Thyroid disorders are common in endocrinology. The document discusses the anatomy and functions of the thyroid gland, as well as the regulation of hormone production and classification of thyroid disorders. It provides an overview of hyperthyroidism (thyrotoxicosis) and hypothyroidism, including their causes, signs, symptoms, and treatment approaches. Graves' disease is described as the most common cause of thyrotoxicosis. Treatment options for hyperthyroidism discussed include beta-blockers, antithyroid medications, radioactive iodine, and thyroidectomy.
Hyperthyroidism, also known as overactive thyroid, results from excessive thyroid hormone production and secretion. Graves' disease, the most common cause, is an autoimmune disorder where antibodies stimulate the thyroid. It is characterized by diffuse thyroid enlargement, ophthalmopathy, and pretibial myxedema. Symptoms include palpitations, heat intolerance, weight loss and tremors. Diagnosis involves low TSH and high T4 levels and presence of thyroid autoantibodies. Treatment options include antithyroid medications, radioactive iodine ablation, or surgery. Thyroid storm is a medical emergency characterized by severe hyperthyroid symptoms that requires urgent beta-blockers, antithyroid drugs and supportive
Thyrotoxicosis- complete review of anatomy, physiology, types and clinical fe...Surjeet Acharya
this presentation covers extensive pictures for clear explanation. this includes the anatomy & physiology of thyroid gland, a case review, types, clinical features and treatment of thyrotoxicosis. and the most intersting part it, it also includes Recent Advances in field of thyrotoxicosis
Hyperthyroidism, also known as Graves' disease, occurs when the thyroid gland produces excessive amounts of thyroid hormone. The most common causes are Graves' disease, toxic multinodular goiter, and toxic adenoma. Clinical features include emotional instability, palpitations, weight loss, and warm skin. Diagnosis involves physical examination, thyroid hormone blood tests, and imaging tests such as thyroid ultrasound. Graves' disease is the most common cause of hyperthyroidism and is an autoimmune disease associated with eye and skin changes.
This document discusses a case of hyperthyroidism in a 39-year-old female presenting with nervousness, anxiety, palpitations, diarrhea, and weight loss. On examination, she had a heart rate of 110 bpm, tremor, increased reflexes, and an enlarged thyroid. Laboratory tests found high free T3 and T4, low TSH, and positive thyroid stimulating immunoglobulins, consistent with a diagnosis of Graves' disease. Graves' disease is an autoimmune disorder causing hyperthyroidism through thyroid stimulating antibodies. If left untreated, hyperthyroidism can progress to a thyroid storm, a life-threatening condition of severe hypermetabolism.
This document discusses endocrine disorders and their causes, symptoms, diagnosis and treatment. [1] Endocrine disorders can be caused by issues with the hypothalamus, pituitary gland, or hormone-producing glands and can result from congenital defects, infections, autoimmunity, tumors or unknown causes. [2] Too much or too little hormone production can occur due to failures in the feedback systems that control hormone levels or dysfunction of the endocrine glands themselves. [3] The document focuses on disorders of the thyroid gland (hypothyroidism, hyperthyroidism), adrenal gland (Addison's disease, Cushing's syndrome) and their clinical presentations and management.
The document provides information on the thyroid gland, including its anatomy, histology, physiology, pathology, and disorders. Some key points:
- The thyroid is one of the earliest endocrine organs to develop. It is located in the neck and weighs 15-25 grams.
- Graves' disease is the most common cause of hyperthyroidism. It is characterized by the triad of thyrotoxicosis, ophthalmopathy, and dermopathy due to autoantibodies that mimic TSH.
