Hypo and Hyper Thyroidism
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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.
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Hypo and Hyper Thyroidism
- 1. Thyroidism & Thyroiditis Dr. Tushar
- 3. problem up here problem down here in a nutshell
- 4. Low Normal High Low Normal euthyroidism High TSH T4
- 7. Low Normal High Low 1° hypo- thyroidism Normal High T4 TSH
- 9. Low Normal High Low Normal subclinical hyper- thyroidism subclinical hypo- thyroidism High T4 TSH
- 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
- 11. GeneralGeneral:: weight loss, heat intoleranceweight loss, heat intolerance CardiacCardiac: (m/c): (m/c) rapid pulse, arrhythmiasrapid pulse, arrhythmias NeuromuscularNeuromuscular:: tremor, emotional labilitytremor, emotional lability SkinSkin:: warm, moist,warm, moist, GastrointestinalGastrointestinal:: diarrheadiarrhea EyeEye:: lid laglid lag Thyroid stormThyroid storm:: extreme, dangerous symptomsextreme, dangerous symptoms Hyperthyroidism Signs and Symptoms
- 12. CommonCommon UncommonUncommon • Thyroiditis • Drugs • Thyroid carcinoma • Pituitary adenoma • Struma ovarii • Factitous • Graves disease • Multinodular goiter • Thyroid adenoma Causes of Hyperthyroidism
- 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.
- 14. Diffuse hyperplasia of thyroid
- 15. • Most common cause of endogenous hyperthyroidism. • Autoimmune: anti-TSH receptor antibodies stimulate thyroid growth • Triad: hyperthyroidism, ophthalmopathy, dermopathy (Pretibial myxedema) • Lab findings: elevated free T4 and T3 • Depressed TSH Graves Disease
- 16. Exophthalmos
- 18. Diffusely hyperplastic thyroid. Follicles are lined by tall, columnar epithelium. papillae and scalloped colloid
- 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
- 21. • Causes: • endemic iodine deficiency, • genetic problems (inborn error of thyroid metabolism [dyshormonogenetic goiter]) • Thyroid agenesis [PAX8, FOXE1, TSH receptor mutations] • Thyroid hypoplasia • Symptoms are mild to severe • Treatment: thyroid hormone replacement • Prevention better Congenital Hypothyroidism
- 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
- 26. Hashimoto thyroiditis: Lymphocyte infiltration, Hürthle cells,
- 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
- 28. Looks scary Really harmless Goes away by itself
- 29. Chronic inflammatory infiltrates with multinucleated giant cell and colloid
- 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
- 31. lymphoid infiltrate (no fibrosis/hurthle cells)
- 32. • Rare! • Extensive fibrosis • Rock-hard neck mass (stimulates carcinoma) • Hypothyroidism • Tracheal compression Reidel Thyroiditis