mardinthyroid-141212101640-conversion-gate02.pptx
TRANSCRIPT
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Thyroid disorder
Mardin mazharShanga ismail
Hawnaz hamasalhHwda mhamad
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Second largest endocrine gland in body,Small butterfly shaped gland located at base of neck below the sternocleidomastoid musclesThyroid is controlled by the hypothalmus and pituitaryWeighs 18-60gms in adults,Histologically it is made up of follicular and parafollicular cells.
Introduction of thyrod gland
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thyrod gland folicular cell
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Stimulates & maintains metabolic processes
Produces thyroid hormones T3-triiodothyronine and T4-thyroxine
These hormones regulate metabolism & affect the growth and function of other systems in the body
Secretes calcitonin to lower serum calcium levels
Parathyroid gland secretes PTH to raise serum calcium levels
function
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Metabolic stimulants of:
Neural and skeletal development Oxygen consumption at rest Stimulating bone turnover by increasing
formation and resorption Promoting chronitropic and ionotropic effects Increasing number of catecholamine receptors in
heart Increasing production of RBC Altering the metabolism of carbs, fats, and
protein
Function cont……..
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T3 (Triiodothyronine) & T4
(Tetraiodothyronine Stored in Follicles (round sacs) in the thyroid
filled with thyroglobulin, a thyroid protein. Dietary iodine enters follicles where they are
stored as T3 and T4 T4 is converted to T3 by peripheral organs such
as kidney, liver, and spleen T3 is 10x more active than T 4 Only 20% of total T3 is secreted by thyroid
Hormones: T3 & T4
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T4-thyroxine contains 4 iodine atoms It is a slow-acting pre-hormone T4 takes 4 days to peak in blood
Half-life 7 days Overall effects take 6 weeks T3 is the active and faster-acting hormone The immediate effects of T3 last 1-2 days
Half-life 1.5 days
Hormones: T4
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T3 and T4 structure
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Dietary Iodide is removed from the
bloodstream by means of an active pump The pump can concentrate iodide in the
follicular sacs at 350x greater than the blood concentration
Oxidation of iodide by thyroid peroxidase converts iodide iodine
Peripheral de-iodination of T4 to T3 is regulated by many factors including health, nutritional status, and other hormones
Iodine
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TSH
TSH is a pituitary hormone Controlled by TRH-thyrotropin releasing hormone
from hypothalamus Functions to stimulate thyroid hormone
production May enlarge thyroid (goiter) when under producing
Labs: High TSH indicates low thyroid hormone= hypo Low TSH indicates high thyroid hormone = hyper
Hormones- TSH
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Produced by thyroid to regulate serum calcium
levels Calcitonin stimulates movement of calcium
into bone Parathyroid hormone (PTH) opposite effect of
calcitonin
Hormones-Calcitonin & PTH
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Negative Feedback System
TRH
T3 & T4 Thyroid
TSH
The disruption of any of these mechanisms can cause abnormal levels of T3 and T4 leading to thyroid disease
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Primary Hypothyroidism
Disease of the thyroid gland
Secondary Hypothyroidism Hypothalamic-pituitary diseases
(reduced TSH)
Hypothyroidism
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PRIMARY Congenital
Agenesis Ectopic thyroid remnants
Defects of hormone synthesis Iodine deficiency Dyshormonogenesis Antithyroid drugs Other drugs (e.g. lithium, amiodarone,
interferon)
Causes of Hypothyroidism
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Autoimmune
Atrophic thyroiditis Hashimoto's thyroiditis Postpartum thyroiditis
Infective Post-subacute thyroiditis
Causes of Hypothyroidism
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Iatrogenic
Radioactive iodine therapy External neck irradiation post-surgery
Infiltration amyloidosis, sarcoidosis, hemochromatosis,
scleroderma
Causes of Hypothyroidism
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SECONDARY Hypopituitarism: tumors, pituitary surgery or
irradiation, infiltrative disorders, Sheehan's syndrome, trauma, genetic forms of combined pituitary hormone deficiencies
Isolated TSH deficiency or inactivity Hypothalamic disease: tumors, trauma,
infiltrative disorders, idiopathic
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Although anyone can develop hypothyroidism, you're at an
increased risk if you: Are a woman older than age 60 Have an autoimmune disease Have a close relative, such as a parent or grandparent, with an
autoimmune disease Have been treated with radioactive iodine or anti-thyroid
medications Received radiation to your neck or upper chest Have had thyroid surgery (partial thyroidectomy) Have been pregnant or delivered a baby within the past six
months
Risk factor
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Fatigue Increased sensitivity to cold Constipation Dry skin Unexplained weight gain Puffy face Hoarseness Muscle weakness Elevated blood cholesterol level Muscle aches, tenderness and stiffness Pain, stiffness or swelling in your joints Heavier than normal or irregular menstrual periods Thinning hair Slowed heart rate Depression Impaired memory
signs and symptom
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Diagnosis of hypothyroidism is based on your
symptoms and the results of blood tests that measure the level of TSH and sometimes the level of the thyroid hormone thyroxine. A low level of thyroxine and high level of TSH indicate an underactive thyroid. That's because your pituitary produces more TSH in an effort to stimulate your thyroid gland into producing more thyroid hormone.