- Hypothyroidism is most commonly caused by Hashimoto's thyroiditis, an autoimmune disorder characterized by lymphocytic infiltration and antibody production. Clinical manifestations range from mild to
This document discusses thyrotoxicosis, or hyperthyroidism, including its various etiologies and clinical presentations. The main causes outlined are Graves' disease, toxic multinodular goiter, and toxic adenoma. Signs and symptoms involve the skin, eyes, cardiovascular and gastrointestinal systems, and muscles. Treatment options include anti-thyroid drugs, radioactive iodine, surgery, and beta-blockers. Radioactive iodine is often the treatment of choice for Graves' disease and toxic nodular goiter due to being inexpensive, effective, and safe.
This document discusses thyrotoxicosis, or hyperthyroidism, summarizing its main causes and treatments. The main causes are Graves' disease, toxic multinodular goiter, and toxic adenoma. Symptoms include eye changes, skin changes, cardiovascular effects, and nervous system effects. Treatment options include anti-thyroid drugs like carbimazole, radioactive iodine, and surgery. Radioactive iodine is often the treatment of choice, especially for Graves' disease and toxic nodular goiter.
Hyperthyroidism, also known as overactive thyroid, results from excessive thyroid hormone production and secretion. Graves' disease, the most common cause, is an autoimmune disorder where antibodies stimulate the thyroid. It is characterized by diffuse thyroid enlargement, ophthalmopathy, and pretibial myxedema. Symptoms include palpitations, heat intolerance, weight loss and tremors. Diagnosis involves low TSH and high T4 levels and presence of thyroid autoantibodies. Treatment options include antithyroid medications, radioactive iodine ablation, or surgery. Thyroid storm is a medical emergency characterized by severe hyperthyroid symptoms that requires urgent beta-blockers, antithyroid drugs and supportive
Thyrotoxicosis- complete review of anatomy, physiology, types and clinical fe...Surjeet Acharya
this presentation covers extensive pictures for clear explanation. this includes the anatomy & physiology of thyroid gland, a case review, types, clinical features and treatment of thyrotoxicosis. and the most intersting part it, it also includes Recent Advances in field of thyrotoxicosis
Hyperthyroidism, also known as Graves' disease, occurs when the thyroid gland produces excessive amounts of thyroid hormone. The most common causes are Graves' disease, toxic multinodular goiter, and toxic adenoma. Clinical features include emotional instability, palpitations, weight loss, and warm skin. Diagnosis involves physical examination, thyroid hormone blood tests, and imaging tests such as thyroid ultrasound. Graves' disease is the most common cause of hyperthyroidism and is an autoimmune disease associated with eye and skin changes.
This document discusses a case of hyperthyroidism in a 39-year-old female presenting with nervousness, anxiety, palpitations, diarrhea, and weight loss. On examination, she had a heart rate of 110 bpm, tremor, increased reflexes, and an enlarged thyroid. Laboratory tests found high free T3 and T4, low TSH, and positive thyroid stimulating immunoglobulins, consistent with a diagnosis of Graves' disease. Graves' disease is an autoimmune disorder causing hyperthyroidism through thyroid stimulating antibodies. If left untreated, hyperthyroidism can progress to a thyroid storm, a life-threatening condition of severe hypermetabolism.
This document discusses endocrine disorders and their causes, symptoms, diagnosis and treatment. [1] Endocrine disorders can be caused by issues with the hypothalamus, pituitary gland, or hormone-producing glands and can result from congenital defects, infections, autoimmunity, tumors or unknown causes. [2] Too much or too little hormone production can occur due to failures in the feedback systems that control hormone levels or dysfunction of the endocrine glands themselves. [3] The document focuses on disorders of the thyroid gland (hypothyroidism, hyperthyroidism), adrenal gland (Addison's disease, Cushing's syndrome) and their clinical presentations and management.
The document provides information on the thyroid gland, including its anatomy, histology, physiology, pathology, and disorders. Some key points:
- The thyroid is one of the earliest endocrine organs to develop. It is located in the neck and weighs 15-25 grams.
- Graves' disease is the most common cause of hyperthyroidism. It is characterized by the triad of thyrotoxicosis, ophthalmopathy, and dermopathy due to autoantibodies that mimic TSH.
