Talk:Thyroid/GA1

Lead

• "and consists of"? Certainly correct, but would "which consists of" be better?
• Neck is linked twice in the first two sentences. Not sure we even need once, but definitely not twice.
• "The hormones also have many other effects including those on development." How about "Thyroid hormones also affect development and have other functions" or something like that? "those on development" seems awkward.
• Not sure we need syntherized/biosynthesis or hormone linked either.
• The second paragraph in the lead might reference the feedback mechanisms mentioned in the 'regulation' paragraph below. It's currently a one-sentence paragraph, and the entire lead can go longer without being too long.
• diseases/thyroid diseases has the same issue as a couple of the prior lead links does: it looks like an overlink of something sufficiently simple that we don't normally link it, but it's really a more subtle and appropriate link. Let's think through how piped links in the lead should best be used. It would be possible to reword the sentence and NOT pipe it so it's obviously NOT an overlink... but I'm not entirely sure that would be necessary or even better. Let's discuss options?
• The lead needs to be longer by a bit, so what can be added? A bit about how T4 turns into T3 might not hurt, but that's possibly my medical provider bias showing. A sentence each on calcitonin and goiter would certainly be appropriate. The article doesn't at all cover treatment for thyroid diseases, otherwise surgery and ablation might merit a mention. Jclemens (talk) 20:05, 7 January 2017 (UTC)

Structure

• "a narrow connecting thyroid isthmus" How about "a narrow thyroid isthmus connecting the halves" to be a bit more obvious to readers who may not immediately remember what an isthmus is? (it's not always isthmus season...)
  •  Done --Tom (LT) (talk) 09:40, 9 January 2017 (UTC)
• Specify which dimension (length, width, depth?) for the isthmus, please.
  • Doing... --Tom (LT) (talk) 21:01, 9 January 2017 (UTC)
    •  Done --Tom (LT) (talk) 00:16, 14 January 2017 (UTC)
• Does it make sense to also list the gland's weight as "slightly less than an ounce" via the convert function or just in text? Ditto with the length measurements--do we want them in inches, too, given this is for a lay audience of whom many will be American?
  •  Not done WP has a global audience; US readers may draw this relationship on their own--Tom (LT) (talk) 09:40, 9 January 2017 (UTC)
• You might want to make it more clear that there are typically four parathyroid glands, two per side.
  •  Done good point --Tom (LT) (talk) 09:40, 9 January 2017 (UTC)
• "and where present Zuckerkandl's tubercle" Hadn't heard of this variance before, may want to clarify it as such "and, in some people, the extension known as..."
  •  Done moved down to the 'variation' section where this belongs, and clarified. --Tom (LT) (talk) 09:40, 9 January 2017 (UTC)
• "they consist of a rim that has a rich blood flow, nerve and lymphatic supply," Is supply the right way to characterize lymphatic presence? I would have thought 'drainage' would be more apt.
  •  Done good point, I have tried to clarify this --Tom (LT) (talk) 09:40, 9 January 2017 (UTC)
• What is the mix of T3 and T4 as secreted by the follicular cells? I always thought T4 was predominant. Jclemens (talk) 20:23, 7 January 2017 (UTC)
  •  Not done see below in the 'production' section. I try to separate information so as not to confuse things.--Tom (LT) (talk) 09:40, 9 January 2017 (UTC)

Development

• "By 18–20 weeks, and the production of thyroxine" pretty sure the ", and" are extra.
  •  Done --Tom (LT) (talk) 09:40, 9 January 2017 (UTC)
• "The fetus needs to be self-sufficient in thyroid hormones in order to guard against neurodevelopmental disorders that would arise from maternal hypothyroidism.[20] The presence of sufficient iodine is essential for healthy neurodevelopment.[21] Preterm neonates are at risk of these disorders as their thyroid glands are insufficiently developed to meet their postnatal needs.[22]" The middle sentence in here seems to break up the flow between the first and third. Would it be reasonable to reorder things? Alternatively, a bit more specificity to 'these disorders' might work. What do you think?
  •  Done have moved the part about preterms to the clinical significance section. --Tom (LT) (talk) 09:40, 9 January 2017 (UTC)

