye disease.
Follow the medication schedule prescribed by your doctor. In addition, ask what side effects the medications may cause. Also discuss with your doctor the kinds of symptoms that would prompt a call to the doctor or a visit to the emergency department.
Prevention
There is no known way to prevent hyperthyroidism or hypothyroidism.
Outlook
Most people with either hypothyroidism or hyperthyroidism, with proper diagnosis and treatment, can control their condition with no long-term effects. However, those with undiagnosed disease may progress to coma or thyrotoxic crisis, with death rates approaching 50%.
Graves eye disease has been treated with corticosteroid medication, radiotherapy, and surgery with varying success.
The thyroid gland is located on the front part of the neck below the thyroid cartilage (Adam's apple). The gland produces thyroid hormones, which regulate body metabolism. Thyroid hormones are important in regulating body energy, the body's use of other hormones and vitamins, and the growth and maturation of body tissues.
Diseases of the thyroid gland can result in either production of too much (hyperthyroidism) or too little (hypothyroidism) hormone.
Production of thyroid hormones: The process of hormone synthesis begins in a part of the brain called the hypothalamus. The hypothalamus releases thyrotropin-releasing hormone (TRH). The TRH travels through the bloodstream to the pituitary gland, also in the brain. In response, the pituitary gland then releases thyroid-stimulating hormone (TSH) into the blood. The TSH then stimulates the thyroid to produce the two main thyroid hormones, L-thyroxine (T4) and triiodothyronine (T3). The thyroid gland also needs adequate amounts of dietary iodine to be able to produce T4 and T3.
Regulation of thyroid hormone production: To prevent the overproduction or underproduction of thyroid hormones, the pituitary gland can sense how much hormone is in the blood and adjust the production of hormones accordingly. For example, when there is too much thyroid hormone in the blood, the TRH does not work effectively to stimulate the pituitary gland. In addition, too much thyroid hormone will prevent the release of TSH from the pituitary gland. The sum effect of this is to decrease the amount of TSH released from the pituitary gland, resulting in less production of thyroid hormones in the thyroid gland. This then works to restore the amount of thyroid hormone in the blood to normal. Defects in these regulatory pathways may result in hypothyroidism or hyperthyroidism.
Hypothyroidism in pregnancy
Newly diagnosed hypothyroidism in pregnancy is rare because most women with untreated hypothyroidism have ovulatory problems, which make it difficult for them to conceive.
It is a difficult new diagnosis to make. Many of the symptoms of hypothyroidism (fatigue, poor attention, weight gain, numbness, and tingling of the hands or feet) are also prominent symptoms of a normal pregnancy.
Undiagnosed hypothyroidism during pregnancy increases the chance of stillbirth or growth retardation of the fetus. It also increases the chance that the mother may experience complications such as anemia, eclampsia, and placental abruption.
Probably the largest group of women who will have hypothyroidism during pregnancy are those who are currently on thyroid hormone replacement. The ideal thyroxine replacement dose during pregnancy may rise by 25-50% during pregnancy. It is important to have regular checks of T4 and TSH during pregnancy to make sure you are at the correct medication dose.
Hyperthyroidism in pregnancy
Newly diagnosed hyperthyroidism occurs in about 1 in 2,000 pregnancies. Graves disease accounts for 95% of hyperthyroidism newly diagnosed during pregnancy.
Like hypothyroidism, many symptoms of mild hyperthyroidism mimic those of normal pregnancy. However, anyone experiencing symptoms such as significant weight loss, vomiting, increased blood pressure, or persistently fast heart rate should have blood tests to look for hyperthyroidism.
Untreated hyperthyroidism does cause fetal and maternal complications similar to untreated hypothyroidism.
Treatment of hyperthyroidism during pregnancy is primarily medical. Propylthiouracil or methimazole are usual first-line agents to block the synthesis of thyroid hormone. They appear to be equally effective and have the same rate of side effects. The rate of side effects of each medication is not increased in pregnancy.