- Hypothyroidism is most commonly caused by Hashimoto's thyroiditis, an autoimmune disorder characterized by lymphocytic infiltration and antibody production. Clinical manifestations range from mild to
This document discusses thyrotoxicosis, or hyperthyroidism, including its various etiologies and clinical presentations. The main causes outlined are Graves' disease, toxic multinodular goiter, and toxic adenoma. Signs and symptoms involve the skin, eyes, cardiovascular and gastrointestinal systems, and muscles. Treatment options include anti-thyroid drugs, radioactive iodine, surgery, and beta-blockers. Radioactive iodine is often the treatment of choice for Graves' disease and toxic nodular goiter due to being inexpensive, effective, and safe.
This document discusses thyrotoxicosis, or hyperthyroidism, summarizing its main causes and treatments. The main causes are Graves' disease, toxic multinodular goiter, and toxic adenoma. Symptoms include eye changes, skin changes, cardiovascular effects, and nervous system effects. Treatment options include anti-thyroid drugs like carbimazole, radioactive iodine, and surgery. Radioactive iodine is often the treatment of choice, especially for Graves' disease and toxic nodular goiter.
The document summarizes key topics in endocrinology, including disorders of the thyroid, parathyroid, and adrenal glands. It discusses hypothyroidism and its causes, signs, symptoms, and treatment with levothyroxine replacement. It also covers thyrotoxicosis, hyperparathyroidism, Cushing's syndrome, and disorders of the adrenal cortex that can cause hormone deficiencies or excesses. The quiz at the end reviews topics like Cushing's syndrome and autoimmune destruction of pancreatic beta cells in type 1 diabetes.
The thyroid gland is located in the neck below the larynx. It produces thyroid hormones including thyroxine (T4) and triiodothyronine (T3) which increase metabolism in nearly every organ system. Disorders of the thyroid gland can cause either hyperthyroidism (overproduction of hormones) or hypothyroidism (underproduction of hormones). Common diseases include Graves' disease, Hashimoto's thyroiditis, and thyroid nodules. Treatment depends on the specific condition and may involve medication, surgery, or radiation therapy.
Hyperthyroidism refers to an overactive thyroid gland that produces excessive thyroid hormones. The most common cause is Graves' disease, an autoimmune disorder. Symptoms include hyperactivity, mood swings, difficulty sleeping, rapid heart rate, weight loss, and bulging eyes. It is diagnosed through blood tests measuring thyroid hormone and TSH levels. Treatment options include antithyroid medication, radioactive iodine therapy, or surgery to remove part of the thyroid gland.
The thyroid gland is located in the neck below the larynx. It produces thyroid hormones including thyroxine (T4) and triiodothyronine (T3) which increase metabolism in nearly every organ system. Iodine is necessary for thyroid hormone production. Disorders include hypothyroidism, where thyroid hormone production is inadequate, and hyperthyroidism, where production is excessive. Graves' disease is an autoimmune cause of hyperthyroidism. Cretinism results from untreated congenital hypothyroidism and causes severe physical and mental impairment.
The thyroid gland is located in the neck below the larynx. It produces thyroid hormones including thyroxine (T4) and triiodothyronine (T3) which increase metabolism in nearly every organ system. Disorders of the thyroid gland can cause either hyperthyroidism from excessive hormone production or hypothyroidism from inadequate production. Common diseases include Graves' disease, Hashimoto's thyroiditis, and iodine deficiency-related goiter.
Diseases of the thyroid gland can cause enlargement known as goiter. Simple goiter is caused by chronic lack of thyroid hormones leading to compensatory TSH elevation and thyroid enlargement. Toxic goiter or hyperthyroidism occurs when the thyroid overproduces hormones. Graves' disease is the most common cause of primary hyperthyroidism due to autoantibodies stimulating the thyroid. Secondary hyperthyroidism has other underlying thyroid pathology causing excess hormone production. Symptoms of hyperthyroidism include tremors, rapid heart rate, weight loss and eye protrusion. Treatment involves antithyroid drugs, beta blockers, radioiodine therapy or surgery.
