This document provides an overview of the endocrine system and various endocrine disorders, including diabetes mellitus and thyroid disorders. It defines diabetes as a condition of high blood glucose levels and describes the characteristics and types of diabetes mellitus. It also discusses the causes, pathophysiology, clinical manifestations, diagnosis, and treatment of hypothyroidism and hyperthyroidism.

1. Endocrine System
Diploma in Pharmacy
2nd Year
Subject : Pharmacotherapeutics
Presented by
Miss Sudipta Roy
Associate Professor
Department : Pharmaceutics
East Point College of Pharmacy

2. Diabetes.
• Diabetes is a condition of over limit of glucose level
in blood than normal.

3. Definition.
• When glucose level is increased in blood known as
diabetes.
• Characteristics of Diabetes :
• Chronic Hyperglycemia (Increased glucose level in
blood)
• Glycosuria (Increased glucose level in urine)
• Hyperlipidemia (Increased lipid level in blood)
• Negative nitrogen balance
• Altered Metabolism of carbohydrates , lipids and
proteins.

4. Definition of Diabetes Mellitus
according to WHO.
• Heterogeneous metabolic disorder.
• Characteristics :
• Chronic Hyperglycemia
• Disturbances of carbohydrates , fat and protein
metabolism.

5. Hyperglycemia.
• Increased concentration of glucose in blood.
• Types of Diabetes.
• Type I Diabetes Mellitus :
• Insulin dependent Diabetes Mellitus (IDDM) .
• Characteristics :
• Absolute deficiency of Insulin caused by β cells
necrosis.
• Visible in children and young adults (below 30
years)
• Juvenile-onset diabetes.

6. Category of Type I Diabetes
Mellitus.
• Subtype I A : Autoimmune destruction of beta cells
that leads to insulin deficiency.
• Subtype I B (Idiopathic) : Insulin deficiency with
tendency to develop ketosis. This is also known as
idiopathic.

7. Type II Diabetes Mellitus.
• Non Insulin Dependent Diabetes Mellitus
• Pancreas secretes insulin but the secretion is either
delayed or the peripheral tissues develop
resistance to the secreted insulin.
• Occurrence at any age but more common in patient
above 40 years.

8. Gestational Diabetes.
• Temporary condition during pregnancy.
• Based on risk factors of pregnancy , 3 % to 13 % of
women will develop gestational diabetes that can
be harmful for the baby.
• The problem usually clears up after delivery .
• Risk : Women who have had gestational diabetes in
higher risk zone of developing type 2 diabetes later
in life.

9. Causes of Diabetes Mellitus.
• Factors affecting Type I Diabetes Mellitus.
• Genetic factors.
• Multiple genes responsible for inheritance of
diabetes mellitus .
• 50% more chances of development of type I DM in
another twin.
• 50 % people have history of Type I DM containing
susceptibility gene on HLB region of chromosome
particularly HLA DR3 , HLA DR4 and HLA DQ locus.

10. Autoimmune factors.
• The beta cells act as autoantigens and activate
CD4+ T lymphocytes , causing destruction of
pancreatic beta cells.

11. Environmental Factors.
• Certain viral infections e.g. Mumps , Measles ,
Coxsackie virus , cytomegalovirus , drugs (e.g.
alloxan , pentamidine , streptozocine ) , geographic
and seasonal variation also induce type I diabetes
mellitus.

12. Type II Diabetes Mellitus
• It occurs either by delayed insulin secretion or
tissues become resistant to insulin . Type 2 diabetes
starts from a combination of genetics and lifestyle
factors.

13. Genetic Factors.
• Study of genetic factors for type II DM is important
than for type I . Identical twins has 80% chances of
getting type II DM . If parents are suffering from
type II DM, then offsprings will be at 50% more risk
to have type II DM.

14. Constituional Factors.
• It involves the environmental factors and other
factors such as obesity, hypertension and low level
of physical of physical activity.

