prof. h.a. pavlyshyn thyroid and parathyroid gland disorders
TRANSCRIPT
Prof. H.A. Pavlyshyn
Thyroid and Parathyroid gland
disorders
Gl. Thyreoidea (normal)Gl. Thyreoidea (normal)Gl. Thyreoidea (normal)Gl. Thyreoidea (normal)
Gl. Thyreoidea (pathology-disorder)Gl. Thyreoidea (pathology-disorder)Gl. Thyreoidea (pathology-disorder)Gl. Thyreoidea (pathology-disorder)
Thyroid hormones affect normal somatic growth and
neurological development in children
Thyroid hormones affect normal somatic growth and
neurological development in childrenFor normal maturation of the
CNSFor normal maturation of the
CNS
Gl. ThyreoideaGl. ThyreoideaGl. ThyreoideaGl. Thyreoidea
ССardio-vascular system ardio-vascular system ССardio-vascular system ardio-vascular system
Skin and hair Skin and hair Skin and hair Skin and hair
GITGIT
Skeletal and muscular systemSkeletal and muscular system
Reproductive functionReproductive functionReproductive functionReproductive function
Regulation of secretion:TRH - TSH - T4 axis
Diagnostic of Thyroid gland disease
Visual & palpating method Investigation of thyroid function (basal level of T3, T4 and freeT3 ,freeT4) Functional tests USG, radiography, scanning, etc. Biopsia
Biopsy (FNAB)
Fine Needle Aspiration Biopsy
Examination methods
Micro follicular/solid thyroid nodule
Auto-Ab in diagnostics
(high specificity)
auto-Ab anti-TSH-R binding to different epitops: growth, goiter stimulation ... Graves-Basedow dis. inhibition ... hypothyroid idiopatic myxoedema
auto-Ab anti-microsomal = anti-TPO (thyroid peroxidase)... Hashimoto dis.
auto-Ab anti-Tg (thyroglobulin) ... x pathogeneticauto-Ab anti-T3 ... in 40% autoimmmune thyroiditis
Examination methods
Examination methods
Examination methods
131I scintigraphy:Retrosternal goiter
Examination methods
Classification of Goiter according Grades Classification Description
Grade 0 No palpable or visible goiter.
Grade 1 Mass in the neck that is enlarged thyroid which is palpable but not visible when the neck is in the normal position. Moves upward in the neck as the patient swallows. Nodular alterations can occur even when the thyroid is not enlarged.
Grade 2 Swelling in the neck that is visible when the neck is in a normal position and enlarged thyroid when the neck is palpated.
From WHO/UNICEF
Classification of hypothyroidism
OnsetCongenital Acquired (rare) – when symptoms
appear after the first year of life, it is presumed to be acquired.
SIGNS OF CONGENITAL HYPOTHYROIDISM
Birth weight and birth length are normal because Thyroid Hormones does not play an important role in prenatal growth.
There is a tendency towards prolonged gestation with 1/3 of pregnancies lasting 42 weeks or more
SYMPTOMS OF CONGENITAL HYPOTHYROIDISM
Prolonged jaundice
Lethargy Constipation
Feeding problems
Cold to touch
SIGNS OF CONGENITAL HYPOTHYROIDISM
Skin mottling and Dry skin
Umbilical hernia and Distended abdomen
Macroglossia Large fontanels
Wide sutures Hoarse cry
Muscle Hypotonia Slow reflexes
Treatment L-thyroxin
Preterm 8 – 10 μg/kg 0-12 mo 6 – 10 μg/kg 1-3 years 4 – 6 μg/kg 3-10 years 3 – 4 μg/kg 10-15 years 2 – 4 μg/kg > 15 years 2 – 3 μg/kg
The onset of symptoms is insidious. Emotional lability, altered mood, nervousness,
hyperactivity, irritability, heat intolerance, poor sleeping;
Tremor, hyperkinesias, tremor of outstretched fingers, fidget, psychosis (rare)
Deterioration of behavior and school performance;
Fatigue, weakness, Increased appetite and weight loss, frequent
loose stool (diarrhea); Goiter - thyroid enlargement
Graves disease (symptoms)
GoiterGoiter
Graves disease (symptoms)
GoiterGoiter
Graves disease (symptoms)
Graves disease (sings)
Heart failure, palpitations, tachycardia and hypertension
Warm, flushed, moist skin, increase sweating
Hair loss Muscle weakness (loss of muscle mass) &
wasting Accelerated bone maturation Dyspnoe
Treatment of Grave’s disease: Antithiroid agents - methimazole (Tapazole),
propylthiouracil (PTU), mercasolil. The beginning dose of methimazole is not less then 15-20 mg/m2
daily, gradually it becomes lower; mercasolyl 0.3-0.5 mg/kg divided 2 -3 times 14-21
days, than supportive dose – 2.5-7.5 mg/daily 1 time; Beta-adrenergic blockers (propranolol (10-20 mg/four
times daily), anaprilin (1-2 mg/kg divided 3 times), Sedatives are necessary to use also Corticosteroids (sometimes in severe cases Radioactive iodine (RAI) (in adults mainly) Euthyrosis – mercasolyl 5-10 mg/daily with L-
thyroxin 25-50 μg/daily Surgical treatment (Sub-total thyroidectomy)
Clinical features of hypoparathyroidism
Convulsive syndrome (titanic more typical), karpopedal spasm, paresthesiae, muscle weakness, tiredness, Trousseau and Hvostek symptoms)
↓Ca2+ + ↑PO4 → neuromuscular hyperactivity
Manifestation depends on actual Ca2+ levelsParesthesia (tingling around mouth,
fingers)
Tetany (attack begins with paresthesias … painful spasms of extremities and face
… flexion of the wrist …Adrenergic reaction (tachycardia, sweating)
Bone syndrome (diffuse bone pain, pathological fracture,
osteoporosis - RTG, densitometry) Renal syndrome
(polyuria, polydipsia, lithiasis, nefrocalcinosis) GIT syndrome
(constipation, nausea, vomiting) Neuromuscular syndrome
(muscular weakness, ECG - bradycardia, arrythmia) Neuropsychical syndrome
(psychosis, somnolence, coma)
Clinical features of hyperparathyroidism
„Salt and peper“ scull
Increased parathyroid activity leading to
characteristic subperiosteal resorption
Hyperparathyroidism
The bone changes are partially reversibleThe same finger pre- and post-treatment for
hyper-PTH. Images were taken 6 months apart.
Hyperparathyroidism