Hyperthyroidism (overactive thyroid) occurs when your thyroid gland produces too much of the hormone thyroxine. Hyperthyroidism can accelerate your body's metabolism, causing unintentional weight loss and a rapid or irregular heartbeat
Hypothyroidism (underactive thyroid) is a condition in which your thyroid gland doesn't produce enough of certain crucial hormones.
Thyroid Gland and Disease of Thyroid GlandRanadhi Das
The thyroid gland is one of the largest endocrine glands.
The thyroid gland is located immediately below the larynx and anterior to the upper part of the trachea. It weighs about 15-20g.
It consists of 2 lateral lobes connected by a narrow band of thyroid tissue called the isthmus.
The isthmus usually overlies the region from the 2nd to 4th tracheal cartilage.
Hyperthyroidism (overactive thyroid) occurs when your thyroid gland produces too much of the hormone thyroxine. Hyperthyroidism can accelerate your body's metabolism, causing unintentional weight loss and a rapid or irregular heartbeat
Hypothyroidism (underactive thyroid) is a condition in which your thyroid gland doesn't produce enough of certain crucial hormones.
Thyroid Gland and Disease of Thyroid GlandRanadhi Das
The thyroid gland is one of the largest endocrine glands.
The thyroid gland is located immediately below the larynx and anterior to the upper part of the trachea. It weighs about 15-20g.
It consists of 2 lateral lobes connected by a narrow band of thyroid tissue called the isthmus.
The isthmus usually overlies the region from the 2nd to 4th tracheal cartilage.
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Thyroiditis is a general term that refers to “inflammation of the thyroid gland”. Thyroiditis includes a group of individual disorders causing thyroidal inflammation but presenting in different ways. For example, Hashimoto's thyroiditis is the most common cause of hypothyroidism in the United States.
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Thyroiditis is a general term that refers to “inflammation of the thyroid gland”. Thyroiditis includes a group of individual disorders causing thyroidal inflammation but presenting in different ways. For example, Hashimoto's thyroiditis is the most common cause of hypothyroidism in the United States.
This simplified lecture gives an account of how to approach a patient with a neck mass. Moreover, it shows hoe master thyroid gland history taking and examination and general examination.
Additionally, the lecture is supported by many real-life scenarios to cover the topics from a clinical point of view.
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http://sandymillin.wordpress.com/iateflwebinar2024
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Students, digital devices and success - Andreas Schleicher - 27 May 2024..pptxEduSkills OECD
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Instructions for Submissions thorugh G- Classroom.pptxJheel Barad
This presentation provides a briefing on how to upload submissions and documents in Google Classroom. It was prepared as part of an orientation for new Sainik School in-service teacher trainees. As a training officer, my goal is to ensure that you are comfortable and proficient with this essential tool for managing assignments and fostering student engagement.
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He discussed the concept of quality improvement, emphasizing its applicability to various aspects of life, including personal, project, and program improvements. He defined quality as doing the right thing at the right time in the right way to achieve the best possible results and discussed the concept of the "gap" between what we know and what we do, and how this gap represents the areas we need to improve. He explained the scientific approach to quality improvement, which involves systematic performance analysis, testing and learning, and implementing change ideas. He also highlighted the importance of client focus and a team approach to quality improvement.
The Roman Empire A Historical Colossus.pdfkaushalkr1407
The Roman Empire, a vast and enduring power, stands as one of history's most remarkable civilizations, leaving an indelible imprint on the world. It emerged from the Roman Republic, transitioning into an imperial powerhouse under the leadership of Augustus Caesar in 27 BCE. This transformation marked the beginning of an era defined by unprecedented territorial expansion, architectural marvels, and profound cultural influence.
The empire's roots lie in the city of Rome, founded, according to legend, by Romulus in 753 BCE. Over centuries, Rome evolved from a small settlement to a formidable republic, characterized by a complex political system with elected officials and checks on power. However, internal strife, class conflicts, and military ambitions paved the way for the end of the Republic. Julius Caesar’s dictatorship and subsequent assassination in 44 BCE created a power vacuum, leading to a civil war. Octavian, later Augustus, emerged victorious, heralding the Roman Empire’s birth.