Iodine will cross the placenta, so its use in either a thyroid scan or in treatment with radioactive iodine is prohibited in pregnancy.
One positive note for women with hyperthyroidism is that those with Graves disease or Hashimoto thyroiditis may have improvement in their symptoms during pregnancy.
Postpartum thyroid disease
Some women may have thyroiditis that usually occurs within 3-6 months after birth. It also may occur after miscarriage. The classic clinical picture is a woman who will first have symptoms of hyperthyroidism, followed by hypothyroidism, culminating in normal thyroid function.
Women with insulin-dependent diabetes have a 25% risk of developing postpartum thyroid dysfunction.
Consult your doctor if you have symptoms of hypothyroidism or hyperthyroidism after pregnancy or miscarriage.
Thyroid Problems Causes
Hypothyroidism
Loss of tissue: Treatment of hyperthyroidism by radioactive destruction of thyroid tissue or surgical removal of thyroid tissue can result in hypothyroidism.
Antithyroid antibodies: These may be present in people who have diabetes, lupus, rheumatoid arthritis, chronic hepatitis, or Sjögren syndrome. These antibodies may cause decreased production of thyroid hormones.
Congenital: Hypothyroidism can be present from birth. This is commonly discovered early with nationwide newborn screening for this disease.
Defects in the production of thyroid hormone: Hashimoto thyroiditis occurs when there are defects in the production of thyroid hormone, resulting in an increased amount of TSH. The increased TSH results in a goiter (enlargement of the thyroid gland itself that can be seen as an obvious swelling in the front of the neck).
Medications: Some medications, particularly lithium, may cause a drug-induced hypothyroidism.
Hyperthyroidism
Graves disease: This thyroid condition results from abnormal stimulation of the thyroid gland by a material in the blood termed the long-acting thyroid stimulator (LATS). LATS overstimulates the thyroid causing a goiter. It also causes Graves eye disease, including a "bug-eyed" look and "frightened stare." This can progress to severe eye pain or eye muscle weakness. It also causes raised, thickened skin over the shins or tops of the feet.
Toxic multinodular goiter: This occurs when part of the thyroid gland produces thyroid hormones all by itself, without regard to TSH stimulation. It usually occurs in people with a long-standing goiter—usually in the elderly. Toxic multinodular goiter is different from Graves disease because of the general lack of eye complications and less severe signs of hyperthyroidism.
Thyroiditis: This inflammatory disorder of the thyroid gland includes such conditions as de Quervain thyroiditis or Hashimoto thyroiditis. In these conditions, you may have periods of increased thyroid hormone release due to the inflammation, causing a hyperthyroid state. As thyroid failure occurs due to the inflammatory response, hypothyroidism may occur.
Pituitary adenoma: This tumor of the pituitary gland causes independent TSH production leading to overstimulation of the thyroid gland.
Drug-induced hyperthyroidism: This is most commonly caused by a heart medication called amiodarone. It may be prevented by monitoring this possible side effect and weighing it against the benefits of using the heart medication.
Thyroid Problems Symptoms
Hypothyroidism
Infants
Constipation
Poor feeding
Jaundice (yellow discoloration of the skin and eyes)
Excessive tiredness
Children
Similar to adult symptoms
Poor school performance
Adults
Early symptoms
Easy fatigue, exhaustion
Poor tolerance to cold temperatures
Constipation
Carpal tunnel syndrome (pain at the wrists and numbness of the hands)
Later symptoms
Poor appetite
Weight increase
Dry skin
Hair falls out
Intellectual ability worsens
Deeper, hoarse voice
Puffiness around the eyes
Depression
Hyperthyroidism
Children
Similar to adult symptoms
Declining school performance
Behavior problems
Adults
Insomnia
Hand tremors
Nervousness
Feeling excessively hot in normal or cold temperatures
Frequent bowel movements
Losing weight despite normal or increased appetite
Excessive sweating
Menstrual period becomes scant, or ceases altogether
Joint pains
Difficulty concentrating
Eyes seem to be enlarging
Elderly
Worsening of angina (chest pain) in person with heart disease
Worsening of shortness of breath in person with heart failure
Muscle weakness, especially in the shoulders and thighs
When to Seek Medical Care
The signs and symptoms of hypothyroidism and hyperthyroidism typically develop slowly over a period of weeks to months. If you have prolonged symptoms or signs of either condition, call your doctor to be evaluated.
