Thyroid Disease

695 views

Published on

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

No Downloads
Views
Total views
695
On SlideShare
0
From Embeds
0
Number of Embeds
1
Actions
Shares
0
Downloads
39
Comments
0
Likes
5
Embeds 0
No embeds

No notes for slide

Thyroid Disease

  1. 1. Thyroid Disease Prof T O’Brien
  2. 4. Thyroid Hormone Excess Clinical Features <ul><li>General </li></ul><ul><ul><li>Heat intolerance, fatigue, tremor. </li></ul></ul><ul><li>Cardiovascular </li></ul><ul><ul><li>Tachycardia, heart failure. </li></ul></ul><ul><li>Gastrointestinal </li></ul><ul><ul><li>Weight loss, diarrhoea </li></ul></ul><ul><li>Ophthalmological </li></ul><ul><ul><li>Lid lag, ophthalmopathy </li></ul></ul>
  3. 5. Thyroid Hormone Excess Clinical Features <ul><li>Genitourinary </li></ul><ul><ul><li>Amenorrhea, infertility. </li></ul></ul><ul><li>Neuromuscular </li></ul><ul><ul><li>Proximal muscle weakness, HPP, MG </li></ul></ul><ul><li>Psychiatric </li></ul><ul><ul><li>Irritability, agitation, anxiety, psychosis </li></ul></ul><ul><li>Dermatological </li></ul><ul><ul><li>Pruritus, hair thinning, onycholysis, vitiligo. </li></ul></ul>
  4. 6. Diagnosis <ul><li>High Free T4, T3 and supressed </li></ul><ul><li>sTSH </li></ul><ul><li>If sTSH is high suspect pituitary tumour or rare cases of thyroid hormone resistance </li></ul>
  5. 7. Causes of Thyroid Hormone Excess <ul><li>Increased radioactive iodine uptake </li></ul><ul><ul><li>Graves </li></ul></ul><ul><ul><li>TMG </li></ul></ul><ul><ul><li>Toxic solitary adenoma </li></ul></ul><ul><ul><li>Pituitary tumour </li></ul></ul>
  6. 8. Causes of Thyroid Hormone Excess <ul><li>Reduced radioactive iodine uptake </li></ul><ul><ul><li>Thyroiditis </li></ul></ul><ul><ul><li>Iodine induced (amiodarone) </li></ul></ul><ul><ul><li>Factitious </li></ul></ul><ul><ul><li>Struma ovarii </li></ul></ul><ul><ul><li>Thyroid carcinoma </li></ul></ul>
  7. 12. Graves Disease <ul><li>Most common cause in Ireland </li></ul><ul><li>Diffuse Goitre </li></ul><ul><li>Hyperthyroidism </li></ul><ul><li>Ophthalmopathy </li></ul><ul><li>Dermopathy </li></ul><ul><li>Autoimmune. TSI. </li></ul>
  8. 13. TMG <ul><li>Older </li></ul><ul><li>Usually less severe hyperthyroidism </li></ul><ul><li>May have subclinical hyperthyroidism </li></ul><ul><li>May have long history of goitre </li></ul>
  9. 14. Toxic Solitary Adenoma <ul><li>Rare cause (< 2% of patients with hyperthyroidism) </li></ul><ul><li>Younger people 30’s and 40’s </li></ul><ul><li>Scan </li></ul><ul><li>Benign follicular adenomas </li></ul>
  10. 15. Thyroiditis <ul><li>Painful (subacute, de Quervain’s) </li></ul><ul><li>Painless (post partum) </li></ul><ul><li>Hyperthyroid, hypothyroid and euthyroid phases </li></ul><ul><li>Anti thyroid drug therapy does not work </li></ul>
  11. 16. Treatment of hyperthyroidism <ul><li>Antithyroid drugs </li></ul><ul><ul><li>Carbimazole 10 mg tid </li></ul></ul><ul><ul><li>Reduce to maintenance after 4 weeks </li></ul></ul><ul><ul><li>Rash, GI, agranulocytosis </li></ul></ul><ul><ul><li>Graves – withdraw drugs after course of treatment </li></ul></ul>
