Your SlideShare is downloading. ×
0
Thyroid  Disorders
Thyroid  Disorders
Thyroid  Disorders
Thyroid  Disorders
Thyroid  Disorders
Thyroid  Disorders
Thyroid  Disorders
Thyroid  Disorders
Thyroid  Disorders
Thyroid  Disorders
Thyroid  Disorders
Thyroid  Disorders
Thyroid  Disorders
Thyroid  Disorders
Thyroid  Disorders
Thyroid  Disorders
Thyroid  Disorders
Thyroid  Disorders
Thyroid  Disorders
Thyroid  Disorders
Thyroid  Disorders
Thyroid  Disorders
Thyroid  Disorders
Thyroid  Disorders
Thyroid  Disorders
Thyroid  Disorders
Thyroid  Disorders
Thyroid  Disorders
Thyroid  Disorders
Thyroid  Disorders
Thyroid  Disorders
Thyroid  Disorders
Thyroid  Disorders
Thyroid  Disorders
Thyroid  Disorders
Thyroid  Disorders
Thyroid  Disorders
Thyroid  Disorders
Thyroid  Disorders
Thyroid  Disorders
Thyroid  Disorders
Upcoming SlideShare
Loading in...5
×

Thanks for flagging this SlideShare!

Oops! An error has occurred.

×
Saving this for later? Get the SlideShare app to save on your phone or tablet. Read anywhere, anytime – even offline.
Text the download link to your phone
Standard text messaging rates apply

Thyroid Disorders

5,119

Published on

Published in: Health & Medicine
0 Comments
8 Likes
Statistics
Notes
  • Be the first to comment

No Downloads
Views
Total Views
5,119
On Slideshare
0
From Embeds
0
Number of Embeds
0
Actions
Shares
0
Downloads
672
Comments
0
Likes
8
Embeds 0
No embeds

Report content
Flagged as inappropriate Flag as inappropriate
Flag as inappropriate

Select your reason for flagging this presentation as inappropriate.