15. Insulin Resistance.
• Most Prominent feature of type II DM is lack of
response to the insulin secreted (peripheral tissues
like skeletal muscle , liver to develop resistance to
inulin. Obesity is strongly associated with insulin
resistance.

16. Impaired Insulin Secretion.
• At earlier stages of type II DM insulin secretes in
large amount to compensate increased glucose
levels. But later on , there is occurrence of failure of
beta cells to secrete adequate insulin.

17. Increased Hepatic Glucose
Synthesis.
• Insulin has role to suppress gluconeogenesis in
liver. But in type II DM , liver becomes resistant to
insulin. So , gluconeogenesis i.e. synthesis of
glucose cannot be suppressed by insulin.

18. Gestational Diabetes.
• Gestational diabetes is the result of hormonal
changes during pregnancy . The placenta produces
hormones that makes a pregnant woman's cells
less sensitive to the effects of insulin. This can
cause high blood sugar during pregnancy. Women
who are overweight when they get pregnant or
who gain too much weight during their pregnancy
are more likely to get gestational diabetes.

19. Pathophysiology.
• Type I Diabetes Mellitus.
• There are three mechanisms which are responsible
for the islets cells destruction or for type I DM.
These are :
• Genetic susceptibility
• Auto immune attack
• Environmental factors

20. Pathways of β-cell Destruction
leading to Type -I DM
• HLA-Linked Genes and other Genetic loci
• Immune Response Against Normal β-cells or
Immune Response Against Altered β-cells -
Environmental Factors (Viral Infection Drugs ,
Geographic and Seasonal Variations.)
• Autoimmune Attack
• β-cells destruction
• Type I Diabetes Mellitus

21. Type II Diabetes Mellitus.
• There are number of factors which are involved in
the pathophysiology of Type II DM.
• These are as follows.
• Genetic Factors
• Constitutional Factors
• Insulin Resistance
• Decreased Insulin Secretion
• Increased hepatic glucose synthesis

22. • Genetic factors :
• Concordance in identical twins (80%)
• Both parents diabetic (50%) risk to the child
• Decreased Insulin Secretion
• Glucose toxicity of islets ?
• Lipotoxicity ?

23. • Constitutional Factors.
• Obesity
• Hypertension
• Low Physical Activity
• Insulin
• Resistance
• Receptor and Post Receptor

24. • Increased Hepatic Glucose Syntheis
• Hyperglycemia
• β cell Exhaustion
• Type II Diabetes Mellitus

25. Clinical Manifestations.
• Type I diabetes occurs generally in age less than 35 years.
Symptoms of Type I DM are :
• Hyperglycemia
• Glycosuria (Glucose in urine)
• Polyurea (Excess urine excretion)
• Polydipsia (Increased Thirst)
• Polyphagia (Increased hunger)
• Weakness in body due to less use of glucose
• Progressive loss of weight
• Ketoacidosis : Degradation of fats produce ketone bodies.
They are poisonous (acidic) causing acidosis.
• Blurred vision.

26. • Type II Diabetes Mellitus.
• Symptoms of type II diabetes can include :
• Increased hunger
• Increased Thirst
• Increased Urination
• Blurry Vision
• Tiredness
• Sores that are slow to heal

27. Diagnosis
• Oral Glucose Tolerance Test (OGTT)
• Blood Test : Randomly , after having breakfast ,
fasting blood level
• Glycated Hemoglobin Test (HbA1C Test )
• Urine Test

28. Treatment
• Non Pharmacologica Treatment
• Pharmacological Treatment
• Surgery
• 1. Non-Pharmacological Treatment :
• To take high diet and avoid high fat and carbohydrate diet.
• Do not eat sweet foods like jam , chocolates , cake , sweets , cream etc.
that raise the levels of triglycerides in body.
• Boiled or steam food to be eaten . Don't use excess oil for cooking.
• Use of oils and colors to be avoided for making sweets.
• Avoid alcohol intake.
• Artificial sweetneres like aspartame and saccharin are available.
• Weight control
• Exercise should be done regularly.
• Ample amount of water should be taken daily.

