Thyroid presentation

Thyroid presentation

1. Thyroid dysfunction

2. What Is the Thyroid Gland? The thyroid gland is located in front of the neck. It has right and left lobes that confer a butterfly-shaped appearance. The hormones produced by this gland control the body’s metabolism. Disorders that affect thyroid function can either speed up or slow down metabolic processes, which can lead to a wide range of symptoms .

3. ANATOMY OF THYROID GLAND

4. Function of Thyroid gland secretes 3 main hormones Thyroxine (T4) Triiodothyronine (T3) Calcitonin Energy & Growth Control of calcium

5. - Regulation of TH secretion: Thyroid Gland TH TSH Anterior Pituitary Hypothalamus TRH - -

6. Calorigenic actions BMR (stimulation of oxygen consumption by tissues) Adipose tissues (catabolic lipolysis ) and cholesterol Muscle (catabolic protein breakdown) Body temperature ( heat production 2 ry to energy production) Bone , skeletal muscle and nervous system (normal development). Actions of thyroid hormone

7. Heart (upregulation of β receptor and sensitivity to circulating catecholamines). CNS stimulation resulting in anxiety, restlessness, insomnia and tremors. Actions of thyroid hormone All these actions are remarkable in patients with abnormally hyperthyroidism

8. Classification of thyroid disorder 1- Hormonal disorder : Hypothyroidism Hyperthyroidism 2- Tumors as thyroid cancer. 3- Drug induced as amiodarone and interferon .

9. Hormonal disorder Hypothyroidism It refers to reduced activity of the thyroid gland (underactive thyroid) leading to a decrease in circulating thyroid hormones. This slows the metabolic activity within the body. HYPERTHYROIDISM It refers to over activity in the thyroid gland leading to excessive production of the thyroid hormones and accelerated metabolism in the peripheral tissue.

10. Causes Hypothyroidism 1- children : cretinism 2- adult (myxedema) Mainly Hashimoto’s (1 ry hypothyroidism) Rarely pituitary or hypothalamic hypofunction (2 ry or 3 ry hypothyroidism) HYPERTHYROIDISM Toxic goiter (Graves’ disease) Toxic adenoma Plummer's disease (toxic multinodular goiter) Thyroiditis 2 ry OR 3 ry hyperthyroidism

11. Weight gain, lethargy and sluggishness Puffiness of skin (myxedema) Bradycardia, cold intolerance Abnormal menstrual periods Symptoms of Hypothyroidism

12. Other Symptoms of Hypothyroidism Dry skin and brittle nails. Numbness or tingling in the hands. Constipation. Falling of hair.

13. How to deal with a case of thyroid dysfunction

14. How we discover a case of thyroid dysfunction in medical commission ? 1- Detected clinically during medical fitness examination. 2- Detected by abnormal CXR.

15. How to deal ? Steps : 1- History taking 2- General examination 3- Local examination of the thyroid 4-Investigations 5-Referral only when indicated.

16. (A) History taking

17. ( B) General examination : Underweight Overweight Hyperthyroidism Hypothyroidism

18. Nervous & Cardiac signs Hyperthyroidism Hypothyroidism Depression , mood swings ,slow thinking Slow speech ,Poor memory. Muscle stiffness. Slow relaxation of muscles. Aches and pains. Bradycardia Low pulse

19. Cardiac changes Hyperthyroidism Hypothyroidism Hypertension/hypotension. Diastolic pressure high while systolic pressure may be low

20. (II) Cutaneous changes : Hypothyroidism * Dry , cold skin . * Dryness * coarse brittle hair , Loss of lateral eyebrows , Falling of hair. * Purple-tinged lips , Itchy skin *peritibial myxoedema Hyperthyroidism

21. Eye signs Hyperthyroidism Exophthalmose Hypothyroidism Puffiness of eye lids Hair Loss of lateral eyebrows.

22. ( C ) LOCAL Examination of thyroid The examination consists of : 1- Inspection With neck in neutral or slightly extended 2- Palpation With neck slightly flexed Examine for size, site , surface , shape and presence of nodules , skin overlying , mobility, consistency . 3- Auscultation for bruit Note: An enlarged thyroid is referred to as a goiter. There is no direct correlation between size and function- a person with a goiter can be euthyroid, hypo- or hyperthyroid. A normal thyroid is estimated to be 10 grams with an upper limit of 20 grams .

23. Inspection

24. Inspection: Anterior Approach The patient should be seated or standing in a comfortable position with the neck in a neutral or slightly extended position. 2.To enhance visualization of the thyroid, you can: Extending the neck, which stretches overlying tissues Have the patient swallow a sip of water, watching for the upward movement of the thyroid gland.

25. Inspection: Lateral Approach Lateral inspection of the thyroid, observe the neck from the side. Estimate the smooth, straight contour from the cricoid cartilage to the suprasternal notch.

26. Palpation Note: There is no data comparing palpation using the anterior approach to the posterior approach so examiners should use the approach that they find most comfortable.

27. Palpation: Anterior Approach The patient is examined in the seated or standing position. Attempt to locate the thyroid isthmus by palpating between the cricoid cartilage and the suprasternal notch. Use one hand to slightly retract the sternomastoid muscle while using the other to palpate the thyroid. Have the patient swallow a sip of water as you palpate, feeling for the upward movement of the thyroid gland.

28. Palpation: Posterior Approach The patient is examined in the seated or standing position. Standing behind the patient, attempt to locate the thyroid isthmus by palpating between the cricoid cartilage and the suprasternal notch. Move your hands laterally to try to feel under the sternomstoids for the fullness of the thyroid. Have the patient swallow a sip of water as you palpate, feeling for the upward movement of the thyroid gland.

29. Do not forget to order ECG for all thyroid cases Hyperthyroidism Hypothyroidism

30. Thyroid hormones and lab. values Hypo- Hyper- TSH ↑ ↓ Total T 4 & T 3 ↓ ↑ FT 3 & FT 4 ↓ ↑ Total cholesterol ↑ ↓ LDL ↑ ↓ HDL ↓ ↑

31. Ultrasound

32. (D) When to refer to Endocrinology ? Abnormal thyroid functions Abnormal CXR Sever Clinical manifestation Abnormal ECG