Thyroid diseases

This presentation deals with etiopathogenesis of Thyroid diseases

1. THYROID DISEASES Dr. Akshay Shetty Asst.Professor SSRAMCH,Inchal

2. Contents Objectives Physiology of Thyroid gland Introduction of Hypothyroidism Clinical features of Hypothyroidism Investigations of Hypothyroidism Introduction of Hyperthyroidism Clinical features of Hyperthyroidism Investigations of Hyperthyroidism Summary Conclusion 02/06/2020 Thyroid Disease (Dr Akshay Shetty) 2

3. Objectives By the end of the presentation the students must be able to- Discuss Physiology of Thyroid gland Explain Introduction of Hypothyroidism Enumerate Clinical features of Hypothyroidism State Investigations of Hypothyroidism Explain Introduction of Hyperthyroidism Enumerate Clinical features of Hyperthyroidism State Investigations of Hyperthyroidism 02/06/2020 Thyroid Disease (Dr Akshay Shetty) 3

4. Physiology of Thyroid Gland 02/06/2020 Thyroid Disease (Dr Akshay Shetty) 4

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6. Synthesis & Metabolism Iodine enters thyroid gland and is used for T3 and T4 production Hormones are released from the thyroid and vast majority are protein bound (TBG) and deposited in peripheral cells T4 has 4 iodine atoms, removal of one produces T3 Total= Bound to TBG Free= Unbound 02/06/2020 Thyroid Disease (Dr Akshay Shetty) 6

7. Cont … T3 &T4 Facilitate normal growth and development Increase metabolism Increase catecholamine effects TSH Most useful marker of thyroid hormone function Released in a pulsatile diurnal rhythm- highest at night 02/06/2020 Thyroid Disease (Dr Akshay Shetty) 7

8. Introduction to Hypothyroidism Insufficient thyroid hormone Primary: thyroid gland failure Secondary: pituitary gland failure Tertiary: hypothalamus failure 02/06/2020 Thyroid Disease (Dr Akshay Shetty) 8

9. Cont … Primary hypothyroidism Iodine deficiency- most common cause worldwide Congenital Autoimmune mediated Hashimoto’s thyroiditis- B lymphocytes invade thyroid Iatrogenic- post-thyroidectomy or radio-iodine treatment Drug-induced – Anti-thyroid, lithium, amiodarone Severe infection Trauma to thyroid/pituitary/hypothalamus Pituitary tumour 02/06/2020 Thyroid Disease (Dr Akshay Shetty) 9

10. Clinical features of Hypothyroidism Increased sleeping (14-16 hours daily) Generalized weakness Anorexia Muscle aches Paresthesias Constipation Cold intolerance Decreased libido, woman:difficulty becoming pregnant, changes in menses;men/impotence 02/06/2020 Thyroid Disease (Dr Akshay Shetty) 10

11. Cont … Coarse features Edema around eyes and face Blank expression Thick tongue Overall muscle movement is slow Lethargic, apathetic, drowsy, poor attention span, poor memory 02/06/2020 Thyroid Disease (Dr Akshay Shetty) 11

12. Investigations of Hypothyroidism T3,T4 TSH 02/06/2020 Thyroid Disease (Dr Akshay Shetty) 12

13. Introduction of Hyperthyroidism Hyperthyroidism (thyrotoxicosis) is excess thyroid hormone Autoimmune Graves Disease (76%) F>M, age 20-40 IgG auto antibodies bind TSH receptors T3 & T4 Leads to gland hyper function Toxic adenoma and toxic multinodular goitre Viral Thyroiditis (de Quervain’s ) Fever and ESR- self limiting 02/06/2020 Thyroid Disease (Dr Akshay Shetty) 13

14. Cont … Exogenous Iodine Neonatal thyrotoxicosis Drugs- Amiodarone TSH secreting pituitary adenoma (rare) HCG producing tumour 02/06/2020 Thyroid Disease (Dr Akshay Shetty) 14

15. Clinical features of Hyperthyroidism Recent weight loss Increased appetite Increase in # BM/day ****heat intolerance Diaphoresis even when temperatures comfortable for others Palpitations/chest pain Dyspnea with or without exertion 02/06/2020 Thyroid Disease (Dr Akshay Shetty) 15

16. Cont … Infiltrative Ex ophthalmopathy (abnormal eye appearance or function) Blurring/double vision/tiring of eyes Increased tears Photophobia Eyelid retraction(eyelid lag) Globe lag (eyeball lag) 02/06/2020 Thyroid Disease (Dr Akshay Shetty) 16

17. Goitre Thyroid gland may be 4 X normal Bruits (turbulence from increased blood flow) heard with stethoscope Systolic BP Tachycardia Dysrhythmia 02/06/2020 Thyroid Disease (Dr Akshay Shetty) 17

18. Cont …. Fine, soft, silky hair Smooth, moist skin Muscle weakness Hyperactive deep tendon reflexes Tremors of hands Restless, irritable, mood swings Decreased attention span Fatigued, inability to sleep 02/06/2020 Thyroid Disease (Dr Akshay Shetty) 18

19. Investigations of Hyperthyroidism T3 T4 TSH in Graves disease Radioactive Thyroid Scan Ultrasonography: used to determine goiter or nodules EKG: note tachycardia 02/06/2020 Thyroid Disease (Dr Akshay Shetty) 19

20. Summary 02/06/2020 Thyroid Disease (Dr Akshay Shetty) 20

21. References Davidson Principles Of Medicine & Practice Of Medicine .20 th Ed 02/06/2020 Thyroid Disease (Dr Akshay Shetty) 21

22. Thank you 02/06/2020 Thyroid Disease (Dr Akshay Shetty) 22