29. Pharmacological Treatment.
• 1. Oral hypoglycemic drugs : Tolbutamide ,
chlorpropamide , Glipizide
• 2. Herbal drugs : Gaurgum , stevia , paneer booti
(Withania coagulence)
• 3. Surgery : Surgery is done rarely . In this case
there is transplantation of β-cells of pancreas ,
weight loss surgery and kidney transplantation.

30. Thyroid disorders.
• Thyroid gland is the largest endocrine gland. The
thyroid gland secretes T3 (Tri-iodothyronine) and
T4 (Thyroxine) . These two hormones collectively
called as thyroid hormone. Hypothalamus release
thyrotropin releasing hormone (TRH) which act on
anterior pituitary and stimulate it. After stimulation
anterior pituitary gland release thyroid stimulating
hormone (TSH) and this hormone act on thyroid
gland to release T3 and T4.

31. • Any abnormalities or change in this release pattern
of these hormones can increase or decrease the
amount of hormone (T3 and T4) . According to the
change in release conditions are named as
hypothyroidism (Deficiency of thyroid hormones )
or hyperthyroidism (Excessive secretion of thyroid
hormones ) .

32. Hypothyroidism.
• Hypothyroidism is a common condition where the
thyroid gland does not release enough thyroid
hormone into the bloodstream. This makes the
metabolism slow down. It is called underactive
thyroid. Hypothyroidism can make the individual feel
tired , gain weight and be unable to tolerate cold
temperatures.
• Definition.
• Hypothyroidism is an endocrine disorder in which
thyroid gland fails to produce enough amount of
thyroid hormones.

33. Types of Hypothyroidism.
• Three types of hypothyroidism - primary ,
secondary and tertiary.
• Primary Hypothyroidism.
• It is defined as low levels of blood thyroid hormone
due to destruction of the thyroid gland itself. This
destruction is usually caused by autoimmunity or
an intervention such as surgery , radioiodine or
radiation . This means that thyroid itself is the
source of the problem.

34. Secondary Hypothyroidism
• In secondary hypothyroidism , pituitary gland fails
to secrete thyroid stimulating hormone (TSH) .
Pituitary gland does not stimulate thyroid gland to
produce enough hormones. This is usually caused
by a tumor in the region of the pituitary.
• Tertiary Hypothyroidism.
• In tertiary hypothyroidism , inadequate secretion of
thyrotropin-releasing hormone (TRH) from the
hypothalamus leads to insufficient release of TSH ,
which in turn causes inadequate thyroid
stimulation. In tertiary hypothyroidism ,
hypothalamus is the source of problem.

35. Etiology.
• There are several factors responsible for hypothyrodism
.
• These are......
• Use of radiactive iodine
• Autoimmune disorders (Hashimoto's thyroiditis)
• Deficiency of dietary iodine.
• Sub-acute thyroiditis
• Lack of functioning of thyroid gland at birth.
• Lithium therapy
• Over treatment with antithyroid drugs
• Destruction , suppression and removal of all or some of
thyroid tissue by thyroidectomy.

36. Pathophysiology.
• Thyroid gland needs iodine for the production of
thyroid hormones (T3 and T4) .Production of
thyroid hormone also depends upon the TSH,
Iodine and Protein Intake. Deficiency of iodine
cause goitre that leads to enlargement of thyroid
gland. The secretion of T3 and T4 reduced from the
thyroid gland.