Function

• Explain to the layman what T3 and T4 being bound vs. free means, please. It's basically buffering them so the available supply isn't all used up at once, right?
  • I wouldn't want to speculate what nature intended for buffering, but the effects of the buffering are here: "After secretion, only a very small proportion of the thyroid hormones travel freely in the blood. Most are bound to thyroxine-binding globulin (about 70%), transthyretin (10%), and albumin (15%).[29] Only the 0.03% of T4 and 0.3% of T3 traveling freely has hormonal activity" --Tom (LT) (talk) 21:01, 9 January 2017 (UTC)
• The last paragraph of the hormone production section is confusing. Are MIT and DIT essentially T1 and T2? It sorta reads that way, but not entirely. I'd like to see this expanded and clarified. I note here we finally see the relative prevalence of T4 noted.
  •  Done have reworked the entire subsection to, hopefully, make it easier to read and clarify this. How does it look now? --Tom (LT) (talk) 21:01, 9 January 2017 (UTC)
• "TRH is secreted at an increased rate in situations such as cold exposure (to stimulate thermogenesis) which is prominent in case of infants." Did we just say babies get cold a lot? I think what we're trying to say is that such thermogenesis is more important in infants than in adults, but I'm not sure that's really what was written.
  • Doing... --Tom (LT) (talk) 21:01, 9 January 2017 (UTC)
    •  Done --Tom (LT) (talk) 08:12, 16 January 2017 (UTC)
• "TSH production is blunted by dopamine and somatostatin which act as local regulators at the level of the pituitary, in response to rising levels of glucocorticoids and sex hormones (estrogen and testosterone), and excessively high blood iodide concentration." I got thrown by the dopamine/somatostatin explanation in the middle of the list. Maybe this should be expanded and separated out a bit more? Jclemens (talk) 20:39, 7 January 2017 (UTC)
  • Doing... --Tom (LT) (talk) 21:01, 9 January 2017 (UTC)
    •  Done --Tom (LT) (talk) 08:12, 16 January 2017 (UTC)