Under Augustus, the empire experienced the Pax Romana, a 200-year period of relative peace and stability. Augustus reformed the military, established efficient administrative systems, and initiated grand construction projects. The empire's borders expanded, encompassing territories from Britain to Egypt and from Spain to the Euphrates. Roman legions, renowned for their discipline and engineering prowess, secured and maintained these vast territories, building roads, fortifications, and cities that facilitated control and integration.
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Culturally, the Romans were eclectic, absorbing and adapting elements from the civilizations they encountered, particularly the Greeks. Roman art, literature, and philosophy reflected this synthesis, creating a rich cultural tapestry. Latin, the Roman language, became the lingua franca of the Western world, influencing numerous modern languages.
Roman architecture and engineering achievements were monumental. They perfected the arch, vault, and dome, constructing enduring structures like the Colosseum, Pantheon, and aqueducts. These engineering marvels not only showcased Roman ingenuity but also served practical purposes, from public entertainment to water supply.
2. TSH
• Produced by Adenohypophysis Thyrotrophs
• Upregulated by TRH
• Downregulated by T4, T3
• Stimulates several processes
• Iodine uptake
• Colloid endocytosis
• Growth of thyroid gland
3. Thyroid Hormone
Majority of circulating hormone is T4
98.5% T4
1.5% T3
Total Hormone load is influenced by serum
binding proteins
Albumin 15%
Thyroid Binding Globulin 70%
Transthyretin 10%
Regulation is based on the free component of
thyroid hormone
5. Iodine deficiency
Iodine deficiency most common cause
of goiter & hypothyroidism worldwide
Effect of I deficiency aggravated by
goitrogens foods, with anti-thyroid
properties
(Africa, South America)
10. Goiter
Etiology
Diet: Iodine deficiency
Brassica (cabbage, turnips, cauliflower, broccoli)
Hashimoto’s thyroiditis
Early stages only, late stages show atrophic changes
May present with hypo, hyper, or euthyroid states
Graves’ disease
Due to chronic stimulation of TSH receptor
Chronic Iodine excess
Iodine excess leads to increased colloid formation and
can prevent hormone release
Medications
Immunosuppressants, antiretrovirals, heart drug
prevents release of hormone, causes goiter in 6% of
chronic users
11. Goiter Classification
Goiter: Chronic enlargement of the thyroid
gland not due to neoplasm
• Endemic goiter
• Areas where > 5% of children 6-12 years of age have
goiter
• Common in China and central Africa
• Sporadic goiter
• Areas where < 5% of children 6-12 years of age have
goiter
• Familial
12. Morphology Classification
Regarding morphology, goiters may be classified either as the
growth pattern or as the size of the growth:
•Growth pattern
•1. Uninodular (struma uninodosa) - can be either inactive or a
toxic nodule
•2. Multinodular (struma nodosa) - can likewise be inactive or
toxic, the latter called toxic multinodular goiter
•3. Diffuse (struma diffuse), with the whole thyroid appearing to
be enlarged.
•Size Class I - palpation struma - in normal posture of the head,
it cannot be seen; it is only found by palpation.
•Class II - the struma is palpative and can be easily seen.
•Class III - the struma is very large and is retrosternal; pressure
results in compression marks.
13. * Pathogenesis:
a. Parenchymatous goiter:
•Iodine deficiency → decreased thyroid hormone
synthesis → increases TSH secretion → thyroid glands
hyperplasia.
•The acini are increased in number and lined by tall
columnar cells and contain little colloid.
•If iodine deficiency is corrected after a short time, the
acini return to the normal state.
