THYROID DISEASE

Advanced Pathophysiology
THYROID GLAND

• Under control of the hypothalamic-

pituitary axis via negative feedback
mechanism
• Stimulated by thyroid stimulating
hormone (TSH), which is secreted by the
anterior pituitary gland
Pituitary gland is stimulated by thyrotropic
releasing hormone which is secreted by the
hypothalamus
• Secretes thyroid hormones: t3 and t4
THYROID HORMONES

t3 and t4 (think metabolism!) Calcitonin

• Secreted by follicular cells of the • Secreted by the parafollicular cells of the
thyroid gland thyroid gland
• Increase basal metabolic rate • Inhibits bone resorption (keeps calcium in
• Adjust body to temperature changes bones, this decreases blood calcium
• Stimulate fight or flight response levels)
• Affect growth of long bones, hair
• Affect secretion from sebaceous and
sweat glands
• Brain development
• Fetus depends on maternal thyroid
hormones for first 10 weeks of gestation
HYPOTHYROIDISM
• Underproduction of t3 & t4 Causes:
• Symptoms: • Underdeveloped countries: diet deficient
Weight gain in iodine (iodine is essential to the
Cold sensitivity production of t3 and t4)
↓ HR
Mental slowness
• Hashimoto’s thyroiditis: auto-immune;
Lethargy antibodies attack thyroid gland
Constipation • Removal or radiation as part of
Changes in menstrual cycle hyperthyroidism treatment
• Complication: • Congenital: infancy - untreated can lead
Myxedema coma (exaggeration of symptoms) to growth/developmental problems
• Life-threatening
• Alterations in consciousness, hypothermia
HYPOTHYROIDISM
Diagnostics:
Elevated TSH
Low t3 and t4

Additionally,
Hashimotos:
US: small, atrophic,
fibrotic gland

Hypothyroidism treated with

synthetic thyroid hormone (PO
medication)

*Pregnancy considerations: specialist;

increase dose*
H Y P E RT H Y R O I D I S M

• “Thyrotoxicosis” • Complication:
• Overproduction of t3 & t4 Thyroid storm: life-threatening; exaggerated
symptoms
• Hypermetabolic state High fever, dehydration, diarrhea,
• Symptoms: rapid/irregular heart beat
Weight loss
Heat intolerance
↑ HR
Sweating
Hyperactivity
Anxiety
Insomnia Exophthalmos (After treatment)
Exophthalmos (bulging eyes)
H Y P E RT H Y R O I D I S M

• Causes
• Grave’s disease: autoimmune;
antibodies bind to TSH receptors,
gland enlarges and produces more
thyroid hormone
• Toxic nodular goiter: mutated TSH
receptors allow for overproduction of
thyroid hormone
• Thyroid adenoma: tumor, secretes
hormones
H Y P E RT H Y R O I D I S M

Diagnostics:
Low TSH
Elevated t3 and t4

Hyperthyroidism treated with

antithyroid medications or surgery to
remove thyroid gland (after removal, will
require life-long synthetic thyroid hormone

Pregnancy considerations: specialist

GOITER

• Thyroid cell hypertrophy

(enlargement) with increased
vascularity; caused by chronic TSH
stimulation
Can occur in hypo OR hyperthyroidism
QUESTIONS?