Cancel
No notes for slide
  • Transcript

    • 1. Thyroid Disorders Tapan A. Patel Cuong Nguyen Mona Jamaldinian
    • 2. Thyroid Gland <ul><li>Second largest endocrine gland in body </li></ul><ul><li>Small butterfly shaped gland located at base of neck below the sternocleidomastoid muscles </li></ul><ul><li>Thyroid is controlled </li></ul><ul><li>by the hypothalmus </li></ul><ul><li>and pituitary </li></ul>
    • 3. Functions <ul><li>Stimulates & maintains metabolic processes </li></ul><ul><ul><li>Produces thyroid hormones T3-triiodothyronine and T4-thyroxine </li></ul></ul><ul><ul><li>These hormones regulate metabolism & affect the growth and function of other systems in the body </li></ul></ul><ul><li>Secretes calcitonin to lower serum calcium levels </li></ul><ul><li>Parathyroid gland secretes PTH to raise serum calcium levels </li></ul>
    • 4. Functions <ul><li>Metabolic stimulants of: </li></ul><ul><ul><li>Neural and skeletal development </li></ul></ul><ul><ul><li>Oxygen consumption at rest </li></ul></ul><ul><ul><li>Stimulating bone turnover by increasing formation and resorption </li></ul></ul><ul><ul><li>Promoting chronitropic and ionotropic effects </li></ul></ul><ul><ul><li>Increasing number of catecholamine receptors in heart </li></ul></ul><ul><ul><li>Increasing production of RBC </li></ul></ul><ul><ul><li>Altering the metabolism of carbs, fats, and protein </li></ul></ul>
    • 5. Hormones: T3 & T4 <ul><li>T3 (Triiodothyronine) & T4 (Tetraiodothyronine </li></ul><ul><ul><li>Stored in Follicles (round sacs) in the thyroid filled with thyroglobulin, a thyroid protein. </li></ul></ul><ul><ul><ul><li>Dietary iodine enters follicles where they are stored as T3 and T4 </li></ul></ul></ul><ul><ul><li>T4 is converted to T3 by peripheral organs such as kidney, liver, and spleen </li></ul></ul><ul><ul><li>T3 is 10x more active than T 4 </li></ul></ul>
    • 6. Hormones: T4 to T3 <ul><ul><li>Only 20% of total T3 is secreted by thyroid </li></ul></ul><ul><ul><ul><li>Majority is formed from catalysis of T4 by 5’-iodthryonine deiodinase (highest activity in liver and kidney) </li></ul></ul></ul>
    • 7. Hormones: T4 <ul><li>T4-thyroxine contains 4 iodine atoms </li></ul><ul><li>It is a slow-acting pre-hormone </li></ul><ul><li>T4 takes 4 days to peak in blood </li></ul><ul><ul><li>Half-life 7 days </li></ul></ul><ul><li>Overall effects take 6 weeks </li></ul><ul><li>T3 is the active and faster-acting hormone </li></ul><ul><li>The immediate effects of T3 last 1-2 days </li></ul><ul><ul><li>Half-life 1.5 days </li></ul></ul>
    • 8. Iodine <ul><li>Dietary Iodide is removed from the bloodstream by means of an active pump </li></ul><ul><li>The pump can concentrate iodide in the follicular sacs at 350x greater than the blood concentration </li></ul><ul><li>Oxidation of iodide by thyroid peroxidase converts iodide  iodine </li></ul><ul><li>Peripheral de-iodination of T4 to T3 is regulated by many factors including health, nutritional status, and other hormones </li></ul>
    • 9. Hormones- TSH <ul><li>TSH </li></ul><ul><ul><li>TSH is a pituitary hormone </li></ul></ul><ul><ul><li>Controlled by TRH-thyrotropin releasing hormone from hypothalamus </li></ul></ul><ul><ul><li>Functions to stimulate thyroid hormone production </li></ul></ul><ul><ul><ul><li>May enlarge thyroid (goiter) when under producing </li></ul></ul></ul><ul><ul><li>Labs: </li></ul></ul><ul><ul><ul><li>High TSH indicates low thyroid hormone= hypo </li></ul></ul></ul><ul><ul><ul><li>Low TSH indicates high thyroid hormone = hyper </li></ul></ul></ul>