- Graves disease is the most common cause of hyperthyroidism. It is an autoimmune disorder characterized by diffuse enlargement of the thyroid gland, ophthalmopathy, and dermopathy. It results from autoantibodies that stimulate the TSH receptor, causing hyperplasia of thyroid follicles.
- Hypothyroidism can be primary or secondary. Primary hypothyroidism is most often caused by Hashimoto's thyroiditis or iatrogenic ablation. It causes a hypometabolic state. Long-term untreated hypothyroidism in infants can cause cretinism, with impaired growth and mental retardation.
This document provides an overview of thyroid function and diseases of the thyroid gland. It discusses the assessment of thyroid function including common tests. It then covers the topics of hypothyroidism and hyperthyroidism in detail. For hypothyroidism, it describes the causes, presentations, diagnoses and treatment approaches for congenital hypothyroidism, autoimmune hypothyroidism, subclinical hypothyroidism and special considerations in pregnancy and the elderly. For hyperthyroidism, it focuses on Graves' disease, outlining its epidemiology, pathogenesis, clinical manifestations, diagnostic evaluation, clinical course and treatment options including antithyroid medications and radioiodine.
Based on the lab results provided:
- T3/T4 are high
- TSH is low
This pattern is seen in primary hyperthyroidism.
The diagnosis would be A) Primary hyperthyroidism.
1. The document discusses various diseases of the thyroid gland including goiter, hypothyroidism, thyroiditis, and thyroid cancer. It describes the etiology, pathogenesis, clinical features, investigations, and management of these conditions.
2. Graves' disease is described as the most common cause of thyrotoxicosis, characterized by hyperthyroidism, goiter, eye signs, and thyrotoxicosis symptoms. It results from thyroid stimulating immunoglobulins that act on the TSH receptor.
3. Papillary carcinoma is the most common type of thyroid cancer, accounting for 60-80% of cases. It often affects women around age 40 and has a 40% rate of neck node metastasis.
Thyrotoxicosis, or hyperthyroidism, is caused by excessive thyroid hormones. It can be primary, resulting from conditions like Graves' disease, or secondary, from a toxic multinodular goiter or toxic adenoma. Graves' disease is an autoimmune disorder caused by antibodies that stimulate the thyroid. Symptoms include hypermetabolism, nervousness, and eye changes. Diagnosis involves thyroid function tests, ultrasound, and radioactive iodine uptake. Treatment options are antithyroid medications, radioactive iodine therapy, or surgery. Complications can include thyroid storm, which is a medical emergency requiring aggressive treatment.
This document outlines the course content for a pathology of the endocrine system lecture. It will cover disorders of the pituitary gland, thyroid gland, parathyroid gland, pancreas, adrenal glands and multiple endocrine neoplasia syndrome. Specific topics include pituitary adenomas, Cushing's syndrome, Graves disease, thyroid cancers, hyperparathyroidism, diabetes mellitus and pancreatic neuroendocrine tumors. For each topic, it provides an overview of the clinical presentation, pathophysiology, diagnostic criteria and histopathological findings.
Hyperthyroidism refers to excessive secretion of thyroid hormones due to overactivity of the thyroid gland. Common causes include Graves' disease, toxic multinodular goiter, and toxic adenoma. Symptoms include nervousness, palpitations, heat intolerance, weight loss, and tremors. Diagnosis involves blood tests to measure thyroid hormones and TSH levels. Treatment options include anti-thyroid medications, radioactive iodine therapy, and surgery. Hypothyroidism is underactivity of the thyroid gland resulting in low thyroid hormone levels and symptoms like fatigue, weight gain, dry skin and constipation. Primary causes are autoimmune disease and treatment for hyperthyroidism. Treatment is thyroid hormone replacement medication.
