thyroid disorders
TRANSCRIPT
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Aspects That Will Be AddressedHyperthyroidismHypothyroidismThyroiditis
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Causes of HyperthyroidismMost common causes
Graves diseaseToxic multinodular
goiterAutonomously
functioning nodule
Rarer causesThyroiditis or other
causes of destructionThyrotoxicosis factitiaStruma ovariiSecondary causes (TSH
or ßHCG)
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Hyperthyroidism SymptomsHyperactivity/ irritability.Heat intolerance and sweating.Palpitations.Fatigue and weakness.Weight loss with increase of appetite.Diarrhoea.Polyuria.Oligomenorrhoea.Loss of libido
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Hyperthyroidism SignsTachycardia (AF)Increased B.PTremorGoiterWarm moist skinProximal muscle
weaknessLid retraction or lagGynaecomastia Brisk tendon
reflexes
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Graves DiseaseAutoimmune disorderAb directed against TSH receptor with
intrinsic activity. Thyroid and fibroblastsResponsible for 60-80% of ThyrotoxicosisMore common in women
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Graves Disease Eye SignsN- no signs or symptomsO – only signs (lid retraction or
lag) no symptomsS – soft tissue involvement
(peri-orbital oedema)P – proptosis (>22 mm)(Hertl’s
test)E – extra ocular muscle
involvement (diplopia)C – corneal involvement
(keratitis)S – sight loss (compression of
the optic nerve)
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Graves Disease Other Manifestations
Pretibial myxedema Thyroid acropachyOnycholysisThyroid enlargement
with a bruit frequently audible over the thyroid
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Diagnosis of Graves DiseaseTSH , free T4 Thyroid auto
antibodies LATS,IF,Gastric
parietal cells.Nuclear thyroid
scintigraphy (I131, Tc99)
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Treatment of Graves DiseaseReduce thyroid hormone production or
reduce the amount of thyroid tissueAntithyroid drugs: propylthiouracil,
carbimazoleRadioactiveiodineSubtotal thyroidectomy – relapse after
antithyroid therapy, young people.Symptomatic treatment
Propranolol.
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Hypothyroidism SymptomsTiredness and
weaknessDry skinFeeling coldHair lossDifficulty in
concentrating and poor memory
Constipation
Weight gain with poor appetite
Hoarse voiceMenorrhagia, later
oligo and amenorrhoea
Paresthesias
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Hypothyroidism SignsDry skin, cold extremitiesYellow tintPuffy face, hands and feetDelayed tendon reflex
relaxationCarpal tunnel syndrome BradycardiaIncreased B.PDiffuse alopeciaSerous cavity effusions
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Causes of HypothyroidismAutoimmune
hypothyroidism (Hashimoto’s, atrophic thyroiditis)
Iatrogenic (I123 treatment, thyroidectomy, external irradiation of the neck)
Drugs: lithium, antithyroid drugs, etc
Iodine deficiencyInfiltrative disorders
of the thyroid: amyloidosis,
sarcoidosis, haemochromatosis.
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Lab Investigations of Hypothyroidism
TSH , free T4 Ultrasound of thyroid – little valueThyroid scintigraphy – little valueAnti thyroid antibodies – anti-TPOSr.CK , Sr.Chol , Sr,Triglyseride Normochromic or macrocytic anemiaECG: Bradycardia with small QRS
complexes
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Treatment of HypothyroidismLevothyroxine
If no residual thyroid function 1.5 μg/kg/dayPatients under age 60, without cardiac disease
can be started on 50 – 100 μg/day. Dose adjusted according to TSH levels
In elderly especially those with CAD the starting dose should be much less (12.5 – 25 μg/day)
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ThyroiditisAcute: rare and due to suppurative infection
of the thyroidSub acute: also termed de Quervins
thyroiditis/ granulomatous thyroiditis – mostly viral origin
Chronic thyroiditis: mostly autoimmune (Hashimoto’s)
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Acute ThyroiditisBacterial – Staph, StrepFungal – Aspergillus, Candida, Histoplasma,
PneumocystisRadiation thyroiditisAmiodarone (acute/ sub acute)Painful thyroid, ESR usually elevated, thyroid
function normal
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Sub Acute ThyroiditisViral (granulomatous) – Mumps, coxsackie,
influenza, adeno and echovirusesMostly affects middle aged women, painful
enlarged thyroid, usually complete resolutionRx: NSAIDS and glucocorticoids if necessary
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Sub Acute ThyroiditisSilent thyroiditis No tenderness of thyroidOccur mostly 3 – 6 months after pregnancy3 phases: hyperhyporesolution, last 12 to 20
weeksESR normal, TPO Ab presentUsually no treatment necessary
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Chronic ThyroiditisHashimoto’s
AutoimmuneInitially goiter later very little thyroid tissueRarely associated with painInsidious onset and progressionMost common cause of hypothyroidismTPO ab present (90 – 95%)
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Chronic ThyroiditisReidel’s
RareMiddle aged womenInsidious painlessSymptoms due to compressionDense fibrosis develop Usually no thyroid function impairment
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ThyroiditisThe most common form of thyroiditis is
Hashimoto thyroiditis, this is also the most common cause of long term hypothyroidism
The outcome of all other types of thyroiditis is good with eventual return to normal thyroid function
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CRETINISMImbecility.Idiocy.
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