This document discusses thyroid diseases and is presented by Dr. Akshay Shetty. It begins with the objectives and physiology of the thyroid gland. It then covers hypothyroidism including its introduction, clinical features such as increased sleeping and muscle aches, and investigations like T3, T4, and TSH levels. Hyperthyroidism is also discussed with its introduction being Graves' disease in most cases. Clinical features include weight loss, heat intolerance, palpitations and eye changes. Investigations include thyroid hormone levels and scans. The summary recaps the content and references Davidson's Principles of Medicine.

1. THYROID
DISEASES
Dr. Akshay Shetty
Asst.Professor
SSRAMCH,Inchal

2. Contents
• Objectives
• Physiology of Thyroid gland
• Introduction of Hypothyroidism
• Clinical features of Hypothyroidism
• Investigations of Hypothyroidism
• Introduction of Hyperthyroidism
• Clinical features of Hyperthyroidism
• Investigations of Hyperthyroidism
• Summary
• Conclusion
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3. Objectives
By the end of the presentation the students must
be able to-
1. Discuss Physiology of Thyroid gland
2. Explain Introduction of Hypothyroidism
3. Enumerate Clinical features of
Hypothyroidism
4. State Investigations of Hypothyroidism
5. Explain Introduction of Hyperthyroidism
6. Enumerate Clinical features of
Hyperthyroidism
7. State Investigations of Hyperthyroidism
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4. Physiology of Thyroid Gland
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5. 02/06/2020 Thyroid Disease (Dr Akshay Shetty) 5

6. Synthesis &
Metabolism
• Iodine enters thyroid gland and is used for T3 and T4
production
• Hormones are released from the thyroid and vast
majority are protein bound (TBG) and deposited in
peripheral cells
• T4 has 4 iodine atoms, removal of one produces T3
Total= Bound to TBG
Free= Unbound
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7. Cont…
T3 &T4
• Facilitate normal growth and development
• Increase metabolism
• Increase catecholamine effects
TSH
• Most useful marker of thyroid hormone function
• Released in a pulsatile diurnal rhythm- highest at
night
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8. Introduction to
Hypothyroidism
• Insufficient thyroid hormone
1. Primary: thyroid gland failure
2. Secondary: pituitary gland failure
3. Tertiary: hypothalamus failure
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9. Cont…
Primary hypothyroidism
• Iodine deficiency- most common cause worldwide
• Congenital
• Autoimmune mediated
• Hashimoto’s thyroiditis- B lymphocytes invade
thyroid
• Iatrogenic- post-thyroidectomy or radio-iodine
treatment
• Drug-induced – Anti-thyroid, lithium, amiodarone
• Severe infection
• Trauma to thyroid/pituitary/hypothalamus
• Pituitary tumour
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10. Clinical features
of
Hypothyroidism
• Increased sleeping (14-16 hours daily)
• Generalized weakness
• Anorexia
• Muscle aches
• Paresthesias
• Constipation
• Cold intolerance
• Decreased libido, woman:difficulty becoming
pregnant, changes in menses;men/impotence
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11. Cont…
Coarse features
• Edema around eyes and face
• Blank expression
• Thick tongue
• Overall muscle movement is slow
• Lethargic, apathetic, drowsy, poor attention
span, poor memory
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12. Investigations of Hypothyroidism
• T3,T4
• TSH
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13. Introduction of
Hyperthyroidism
Hyperthyroidism (thyrotoxicosis) is excess thyroid
hormone
• Autoimmune
• Graves Disease (76%)
• F>M, age 20-40
• IgG auto antibodies bind TSH receptors T3
& T4
• Leads to gland hyper function
• Toxic adenoma and toxic multinodular goitre
• Viral Thyroiditis (de Quervain’s)
• Fever and ESR- self limiting
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14. Cont…
• Exogenous Iodine
• Neonatal thyrotoxicosis
• Drugs- Amiodarone
• TSH secreting pituitary adenoma (rare)
• HCG producing tumour
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15. Clinical features
of
Hyperthyroidism
• Recent weight loss
• Increased appetite
• Increase in # BM/day
• ****heat intolerance
• Diaphoresis even when temperatures
comfortable for others
• Palpitations/chest pain
• Dyspnea with or without exertion
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16. Cont…
• Infiltrative Ex ophthalmopathy (abnormal eye
appearance or function)
• Blurring/double vision/tiring of eyes
• Increased tears
• Photophobia
• Eyelid retraction(eyelid lag)
• Globe lag (eyeball lag)
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17. Goitre
• Thyroid gland may be 4 X normal
• Bruits (turbulence from increased blood flow)
heard with stethoscope
• Systolic BP
• Tachycardia
• Dysrhythmia
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18. Cont….
• Fine, soft, silky hair
• Smooth, moist skin
• Muscle weakness
• Hyperactive deep tendon reflexes
• Tremors of hands
• Restless, irritable, mood swings
• Decreased attention span
• Fatigued, inability to sleep
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19. Investigations of Hyperthyroidism
• T3
• T4
• TSH in Graves disease
• Radioactive Thyroid Scan
• Ultrasonography: used to determine goiter or nodules
• EKG: note tachycardia
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20. Summary
Physiology of Thyroid
gland
Introduction of
Hypothyroidism
Clinical features of
Hypothyroidism
Investigations of
Hypothyroidism
Introduction of
Hyperthyroidism
Clinical features of
Hyperthyroidism
Investigations of
Hyperthyroidism
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21. References • Davidson Principles Of Medicine & Practice Of
Medicine .20th Ed
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22. Thank you
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