37. Clinical Manifestation.
• The signs and symptoms may include :
• Fatigue
• Increased sensitivity to cold
• Weight gain
• Constipation
• Dry skin
• Puffy face
• Muscle Weakness

38. • Elevated blood cholesterol level.
• Muscle aches , tenderness and stiffness.
• Pain , stiffness or swelling in your joints.
• Heavy menstrual periods in females.
• Thinning hair.
• Abnormal temperature and pulse rate.
• Depression , irritability and anxiety.
• Impaired memory
• Enlarged thyroid gland

39. Diagnosis.
• History collection
• Physical Examination
• Thyroid function test - Check low level of T3 and T4
in the blood.
• Elevated Thyroid-stimulating hormone (TSH) level.
• Serum Cholesterol Test
• ABG (Arterial Blood Gas) Analysis
• Electrocardiogram

40. Treatment
• 1. Non Pharmacological Treatment.
• Avoid Smoking
• Avoid eating fatty food
• Take iodine containing diet
• Pharmacological Treatment.
• 1. Liothyronine. It is synthetic T3. It has uniform
potency but has a higher incidence of cardiac
adverse effects, higher cost and difficulty in
monitoring with conventional laboratory tests.
• Liotrix (Synthetic T4:T3 in a 4:1 ratio) : It is
chemically stable , pure and has a predictable

41. Hyperthyroidism.
• Hyperthyroidism , also called overactive thyroid, is
a condition where thyroid gland produce and
releases high levels of thyroid hormone.
• Hyperthyroidism can accelerate the body's
metabolism , cause unintentional weight loss ,
rapid heart beat , increased appettite and anxiety.

42. • Types of Hyperthyroidism :
• There are several forms of hyperthyroidism , including :
• 1. Grave's Disease (Diffuse Toxic Goitre) .
• Grave's disease is the most common cause of
hyperthyroidism . Graves' disease is caused by an antibody
that stimulates the thyroid too much. This overstimulation
causes the excess production of thyroid hormone . It is most
common in young to middle aged women and tends to run
in families. The thyroid gland swells up leading to goiter. It is
characterized by exophthalmia (bulging eyeballs with a
staring look and less blinking). because of fluid
accumulation behind them , loss of weight , increase body
temperature , rapid heartbeat , nervousness and
restlessness.

43. Toxic Nodular Goiter
(Multinodular Goiter) :
• In this condition one or two nodules of a gland that
is already affected by goiter (simple goiter)
becomes active and secrete excess T3 and T4
causing the effects of hyperthyroidism.

44. Thyroiditis.
• Sometimes thyroid gland can become inflamed
after pregnancy , due to an autoimmune condition
or for unknown reasons . The inflammation can
cause excess thyroid hormone stored in the gland
to leak into your bloodstream. Some types of
thyroiditis may cause pain , while others are
painless.

45. Etiology.
• Hyperthyroidism can be caused by a number of
conditions , including :
• Graves' Disease
• Hyperfunctioning of thyroid nodules (toxic
adenoma , toxic multinodular goiter or plummer's
disease)
• Thyroiditis
• Pituitary Disease
• Genetic Factors
• Consuming excess iodine.

46. Other risk factors for
hyperthyroidism include:
• A family history , particularly of Grave's Disease
• Female Sex
• A personal history of certain chronic illness , such
as type 1 diabetes , pernicious aneamia and
primary adrenal isufficiency.

47. Pathophysiology.
• Graves' Disease .
• Production of Thyroid Stimulating Immunoglobins. (TSI)
• Thyroiditis : Stimulation of TSI
• Excess of Intake of Iodine :
• Stimulation of B-lymphocytes
• TSI bind to the thyroid stimulating hormone receptor to mimic the
action of TSH.
• Follicular cell growth inside the thyroid gland.
• Enhance the synthesis and secretion of thyroid hormone.
• Hyper Metabolism
• Increase sympathetic nervous system activity
• Excessive amount of thyroid hormone stimulates cardiac system and
stimulates adrenergic recepetors.
• Tachycardia , increase cardic output , stroke volume and peripheral
blood flow.