Untreated hypothyroidism may have severe effects on the brain as well as cause intestinal obstruction and inability of the heart to beat effectively. An infection, exposure to cold, trauma, and certain medications may often cause a worsening of hypothyroidism.
Seek immediate attention at a hospital's emergency department if you have these signs and symptoms associated with thyroid problems.
Shortness of breath
Abdominal pain
Vomiting
Confusion
Coma
Severe hyperthyroidism, called thyrotoxic crisis, may be life threatening because of the effects it has on the heart and brain. It often occurs in people who are untreated or are receiving inadequate treatment for thyroid problems. A severe infection can also cause a thyrotoxic crisis.
Seek immediate attention at a hospital's emergency department if you have these signs and symptoms associated with thyroid problems.
Chest pain
Shortness of breath
Abdominal pain
Vomiting
Extreme agitation or irritability
Disorientation (person has no knowledge of the date or location)
Coma
Exams and Tests
The medical history and physical exam are important parts of the evaluation for thyroid problems. The doctor will focus on eye, skin, cardiac, and neurologic findings.
Blood tests
Thyroid-stimulating hormone (TSH): In most cases, this is the single most useful lab test in diagnosing thyroid disease. When there is an excess of thyroid hormone in the blood, as in hyperthyroidism, the TSH is low. When there is too little thyroid hormone, as in hypothyroidism, the TSH is high.
L-thyroxine (T4): T4 is one of the thyroid hormones. High T4 may indicate hyperthyroidism. Low T4 may indicate hypothyroidism.
Triiodothyronine (T3): T3 is another one of the thyroid hormones. High T3 may indicate hyperthyroidism. Low T3 may indicate hypothyroidism.
TSH receptor antibody: This antibody is present in Graves disease.
Antithyroid antibody: This antibody is present in Hashimoto disease.
Thyroid scan: For this test, a small amount of radioactive iodine is given into the blood, and then an x-ray image of the thyroid is taken. Increased uptake of the radioactive material in the thyroid gland indicates hyperthyroidism, while decreased uptake is present in hypothyroidism. This test should not be done on pregnant women.
Thyroid ultrasound: This exam helps to differentiate between different types of nodules of the thyroid gland.
Fine-needle aspiration: For this test, a small needle is inserted into the thyroid gland in order to get a sample of thyroid tissue, usually from a nodule. The tissue is then observed under a microscope to look for any signs of cancer.
Thyroid Problems Treatment
Medications
Medications for hyperthyroidism
Beta-blockers: This class of medications works by blocking many of the body’s responses to hyperthyroidism. It decreases tremor, nervousness, and agitation. It also reduces the fast heart rate. It is given as tablets to the person with mild to moderate symptoms, and as an IV preparation to the person with the severe form of hyperthyroidism (thyrotoxic crisis).
Propylthiouracil: This antithyroid drug works by blocking thyroid hormone synthesis. It takes about a week after starting the medication for full therapeutic effect. Common mild side effects include rash, itching, and mild fever. More rare, serious side effects include a decrease in white blood cell count, which can decrease the ability to fight off infection. Therefore, a high fever should prompt a call to the doctor.
Methimazole (Tapazole): This antithyroid drug also works by blocking thyroid hormone synthesis. It may take slightly longer than propylthiouracil to achieve full effect. It has similar side effects as propylthiouracil and may also cause a decreased white blood cell count.
