Hyperthyroidism its cause and treatment.pptx

diseases of thyrotoxicosis

1. Hyperthyroidism Muhammad Usama Jamil Roll No. 268

2. Hyperthyroidism O v er p r od uc ti o n o f t h y r o i d h o r m o n e b y t h y r o i d g l an d M eta b ol i s m S P EE D S U P Hyperactivity H ea t in t o l e r a n c e Weight loss with increased appet ite Diarrhea Hyperreflexia W ar m , m o i s t sk i n F i n e h ai r T a c h y c a r d i a ( atria l fi b ri ll a t i o n ) Sh utter s to c k

3. Hyperthyroidism Subtypes P r ima r y h y p e r t h y r oi d is m M o s t co mm o n f o r m O v e r act i v it y o f t h y r o i d gl a n d n o t d u e t o h ig h TS H L o w TS H wi t h h ig h T 3 /T 4 Cent r a l h y p ert h y r o i d i s m : r a r e E x c e s s TS H f r o m p i t ui t a r y gl a n d H ig h TS H a n d h ig h T 3 /T 4 N e o p la s t i c : pi t ui t a r y t um o r ( T SH o m a ) No n-ne o p l a s ti c : p i t uita r y r e s i s ta n c e t o t h y r o i d h o rm o n e Sh utter s to c k

4. Hyperthyroidism L a b F in d i n g s Test Normal Value Primary Central TSH 0.5 to 5.0 mU/L LOW NL or HIGH Total T4 60 to 145 nmol/L High High Total T3 1.1 to 3 nmol/L High High Free T4 0.01-0.03nmol/L High High

5. P r ima r y H ype r t h y r o i d i s m Causes G r av e s ’ d i s ea s e (m os t c o mm o n ) M u l ti n o d u l a r g o i t e r T o xi c a d en o m a Iodine-induced Amiodarone Thyroiditis Levothyroxine

6. G r av e s ’ D i s ea s e A u t o i mmu n e d i s ea s e T h y r o i d s ti mu l ati n g a n ti b o d ie s p r o d u c e d S y mp t o m s o f h y p ert h y r o i d i s m o ccu r L a r g e n o n - n od ul a r t h y r o i d Shutterstock

7. G r av e s ’ D i s ea s e Sp e c ia l f eat u r e s E x o ph t h a l mo s ( bu l gi n g e y es ) Proptosis (protrusion of eye) and periorbital edema Retroocular fibroblast and adipocyte activation P r eti b ia l m y x e d em a ( s h i n s ) F ib r o bl a s t s co n ta i n TS H r e c e p t o r S t imu l a t i o n  s e c r e t i o n o f g ly c os a m i n o g l y c a n s D r a w s i n w a te r  s w ellin g Jon a th a n T robe, M . D ./ Wi k ip ed i a Herbert L. Fred, MD and Hendrik A. van Dijk

8. G r av e s ’ D i s ea s e Diagnosis Often clinical: hyperthyroid symptoms and labs, goiter plus exophthalmos T S H r e c e p t o r a nti b o d i e s T h y r ot r o p i n r e c e p t o r a n t ib od i e s ( T R A b ) Also called TSIs: “Thyroid stimulating immunoglobulins” R a d ioa c t i v e io d i n e up ta k e In c r e a s e d d u e t o o v e r act i v e t h y r o i d Radioactive Iodine Uptake Scan

9. G r av e s ’ D i s ea s e Treatment S y mp t o m c o nt r o l : b et a b l o c k e r s Us e d f o r ini t i a l t r e at m en t o f s ymp t o m s I mp r o v e s tac hy c a r d i a Us u a l l y a ten o l o l – o n c e da i l y do s in g D e c r ea s e t h y r o i d h o r m o n e s y nt h e s i s Thionamides R ad i o i o d i n e t h y r o i d a bl at i o n Surgery Public Domain

10. G r av e s ’ D i s ea s e Treatment R a d ioio d i n e a b l atio n Us u a l l y g iv e n a s o r a l ca ps ul e C o n c en t r a t e d i n t h y r o i d  a bl at i o n R equi r e s li f el o n g r e p l ac e m e n t t h e r a p y Ass oc i a t e d wi t h in c r e a s e i n T R A b M a y le a d t o w or se n i n g o r bi t o p a t h y S u r ge r y ( t h y r oi d e c t o m y ) May cause hypoparathyroidism M a y ca u s e r e c u r r en t l a ry n g e a l ne r v e da m a g e A sso c i a t e d wi t h a f a l l i n TR A b D o e s n o t w o rs e n o r bit o p at h y Shutterstock

11. T o x i c A d e n o ma s T h y r oi d n o du l e s F un ct i o n in d e p en d ent l y Usually contain mutated TSH receptor N o r e sp o n s e t o TS H O n e n od ule : t o x i c ad en o m a Multiple: toxic multinodular goiter Findings: P a l p a bl e n od ule (s ) o r n od ul a r go ite r H yp e r t h y r o i d i s m s ymp t o m s / lab s In c r e a s e d u p ta k e o f r a d i o i o d i n e i n n od ule (s ) Multinodular Goiter Public Domain