    • 10. Hormones-Calcitonin & PTH <ul><li>Produced by thyroid to regulate serum calcium levels </li></ul><ul><li>Calcitonin stimulates movement of calcium into bone </li></ul><ul><li>Parathyroid hormone (PTH) opposite effect of calcitonin </li></ul>
    • 11. Negative Feedback System The disruption of any of these mechanisms can cause abnormal levels of T3 and T4 leading to thyroid disease TRH T3 & T4 Thyroid TSH
    • 12. Diseases <ul><li>Hypothyroidism-Under Activity </li></ul><ul><li>Prevalence </li></ul><ul><ul><li>Affects 5-17% of population </li></ul></ul><ul><ul><li>Females> Males </li></ul></ul><ul><ul><li>Higher in >60 years old </li></ul></ul><ul><li>Types </li></ul><ul><ul><li>Hashimoto’s thyroiditis </li></ul></ul><ul><ul><li>Ord’s thyroiditis </li></ul></ul><ul><ul><li>Postoperative hypothyroidism </li></ul></ul><ul><ul><li>Postpartum hypothyroidism </li></ul></ul><ul><ul><li>Iatrogenic hypothyroidism </li></ul></ul>
    • 13. Diseases <ul><li>Hyperthyroidism- Over activity </li></ul><ul><li>Prevalence </li></ul><ul><ul><li>Affect 5-17% of population </li></ul></ul><ul><ul><li>Females> Males </li></ul></ul><ul><ul><li>More common in younger persons </li></ul></ul><ul><li>Types </li></ul><ul><ul><li>Thyroid storm </li></ul></ul><ul><ul><li>Graves disease </li></ul></ul><ul><ul><li>Toxic thyroid nodule </li></ul></ul><ul><ul><li>Plummers disease </li></ul></ul><ul><ul><li>Hashitoxicosis </li></ul></ul><ul><ul><li>De Quervain thryoiditis </li></ul></ul><ul><ul><li>Iatrogenic hyperthyroidism </li></ul></ul>
    • 14. Labs 80-220ng/dL Bound & Free T 3 Total(T 3 ) 0.25-6.7U/mL Thyroid stimulating hormone TSH 22-34% Binding capacity of TBG T 3 Resin Uptake 80-220ng/dL Bound & Free T 3 Total T 3 (TT 3 ) 0.8-1.5 ng/dL Free T 4 Free T 4 (FT 4 ) 4.5-12.5mg/dL Bound & Free T 4 Total T 4 (TT 4 ) Normal Range Measurement Thyroid Function Test
    • 15. Labs <ul><li>Hyperthyroidism </li></ul><ul><ul><li> FT4 </li></ul></ul><ul><ul><li> TSH </li></ul></ul><ul><li>Hypothyroidism </li></ul><ul><ul><li> FT4 </li></ul></ul><ul><ul><li> TSH </li></ul></ul>
    • 16. Hyperthyroidism-Types <ul><li>Graves disease </li></ul><ul><ul><li>Most common form (70-80%) </li></ul></ul><ul><ul><ul><li>Autoimmune disorder in which thyroid-stimulating antibodies are circulating in blood. These bind to thyroid cells and activate cells in the same manner as TSH. </li></ul></ul></ul><ul><ul><li>7 times greater in women </li></ul></ul><ul><ul><li>Peak onset is 20-30’s </li></ul></ul>
    • 17. Hyperthyroidism-Types <ul><li>Can be caused by: </li></ul><ul><ul><li>Toxic multinodular goiter </li></ul></ul><ul><ul><li>Solitary toxic nodule </li></ul></ul><ul><ul><li>Thyroiditis </li></ul></ul><ul><ul><li>Drug-induced thryotoxicosis </li></ul></ul><ul><ul><li>Pituitary or trophoblastic tumors </li></ul></ul>
    • 18. Hyperthyroidism-Symptoms <ul><li>Weight loss </li></ul><ul><li>Tachycardia </li></ul><ul><li>Bulging eyes </li></ul><ul><li>Nervous/Anxious </li></ul><ul><li>Insomnia </li></ul><ul><li>Intolerant of heat </li></ul><ul><li>Goiter </li></ul>
    • 19. Goiter <ul><li>A diet deficient in iodine </li></ul><ul><li>Increase in thyroid stimulating hormone (TSH) in response to a defect in normal hormone synthesis within the thyroid gland. </li></ul>
    • 20. Thyroid Storm <ul><li>Life threatening syndrome </li></ul><ul><li>Decompensated hyperthyroidism </li></ul><ul><li>Symptoms </li></ul><ul><ul><li>Hyperthyroid symptoms with agitation, confusion, delirium, psychosis </li></ul></ul><ul><ul><li>Gastrointestinal: Nausea/Vomiting, Abdominal pain </li></ul></ul><ul><ul><li>Tachycardia associated with CHF </li></ul></ul>