Iodide (Lugol’s solution, Strong iodine): This medication works by inhibiting the release of thyroid hormone from the overfunctioning thyroid gland. It must be used in conjunction with an antithyroid drug because the iodine can be used to increase the amount of thyroid hormone and worsen the hyperthyroidism. Common side effects include nausea and a metallic taste in the mouth.
Medications for hypothyroidism
L-thyroxine: This medication is the mainstay of thyroid hormone replacement therapy in hypothyroidism. This is a synthetic form of thyroxine. The body tissues convert it to the active product L-triiodothyronine. Side effects are rare, and it has an excellent safety record.
L-triiodothyronine: This is rarely used alone as thyroid hormone replacement, because it has less uniform potency than L-thyroxine. Its use can cause rapid increases in L-triiodothyronine concentration, which can be dangerous in the elderly and in people with cardiac disease. It may be used in combination with L-thyroxine for people who have poor symptomatic relief with L-thyroxine alone.
Surgery
Surgery for hyperthyroidism may involve removal of much of the thyroid tissue, leaving some intact to continue to produce thyroid hormone. Risks in this procedure include damage to nerves that control the vocal cords, damage to the parathyroid glands, which lie just behind the thyroid gland, and bleeding causing breathing problems. Hypothyroidism may also occur, but occurs less frequently than in radioactive iodine treatment. Persistent hyperthyroidism may also occur. If so, the entire thyroid gland is removed. In general, in the hands of an experienced surgeon, this is considered an effective and relatively safe procedure.
Next Steps
Follow-up
Anyone diagnosed with Graves disease should stop smoking immediately because smoking increases the risk of progression to Graves eye disease.
Follow the medication schedule prescribed by your doctor. In addition, ask what side effects the medications may cause. Also discuss with your doctor the kinds of symptoms that would prompt a call to the doctor or a visit to the emergency department.
Prevention
There is no known way to prevent hyperthyroidism or hypothyroidism.
Outlook
Most people with either hypothyroidism or hyperthyroidism, with proper diagnosis and treatment, can control their condition with no long-term effects. However, those with undiagnosed disease may progress to coma or thyrotoxic crisis, with death rates approaching 50%.
Graves eye disease has been treated with corticosteroid medication, radiotherapy, and surgery with varying success.
Blood in Urine
Blood in Urine Overview
Blood in the urine is a common problem. The medical term for red blood cells in the urine is hematuria. Sometimes blood in the urine is a sign of a serious problem in the urinary tract, while other times it is not serious and requires no treatment. Only after a thorough evaluation by a healthcare provider should blood in the urine be attributed to a non-serious cause.
The urinary tract consists of the following structures:
Kidneys: You have two kidneys, located closer to your back than your front at about waist level. The kidneys filter the blood in your body and produce urine.
Ureters: These narrow, hollow tubes carry urine from the kidneys to the bladder.
Bladder: The bladder is a balloon-like organ that holds urine until it is convenient for you to empty your bladder (urinate).
Urethra: This narrow, hollow tube carries urine from the bladder to the outside of your body. The flow of urine is controlled by internal and external sphincter muscles, which tighten or relax around the urethra, holding or releasing urine.
In men, the genitals and prostate are considered part of the urinary system. The prostate surrounds the urethra in men. It is made up of glands that secrete a fluid that is part of semen. The prostate often becomes enlarged in older men.
Blood in the urine is not always visible. If the amount of blood is small, the urine looks normal. This is called microscopic hematuria because the blood cells are visible only under a microscope. Typically, this is discovered when the patient has a urine test for some other reason.
When there is enough blood to be visible, the urine may look pinkish, red, or smoky brown (like tea or cola). This is called gross or frank hematuria. It takes very little blood in urine to be visible —about one-fifth of a teaspoon in a half quart of urine.
