The document discusses various thyroid conditions including:
1) Hyperthyroidism which can be primary, secondary, or tertiary based on where the problem originates and causes signs of a hypermetabolic state. Graves disease is mentioned as the most common cause.
2) Hypothyroidism which also can be primary, secondary, or tertiary and causes a hypometabolic state. Causes mentioned include Hashimoto's thyroiditis which is the most common in the US.
3) Specific thyroid conditions are described briefly including Hashimoto's thyroiditis, DeQuervain thyroiditis, subacute lymphocytic thyroiditis, and Riedel's thyroiditis.
10. A hypermetabolic state causedA hypermetabolic state caused
by increased thyroid hormones.by increased thyroid hormones.
1°: thyroid problem1°: thyroid problem
2°: pituitary problem2°: pituitary problem
3°: hypothalamic problem3°: hypothalamic problem
HyperthyroidismHyperthyroidism
13. Diagnosis
Lab Diagnosis :Lab Diagnosis : Low or suppressed TSH,
elevated free thyroxin
level (FT4)
[Normal value TSH – 0.46 – 5.68
mcIU/ml
FT4 – 10.0 – 28.2 pmol/L]
• 10% of patients have an increased total or free T3 level and
normal T4 level with suppressed TSH level, a condition
called "T3 toxicosis“ [Normal FT3 – 4.26 – 8.10 pmol/L]
• In Graves disease, elevated levels of antitopoisomerase
antibodies and antithyroglobulin antibodies are found in 80%
and 50% of cases, respectively.
19. A hypometabolic state causedA hypometabolic state caused
by decreased thyroid hormones.by decreased thyroid hormones.
1°: thyroid problem1°: thyroid problem
2°: pituitary problem2°: pituitary problem
3°: hypothalamic problem3°: hypothalamic problem
HypothyroidismHypothyroidism
20. GeneralGeneral:: fatigue, weight gain, cold intolerancefatigue, weight gain, cold intolerance
CardiacCardiac:: slow pulse, impaired contractionslow pulse, impaired contraction
NervousNervous:: delayed reflexes, lethargydelayed reflexes, lethargy
SkinSkin:: rough, dry; hair loss (eyebrows)rough, dry; hair loss (eyebrows)
GastrointestinalGastrointestinal:: reduced appetite, constipationreduced appetite, constipation
MyxedemaMyxedema:: deepened voice,deepened voice, “edema”“edema”
Myxedema comaMyxedema coma:: deteriorating mental statusdeteriorating mental status
Hypothyroidism Signs and
Symptoms
22. CommonCommon UncommonUncommon
• Goiter
• Infiltrative stuff
• Too much iodine
• 2° hypothyroidism
• 3° hypothyroidism
• Other thyroiditis
• Hashimoto
• Iatrogenic
Causes of Acquired Hypothyroidism
23. • Also known as struma lymphomatosa, lymphocytic thyroiditis
• Most common cause of hypothyroidism in the US!
• F>>M
• Autoimmune destruction of gland
• Circulating autoantibodies
• Antimicrosomal antibodies
• Antithyroid peroxidase
• Antithyroglobulin antibodies
• Associated with HLA-DR5 (goitrous form), HLA-DR3 (atrophic
form)
Hashimoto Thyroiditis
24. Breakdown of peripheral tolerance to thyroid autoantigens, results in progressive
autoimmune destruction of thyroid cells by infiltrating cytotoxic T cells, locally released
cytokines, or by antibody-dependent cytotoxicity.
25. Moderately cellular with aggregates of oncocytes (finely granular cytoplasm, large
hyperchromatic nuclei, variable pleomorphism) and mature lymphocytes; also
follicular cells, plasma cells, macrophages, neutrophils
27. • Also known as Granulomatous thyroiditisAlso known as Granulomatous thyroiditis
• Big, sore thyroidBig, sore thyroid
• History of recent URIHistory of recent URI
• In association with coxsackievirus, mumps, measles,In association with coxsackievirus, mumps, measles,
adenovirusadenovirus
• Immune cross-reaction with thyroid folliclesImmune cross-reaction with thyroid follicles
• Self-limitingSelf-limiting
DeQuervain Thyroiditis
30. • Also known as Painless thyroiditis
• Post-partum or middle age.
• Slightly enlarged thyroid.
• Circulating Antithyroid peroxidase antibodies.
• Family history of other autoimmune disorder.
Subacute Lymphocytic
Thyroiditis