The document discusses hyperthyroidism and hypothyroidism.
Hyperthyroidism results from excess thyroid hormone in the blood and common causes include Graves' disease, toxic adenomas, and thyroiditis. Symptoms include nervousness, rapid heart rate, weight loss, and eye changes. Diagnosis involves thyroid function tests and treatment options are anti-thyroid medications, radioactive iodine, beta blockers, or surgery.
Hypothyroidism is caused by an underactive thyroid gland and risks factors include older age and autoimmune diseases. Symptoms are fatigue, weight gain, dry skin and constipation. Diagnosis is via thyroid hormone levels and treatment is thyroid hormone replacement medication.
Hyperthyroidism refers to overactivity of the thyroid gland resulting in excessive secretion of thyroid hormones throughout the body. Some common causes include Graves' disease, toxic adenomas, and thyroiditis. Symptoms include nervousness, palpitations, heat intolerance, tremor, and weight loss. Diagnosis involves tests of thyroid and pituitary hormones. Treatment options are radioactive iodine to destroy the thyroid gland, anti-thyroid medications, beta-blockers to control symptoms, or surgery to remove part or all of the thyroid. Nursing care focuses on managing nutrition, activity tolerance, risk of injury from eye involvement, and hyperthermia due to the increased metabolic rate.
Thyrotoxicosis and other thyroid diseases is a document discussing various thyroid conditions including hyperthyroidism, Graves' disease, toxic multinodular goiter, toxic adenoma, subacute thyroiditis, hypothyroidism, autoimmune thyroiditis, and other causes of hypothyroidism. It provides details on the epidemiology, etiology, clinical features, pathophysiology, diagnosis, differential diagnosis and management of these conditions.
This document provides an overview of thyrotoxicosis, including its epidemiology, pathophysiology, causes, clinical manifestations, diagnosis, and management. Some key points:
- Thyrotoxicosis is defined as thyroid hormone excess and can be caused by hyperthyroidism, thyroiditis, or excess hormone ingestion. The major causes of hyperthyroidism are Graves' disease, toxic multinodular goiter, and toxic adenomas.
- Clinical manifestations depend on severity and duration of thyrotoxicosis, and include symptoms like palpitations, sweating, weight loss as well as signs like goiter, tremor, eye changes. Diagnosis involves testing thyroid function through TSH,
1) The document discusses hyperthyroidism and hypothyroidism, which are conditions caused by abnormal thyroid hormone levels. Hyperthyroidism is caused by excess thyroid hormone production, while hypothyroidism is caused by insufficient hormone production.
2) Common causes of hyperthyroidism include Graves' disease, toxic multinodular goiter, and toxic adenoma. Hypothyroidism is commonly caused by iodine deficiency, autoimmune thyroiditis, and treatment for hyperthyroidism.
3) Symptoms and signs of the conditions vary but include changes in appetite, weight, and mood. Diagnosis involves thyroid function tests measuring TSH, T4, and T3 levels
This document discusses benign thyroid conditions. It covers thyroid anatomy, hormone synthesis, the hypothalamic-pituitary axis regulation of the thyroid gland, effects of thyroid hormones, and disorders like hypothyroidism and hyperthyroidism. It also describes investigations for thyroid function including TSH, T4, T3, thyroid antibodies, radioactive iodine uptake studies, TRH stimulation tests, T3 suppression tests, FNAC, and thyroid scans.
Hyperthyroidism is a condition characterized by excessive secretion of thyroid hormones from the thyroid gland, causing a hypermetabolic state in the body. Common symptoms include rapid or irregular heartbeat, sweating, nervousness, weight loss despite increased appetite, and eye bulging. Treatment options include antithyroid medications to reduce hormone production, radioactive iodine to destroy thyroid tissue, or surgery to remove part or all of the thyroid gland. Nursing care focuses on managing symptoms, maintaining nutrition and fluid balance given increased metabolic rate, promoting rest, and addressing anxiety related to the condition and its treatment.