A trace amount of blood in your urine is normal. The average person with a healthy urinary tract excretes about 1 million red blood cells (RBC) in the urine each day. This amount of blood is not visible. This is not considered to be hematuria.
An abnormal amount of blood in the urine can be acute (new, occurring suddenly) or chronic (ongoing, long term). Acute hematuria can occur just once, or it can occur many times.
Sometimes the urine can appear with a color indicating hematuria, but the urine actually does not contain red blood cells, but rather is discolored by medications or foods.
Up to 10% of people have hematuria. About 3% of people develop gross hematuria.
Women develop hematuria more than men because women are more likely to have urinary tract infections.
Older adults, especially men, have hematuria more often than younger people because they are more likely to take medications that can irritate the urinary tract, have enlargement of the prostate, or cancer.
Causes of Blood in Urine
Hematuria has many different causes.
Blood in the urine can come from any condition that results in infection, inflammation, or injury to the urinary system.
Typically, microscopic hematuria indicates damage to the upper urinary tract (kidneys), while visible blood indicates damage to the lower tract (ureters, bladder, or urethra). But this is not always the case.
The most common causes in people younger than 40 years of age are kidney stones or urinary tract infections.
These may also cause hematuria in older people, but cancers of the kidney, bladder, and prostate become a more common concern in people older than 40 years of age.
Several conditions causing hematuria may exist at the same time.
Some causes of hematuria are serious, others are not. Your healthcare provider will perform tests to help tell the difference.
The well-known causes of blood in the urine include the following:
Kidney stones
Infections of the urinary tract or genitals
Blockage of the urinary tract, usually the urethra - by a stone, a tumor, a narrowing of the opening (stricture), or a compression from surrounding structures
Cancer of the kidney, bladder, or prostate
Kidney disease
Blood clotting disorders
Injury to the upper or lower urinary tract, as in a car accident or a bad fall
Medications - Antibiotics [for example, rifampin (Rifadin)], analgesics such as aspirin, anticoagulants [blood thinners such as warfarin, (Coumadin)], phenytoin (Dilantin), quinine (Quinerva, Quinite, QM-260)
Benign (noncancerous) enlargement of the prostate - known as benign prostatic hypertrophy (BPH), a common condition in older men
Chronic diseases such as diabetes, hypertension, and sickle cell anemia
Viral infections
Inflammation of the kidney - usually of unknown cause
Strenuous exercise, especially running - results from repeated jarring of the bladder
Sometimes no cause is found for blood in the urine.
If serious conditions such as cancer, kidney disease, and other chronic diseases that cause kidney damage or bleeding are ruled out, the cause is usually not serious.
The hematuria will probably go away by itself or continue as a chronic condition without doing harm. Any changes should immediately trigger a return visit and evaluation by your healthcare provider.
Urine can be colored pink, red, or brown for reasons that have nothing to do with bleeding in the urinary tract:
Foods - beets, berries, rhubarb in large amounts
Food coloring
Medications - Certain laxatives and pain medications
Menstrual blood
Liver diseases - also can be very serious
Blood in Urine Symptoms
Blood in the urine is itself a symptom rather than a disease. The appearance of the urine is usually not a clue as to the cause.
In gross hematuria, the urine appears pinkish, red, or smoky brown (like cola or tea). There may be small blood clots. The amount of blood in the urine does not indicate the seriousness of the condition.
In microscopic hematuria, the urine appears normal.
Many people with hematuria have no other symptoms. Other symptoms are related to the underlying cause of the bleeding.
Pain in the flank (side of the body between the ribs and the hips), back, or lower belly (abdomen) or groin
Burning sensation or pain when urinating (dysuria)
Fever
Nausea or vomiting
Weight loss
Decreased appetite
Kidney stones: Not all people with kidney stones have all of these symptoms.