48. Clinical Manifestations.
• According to the National Institutes of Health (NIH) , signs and symptoms of
hyperthyroidism include :
• Weight loss , but with an increased appetite
• Rapid or irregular heartbeat.
• Feeling nervous or irritable.
• Fatigue
• Trouble sleeping
• Hand tremors , muscle weakness
• Getting easily overheated
• Diarrhea and more frequent bowel movements
• Vision changes
• Thin , warm and moist skin
• Menstrual changes
• Intolerance to heat and excessive sweating.
• Swelling and enlargement of the neck from an enlarged thyroid gland (goiter)
• Hair loss and change in hair texture (brittle)
• Bulging of the eyes (seen with Graves' disease)

49. Diagnosis.
• Physical Examination.
• Thyroid gland , heart (to check irregular heart beat)
, hands tremor , skin (warm and moist).
• Opthalmologic Examination
• Blood Tests.
• THT (Thyroid function test) : T3, T4, TSH , TRH
• Imaging tests to look at your thyroid : Radioactive
Iodine Uptake (RAIU) Test , Thyroid scan , Thyroid
ultrasound.

50. Treatment.
• Antithyroid Drugs.
• These drugs help to lower the level of thyroid hormone in
the blood.
• Examples - Methimazole , Propylthiouracil
• Radioactive Iodine -
• It is available in the form of a pill or liquid that damages
thyroid cells so that production of thyroid hormones is
slowed down.
• Surgery to remove all or part of the thyroid .
• Beta blockers .
• These drugs block the action of thyroid hormone on the
body , mostly to decrease the rapid heart rate and
palpitations.

51. Short answe questions.
• What is Grave's Disease?
• Define Diabetes Mellitus.
• What is IDDM?
• Define Hypothyroidism.
• Which hormones are released by thyroid gland?
• What is hyperglycemia?

52. Long Answer Questions.
• Explain different types of diabetes mellitus.
• Explain pathophysiology of type I, type II DM.
• Write a note on hypothyroidism .
• What are three types of hypothyroidism ?
• Write note on hyperthyroidism.

53. MCQ Questions.
• Diabetes is defined as -
• 1. A metabolic disorder characterized by low blood
sugar
• 2. A metabolic disorder characterized by high blood
sugar
• 3. A family of blood infections
• 4. None of the above.

54. Which is not a symptom of
diabetes ?
• Blurry Vision
• Thirst
• Frequent Urination
• Muscle Pain
• Insulin is natural hormone secreted by which gland
?
• Pituitary
• Pancreas
• Thyroid
• Adrenal

55. Type II Diabetes can cause long
term damage in the :
• Kidneys
• Nerves
• Eyes
• All of the above
• Gestational Diabetes occurs......
• During pregnancy
• After a bout with shingles
• At birth
• After menopause

56. • When the body does not respond to insulin it makes ,
this is called......
• Type I Diabetes
• Type II Diabetes
• Both
• None of the Above
• With .......diabetes , the body does not produce insulin
.....
• Type I
• Type II
• Gestational
• None of the Above

57. • Which one is the main hormone secreted by the
thyroid gland?
• T3
• T4
• Both
• TSH
• Grave's Disease is due to :
• Hyperactivity of adrenal gland
• Hyperactivity of thyroid gland
• Hypoactivity of adrenal gland

58. • Which of these disease is not related to thyroid gland?
• Cretinism
• Myxoedema
• Goiter
• Acromegaly
• The condition of chronic inflammation of thyroid
leading to under activity is -
• Thyroiditis
• Goiter
• Hypothyroidism
• Hyperthyroidism

59. • The thyroid produces hormones that regulate what
bodily function-
• Metabolism
• Temperature
• Blood Pressure
• Digestion
• Weigh loss , rapid heart rate and heat sensitivity are
likely symptoms of .
• Hypothyroidism
• Hyperthyroidism
• Thyroid cancer
• All of the above

60. • Thyroid Disorders are sometimes mistaken for which disease or condition?
• Crohn's disease
• Pregnancy
• Menopause
• Posttraumatic stress disorder
• How is hypothyroidism treated?
• with radiation
• with surgery
• with a synthetic hormone
• untreated condition
• the symptoms of hypothyroidism is
• Fatigue
• Intolerance to cold
• Weight gain
• All of the above