Clinical significance

• Do we need some introductory text to tie the subsections together?
• "Excessive production of the thyroid hormone" which one? Drop the 'the', add an 's' to hormone, or...?
  •  Done pluralised. --Tom (LT) (talk) 02:31, 10 January 2017 (UTC)
• "which is most commonly a result of Graves' disease, a toxic multinodular goitre, a solitary thyroid adenoma, and inflammation." pretty sure that needs to be OR inflammation.
  •  Done --Tom (LT) (talk) 02:31, 10 January 2017 (UTC)
• Hormone therapy links to a disambiguation article. Thyroid_hormones#replacement seems like a much more apt target.
  •  Done also reworded --Tom (LT) (talk) 02:31, 10 January 2017 (UTC)
• The treatment of hyperthyroidism may well merit more discussion, but what is here seems to be spot on to me.
  • thanks for your kind comment --Tom (LT) (talk) 02:31, 10 January 2017 (UTC)
• "An underactive thyroid gland results in hypothyroidism." Technically, it's a mismatch between the body's current thyroid hormone needs and what's being produced in the thyroid, right?
  • Right! I think that is implied by the above sentence. --Tom (LT) (talk) 09:56, 16 January 2017 (UTC)
• Might hair loss be a better symptom descriptor than baldness, which is of course late stage hair loss?
  •  Done good point, this may have got lost in translation over several edits --Tom (LT) (talk) 02:31, 10 January 2017 (UTC)
• "Hypothyroid disorders may occur as a result of autoimmune disease such as Hashimoto's thyroiditis; iodine deficiency; as a result of medical treatments such as surgical removal or radioablation of the thyroid, amiodarone and lithium; as a result of congenital thyroid abnormalities; or as a result of diseases such as amyloidosis or sarcoidosis or because of transient inflammation of the thyroid.[49]" OK, that's 1) far too complex a list for a single sentence, and 2) I'm pretty sure the punctuation needs to be taken out back and shot.
  •  Done hah! I would say the punctuation deserves a medal although I am a little biased :P. I have reworked the sentence - let me know what you think. --Tom (LT) (talk) 03:53, 11 January 2017 (UTC)
• The article talks about thyroid hormone replacement both after ablation for hyperthyroid, and for hypothyroid. Might it make sense to pull it out into its own section? Again, my medical provider bias is showing.
  •  Not done that's a good point, and in many other anatomical articles I would do that; however because it is a relatively simple concept I can break my normal rule (about one fact in one spot only) and mention it in both sections. I don't think a section about thyroid hormone replacement would (1) be long enough and (2) justify a subsection on the main thyroid article --Tom (LT) (talk) 02:31, 10 January 2017 (UTC)
• "an ultrasound is often used to investigate the nodule, and provide information such as whether the nodule is fluid-filled or a solid mass, and whether the appearance is suggestive of a benign or malignant cancer." Are those separate things, or does one follow from the other? In other words, can you see "fluid/solid" and "benign/malignant" separately, or does the latter flow from the former?
  • Sorry, I'm not sure what you mean here. These are all pieces of information that can be provided by an ultrasound. An ultrasonographer or interpreting physician may use a pathway to interpret results as you suggest.--Tom (LT) (talk) 02:31, 10 January 2017 (UTC)
• "Investigations of a malignant nodule, or when hyperthyroidism is present, is discussed in the "Cancer" section below." I don't see this construction in Wikipedia articles very often. Not opposed to it, but what do you think?
  • Gah, my spelling is not great on these edit summaries. I wasn't quite sure what to write, and like you had some hesitations, as I didn't want to cover that information twice. What do you think now? --Tom (LT) (talk) 02:31, 10 January 2017 (UTC)
• "Goiters may be associated with causes or hyperthyoidism, hypothyroidism, relating to the underlying cause." What?
  •  Done clarified --Tom (LT) (talk) 03:53, 11 January 2017 (UTC)