Pain, often severe, in the flank, back, or lower abdominal pain that may radiate to the groin area
Nausea and vomiting
Usually a normal temperature
Frequent urination
Burning sensation with urination
Restlessness - constant moving around (writhing) to find relief from pain
Urinary tract infection: Symptoms may be similar to those of kidney stones.
Pain in lower back, flank, lower abdomen, or groin - may be severe but not enough to cause writhing
Fever with or without chills
More frequent urination
Sensation of having to urinate but little urine produced (urgency)
Burning sensation or pain with urination
Cloudy urine - due to pus in the urine
When to Seek Medical Care
Any time you have blood in the urine or other symptoms of urinary tract disease call your healthcare provider. If you cannot get in touch with your provider or get an appointment that day, go to a hospital emergency department.
Any time you have the combination of blood in the urine, fever, and flank pain, you should seek emergency medical care, because this may represent a severe infection in your kidney.
Blood in Urine Treatment
Self-Care at Home
If you have visible blood in your urine, do not attempt to treat yourself with home remedies. See a medical professional without delay.
If you have a urinary tract infection, you will take antibiotics for 3-14 days, depending on what part of the urinary tract is infected.
If you have kidney stones, be sure to drink plenty of liquids to help pass the stones and prevent other stones from forming. You may need to take pain relievers.
Medical Treatment
Many conditions can cause blood in the urine. Some of these have no medical significance and do not require treatment. They usually go away by themselves. Others can be serious and require immediate treatment. Treatment depends on the underlying cause of the bleeding. Anytime you notice blood in the urine you need to consult a healthcare provider for an evaluation.
Kidney stones: For most cases of kidney stones, you will be told to drink plenty of water and other fluids and to take pain relievers.
Most stones will pass through urinary system by themselves. In certain instances, more extensive measures may be required.
One form of therapy, called extracorporeal shock wave lithotripsy, uses sound waves to crush the stones. The smaller pieces can then pass through more easily, though some pain will remain.
Another form of therapy uses cystoscopy to find the stone in the ureter and then to grab and remove it with a small scoop.
Urinary tract infection: Treatment seeks to get rid of the bacteria responsible for the infection. If you have no other significant illness, you will take a course of antibiotics for 3-14 days, depending on the source of the infection.
Benign prostate enlargement: Sometimes eliminating certain foods and medications that irritate the prostate can help shrink the prostate. Sometimes medication is necessary.
Medications: If a medication is causing hematuria, the medication should be stopped. Some medications only discolor the urine without actually causing hematuria. Your healthcare provider should determine if these can be continued. Do not stop a medication without talking it over with your healthcare provider.
Urinary tract blockage: A blockage usually requires surgery or other procedure to correct or remove the block.
Injury: These may heal over time, or you may need surgery or another procedure to repair the injury or remove the damaged tissue.
Next Steps
Follow-up
Follow-up is very important if you have blood in your urine.
Typically, you will go back to your health care provider in one to two weeks for a repeat analysis of your urine to make sure the hematuria has cleared up.
If bloody urine continues, you might need further testing or need to see a specialist (urologist).
You should drink plenty of water and take all medications as recommended if the hematuria is to go away.
Men older than 50 years of age for whom no definite cause is found should have yearly screening for prostate cancer.
Blood in the urine is a common problem. The medical term for red blood cells in the urine is hematuria. Sometimes blood in the urine is a sign of a serious problem in the urinary tract, while other times it is not serious and requires no treatment. Only after a thorough evaluation by a healthcare provider should blood in the urine be attributed to a non-serious cause.
The urinary tract consists of the following structures:
Kidneys: You have two kidneys, located closer to your back than your front at about waist level. The kidneys filter the blood in your body and produce urine.
Ureters: These narrow, hollow tubes carry urine from the kidneys to the bladder.
Bladder: The bladder is a balloon-like organ that holds urine until it is convenient for you to empty your bladder (urinate).
Urethra: This narrow, hollow tube carries urine from the bladder to the outside of your body. The flow of urine is controlled by internal and external sphincter muscles, which tighten or relax around the urethra, holding or releasing urine.