diagnosis
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Replacement therapy with
levothyroxine (thyroxine, i.e. T4) is given for life. In the young and fit, 100 - 150 μg daily is
suitable. thyroid function tests after at least 2 months on
a steady dose the aim is to restore T4 and TSH to well within
the normal range An annual thyroid function test is recommended
.
Treatment
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Excessive amounts of the hormone can cause
side effects, such as: Increased appetite Insomnia Heart palpitations Shakiness
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Goiter. Constant stimulation of your thyroid to release
more hormones may cause the gland to become larger — a condition known as a goiter.
Heart problems. Hypothyroidism may also be associated with an increased risk of heart disease, primarily because high levels of low-density lipoprotein (LDL) cholesterol — the "bad" cholesterol — can occur in people with an underactive thyroid.
Mental health issues. Depression may occur early in hypothyroidism and may become more severe over time. Hypothyroidism can also cause slowed mental functioning.
Complication
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Peripheral neuropathy. Long-term uncontrolled hypothyroidism can
cause damage to your peripheral nerves — the nerves that carry information from your brain and spinal cord to the rest of your body,
Myxedema. This rare, life-threatening condition is the result of long-term, undiagnosed hypothyroidism. Its signs and symptoms include intense cold intolerance and drowsiness followed by profound lethargy and unconsciousness.
Infertility. Low levels of thyroid hormone can interfere with ovulation, which impairs fertility.
Birth defects. Babies born to women with untreated thyroid disease may have a higher risk of birth defects than may babies born to healthy mothers. These children are also more prone to serious intellectual and developmental problems. Infants with untreated hypothyroidism present at birth are at risk of serious problems with both physical and mental development.
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Hyperthyroidism - result of excessive thyroid
function major etiologies of thyrotoxicosis are
hyperthyroidism caused by Graves' disease, toxic MNG, and toxic adenomas
Hyperthyrodism
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Common Graves' disease (autoimmune) Toxic multinodular goitre Solitary toxic nodule/adenoma
Causes of hyperthyroidism
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Graves' disease. Graves' disease, an autoimmune
disorder in which antibodies produced by your immune system stimulate your thyroid to produce too much T-4, is the most common cause of hyperthyroidism.
Hyperfunctioning thyroid nodules (toxic adenoma, toxic multinodular goiter, Plummer's disease). This form of hyperthyroidism occurs when one or more adenomas of your thyroid produce too much T-4. An adenoma is a part of the gland that has walled itself off from the rest of the gland, forming noncancerous (benign) lumps that may cause an enlargement of the thyroid. Not all adenomas produce excess T-4, and doctors aren't sure what causes some to begin producing too much hormone.
Reasons for too much thyroxine (T-
4)
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Thyroiditis. Sometimes your thyroid gland
can become inflamed for unknown reasons. The inflammation can cause excess thyroid hormone stored in the gland to leak into your bloodstream. One rare type of thyroiditis, known as subacute thyroiditis, causes pain in the thyroid gland. Other types are painless and may sometimes occur after pregnancy (postpartum thyroiditis).