• Why is there a 'disease' section after we've spent the last few sections talking about... diseases? Should it be up top where I highlighted the lack of introductory text for the clinical significance section?
  • Comment: I have separated the initial sections into a 'symptoms' and 'diseases' subsections. What do you think here? It was a matter of some discussion between me and another editor, Iztwoz. It's my opinion that what I have grouped are symptoms (ie, something a patient notices or causes them distress) that represent an underlying condition, which is why I have separated them, but Iztwoz has pointed out to readers there may be some confusion as technically hyper/hypothyroidism are syndromes (ie collections of symptoms). A third opinion may be useful here - what do you think? --Tom (LT) (talk) 02:31, 10 January 2017 (UTC)
• "There are two types of thyroiditis where initially hyperthyroidism presents which is followed by a period of hypothyroidism; (the overproduction of T3 and T4 followed by the underproduction of T3 and T4). These are Hashimoto's thyroiditis and postpartum thyroiditis." I think two sentences are right; I think the parenthetical ending of the first sentence here should actually be a standalone sentence.
  •  Done clarified and removed parenthetical statement as it is a tautology of the first sentence.--Tom (LT) (talk) 02:31, 10 January 2017 (UTC)
• "an autoimmune disorder whereby the body's own immune system reacts with the thyroid tissues in an attempt to destroy it." It? If it's trying to destroy the body (it's not) that would be OK, otherwise I'm pretty sure tissues are plural, hence "... to destroy them."
  • Doing... will clarify --Tom (LT) (talk) 03:53, 11 January 2017 (UTC)
    •  Done let me know what you think --Tom (LT) (talk) 09:56, 16 January 2017 (UTC)
• Gland is overlinked.
  •  Done --Tom (LT) (talk) 02:31, 10 January 2017 (UTC)
• "hyper-to-hypothyroid" "hyper- to hypo-thyroid"?
  •  Done removed --Tom (LT) (talk) 02:31, 10 January 2017 (UTC)
• Not sure "swings" belongs in quotes. Seems scare quotesish.
  •  Done removed --Tom (LT) (talk) 02:31, 10 January 2017 (UTC)
• Note the citation needed tag here--can you make that go away or rephrase the challenged statement?
  •  Done removed entire statement; this is not something that should be on the primary article--Tom (LT) (talk) 02:31, 10 January 2017 (UTC)
  • Doing... I will provide citations for this section and also clarify the target of Hashimoto's thyroiditis --Tom (LT) (talk) 02:31, 10 January 2017 (UTC)
• "There are other disorders that cause inflammation of the thyroid," but it just said there were two not but a few paragraphs ago. How about combine this with that section to clarify that the two main types, Hashimoto and postpartum, will get attention but these other, minor causes will just be linked without further comment?
  • •  Done good idea --Tom (LT) (talk) 09:56, 16 January 2017 (UTC)
• The relationship between inflammation and hyperthyroidism should be discussed somewhere.
  • Comment: Sorry, what do you mean here? Inflammation can be associated with both hypo and hyperthyroidism? --Tom (LT) (talk) 03:53, 11 January 2017 (UTC)
• "Malignant thyroid cancers are most often carcinomas, although cancer can occur in any tissue that the thyroid consists of, including C-cells, lymphomas." What?
  •  ? have attempted to clarify, let me know what you think.--Tom (LT) (talk) 03:53, 11 January 2017 (UTC)
• The cancer section doesn't transition well between surgery, radioiodine ablation, and replacement. Again, there's probably a call for a separate section on these.
  • Doing... will clarify. --Tom (LT) (talk) 03:53, 11 January 2017 (UTC)
• The 'congenital' section seems largely redundant to portions of the development section, above. Consider condensing and combining.
  •  Done moved disease-related information from development section to here. Separating them into two sections helps keep the content clear and is easier to read and convey information to readers. --Tom (LT) (talk) 02:31, 10 January 2017 (UTC)