In men, the genitals and prostate are considered part of the urinary system. The prostate surrounds the urethra in men. It is made up of glands that secrete a fluid that is part of semen. The prostate often becomes enlarged in older men.
Blood in the urine is not always visible. If the amount of blood is small, the urine looks normal. This is called microscopic hematuria because the blood cells are visible only under a microscope. Typically, this is discovered when the patient has a urine test for some other reason.
When there is enough blood to be visible, the urine may look pinkish, red, or smoky brown (like tea or cola). This is called gross or frank hematuria. It takes very little blood in urine to be visible —about one-fifth of a teaspoon in a half quart of urine.
A trace amount of blood in your urine is normal. The average person with a healthy urinary tract excretes about 1 million red blood cells (RBC) in the urine each day. This amount of blood is not visible. This is not considered to be hematuria.
An abnormal amount of blood in the urine can be acute (new, occurring suddenly) or chronic (ongoing, long term). Acute hematuria can occur just once, or it can occur many times.
Sometimes the urine can appear with a color indicating hematuria, but the urine actually does not contain red blood cells, but rather is discolored by medications or foods.
Up to 10% of people have hematuria. About 3% of people develop gross hematuria.
Women develop hematuria more than men because women are more likely to have urinary tract infections.
Older adults, especially men, have hematuria more often than younger people because they are more likely to take medications that can irritate the urinary tract, have enlargement of the prostate, or cancer.
Causes of Blood in Urine
Hematuria has many different causes.
Blood in the urine can come from any condition that results in infection, inflammation, or injury to the urinary system.
Typically, microscopic hematuria indicates damage to the upper urinary tract (kidneys), while visible blood indicates damage to the lower tract (ureters, bladder, or urethra). But this is not always the case.
The most common causes in people younger than 40 years of age are kidney stones or urinary tract infections.
These may also cause hematuria in older people, but cancers of the kidney, bladder, and prostate become a more common concern in people older than 40 years of age.
Several conditions causing hematuria may exist at the same time.
Some causes of hematuria are serious, others are not. Your healthcare provider will perform tests to help tell the difference.
The well-known causes of blood in the urine include the following:
Kidney stones
Infections of the urinary tract or genitals
Blockage of the urinary tract, usually the urethra - by a stone, a tumor, a narrowing of the opening (stricture), or a compression from surrounding structures
Cancer of the kidney, bladder, or prostate
Kidney disease
Blood clotting disorders
Injury to the upper or lower urinary tract, as in a car accident or a bad fall
Medications - Antibiotics [for example, rifampin (Rifadin)], analgesics such as aspirin, anticoagulants [blood thinners such as warfarin, (Coumadin)], phenytoin (Dilantin), quinine (Quinerva, Quinite, QM-260)
Benign (noncancerous) enlargement of the prostate - known as benign prostatic hypertrophy (BPH), a common condition in older men
Chronic diseases such as diabetes, hypertension, and sickle cell anemia
Viral infections
Inflammation of the kidney - usually of unknown cause
Strenuous exercise, especially running - results from repeated jarring of the bladder
Sometimes no cause is found for blood in the urine.
If serious conditions such as cancer, kidney disease, and other chronic diseases that cause kidney damage or bleeding are ruled out, the cause is usually not serious.
The hematuria will probably go away by itself or continue as a chronic condition without doing harm. Any changes should immediately trigger a return visit and evaluation by your healthcare provider.
Urine can be colored pink, red, or brown for reasons that have nothing to do with bleeding in the urinary tract:
Foods - beets, berries, rhubarb in large amounts
Food coloring
Medications - Certain laxatives and pain medications
Menstrual blood
Liver diseases - also can be very serious
Blood in Urine Symptoms
Blood in the urine is itself a symptom rather than a disease. The appearance of the urine is usually not a clue as to the cause.
