Hyperthyroidism and Hypothyroidism

Kuo-Bin Tseng, MD
Division of Endocrinology and Metabolism
Department of Internal Medicine
E-DA Hospital
E-mail: ed105478@edah.org.tw
18/Nov/2019

*
 Outline
• Thyroid Testing
• Hypothyroidism
– Causes
– Signs/symptoms
– Treatment
• Hyperthyroidism
– Causes
– Signs/symptoms
– Treatment
• Take home messages

*
Thyroid Gland Anatomy
• Weights: approximately 15 to 20 g
in average adult.
• It lies anterior to the trachea and
below the cricoid cartilage at the
level of C5-T1.
• It is composed of a right and left
lobe connected by an isthmus.
• Approximately 50% of people,
there is a small accessory lobe, the
pyramidal lobe that extends
superiorly from the isthmus at the
midline.
 Actions of Thyroid Hormones
T4
5’- iodinase

T3

T3

Nuclear receptor

Transcription of DNA

Translation of mRNA

Synthesis of new proteins

Growth CNS BMR Metabolism Cardiovascular

Growth formation ↑ Na+K+ ATPase ↑ Glucose absorption ↑Cardiac output

Maturation of
Bone maturation ↑ O2 consumption ↑ Glucogenolysis
CNS
↑ Heat production ↑ Gluconeogenolsis
↑ Lipolysis
* ↑ BMR
↑ Protein synthesis and
degradation (net catabolic)
Hypothalamus-Pituitary-Thyroid axis
 Thyroid hormones synthesis

TSH stimulates pinocytosis into the follicular cell

*
William textbook of Endocrinology 12th
 Outline
• Thyroid Testing
• Hypothyroidism
– Causes
– Signs/symptoms
– Treatment
• Hyperthyroidism
– Causes
– Signs/symptoms
– Treatment
• Take home messages
Thyroid Testing
(Thyroid stimulating hormone)
Thyroid Testing
Overview of Thyroid Function Tests
Laboratory tests useful in the differential
diagnosis of hyperthyroidism
 Thyroid Testing
(Thyroid Peroxidase)

(Thyroid Stimulating Immunoglobulin)

− Elevated Tg level in hyperthyroidism, thyroiditis, hemorrhagic cyst

, recurrent differential thyroid cancer (PTC, FTC)…
The following table summarizes when thyroid
autoantibody tests may be done

Thyroid Antibodies: The Test - Lab Tests Online

https://labtestsonline.org/understanding/analytes/thyroid-antibodies/tab/test/
 Thyroid Testing

For patient with hyperthyroidism , thyroid scan

is indicated for further evaluation. If cold
lesion(s) is noted from thyroid scan, then FNA
of thyroid lesion(s) may be needed to rule out
malignancy (the relative risk of malignancy is
approximately 5~10% in cold lesion). Almost
hot lesion from thyroid scan is benign, so FNA
of thyroid lesion(s) is not needed.
 Thyroid Testing

* Multiple endocrine neoplasia

 Outline
• Thyroid Testing
• Hypothyroidism
– Causes
– Signs/symptoms
– Treatment
• Hyperthyroidism
– Causes
– Signs/symptoms
– Treatment
• Take home messages
Hypothyroidism
Hypothyroidism
 Thyroiditis

⚫ Clinical course of painful subacute thyroiditis, painless postpartum

thyroiditis, and pain sporadic thyroiditis.
⚫ Measurements of serum thyrotropin (TSH, Thyroxine(T4) and iodine-123
(123 I) uptake show thyrotoxicosis during the first three months, followed
by hypothyroidism for three months and then by euthyroidism.
Hypothyroidism
Hypothyroidism
Hypothyroidism
Hypothyroidism
Hypothyroidism (treatment)
Hypothyroidism (Treatment in general)
Hypothyroidism (Treatment in general)
Hypothyroidism (Treatment in general)
Causes of Increased LT4 Requirement
Causes of Increased LT4 Requirement
 Outline
• Thyroid Testing
• Hypothyroidism
– Causes
– Signs/symptoms
– Treatment
• Hyperthyroidism
– Causes
– Signs/symptoms
– Treatment
• Take home messages
Hyperthyroidism
Hyperthyroidism
→The most common cause of hyperthyroidism
Hyperthyroidism

(≈37.5% iodine contained)

Hyperthyroidism
Hyperthyroidism
 Hyperthyroidism Eye Disease

Ophthalmopathy associated with

Graves Disease
Hyperthyroidism Eye Disease
Graves’ Dermopathy
Graves’ Dermopathy
Thyroid Acropachy
Onycholysis of Thyrotoxicosis
Distal separation of
the nail plate from
nail bed (Plummer’s
nails)
Hyperthyroidism
RAIU/Scan
RAIU/Scan
Hyperthyroidism (Treatment)
Hyperthyroidism (Treatment)
Hyperthyroidism (Treatment)
Side effects of anti-thyroid agents

Williams Textbook of Endocrinology 12th 50

Hyperthyroidism (Treatment)
Hyperthyroidism
Subclinical Hyperthyroidism
Indications for treatment of persistent
subclinical hyperthyroidism
• Postmenopausal osteoporosis
• Rheumatic valvular disease with left atrial enlargement or
atrial fibrillation
• Recent-onset atrial fibrillation or recurrent cardiac
arrhythmias
• Congestive heart failure
• Angina pectoris
• Infertility or menstrual disorders
• Nonspecific symptoms such as fatigue, nervousness,
depression, or gastrointestinal disorders, especially in patients
older than 60 years of age (consider therapeutic trial)

Williams Textbook of Endocrinology, Thirteen Edition

 Outline
• Thyroid Testing
• Hypothyroidism
– Causes
– Signs/symptoms
– Treatment
• Hyperthyroidism
– Causes
– Signs/symptoms
– Treatment
• Take home messages
 Take home messages
• Hypothyroidism results from a lack of thyroid hormone
available to the body’s tissues and organ systems.
• Hyperthyroidism results from the overproduction of thyroid
hormone by the thyroid gland.
• Check TRAb, TPOAb, TgAb to rule out autoimmune thyroid
disease.
• TSH, best test for screening for thyroid dysfunction.
• Hashimoto’s is the most common thyroid disease that causes
hypothyroidism.
• LT4 or LT3 supplementation is the major treatment of
hypothyroidism.
• Antithyroidal agents, low dose radioactive iodine ablation,
and surgery are the major treatment of hyperthyroidism.
• If patients are not treated for subclinical hypothyroidism, then
careful follow-up are recommended.
 References
• Williams Textbook of Endocrinology, Thirteen
Edition.
• Greespan’s Basic & Clinical Endocrinology,
Ninth edition.
• The thyroid gland and disorders of thyroid
function, Fifth edition.
THE END !