Thyroid presentation

1. Thyroid dysfunction

2. What Is the Thyroid
Gland?
•The thyroid gland is
located in front of the neck.
• It has right and left lobes
that confer a butterfly-
shaped appearance.
•The hormones produced
by this gland control the
body’s metabolism.
•Disorders that affect
thyroid function can either
speed up or slow down
metabolic processes, which
can lead to a wide range of
symptoms.

3. ANATOMY OF THYROID GLAND

4. Function of Thyroid gland
secretes 3 main hormones
• Thyroxine (T4)
• Triiodothyronine (T3)
• Calcitonin
Energy
&
Growth
Control of calcium

5. - Regulation of TH secretion:
Thyroid Gland
TH
TSH
Anterior Pituitary
Hypothalamus
TRH
-
-

7.  Calorigenic actions BMR
(stimulation of oxygen consumption by tissues)
Adipose tissues (catabolic lipolysis ) and cholesterol
Muscle (catabolic protein breakdown)
 Body temperature ( heat production 2ry to energy
production)
 Bone, skeletal muscle and nervous system (normal
development).
Actions of thyroid hormone

8. Heart (upregulation of β receptor and sensitivity to
circulating catecholamines).
CNS stimulation resulting in anxiety, restlessness, insomnia and
tremors.
Actions of thyroid hormone
All these actions are remarkable in patients with abnormally hyperthyroidism

9. Classification of thyroid disorder
1- Hormonal disorder :
• Hypothyroidism
• Hyperthyroidism
2- Tumors as thyroid cancer.
3- Drug induced as amiodarone and interferon .

10. Hormonal disorder
• Hypothyroidism
• It refers to reduced
activity of the thyroid
gland (underactive
thyroid) leading to a
decrease in circulating
thyroid hormones. This
slows the metabolic
activity within the body.
• HYPERTHYROIDISM
• It refers to over activity
in the thyroid gland
leading to excessive
production of the
thyroid hormones and
accelerated metabolism
in the peripheral tissue.

11. Causes
Hypothyroidism
1- children : cretinism
2- adult (myxedema)
• Mainly Hashimoto’s (1ry
hypothyroidism)
• Rarely pituitary or
hypothalamic hypofunction
(2ry or 3ry hypothyroidism)
HYPERTHYROIDISM
• Toxic goiter (Graves’
disease)
• Toxic adenoma
• Plummer's disease (toxic
multinodular goiter)
• Thyroiditis
• 2ry OR 3ry hyperthyroidism

19. •Weight gain, lethargy and sluggishness
• Puffiness of skin (myxedema)
•Bradycardia, cold intolerance
•Abnormal menstrual periods
Symptoms of Hypothyroidism

20. Other Symptoms of Hypothyroidism
• Dry skin and brittle nails.
• Numbness or tingling in the hands.
• Constipation.
• Falling of hair.

21. How to deal with a case of thyroid
dysfunction

22. How we discover a case of thyroid
dysfunction in medical commission ?
• 1- Detected clinically during medical fitness
examination.
• 2- Detected by abnormal CXR.

23. How to deal ?
Steps :
• 1- History taking
• 2- General examination
• 3- Local examination of the thyroid
• 4-Investigations
• 5-Referral only when indicated.

24. (A) History taking

25. (B) General examination :
• Underweight • Overweight
Hyperthyroidism Hypothyroidism

26. Nervous & Cardiac signs
Hyperthyroidism Hypothyroidism
Depression , mood swings ,slow thinking
Slow speech ,Poor memory.
Muscle stiffness. Slow relaxation of muscles.
Aches and pains.
Bradycardia
Low pulse

27. Cardiac changes
Hyperthyroidism Hypothyroidism
• Hypertension/hypotension. Diastolic
pressure high while systolic pressure may be
low

28. (II) Cutaneous changes :
Hypothyroidism
* Dry , cold skin .
* Dryness
* coarse brittle hair ,
Loss of lateral eyebrows , Falling of
hair.
* Purple-tinged lips , Itchy skin
*peritibial myxoedema
Hyperthyroidism

29. Eye signs
Hyperthyroidism
• Exophthalmose
Hypothyroidism
• Puffiness of eye lids
• Hair Loss of lateral eyebrows.

33. ( C ) LOCAL Examination of thyroid
The examination consists of :
1- Inspection
With neck in neutral or slightly extended
2- Palpation
With neck slightly flexed
• Examine for size, site , surface , shape and presence of nodules ,
skin overlying , mobility, consistency .
•3- Auscultation for bruit
•Note: An enlarged thyroid is referred to as a goiter. There is no direct
correlation between size and function- a person with a goiter can be
euthyroid, hypo- or hyperthyroid. A normal thyroid is estimated to be
10 grams with an upper limit of 20 grams .

34. Inspection

35. Inspection: Anterior
Approach
1.The patient should be
seated or standing in a
comfortable position with the
neck in a neutral or slightly
extended position.
2.To enhance visualization of
the thyroid, you can:
1.Extending the neck,
which stretches overlying
tissues
2.Have the patient
swallow a sip of water,
watching for the upward
movement of the thyroid
gland.

36. Inspection: Lateral
Approach
1.Lateral inspection of the
thyroid, observe the neck
from the side.
2.Estimate the smooth,
straight contour from the
cricoid cartilage to the
suprasternal notch.

37. Palpation
• Note: There is no data comparing palpation using the
anterior approach to the posterior approach so
examiners should use the approach that they find most
comfortable.

38. Palpation: Anterior
Approach
•The patient is examined in
the seated or standing
position.
•Attempt to locate the
thyroid isthmus by palpating
between the cricoid cartilage
and the suprasternal notch.
•Use one hand to slightly
retract the sternomastoid
muscle while using the other
to palpate the thyroid.
•Have the patient swallow a
sip of water as you palpate,
feeling for the upward
movement of the thyroid
gland.

39. Palpation: Posterior
Approach
•The patient is examined in the
seated or standing position.
•Standing behind the patient,
attempt to locate the thyroid
isthmus by palpating between
the cricoid cartilage and the
suprasternal notch.
•Move your hands laterally to
try to feel under the
sternomstoids for the fullness
of the thyroid.
•Have the patient swallow a sip
of water as you palpate,
feeling for the upward
movement of the thyroid
gland.

43. Do not forget to order ECG for all thyroid cases
Hyperthyroidism Hypothyroidism

44. Thyroid hormones and lab. values
Hypo- Hyper-
TSH ↑ ↓
Total T4 & T3 ↓ ↑
FT3 & FT4 ↓ ↑
Total cholesterol ↑ ↓
LDL ↑ ↓
HDL ↓ ↑

45. Ultrasound

47. (D) When to refer to Endocrinology ?
• Abnormal thyroid functions
• Abnormal CXR
• Sever Clinical manifestation
• Abnormal ECG