    • 21. Thyroid Storm Treatment <ul><li>Antithyroids </li></ul><ul><ul><li>PTU 200-400mg po/NG q4-8h </li></ul></ul><ul><ul><li>Methimazole 60-120mg/d PO/NG divided q6-8h </li></ul></ul><ul><li>Potassium Iodide 2-5 drops PO/NG q6h </li></ul><ul><li>Lugol Solution-Strong Iodine10 drops po TID </li></ul><ul><li>Glucorticoids: block conversion of T4 to T3 </li></ul><ul><ul><li>Hydrocortisone succinate 100-200mg IV q6-8 </li></ul></ul><ul><ul><li>Dexamethasone 2mg Po/IV q6-8h </li></ul></ul><ul><li>BB </li></ul><ul><ul><li>Esmolol: 500mcg/kg/min </li></ul></ul><ul><ul><li>Propranolol 20-80mg/dose PO/NG q4-6h </li></ul></ul>
    • 22. Hyperthyroidism-Treatment <ul><li>Drug Therapy </li></ul><ul><ul><li>Beta blocker </li></ul></ul><ul><ul><ul><li>Atenolol 50mg-100mg po daily </li></ul></ul></ul><ul><ul><ul><li>Propranolol 20-40mg po TID </li></ul></ul></ul><ul><ul><li>Antithyroids </li></ul></ul><ul><ul><ul><li>Methimazole 15-30mg po daily </li></ul></ul></ul><ul><ul><ul><li>Propylthiouracil (PTU) 300mg TID </li></ul></ul></ul>
    • 23. Hyperthyroid-Treatment <ul><li>Procedural Therapy </li></ul><ul><ul><li>Radionuclide albation of thyroid gland </li></ul></ul><ul><ul><li>Total thyroidectomy </li></ul></ul>
    • 24. Methimazole <ul><li>Methimazole prevents peroxidase enzyme from coupling and iodinating the tyrosine residues on thyroglubulin. Reduces T3 & T4 production. </li></ul><ul><li>Dosage </li></ul><ul><ul><li>15-30mg PO daily </li></ul></ul>
    • 25. Methimazole <ul><li>Adverse Effects </li></ul><ul><ul><li>Skin rash </li></ul></ul><ul><ul><li>Loss of taste </li></ul></ul><ul><ul><li>GI upset </li></ul></ul><ul><ul><li>Drowsiness </li></ul></ul><ul><ul><li>Decreased Platelets </li></ul></ul><ul><li>antagonistic properties of Methimazole </li></ul>
    • 26. Methimazole <ul><li>Drug Interactions: </li></ul><ul><ul><li>Discontinue before treatment with radioiodine; affects uptake </li></ul></ul><ul><ul><li>Amiodarone: Increases T3 and T4 serum levels </li></ul></ul><ul><ul><li>Warfarin: enhanced due to vitamin K </li></ul></ul>
    • 27. Propylthiouracil -PTU <ul><li>Thio-urea derivative </li></ul><ul><li>Preferred agent in pregnant women </li></ul><ul><li>DOC for severe thyrotoxicosis </li></ul><ul><li>Dosage </li></ul><ul><ul><li>Adults: 300-450mg/day divided q8h </li></ul></ul><ul><ul><li>Severe cases: 600-1200mg/day </li></ul></ul><ul><ul><li>Maintenance dose 100-150mg/day divided q 8-12 hours </li></ul></ul><ul><li>Drug Interactions </li></ul><ul><ul><li>Similar to Methimazole </li></ul></ul>
    • 28. PTU <ul><li>Adverse reactions </li></ul><ul><ul><li>Rash </li></ul></ul><ul><ul><li>Itching </li></ul></ul><ul><ul><li>Hives </li></ul></ul><ul><ul><li>Agranulocytosis </li></ul></ul><ul><ul><li>Vasculitis </li></ul></ul>
    • 29. Carbimazole-UK <ul><li>Pro-drug converted to active form -methimazole </li></ul><ul><li>Dosage </li></ul><ul><ul><li>15-40mg PO daily until normal function </li></ul></ul><ul><ul><li>Reduce to 5-15mg po daily maintenance dose </li></ul></ul><ul><li>Adverse Effects </li></ul><ul><ul><li>Bone marrow suppression </li></ul></ul><ul><ul><li>Neutropenia </li></ul></ul><ul><ul><li>Agranulocytosis </li></ul></ul>
    • 30. Sodium Iodide I-131 (Iodotope) <ul><li>Quickly absorbed and taken up by thyroid </li></ul><ul><li>No other tissue capable of retaining radioactive iodine therefore low adverse effects </li></ul><ul><li>Dose </li></ul><ul><ul><li>Adult 75-150mCi/g of thyroid x estimated thyroid gland size </li></ul></ul><ul><ul><li>24hour radioiodine uptake </li></ul></ul><ul><ul><li>Discontinue antithyroid therapy 3-4days before </li></ul></ul>