Cont……
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Hyperthyrodism
Clinical features: due to
Hypermetabolic state
Overactivity of sympathetic nervous system
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Symptoms
Weight loss Increased
appetite Irritability Tremor Goiter Restlessness Stiffness Muscle weakness Breathlessness
PalpitationHeat intoleranceExcessive
sweatingItchingThirstVomitingDiarrhoeaOligomenorrhoeaLoss of libido
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Signs
Tremor Irritability Psychosis Tachycardia or atrial fibrillation Warm peripheries Systolic hypertension Cardiac failure Lid lag Proximal myopathy Proximal muscle wasting Onycholysis Palmar erythema
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Medical history and physical exam. During the exam your doctor may try to detect a slight tremor in your fingers when they're extended, overactive reflexes, eye changes and warm, moist skin. Your doctor will also examine your thyroid gland as you swallow.Blood tests. A diagnosis can be confirmed with blood tests that measure the levels of thyroxine and TSH in your blood. High levels of thyroxine and low or nonexistent amounts of TSH indicate an overactive thyroid.
diagnosis
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Radioactive iodine uptake test. For this test, you
take a small, oral dose of radioactive iodine (radioiodine). Over time, the iodine collects in your thyroid gland because your thyroid uses iodine to manufacture hormones. You'll be checked after two, six or 24 hours — and sometimes after all three time periods — to determine how much iodine your thyroid gland has absorbed.
A high uptake of radioiodine indicates your thyroid gland is producing too much thyroxine. The most likely cause is either Graves' disease or hyperfunctioning nodules.
If blood tests indicate hyperthyroidism, your doctor may recommend one of the following tests to help determine why
your thyroid is overactive:
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Thyroid scan. During this test, you'll have a
radioactive isotope injected into the vein on the inside of your elbow or sometimes into a vein in your hand. You then lie on a table with your head stretched backward while a special camera produces an image of your thyroid on a computer screen.
The time needed for the procedure may vary, depending on how long it takes the isotope to reach your thyroid gland. You may have some neck discomfort with this test, and you'll be exposed to a small amount of radiation.
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Treatment
Antithyroid drugs:
1. Carbimazole.
2. Propylthiouracil. These drugs inhibit the formation of thyroid hormones common side effects - rash, urticaria, fever,
and arthralgia Rare but major side effects include hepatitis;
an SLE-like syndrome; and, most important, agranulocytosis
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Treatment
Radioactive iodine RAI accumulates in the thyroid and destroys the
gland by local radiation. It takes several months to be fully effective. Surgery:
subtotal thyroidectomy
Only in patient who have previously been rendered euthyroid.
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Goiter
Goiter refers to an enlarged thyroid gland Biosynthetic defects, iodine deficiency,
autoimmune disease, and nodular diseases can each lead to goiter
diffuse nontoxic goiter - diffuse enlargement of the thyroid occurs in the absence of nodules and hyperthyroidism
Worldwide, diffuse goiter is most commonly caused by iodine deficiency and is termed endemic goiter
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Congenital Thyroid Diseases
Agenesis /Aplasia Hypoplasia Accessory or aberrant thyroid glands Thyroglossal duct cyst
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Thyroglossal Duct Cyst
A thyroglossal duct cyst is a neck mass or lump that develops from cells and tissues remaining after the formation of the thyroid gland during embryonic development.
Children Failure of regression Neck, medial Squamous or columnar lining often appears after an upper respiratory infection
when it enlarges and becomes painful. Complications: inflammation, sinus tracts
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History: A 50 year old housewife complains of progressive
weight gain of 20 pounds in 1 year, fatigue, postural dizziness, loss of memory, slow speech, deepening of her voice, dry skin, constipation, and cold intolerance.
Physical examination: Vital signs include a temperature 96.8oF, pulse 58/minute and regular, BP 110/60. She is moderately obese and speaks slowly and has a puffy face, with pale, cool, dry, and thick skin. The thyroid gland is not palpable. The deep tendon reflex time is delayed.
Laboratory studies: CBC and differential WBC are normal. The serum T4 concentration is 3.8 ug/dl (N=4.5-12.5), the serum TSH is 1 uU/ml (N=0.2-3.5), and the serum cholesterol is 255 mg/dl (N<200)
Case with hypothyrodism
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History: A 35 year old nurse complained of nervousness, mood
swings, weakness, and palpitations with exertion for the past 6 months. Recently, she noticed excessive sweating and wanted to sleep with fewer blankets than her husband. She used oral contraceptives and her menstrual periods were regular.
Physical examination: Pulse was 92/minute and BP was 130/60. She appeared anxious, with a smooth, warm, and moist skin, a fine tremor, a bounding cardiac apical impulse, and she couldn't rise from a deep knee bend without aid. Her thyroid was diffusely enlarged, soft, mobile, without nodularity and there was no lymphadenopathy. Her eyes were not prominent (proptotic) and she had no focal skin thickening.
Laboratory studies: Serum T4=15.6 ug/dl and serum T3=210 ng/dl.
Case with hyperthyrodism
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Thank you