Thyroid disorders

Thyroid gland
• -Thyroid is endocrine gland Situated at the root of the neck on
either side of trachea.
• -It has 2 lobes
-Right lobe
-Left lobe
• Extension- 5th 6th 7th cervical and 1st thoracic vertebrae.
• Lobes are connected in the middle by the isthmus
• Weigh 20 to 40 gram in adult
• Thyroid is larger in female than in male
Hormones of thyroid gland
- Secrets three hormones
1. Tetraidothyronine or T4 (thyroxine)
2.Tri-iodothyronine or T3
3. Calcitonin.
Rate of secretion
Thyroxine -80 to 90 ug/day
Tri-iodothyronin- 4 to 5 ug/day
Reverse T3 - 1 to 2 ug /day
Function
1. To increase basal metabolic rate.
2. To stimulate growth in children
 Hyperthyroidism
• Increased secretion of thyroid hormone is called
hyperthyroidism.
- it is more common in female than male
T3 ,T4 – function
- oxygen use
-heat production
-basal and cellular metabolism
-Growth and development of skeleton and nervous system
 Etiology
- Infection – Thyroid gland
- Emotional shock
- stress
-thyroiditis – goiter , Autoimmune disorders
-excessive ungestation of thyroid hormone
-iodine induced hyperthyroidism
-graves disease ( autoimmune disease) most common cause.
 Sign and symptoms of hyperthyroidism
1. Skin is warm and moist, Palms are warm moist due to increased
basal metabolic rate
2.Alopecia (loss of hair) and vitiligo (loss of skin color discolouration)
3.Excessive sweating and heat intolerance
4.CVS – palpitation
-CHF
- systolic hypertension
5.Appetite –increase weight loss - metabolic rate fast - But storage
not proper
6.Hyperdefecation – more than 3 time stool
7. Nervousness
- irritability
-tremor
-insomnia
-proximal muscle weaknesses
8. In male –impotence
-Libido
in female –Amenorrhea –loss of mensuration cycle
-oligomenorrhea –infrequient mensuration cycle/irregular
Investigation
• Serum T3 and T4
• Serum TSH
• Blood ESR
• Antithyroglobulin –graves disease
• Thyroid uptake or radioiodine is increased.
• CT scan
• USG of thyroid gland
• Serum calcium
• Liver function test
Treatment
• Immediate control of symptoms can be achieved by –propranol
40 mg 6 to 8 hourly
• Long term control hyperthyroidism
antithyroid drug
Carbimazole -15 mg 8 hourly 0-3 weeks
Methimazole 10mg 8 hourly 4-8 weeks
Propylthiouracil 5mg 8hourly 18-24 months
• Radioactive iodine orally 185-370 mBq
depending upon clinical-goiter
• By surgical removal
in advance case of hyperthyroidism treatment by using
antithyroid substance is not possible
So Thyroid gland of these patient must be removed
- Surgical removal of thyroid gland is called thyroidectomy.
-Before surgery the patient is prepared by reducing basal
metabolic rate
* * It’s done by injection propylthiouracil for several week – until
basal metabolic rate reach at normal level.
Hypothyroidism
-It is an endocrine disorder that decrease the level of thyroid hormone
in the body.
- Hypothyroidism leads to myxedema in adult and cretinism in children.
Myxedema
Myxedema is the hypothyroidism in adult characterized by
generalized edematous appearance.
-Common cause of Myxedema is the autoimmune disease called
Hashimoto’s thyroiditis
- Late middle aged women
• Cretinism
- Cretinism is the hypothyroidism in children characterized by stunted
growth.
- Cretinism occur due to congenital absence of thyroid gland, genetic
disorder or lack of iodine in the diet
#*#- a newborn baby with Thyroid deficiency may appear normal at the
time of birth because thyroxine might have been supplied from mother
-But a few weeks after birth the baby starts developing the signs like
sluggish movement and croaking sound while crying.unless treated
immediately the baby will mentally regarded permanently
 Etiology
- Auto-immune disorder (thyroditis)
- Patient having previous hypothyroidism
- Radiation therapy for the treatment of head and neck cancer
- Medication having lithium and iodine compound
- Iodine deficiency- goiter – swewling of thyroid gland
Classification
1.Primary or thyrodial hypothyroidism.
-Due to dysfunction of thyroid gland
2.Central hypothyroidism.
-due to hypothalamus and pituitary gland
3.Pitutary or secondary hypothyroidism
-Dysfunction of pituitary gland
4.Hypothalmic or tertiary hypothyroidism
-Dysfunction of hypothalamus
5.Cretinism
-congenital hypothyroidism
Clinical feature of hypothyroidism
• Hair loss
• Dry skin –dehydration
• Hoarseness of voice –thyroiditis
• Loss of libido
• Mensural disturbance
• Subnormal temperature and pulse rate
• Fatigue
• Weight gain
• Constipation
• Deafness- hearing problem
• Face become expression less
• Diagnosis
Serum T3 and T4
Serum TSH
Blood ESR
Antithyroglobulin –graves disease
Thyroid uptake or radioiodine is increased.
CT scan
USG of thyroid gland
Serum calcium
Liver function test
Treatment
• Replacement of deficient hormone is the basic of therapy
Dose is 100-300 micrograms
thyroxine per day as single dose orally
If any patient heart disease we should start small dose of thyroxine
25 -50 microgram per day then
Increased by 25 -50 micrograms every 2 -3 weeks until a full
maintenance dose reached
• Treatment is usually Life long
• If patient develop angina eirjy thyroxine B-blocker should be added
Thank you