This document summarizes acute leukaemias, including their epidemiology, etiology, clinical features, investigations, classification, treatment, and special considerations. Acute leukaemias result from malignant transformation of haematopoietic stem cells and can be myeloid, lymphoid, or biphenotypic. Risk factors include genetic syndromes, radiation, chemicals, and viruses. Treatment involves supportive care, chemotherapy consisting of induction and consolidation phases, and sometimes stem cell transplant. Prognosis has improved with advances in diagnosis and therapy but acute leukaemias still require rapid assessment and treatment initiation.
This document provides an overview of renal tubular acidosis (RTA). It defines RTA as a condition where the kidneys are unable to appropriately acidify the urine, resulting in acid accumulation in the body. There are four main types of RTA - type 1 involves a defect in the distal tubule, type 2 involves a defect in the proximal tubule, type 3 is a combined defect, and type 4 involves hyperkalemia. The document outlines the pathophysiology, clinical features, diagnostic testing and management considerations for each type of RTA.
The document summarizes key topics in endocrinology, including disorders of the thyroid, parathyroid, and adrenal glands. It discusses hypothyroidism and its causes, signs, symptoms, and treatment with levothyroxine replacement. It also covers thyrotoxicosis, hyperparathyroidism, Cushing's syndrome, and disorders of the adrenal cortex that can cause hormone deficiencies or excesses. The quiz at the end reviews topics like Cushing's syndrome and autoimmune destruction of pancreatic beta cells in type 1 diabetes.
The thyroid gland is located in the neck below the larynx. It produces thyroid hormones including thyroxine (T4) and triiodothyronine (T3) which increase metabolism in nearly every organ system. Disorders of the thyroid gland can cause either hyperthyroidism (overproduction of hormones) or hypothyroidism (underproduction of hormones). Common diseases include Graves' disease, Hashimoto's thyroiditis, and thyroid nodules. Treatment depends on the specific condition and may involve medication, surgery, or radiation therapy.
Hyperthyroidism refers to an overactive thyroid gland that produces excessive thyroid hormones. The most common cause is Graves' disease, an autoimmune disorder. Symptoms include hyperactivity, mood swings, difficulty sleeping, rapid heart rate, weight loss, and bulging eyes. It is diagnosed through blood tests measuring thyroid hormone and TSH levels. Treatment options include antithyroid medication, radioactive iodine therapy, or surgery to remove part of the thyroid gland.
The thyroid gland is located in the neck below the larynx. It produces thyroid hormones including thyroxine (T4) and triiodothyronine (T3) which increase metabolism in nearly every organ system. Iodine is necessary for thyroid hormone production. Disorders include hypothyroidism, where thyroid hormone production is inadequate, and hyperthyroidism, where production is excessive. Graves' disease is an autoimmune cause of hyperthyroidism. Cretinism results from untreated congenital hypothyroidism and causes severe physical and mental impairment.
The thyroid gland is located in the neck below the larynx. It produces thyroid hormones including thyroxine (T4) and triiodothyronine (T3) which increase metabolism in nearly every organ system. Disorders of the thyroid gland can cause either hyperthyroidism from excessive hormone production or hypothyroidism from inadequate production. Common diseases include Graves' disease, Hashimoto's thyroiditis, and iodine deficiency-related goiter.
Diseases of the thyroid gland can cause enlargement known as goiter. Simple goiter is caused by chronic lack of thyroid hormones leading to compensatory TSH elevation and thyroid enlargement. Toxic goiter or hyperthyroidism occurs when the thyroid overproduces hormones. Graves' disease is the most common cause of primary hyperthyroidism due to autoantibodies stimulating the thyroid. Secondary hyperthyroidism has other underlying thyroid pathology causing excess hormone production. Symptoms of hyperthyroidism include tremors, rapid heart rate, weight loss and eye protrusion. Treatment involves antithyroid drugs, beta blockers, radioiodine therapy or surgery.