12. T o x i c A d e n o ma s Treatment I nit i a l s y mp t o m c o nt r o l : b et a bl o c k er s an d t h i o na m i d e s Preferred therapy for most patients: radioiodine ablation Accumulates in hyperfunctioning nodules U n d e r act i v e s u r r o u n d i n g t i ss u e n o t af f e c t e d Patient may become euthryoid and avoid thyroid replacement S ur g er y i n s e l e c t p atie n t s La r g e , o b s t r u c t iv e go ite r s C o e x i s t i n g t h y r o i d m a li g n an c y Shutterstock

13. I od i n e- In d u c e d H ype r t h y r o i d i s m Jo d - B a s e d o w P h en o m en o n Wolff-Chaikoff effect: excess iodine  decreased hormone production Some patients “escape” the Wolff-Chaikoff effect Ca ll e d t h e J od -B a s e d o w P h en o m en o n E x c e s s i od in e  h y p ert h y r o i d i s m

14. I od i n e- In d u c e d H ype r t h y r o i d i s m Jo d - B a s e d o w P h en o m en o n Of t e n o ccu r s i n r e g i o n s o f io d i n e d e f i c ie nc y In t r od u c ti o n o f i od in e  h yp e r t h y r o i d i s m Of t e n o ccu r s i n p atient s w it h to xi c a d e n oma s Drugs administered with high iodine content E x p e c t o r a n t s (p ot a s s iu m i od i d e ) , C T co n t r a s t d y e Amiodarone

15. A mi od a r o n e Hyperthyroidism T y p e I Occurs in patients with pre-existing thyroid disease G r a v e s ’ o r Mul t i-n o d u la r go ite r Amiodarone provides iodine  excess hormone production In c r e a s e d r ad i o i o d i n e u p ta k e T y p e I I De s t r u ct i v e t h y r o i d it i s Excess release T4/ T3 (no ↑ hormone synthesis) Di r e c t t o x i c e f f e c t o f d r u g Can occur in patients without pre-existing thyroid illness De c r e a s e d r ad i o i o d i n e u p ta k e Amiodarone

16. A mi od a r o n e Amiodarone H y p ert h y r o i d i s m M anage m e n t S t o p a m i od a r o n e i f p oss i bl e Radioiodine uptake test to distinguish type I from type II T y p e I : b et a bl o c k er s , t h i o na m i d e s , a bl ati o n o r s u r g er y T y p e I I ( t h y r o i d i t i s ) : g l u c o c o r ti c o i d s

17. Hyperthyroidism Ot h e r C a u s e s E a r l y t h y r oi d iti s L o w r ad i o i o d i n e u p ta k e H ig h s e r u m t h y r o g l o buli n co n c en t r at i o n Exogenous hyperthyroidism E x c e s s l e v ot h y r o x i n e S u pp leme n t s wi t h t h y r o i d h ormo n e

18. Hyperthyroidism Workup

19. T h y r o i d S t or m L i f e - t h r ea t en i n g h y p ert h y r o i d i s m Us u a l l y p r e c i p ita t e d b y a c u t e e v e n t Patient with pre-existing hyperthyroid disease Graves’ or toxic multinodular goiter S u r g e r y , t r a u m a , in f e ct i o n M a ss iv e c a t e chol a m i n e s ur g e A cu t e in c r ea s e i n t h y r o i d h o r m o n e l e v e l s Pixabay.com

20. T h y r o i d S t or m C l in i c a l F eat u r e s F e v e r (u p t o 106 ⁰F ) Delirium T a c h y c a r d i a w it h p oss i bl e d eat h f r o m ar r h y t hm i a W ar m sk i n T r emo r Hyperglycemia (catecholamines/thyroid hormone) H y p e r c a lc e m i a (b o n e t u rn o v er ) D ia g n os i s : in c r ea s e d f r e e T 4 an d T3 ; l o w T S H

21. T h y r o i d S t or m Treatment Propranolol B e t a bl oc k e r  i mp r o v e s s ymp t o m s A l s o bl oc k s T 4  T 3 co nv e rs i o n Propylthiouracil P r e f e r r e d o v e r m e t h i m a z o l e D e c r e a s e s T 4  T 3 c o nv e rs i o n Glucocorticoids De c r e a s e s T 4  T 3 co nv e rs i o n Reduces inflammation if Graves' disease present Triiodothyronine (T 3 ) – More Potent 4 Thyroxine (T ) 5’-deiodinase Peripheral Tissues I o dine

22. T h y r o i d S t or m Treatment Iodine Potassium iodide-iodine (Lugol’s) solution B l oc k s r ele a s e o f T 4 a n d T 3 f r o m t h y r o i d gl a n d I C U l e v e l c a r e AfraTafreeh.com Public Domain