    • 31. Hypothyroidism <ul><li>Types: </li></ul><ul><ul><li>Primary hypothyroidism </li></ul></ul><ul><ul><ul><li>Most common cause </li></ul></ul></ul><ul><ul><ul><li>Failure of thyroid gland </li></ul></ul></ul><ul><ul><ul><li>Occurs primarily in women aged 30-50 years old </li></ul></ul></ul><ul><ul><ul><ul><li>Chronic autoimmune thyroiditis or Hashimotos disease is the most common primary hypothyroidism AND hypothyroidism overall </li></ul></ul></ul></ul><ul><ul><li>Secondary Hypothyroidism </li></ul></ul><ul><ul><li>Tertiary Hypothyroidism </li></ul></ul><ul><ul><li>Other causes </li></ul></ul>
    • 32. Hypothyroidism-Symptoms <ul><li>Fatigue </li></ul><ul><li>Weight Gain </li></ul><ul><li>Depression </li></ul><ul><li>Dry skin </li></ul><ul><li>Bradycardia </li></ul><ul><li>Constipation </li></ul><ul><li>Intolerant to cold </li></ul>
    • 33. Hashimoto’s Disease <ul><li>Autoimmune disorder in which antibodies are directed against a thyroid sites to : </li></ul><ul><ul><li>Inhibit thyroid peroxidase </li></ul></ul><ul><ul><li>Inhibit effects of TSH </li></ul></ul><ul><ul><li>Stimulate thyroid growth </li></ul></ul>
    • 34. Hypothyroidism-Primary <ul><li>Drug induced </li></ul><ul><ul><li>Amiodarone, lithium, thiocyanates, phenylbutazone, sulfonylureas, PTU & methimazole </li></ul></ul><ul><li>Iatrogenic </li></ul><ul><ul><li>Surgical removal of the thyroid gland and radiation treatment </li></ul></ul>
    • 35. Primary Hypothyroidism <ul><li>Thyroid gland failure </li></ul><ul><ul><li>Decrease T3 & T4 </li></ul></ul><ul><ul><li>Increase TRH due to negative feedback </li></ul></ul><ul><ul><li>Increased TSH due to decreased TRH </li></ul></ul>
    • 36. Secondary Hypothyroid <ul><li>Pituitary failure </li></ul><ul><ul><li>Insufficient TSH release as a result of: </li></ul></ul><ul><ul><ul><li>Pituitary tumors </li></ul></ul></ul><ul><ul><ul><li>Surgery </li></ul></ul></ul><ul><ul><ul><li>Pituitary radiation </li></ul></ul></ul><ul><ul><ul><li>Pituitary necrosis </li></ul></ul></ul><ul><ul><ul><li>Autoimmune mechanisms </li></ul></ul></ul>
    • 37. Tertiary Hypothyroidism <ul><li>Hypothalamic Failure- very rare </li></ul><ul><li>Insufficient TRH release as a result of: </li></ul><ul><ul><li>Trauma </li></ul></ul><ul><ul><li>Irradiation </li></ul></ul><ul><ul><li>Tumors </li></ul></ul>
    • 38. Hypothyroidism-Treatment <ul><li>Drug Therapy </li></ul><ul><ul><li>Levothyroxine Sodium-DOC synthetic T4 </li></ul></ul><ul><ul><ul><li>Adults 1-1.5mgc/kg/day orally initially, adjust as needed. Average dose 1.6-1.8mcg/kg/day </li></ul></ul></ul><ul><ul><ul><li>Pediatrics 1-1.5mgc/kg/day. Average 4 mcg/kg/day </li></ul></ul></ul><ul><ul><li>Thyroid (Armour) </li></ul></ul><ul><ul><ul><li>30mg PO daily, increase 15mg q 2-3 week </li></ul></ul></ul><ul><ul><li>Liotrix (Thyrolar) synthetic combo T3 & T4 </li></ul></ul><ul><ul><ul><li>Thyrolar 1/2 (6.25/25mcg) start1 tab daily , increase PRN q 2-3 weeks. </li></ul></ul></ul><ul><ul><li>L-triiodothyronine (Cytomel) synthetic T3 </li></ul></ul><ul><ul><ul><li>25mcg PO daily/ increase 12.5-25mcg daily every 1-2 weeks </li></ul></ul></ul>
    • 39. Hypothyroidism-Treatment <ul><li>Adverse Effects </li></ul><ul><ul><li>MI </li></ul></ul><ul><ul><li>Osteopenia </li></ul></ul><ul><ul><li>HA </li></ul></ul><ul><li>Contraindicated </li></ul><ul><ul><li>Acute MI </li></ul></ul><ul><ul><li>Treatment of obesity </li></ul></ul><ul><ul><li>Uncontrolled HTN </li></ul></ul>
    • 40. Monitoring <ul><li>Obtain baseline FT4, TSH, LFT, CBCs before initiation of therapy </li></ul><ul><li>Repeat FT4 and TSH after 4-6 weeks on therapy and 4-6 weeks after adjustments </li></ul><ul><li>Once euthyroid state obtain thyroid function test after 3-6 months </li></ul>
    • 41.  

    ×