• The paragraph on iodine tablets for nuclear accident mitigation is cool... but I'm not sure the placement is right. I think the entire section on iodine deficiency and excess could stand to be upleveled and expanded.
  •  Done moved congenital disease up. --Tom (LT) (talk) 03:53, 11 January 2017 (UTC)
  •  Done trimmed and renamed section. --Tom (LT) (talk) 03:53, 11 January 2017 (UTC)
  • Doing... still working here... --Tom (LT) (talk) 03:53, 11 January 2017 (UTC)
    •  Done let me know what you think now --Tom (LT) (talk) 09:56, 16 January 2017 (UTC)
• Graves' Disease section seems partially overlapping with/redundant to the hyperthyroid sections.
  •  Not done a common condition, I believe this deserves its own section, and as one of the presenting symptoms of Grave's is hyperthyroidism, this requires some duplication.--Tom (LT) (talk) 03:53, 11 January 2017 (UTC)
• "Physicians who specialise in the treatment of thyroid disorders are known generally as endocrinologists, thyroid specialists or thyroidologists. Thyroid surgeons may play a role in the surgical management of thyroid disease and general practitioners may play a role in monitoring for and identifying symptoms related to thyroid disease." Endocrinologists are the general class of specialists within internal medicine, and thyroid specialists a sub-specialty within endocrinology, correct? I'd also expect that otolaryngologists should be mentioned as surgeons. General practitioners seems very commonwealth oriented--we have primary care providers here in the U.S. At any rate, a worldwide view of medical providers could be readily improved.
  •  Done let me know what you think. --Tom (LT) (talk) 09:56, 16 January 2017 (UTC)
• "The character of the thyroid, swellings, nodules, and their consistency may all be able to be felt." "... may all be palpable."?
  •  Not done "felt" is the term that non-medical humanoids use when discussing something that was "palpated". --Tom (LT) (talk) 02:31, 10 January 2017 (UTC)
• Does the whole examination section somewhat run afoul of WP:NOT#HOWTO?
  • Comment: I don't agree here. Examination is an important part of any anatomical structure in terms of how it relates to medicine. An overview of what would be done in a standard exam is encyclopedic, and I have tried to write this in a way that conveys that... without trying to be too structured about it or write it in terms of the perspective of a medical professional (which is quite difficult). Let me know if you think something in particular should be changed here. --Tom (LT) (talk) 02:31, 10 January 2017 (UTC)
• Blood tests is overlinked.
  •  Done good point; removed --Tom (LT) (talk) 03:53, 11 January 2017 (UTC)
• What is the point of the table in the blood tests section?
  •  Done my oversight - section expanded; table removed. --Tom (LT) (talk) 09:56, 16 January 2017 (UTC)
• Blood tests section again gives some specific guidance for usage, which will vary by country in which these tests are performed. It might discuss the American practice of checking TSH, with a "reflex" to Free T4--that is, if the TSH is normal, nothing further is checked, but if the TSH is abnormal then FT4 is immediately checked by the lab and reported back to the ordering clinician together.
  • Comment: It is my understanding that (worldwide) high T3 and T4 are generally considered to be hyperthyroidism, and likewise low T3 and low T3 hypothyroidism. --Tom (LT) (talk) 09:56, 16 January 2017 (UTC)
• Imaging and biopsy sections appear redundant to content already covered above.
  •  Done good point. I've rolled this into a single section, hopefully much better to read. --Tom (LT) (talk) 09:56, 16 January 2017 (UTC)
• Can I just say that the 'Clinical Significance' section as currently constituted is too long and really needs to be appropriately broken up? Jclemens (talk) 21:28, 7 January 2017 (UTC)
  • Comment: Ok, let me know what you think now. Unfortunately I think "symptoms", "disease" and "tests/exam" need to be in the same section as they are logically linked. That said I've made a few changes to structure (eg re-including 'symptoms' and removing headings from 'tests') - let me know what you think. --Tom (LT) (talk) 09:56, 16 January 2017 (UTC)

