03-Dec-17. Thyroid Disorders GOITRE. Grossly enlarged thyroid - in hypothyroidism in hyperthyroidism - production of anatomical symptoms

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1 Thyroid Disorders GOITRE Grossly enlarged thyroid - in hypothyroidism in hyperthyroidism - production of anatomical symptoms 1

2 Physiological Goiter load on thyroid supply of I - limited stress due to: - pregnancy - lactation - adolescence Goitre Toxic Goiter Marked hyperplasia activity of gland T 3 & T 4 Goitre Hereditary Goiter Gland ½ or partially absent rest enlarged Endemic Goiter iodine in soil I - availability Simple Goiter T 3 & T 4 normal hypertrophy of gland Colloid Goiter size & activity / hyperplasia of cells colloid (due to thyroglobulin T 3 & T 4 ) Clinically - hypothyroid Neoplastic Goiter Inflammatory Goiter Goitre HYPERTHYROIDISM Toxic Goiter / Thyrotoxicosis / Grave s Disease Causes Grave s Disease: thyroid-stimulating antibodies (TSIs) act on TSH receptors of thyroid gland induce activation of camp no. & size of follicular cells (hyperplasia / hyperactivity) weight of thyroid gland T 3 & T 4 TSH T 3 & T 4 - Ant. Pituitatary TSH 2

appetite) muscle weakness mild to extreme weight loss (upto 100 pounds) fatigue / sleep varying degrees of diarrhea tremor of the hands Heart rate / stroke volume / cardiac output systolic blood

3 Thyroid Adenoma: Localized adenoma (tumor) secretes T 3 & T 4 Hyperthyroidism Gland increased 2 3 times in size hyperplasia no. of cells Hyperthyroidism Hyperthyroidism Features of Hyperthyroidism: excitability / psychic disorders (quarrelsome / nervous) body temperature / sweating heat intolerance Weight loss (with normal or appetite) muscle weakness mild to extreme weight loss (upto 100 pounds) fatigue / sleep varying degrees of diarrhea tremor of the hands Heart rate / stroke volume / cardiac output systolic blood pressure glucose cholesterol Menstrual disturbances Hyperthyroidism EXOPHTHALMOS (in ⅓ rd cases) protrusion of eyeballs stretch of optic nerve damage to vision eyelids do not close completely epithelial surfaces of eyes become dry & irritated / often infected ulceration of the cornea Cause edematous swelling of the retro-orbital tissues & degenerative changes in extraocular muscles 3

Diagnostic Tests Radioimmunoassay T3 T4 TSH TSI Treatment Thyroidectomy (complete / partial) prepare the patient Propylthiouracil administration of high concentrations of iodides for 1 to 2 wks

4 Diagnostic Tests Radioimmunoassay T3 T4 TSH TSI Treatment Thyroidectomy (complete / partial) prepare the patient Propylthiouracil administration of high concentrations of iodides for 1 to 2 wks immediately before operation reduces gland in size 5 millicuries of radioactive iodine Radiotherapy Antithyroid drugs HYPOTHYROIDISM Primary (abnormality of thyroid gland) T 3 ; T 4 ; TSH; TRH Secondary (abnormality of pituitary gland) T 3 ; T 4 ; TSH; TRH Autoimmunity Thyroiditis HYPOTHYROIDISM Endemic Colloid Goiter - Dietary Iodide Deficiency Idiopathic Nontoxic Colloid Goiter Tertiary (abnormality of hypothalamus) T 3 ; T 4 ; TSH; TRH 4

5 Endemic Colloid Goiter - Dietary Iodide Deficiency I - supply T 3 / T 4 TSH Endemic Colloid Goiter - Dietary Iodide Deficiency people having insufficient iodine - extremely large thyroid glands - endemic goiters Thyroglobulin colloid T 3 & T 4 Ant. Pituitatary no inhibition - size of gland - Hypothyroid size of follicles TSH Idiopathic Nontoxic Colloid Goiter HASHIMOTOS THYROIDITIS mild thyroiditis Inflammation / autoimmune slight hypothyroidism - TSH secretion & progressive growth of non inflamed portions of gland usually are nodular Thyroiditis Hypothyroidism TSH ( T 3 & T 4 ) growth of non-inflammed parts (nodular) GOITEROGENIC SUBSTANCES e.g., in turnips / cabbages Abnormality of enzyme system required for formation of thyroid hormones Deficient iodide-trapping mechanism Deficient peroxidase system Deficient coupling of iodinated tyrosines in the thyroglobulin molecule Deficiency of the deiodinase enzyme 5