  12. 17. Treatment of hyperthyroidism <ul><li>Radio-iodine </li></ul><ul><ul><li>Inflammatory response followed by fibrosis </li></ul></ul><ul><ul><li>May be used for Graves, TMG or TA </li></ul></ul><ul><ul><li>? Need for drug treatment before and after </li></ul></ul><ul><ul><li>May need retreatment </li></ul></ul><ul><ul><li>Long term risk of hypothyroidism </li></ul></ul>
  13. 18. Treatment of Hyperthyroidism <ul><li>Surgery </li></ul><ul><ul><li>Rarely used nowadays </li></ul></ul><ul><ul><li>Need to be rendered euthyroid before surgery </li></ul></ul><ul><ul><li>Lugol’s iodine 0.1-0.3 mls tid for 10 days before surgery </li></ul></ul>
  14. 19. Treatment of Hyperthyroidism <ul><li>Patient presents with hyperthryoidism </li></ul><ul><li>Make diagnosis, get RAI uptake. </li></ul><ul><li>Beta block (inderal 40-80 mg tid). </li></ul><ul><li>If RAI uptake is high – treat with RAI. </li></ul><ul><li>If RAI is low - symptomatic </li></ul>
  15. 20. Thyroid Storm <ul><li>Carbimazole (or PTU) </li></ul><ul><li>Inderal, 80mg qid </li></ul><ul><li>Iodine (Lugols 5 drops q6) </li></ul><ul><li>Dexamethasone 2mg q6 </li></ul><ul><li>Other supportive measures </li></ul>
  16. 21. Graves Eye Disease <ul><li>Onset relative to hyperthyroidism is variable. </li></ul><ul><li>Pain, watering, photophobia, blurred vision, double vision </li></ul><ul><li>Usually mild – Tx, protective glasses, elevate head of bed, conjunctival lubricants </li></ul>
  17. 22. Graves Eye Disease <ul><li>High dose steroids </li></ul><ul><li>External radiotherapy </li></ul><ul><li>Orbital decompression </li></ul>
  18. 24. Hypothyroidism <ul><li>Hashimoto’s </li></ul><ul><li>Iatrogenic </li></ul><ul><li>Congenital </li></ul><ul><li>Hypopituitarism </li></ul>
  19. 25. Treatment <ul><li>Thyroxine 100-150ug daily. </li></ul><ul><li>Aim to normalize sTSH </li></ul><ul><li>In patients with CAD start with lower dose e.g. 25ug qd. </li></ul>
  20. 27. Simple non-toxic goitre <ul><li>Normal TFT’s </li></ul><ul><li>No treatment required </li></ul><ul><li>Surgery if obstructive symptoms </li></ul>
  21. 28. Non-thyroidal illness <ul><li>Ill patients may have low T3 and/or T4 usually with a normal sTSH </li></ul><ul><li>Psychotic patients may have elevated T3 and/or T4. </li></ul>
  22. 29. Thyroid Nodule <ul><li>FNA </li></ul><ul><li>Benign no further intervention </li></ul><ul><li>Malignant or suspicious– papillary or follicular. </li></ul>
  23. 30. Papillary Cancer <ul><li>Controversies </li></ul><ul><ul><li>Extent of surgery (near total thyroidectomy). Follow up with sTSH, thyroglobulin exam and US. </li></ul></ul><ul><ul><li>Radioactive iodine ablation for high risk tumours. Follow up with RAI scans plus the above. </li></ul></ul>
  24. 31. Follicular cancer <ul><li>Less common than papillary </li></ul><ul><li>Total thyroidectomy (or near total). </li></ul><ul><li>Routine remnant ablation with RAI due to increased risk of metastatic disease. </li></ul>

×