History

• Renaissance is probably overlinked.
  •  Not done Seems only to be linked once? --Tom (LT) (talk) 00:57, 8 January 2017 (UTC)
    • Right, but should it even be linked at all, given that the average reader will or should know basically what it is? Jclemens (talk) 01:17, 8 January 2017 (UTC)
      • I think so... I am trying to write at about the level of a year 10 student, and I would not have known about it in year 10. --Tom (LT) (talk) 00:14, 14 January 2017 (UTC)
• As a scientific article, should BC or BCE dating be used? WP:BCE suggests the format not be disturbed, but I've not seen BC used in any recent medical historical literature.
  •  Done Good point. --Tom (LT) (talk) 06:13, 13 January 2017 (UTC)
• "In 1110 a Persian scientist was the first to describe symptoms associated with Grave's disease, describing protruding eyes and goitre,[82] although Robert Graves himself only described it in 1834.[81]" 1) Awkward wording and 2) the source names the Persian scientist, so we probably should too. Oh, also, one sentence paragraph.
  •  Done removed - another sources mentions an earlier reference. It is hard because sources differ quite markedly in their mentions of different discoveries. --Tom (LT) (talk) 06:13, 13 January 2017 (UTC)
• "There are several findings that evidence a great interest for thyroid disorders just in the Medieval Medical School of Salerno (12th century)." So what? Even if important, that's very wordy.
  •  Done removed entire paragraph - puffery and not providing any useful information --Tom (LT) (talk) 06:13, 13 January 2017 (UTC)
• "Rogerius Salernitanus, the Salernitan surgeon and author of "Post mundi fabricam" (around 1180) was considered at that time the surgical text par excellence all over Europe." I think a "which was" is needed in the middle there. 'par excellence' is probably puffery and could be toned down; ditto with magnum opus in the next sentence. This paragraph feels like someone dropped in in out of his or her dissertation.
  • Oh dear. This whole section has changed quite a bit from previously. I will have to have a look at the whole section as other bits are out of order too. --Tom (LT) (talk) 00:57, 8 January 2017 (UTC)
    •  Done removed paragraph--Tom (LT) (talk) 06:13, 13 January 2017 (UTC)
• "A Chinese physician Wang Hei recommended that the treatment of goitre should be dried minced thyroid.[80] Paracelsus, some fifty years later, attributed goitre to mineral impurities in the water." Fifty years later than what? Citation needed for the second sentence, by the way.
  •  Done removed, I do not think this merits inclusion in the list. --Tom (LT) (talk) 06:13, 13 January 2017 (UTC)
• "In 1500 Leonardo da Vinci first recognised and drew the thyroid.[80] In 1543 Andreas Vesalius gave the first description and illustration of the gland.[80]" They cannot BOTH have been first.
  •  Done clarified --Tom (LT) (talk) 06:13, 13 January 2017 (UTC)
• Overall, the history section feels like a bunch of tidbits strung together, rather than a holistic overview.
  •  Done Thanks for this - I have tried to rewrite it in sections and hope the rewrite helps. --Tom (LT) (talk) 00:14, 14 January 2017 (UTC)
• Overall comment - I have tried to list discoveries chronologically in order to give some idea of how knowledge of the thyroid has progressed. It is however hard to place this in the overall context of anatomical discoveries given (1) I feel that would be speculation on my part to link it to a general trend and (2) discoveries vary geographically by some margin. If you think it merits inclusion I may provide some context (eg transition from Graecoroman -> Arabic-Persian -> Renaissance --Tom (LT) (talk) 06:13, 13 January 2017 (UTC)
  • Doing... I realise I may be missing some parts of modern history - will include --Tom (LT) (talk) 06:13, 13 January 2017 (UTC)
    •  Done let me know what you think now --Tom (LT) (talk) 00:14, 14 January 2017 (UTC)

Other animals

• In contrast to History, this section is relatively well written as is. Frog is overlinked, however.
  • Frog isn't linked at all on the version I am seeing? --Tom (LT) (talk) 00:57, 8 January 2017 (UTC)
    • "the amphibian metamorphosis that transforms the vegetarian aquatic tadpole into a carnivorous terrestrial adult frog" is the one in question. The earlier Frog isn't linked. Jclemens (talk) 01:26, 8 January 2017 (UTC)
      • Good point, and what a mouthful. Have reordered and simplified this sentence.--Tom (LT) (talk) 09:40, 9 January 2017 (UTC)

Additional images

• Integrate these into the appropriate sections--these are good images. If you don't want to, I'd delete them as we have a commons link at the bottom of the article.
  •  Done removed these images. I have chosen to remove them because I think the position of the parathyroids is tangential to the primary topic, and I don't think another image of blood vessels (this time veins) really benefits the article that much. --Tom (LT) (talk) 00:18, 14 January 2017 (UTC)

Etc

• Unless you end up populating this, delete the blank Notes section.
  •  Done --Tom (LT) (talk) 00:57, 8 January 2017 (UTC)
• References mostly look good, but I see an access-date issue with #80 displayed.
• Anything else you want for See Also? Parathyroid, maybe?
• In the Endocrine System navbox, thyroid gland is a redirect to Thyroid, so this article doesn't appear in black.
  •  Done good pickup. --Tom (LT) (talk) 00:57, 8 January 2017 (UTC)

OK, that's the first read through. Have fun digesting that! Jclemens (talk) 21:50, 7 January 2017 (UTC)