FEATURES OF HYTHYROIDISM: extreme muscular sluggishness Intolerance to COLD fatigue extreme somnolence with

constipation depressed growth of hair and scaliness of the skin development of FROG LIKE HUSKY VOICE Severe

greatly reduced total lack of thyroid hormone function SKIN Thick, leathery, puffy & yellow THICK,

quantity of interstitial fluid Slow husky voice nonpitting edema Myxedema madness YELLOW β-carotene

6 FEATURES OF HYTHYROIDISM: extreme muscular sluggishness Intolerance to COLD fatigue extreme somnolence with sleeping - 12 to 14 hours / day edematous appearance heart rate; cardiac output; blood volume body weight constipation depressed growth of hair and scaliness of the skin development of FROG LIKE HUSKY VOICE Severe cases - development of an edematous appearance throughout the body called MYXEDEMA Myxedema When T 3 & T 4 greatly reduced total lack of thyroid hormone function SKIN Thick, leathery, puffy & yellow THICK, LEATHERY, PUFFY deposition of mucopolysaccharides in skin H 2 O retention Formation of gel like substance quantity of interstitial fluid Slow husky voice nonpitting edema Myxedema madness YELLOW β-carotene (provitamin A), a yellow pigment is converted by T 3 & T 4 into vitamin A Lack of T 3 & T 4 deposition of β-carotene in skin 6

CRETINISM extreme hypothyroidism during fetal life, infancy, or childhood failure of body growth & mental retardation

placenta) - neonate - Idiot looking - height / growth of soft tissue - Sexually retarded - Thick coarse skin Cretinism

more inhibited Soft tissues enlarge excessively obese, stocky & short appearance tongue large; obstructs swallowing &

7 CRETINISM extreme hypothyroidism during fetal life, infancy, or childhood failure of body growth & mental retardation Congenital cretinism Endemic cretinism Baby hypothyroid - before birth (if mother too hypothyroid, becz T 4 can cross placenta) - neonate - Idiot looking - height / growth of soft tissue - Sexually retarded - Thick coarse skin Cretinism few weeks after birth - neonate s movements become sluggish physical & mental growth greatly retarded Skeletal growth more inhibited Soft tissues enlarge excessively obese, stocky & short appearance tongue large; obstructs swallowing & breathing Antithyroid Substances suppress thyroid secretion: Thiocyanate Propylthiouracil high conc. of inorganic iodides 7

Use of Plasma Hormone Measurements to Diagnose the Problem in a Person with Symptoms of Hyperthyroidism Hypothyroidism

Heat Intolerance CHO Metabolism glucose absorption glucose absorption Fat Metabolism plasma cholesterol plasma

CNS CVS Body Weight Cretinism (if perinatal deficiency) Sluggish mentation cardiac output; heart rate; circulation time

8 Use of Plasma Hormone Measurements to Diagnose the Problem in a Person with Symptoms of Hyperthyroidism Hypothyroidism symptoms and signs Hyperthyroidism symptoms and signs HYPOTHYROIDISM HYPERTHYROIDISM Heat BMR / Cold Intolerance BMR / Heat Intolerance CHO Metabolism glucose absorption glucose absorption Fat Metabolism plasma cholesterol plasma cholesterol Protein Metabolism protein synthesis Myxedema protein catabolism Growth Deficient growth growth (initially) CNS CVS Body Weight Cretinism (if perinatal deficiency) Sluggish mentation cardiac output; heart rate; circulation time body weight / obesity Restlessness Over anxiety Irritability cardiac output; heart rate; circulation time Loss of weight despite appetite 8

9 Anxiety tachycardia - sleeping pulse rate normal Tachcardia in hyperthyroidism - sleeping pulse Jazak Allah 9

HYPERTHYROIDISM. Hypothalamus. Thyrotropin-releasing hormone (TRH) Anterior pituitary gland. Thyroid-stimulating hormone (TSH) Thyroid gland T4, T3

HYPERTHYROIDISM. Hypothalamus. Thyrotropin-releasing hormone (TRH) Anterior pituitary gland. Thyroid-stimulating hormone (TSH) Thyroid gland T4, T3 HYPERTHYROIDISM Hypothalamus Thyrotropin-releasing hormone (TRH) Anterior pituitary gland Thyroid-stimulating hormone (TSH) Thyroid gland T4, T3 In hyperthyroidism, there is an increased production of