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Everything You Need to Know About Thyroid Gland Disorders
- 1. THYROID GLAND DISORDERS www.freelivedoctor.com
- 38. vii) Ocular wide, staring gaze and lid lag - SNS overstimulation of levator palpebrae superiosis - ptosis - true thyroid opthalmopathy seen only in Graves disease viii) GI SNS hypermotility, malabsorption and diarrhea ix) Skeletal system bone resorption, osteoporosis b) thyroid storm i) abrupt onset of severe hyperthyroidism (Graves & SNS) www.freelivedoctor.com
- 39. ii) febrile, HR (out of proportion to febrile response) iii) is a medical emergency - death from cardiac arrhythmias c) apathetic hyperthyroidism i) seen in elderly ii) age and other comorbidities blunt effects of excess thyroid hormone excess - diagnosis during work up for unexplained weight loss or worsening CV disease www.freelivedoctor.com
- 40. d) Diagnosis i) measurement of serum TSH ( ) in 1 O - in 2 O TSH may be – or - “TRH stimulation test” excludes secondary hyperthyroidism ii) T 4 (sometimes T 3 ) - in some cases, T 4 may be - T 3 may therefore be useful www.freelivedoctor.com
- 41. Thyrotoxicosis results in an increase in metabolic rate. This may result in: Smooth, moist, warm skin Flushing of face and hands Overgrown nails (acropachy, clubbing), which may lift off the nail bed ( onycholysis ) Fine soft thinned scalp hair Generalized itching ( pruritus ) Urticaria Increased skin pigmentation “ Pretibial myxedema” www.freelivedoctor.com
- 43. ii) most are due to Hashimoto thyroiditis (later) d) drugs i) to thyroid secretion ii) non thyroid conditions (lithium, -aminosalicylic acid) e) inborn errors of thyroid metabolism i) uncommon ii) any step of thyroid hormone synthesis may be involved - e.g., “Pendred syndrome” failure of binding iodine in thyroglobulin www.freelivedoctor.com
- 44. f) thyroid hormone resistance i) receptor mutations g) 2 O hypothyroidism i) TSH deficiency ii) any of causes of hypopituitarism (frequently tumor). Other causes include: postpartum pituitary necrosis, trauma, nonpituitary tumors h) 3 O (central) hypothyroidism i) anything that interfere with hypothalamic-portal system ii) inadequate TRH delivery www.freelivedoctor.com
- 46. b) clinical: i) impaired skeletal development ii) impaired CNS development - inadequate maternal thyroid hormone prior to fetal thyroid gland formation SEVERE mental retardation - normal brain development if maternal thyroid deficiency occurs after fetal thyroid gland development www.freelivedoctor.com
- 49. vii) skin pale, cool ( blood flow) viii) edema, puffy face, coarse hair ix) broadening of facial features x) enlarged tongue xi) deepening of voice c) clinical: i) TSH level most sensitive screening test - in 1 O (due to loss of feedback inhibition of TRH release) - normal or not elevated in 2 O or 3 O hypothyroidism - T 4 in all forms of hypothyroidism www.freelivedoctor.com
- 53. v) genetic component - patients with Turner syndrome have circulating antithyroid Ab vi) Clinical: 1) progressive depletion of thyroid epithelial cells 2) replaced with mononuclear cells and fibrosis 3) comes to clinical attention as painless enlargement of thyroid with some degree of hypothyroidism 4) hypothyroidism progresses slowly 5) can be preceeded by “hashitoxicosis” 6) patients at risk in developing other autoimmune diseases 7) no CA risk www.freelivedoctor.com
- 54. b) Subacute (granulomatous) thyroiditis [“aka De Quervain thyroiditis”] i) occurs less often than Hashimoto ii) 30-50 yrs iii) female preponderance 5:1 iv) caused by viral infection v) history of upper respiratory infection just prior to onset of thyroiditis vi) seasonal incidence (summer peak) vii) acute or gradual viii) painful presentation, radiating to jaw, throat, ears: especially when swallowing !! www.freelivedoctor.com
- 55. ix) inflammation and hyperthyroidism are transient - followed by transient period of asymptomatic hypothyroidism x) self limited disease c) subacute lymphocytic (painless) thyroiditis i) uncommon ii) hyperthyroid presentation - may present with any of signs of hyperthyroidism (no opthalmopathy, as in Graves disease) www.freelivedoctor.com
- 56. d) Riedel thyroiditis i) fibrosis of thyroid and neighboring structures ii) presents as hard and fixed thyroid which clinically is similar to CA e) Palpation thyroiditis i) vigorous clinical palpation ii) thyroid function not affected iii) usually an incidental finding. www.freelivedoctor.com
- 58. Thyrotoxicosis results in an increase in metabolic rate. This may result in: Smooth, moist, warm skin Flushing of face and hands Overgrown nails (acropachy, clubbing), which may lift off the nail bed ( onycholysis ) Fine soft thinned scalp hair Generalised itching ( pruritus ) Urticaria Increased skin pigmentation “ Pretibial myxedema” www.freelivedoctor.com
- 66. c) two types: i) endemic ii) sporadic d) endemic goiter (<10% population) i) geographic area deficient in iodine ii) mountainous areas of world - Alps, Himalayas, Andes. iii) TSH iv) can result from ingestion of certain “goitrogens” - cabbage, cauliflower, Brussels sprouts, turnips, cassava - excessive calcium www.freelivedoctor.com
- 78. i) in past, radiation of head and neck in children for a variety of problems has led to ~ 10% developing thyroid carcinoma ii) atomic bomb survivors as well as those survivors following Chernobyl incident have thyroid carcinoma - type is papillary carcinoma c) pre-existing thyroid disease i) multi-nodular goiter have predisposition to develop carcinoma due to areas of iodine - type is follicular carcinoma www.freelivedoctor.com