In gross hematuria, the urine appears pinkish, red, or smoky brown (like cola or tea). There may be small blood clots. The amount of blood in the urine does not indicate the seriousness of the condition.
In microscopic hematuria, the urine appears normal.
Many people with hematuria have no other symptoms. Other symptoms are related to the underlying cause of the bleeding.
Pain in the flank (side of the body between the ribs and the hips), back, or lower belly (abdomen) or groin
Burning sensation or pain when urinating (dysuria)
Fever
Nausea or vomiting
Weight loss
Decreased appetite
Kidney stones: Not all people with kidney stones have all of these symptoms.
Pain, often severe, in the flank, back, or lower abdominal pain that may radiate to the groin area
Nausea and vomiting
Usually a normal temperature
Frequent urination
Burning sensation with urination
Restlessness - constant moving around (writhing) to find relief from pain
Urinary tract infection: Symptoms may be similar to those of kidney stones.
Pain in lower back, flank, lower abdomen, or groin - may be severe but not enough to cause writhing
Fever with or without chills
More frequent urination
Sensation of having to urinate but little urine produced (urgency)
Burning sensation or pain with urination
Cloudy urine - due to pus in the urine
When to Seek Medical Care
Any time you have blood in the urine or other symptoms of urinary tract disease call your healthcare provider. If you cannot get in touch with your provider or get an appointment that day, go to a hospital emergency department.
Any time you have the combination of blood in the urine, fever, and flank pain, you should seek emergency medical care, because this may represent a severe infection in your kidney.
Blood in Urine Treatment
Self-Care at Home
If you have visible blood in your urine, do not attempt to treat yourself with home remedies. See a medical professional without delay.
If you have a urinary tract infection, you will take antibiotics for 3-14 days, depending on what part of the urinary tract is infected.
If you have kidney stones, be sure to drink plenty of liquids to help pass the stones and prevent other stones from forming. You may need to take pain relievers.
Medical Treatment
Many conditions can cause blood in the urine. Some of these have no medical significance and do not require treatment. They usually go away by themselves. Others can be serious and require immediate treatment. Treatment depends on the underlying cause of the bleeding. Anytime you notice blood in the urine you need to consult a healthcare provider for an evaluation.
Kidney stones: For most cases of kidney stones, you will be told to drink plenty of water and other fluids and to take pain relievers.
Most stones will pass through urinary system by themselves. In certain instances, more extensive measures may be required.
One form of therapy, called extracorporeal shock wave lithotripsy, uses sound waves to crush the stones. The smaller pieces can then pass through more easily, though some pain will remain.
Another form of therapy uses cystoscopy to find the stone in the ureter and then to grab and remove it with a small scoop.
Urinary tract infection: Treatment seeks to get rid of the bacteria responsible for the infection. If you have no other significant illness, you will take a course of antibiotics for 3-14 days, depending on the source of the infection.
Benign prostate enlargement: Sometimes eliminating certain foods and medications that irritate the prostate can help shrink the prostate. Sometimes medication is necessary.
Medications: If a medication is causing hematuria, the medication should be stopped. Some medications only discolor the urine without actually causing hematuria. Your healthcare provider should determine if these can be continued. Do not stop a medication without talking it over with your healthcare provider.
Urinary tract blockage: A blockage usually requires surgery or other procedure to correct or remove the block.
Injury: These may heal over time, or you may need surgery or another procedure to repair the injury or remove the damaged tissue.
Next Steps
Follow-up
Follow-up is very important if you have blood in your urine.
Typically, you will go back to your health care provider in one to two weeks for a repeat analysis of your urine to make sure the hematuria has cleared up.
If bloody urine continues, you might need further testing or need to see a specialist (urologist).
You should drink plenty of water and take all medications as recommended if the hematuria is to go away.
Men older than 50 years of age for whom no definite cause is found should have yearly screening for prostate cancer.
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