14. DIFFUSE NONTOXIC (SIMPLE) GOITER
GROSS
Diffuse symmetrical
enlargement of the
gland
SIZE: Rarely exceeds
100-150gm
C/S: Brown, glassy,
translucent
MICROSCOPY
Follicles lined by low
cuboidal or flattened
epithelial cells
Abundant colloid during
involution
16. Multinodular Goiter (MNG)
• MNG is an enlarged thyroid gland containing
multiple nodules
– The thyroid gland becomes more nodular with
increasing age
– In MNG, nodules typically vary in size
• MNG may be toxic or nontoxic
– Toxic MNG occurs when multiple sites of autonomous
nodule hyperfunction develop, resulting in
THYROTOXICOSIS
– Toxic MNG is more common in the elderly
24. Clinical Manifestations
• If thyroid function is preserved, most
goiters are asymptomatic
• If the thyroid is markedly enlarged, it can
cause tracheal or esophageal compression
25. •Swollen front of the neck
•Protruding (popping out) eyes
•A tight feeling in the throat
•Coughing
•Difficulty in swallowing & breathing
26. • Substernal goiter
– May obstruct the thoracic inlet
– Respiratory flow measurements and CT or MRI
should be used to evaluate substernal goiter in
patients with obstructive signs or symptoms
• Pemberton's sign
– Symptoms of faintness with evidence of facial
congestion and external jugular venous
obstruction when the arms are raised above the
head, a maneuver that draws the thyroid into the
thoracic inlet
27. Symptoms also include:
•Fatigue
•Frequent bowel movements
•Heat intolerance
•Increased appetite
•Increased sweating
•Menstrual irregularities (in women)
•Muscle cramps
•Nervousness
•Restlessness
•Weight loss
29. Enlargement
• 0 – the gland is not palpated
• I – some part of the gland can be palpated
• II- the gland can be seen although the neck is in a
normal shape
• III – shape of the neck is being changed
• IV – configuration of the neck is being changed
• V – an giant goiter with complications
31. Treatment Options
1. Symptom relief medications
2. Anti Thyroid Drugs – ATD
Methimazole, Carbimazole
Propylthiouracil (PTU)
1. Radio Active Iodine treatment – RAI
Rx.
2. Thyroidectomy – Subtotal or Total
3. NSAIDs and Corticosteroids – for
SAT
32. •The use of iodized table salt
•Avoid goiter promoting foods such as
cabbage, Brussels sprouts, & soy
•Thyroid Replacement Therapy
•Thyroidectomy- surgery to remove part or all
of the thyroid.
33.
34. Complications
• Heart complications:
• Atrial fibrillation
• Congestive heart failure
• Rapid heart rate
• Superior vena cava obstruction
• Other complications:
• Bone loss leading to Osteoporosis
Multinodular Goiter (MNG).
The thyroid gland becomes more nodular with age.1 MNG develops in an enlarged thyroid gland and is especially prevalent in populations in iodine-deficient areas.2 Thyroid enlargement may have progressed from a simple nontoxic goiter or have been associated with Hashimoto disease.3 MNG usually results from a low-grade, probably intermittent stimulus to the thyroid gland from iodine deficiency, goitrogens (foods that induce hypothyroidism and goiter in the diet such as cabbage, broccoli, cauliflower, and brussels sprouts),4 decreased thyroid hormone production, or an autoimmune disease, which causes multiplication and growth of small groups of thyroid cells.3 After Graves disease, toxic multinodular goiter (TMG) is the most common cause of hyperthyroidism5 and thyrotoxicosis in the elderly.6 TMG occurs most often in patients aged 50 or older and mainly in women, when the nodules in a nontoxic MNG become autonomous5 and function independent of TSH stimulation.7 It is very prevalent in geographic regions with iodine deficiency and rarely occurs in places where iodine intake is sufficient. Thyroid autonomy is most frequently found in TMGs.7 Patients are often asymptomatic or very mildly toxic, and have a goiter, and lab findings that indicate suppressed TSH with normal FT4 and T3 levels.5
References
1. Hurley DL, et al. Geriatrics. 1995;50:24-26,29-31.
2. Tonacchera M, et al. J Clin Endocrinol Metab. 2002;87:352-367.
3. Bayliss RIS, Tunbridge WMG. Thyroid Disease: the Facts. 3rd ed. Oxford, UK: Oxford University Press; 1998:121.
4. Stoewsand GS. Food Chem Toxicol. 1995;33:537-543.
5. Fisher JN. South Med J. 2002;95:493-505.
6. Vitti P, et al. J Endocrinol Invest. 2002;25(10 Suppl):16-18.
7. Krohn K, et al. J Clin Endocrinol Metab. 2001;86:3336-3345.
