internal medicine endocrine syndrome of hypo and hypothyroidism

hyper and hypothyroidism

1. I.K.AKHUNBAEV KYRGYZ STATE MEDICAL ACADEMY
Department of рropedeutics of internal diseases with
endocrinology course
Examination, physical, laboratory-
instrumental signs
of syndromes hyperthyroidism and
hypothyroidism.
Syndrome of thyroid gland enlargement.
Goiter.
Lecturer: Zhalilova Baktygul

2. Thyroid gland
Thyroid hormons:T3 –triiodothyronine
T4 –tetraiodthyronine(thyroxine)

3. Syndromeofhyperthyroidismistheclinical-laboratory
syndromecausedbypathologicalincreasedsecretionof
thyroidhormones(thyroxineandtriiodothyronine)andtoxic
changesofbodiesandsystems,firstofallnervousand
cardiovascular.
SYNDROME OF HYPERTHYROIDISM
(Grave’s disease, Thyroid hyperfunction)
Hypothalamus -pituitary diseases
Pregnancy
Reception of the big dozes of iodine
Infections
Mental & craniocereberal traumas
Excessive insolation
Сauses:

4. COMPLAINTS:
Goiter
Hoarseness
Palpitations
Feeling of pressure in
the field of neck
Sweating
Weight loss often with
increased appetite
Diarrhea
Tachycardia
Irritability
Tremor of hands
(sometimes all body)
Exophthalm
Hot intolerance
Sensitivityofcardiovascularsystemto
catecholamines’actionunderinfluenceof
excessivethyroidsecretionisincreased.Itis
characterizedbytachycardia,hypertension.

5. INSPECTION
1. Features of
behaviour:
•Nervousness
•Irritability
•Emotional lability
•Psychosis
2.A general view:
•A young-looking
kind
•An angry sight
•Thin and soft
head hair

6. 3. Examination of eyes:Exophthalmos(protruding eyes),
Gref’s, Moebius’s symptoms -sclera visible below and
above cornea.

7. 4. Examination of neck-neck circle increased
Normal Goiter Inflammation Tumor

8. 5. Hands: tremor, warmth, sweating
6. Examination of legs–proximal myophathy, pretibial
myxedema (ankle edema)

9. PALPATION
Skin-warm and moist,soft, hot, damp, elastic, velvety.
Thyroid gland-determination of size, consistency,
tenderness,mobility.
diffusely enlarged to two to three timesits normal size

10. Classification of degrees of increased thyroid gland
according the WOH (1999)
0 -not palpation
I –it is palpated, not visible
II -it is visible and palpated.
Apical impulse–amplified, high, displaced to the left.
Pulse–sinus tachycardia, full volume, high, irregular pulse due to
atrial fibrillation.
Muscles-proximal myophathy
AUSCULTATION
Thyroid gland–bruit is audible
Cardiovascular system–clapping of I sound, tachycardia, systolic murmur
above apex, atrial fibrillation. Arterial pressure -increased systolic & pulse
pressure, decreased diastolic pressure. Arterialhypertension.
PERCUSSION
Expansion of the heart left border in severe thyrotoxicosis.

11. Нormones:increasedТ3,Т4;decreasedTSH
TBC:anemia,leukopenia.
Biochemistryofblood:hypocholesterinemia,
hypolipidemia;hyperglycemia
Ultrasoundofthyroidgland:
diffuseincreasedsize,
nodules.
ECG-sinustachycardia,atrialfibrillation,increased
wave’svoltage.
INVESTIGATION:

12. Syndromeofhypothyroidismisaclinical-laboratorysyndrome
causedbydecreasedorfulllostthyroidsecretionandfunctionchangesof
allsystems.
Primary (pathology of thyroid gland):
Aplasia, hypoplasia of thyroid gland;
After operation on a thyroid gland (subtotal or total thyroidectomy);
After treatment by radioactive iodine;
Inflammatory diseases of a thyroid gland;
Insufficient receipt of iodine in an organism;
Influence of medicines (antithyroid drug).
CAUSES:
Secondary(pathologyofAnteriorPituitaryGland):tumors,pituitarysurgeryor
irradiation,infiltrativedisorders,Sheehan’ssyndrome,trauma,geneticforms
ofcombinedpituitaryhormonedeficiencies-decreasedTSHsecretion
(thyroidstimulatinghormone)duetopituitarydefeat.
Tertiary (pathology of hypothalamus) decreased TRH secretion (thyrotrophin-
releasing hormone) due to hypothalamus defeat.
SYNDROME OF HYPOTHYROIDISM
(Thyroid insufficiency, Thyroid hypofunction)

13. COMPLAINTS:
Somnolence
Chilly sensation
Tiredness,weakness
Cold intolerance
Constipation
Weight gain
Dryness of a skin
Change of a voice
Loss of hair
Speech slow

14. EXAMINATION
The general examination:
•patient is adynamic,
•speech is slowed down,
•a voice gets hoarse,
•мental slowness, depression.
Skin–pale, icteric (due to
carotenaemia
The person’s face:
•Alopecia, dry & thin hair
•Periorbital edema
•Loss of outer halves of eyebrows
•Vitiligo
•Tongue may be swollen, oedematous
muscles

15. Congenital hypothyroidism

16. PALPATION
Skin-dry, cold; hypostases of muscles, there isn’t deepening after
pressing.

17. The thyroid gland-Goiter may be palpated, or the thyroid may
be atrophic and nonpalpable.
Apical impulse-is weakened.
Pulse–bradycardia.

18. PERCUSSION
Expansion of borders of relative heart dullness (due to myocardial
dystrophy or pericardial effusion).
AUSCULTATION
Cardiovascular system–weakened heart tones, bradycardia.
Hypotension.
Arterial pressure -is reduced more often.

19. Нormones:Decreased Т3, Т4; Increased TSH -in primary
hypothyroidism, normal or decreased TSH -in secondary
hypothyroidism due to pituitary insufficiency.
TBC-anemia, leukopenia.
Biochemistry of blood:hypercholesterinemia,
hyperlipidemia.
Ultrasound of a thyroid gland -reduced sizes in initial defeat.
ECG-bradycardia, low voltage.
Echocardiography -increased sizes of heart, attributes of
decreased myocardium contraction function, pericardial effusion.
LAB TESTS, IMAGING STUDIES:

20. Thank you for attention!