- Graves disease is the most common cause of hyperthyroidism. It is an autoimmune disorder characterized by diffuse enlargement of the thyroid gland, ophthalmopathy, and dermopathy. It results from autoantibodies that stimulate the TSH receptor, causing hyperplasia of thyroid follicles.
- Hypothyroidism can be primary or secondary. Primary hypothyroidism is most often caused by Hashimoto's thyroiditis or iatrogenic ablation. It causes a hypometabolic state. Long-term untreated hypothyroidism in infants can cause cretinism, with impaired growth and mental retardation.
This document provides an overview of thyroid function and diseases of the thyroid gland. It discusses the assessment of thyroid function including common tests. It then covers the topics of hypothyroidism and hyperthyroidism in detail. For hypothyroidism, it describes the causes, presentations, diagnoses and treatment approaches for congenital hypothyroidism, autoimmune hypothyroidism, subclinical hypothyroidism and special considerations in pregnancy and the elderly. For hyperthyroidism, it focuses on Graves' disease, outlining its epidemiology, pathogenesis, clinical manifestations, diagnostic evaluation, clinical course and treatment options including antithyroid medications and radioiodine.
Based on the lab results provided:
- T3/T4 are high
- TSH is low
This pattern is seen in primary hyperthyroidism.
The diagnosis would be A) Primary hyperthyroidism.
1. The document discusses various diseases of the thyroid gland including goiter, hypothyroidism, thyroiditis, and thyroid cancer. It describes the etiology, pathogenesis, clinical features, investigations, and management of these conditions.
2. Graves' disease is described as the most common cause of thyrotoxicosis, characterized by hyperthyroidism, goiter, eye signs, and thyrotoxicosis symptoms. It results from thyroid stimulating immunoglobulins that act on the TSH receptor.
3. Papillary carcinoma is the most common type of thyroid cancer, accounting for 60-80% of cases. It often affects women around age 40 and has a 40% rate of neck node metastasis.
Thyrotoxicosis, or hyperthyroidism, is caused by excessive thyroid hormones. It can be primary, resulting from conditions like Graves' disease, or secondary, from a toxic multinodular goiter or toxic adenoma. Graves' disease is an autoimmune disorder caused by antibodies that stimulate the thyroid. Symptoms include hypermetabolism, nervousness, and eye changes. Diagnosis involves thyroid function tests, ultrasound, and radioactive iodine uptake. Treatment options are antithyroid medications, radioactive iodine therapy, or surgery. Complications can include thyroid storm, which is a medical emergency requiring aggressive treatment.
This document outlines the course content for a pathology of the endocrine system lecture. It will cover disorders of the pituitary gland, thyroid gland, parathyroid gland, pancreas, adrenal glands and multiple endocrine neoplasia syndrome. Specific topics include pituitary adenomas, Cushing's syndrome, Graves disease, thyroid cancers, hyperparathyroidism, diabetes mellitus and pancreatic neuroendocrine tumors. For each topic, it provides an overview of the clinical presentation, pathophysiology, diagnostic criteria and histopathological findings.
Hyperthyroidism refers to excessive secretion of thyroid hormones due to overactivity of the thyroid gland. Common causes include Graves' disease, toxic multinodular goiter, and toxic adenoma. Symptoms include nervousness, palpitations, heat intolerance, weight loss, and tremors. Diagnosis involves blood tests to measure thyroid hormones and TSH levels. Treatment options include anti-thyroid medications, radioactive iodine therapy, and surgery. Hypothyroidism is underactivity of the thyroid gland resulting in low thyroid hormone levels and symptoms like fatigue, weight gain, dry skin and constipation. Primary causes are autoimmune disease and treatment for hyperthyroidism. Treatment is thyroid hormone replacement medication.
The document discusses hyperthyroidism and hypothyroidism.
Hyperthyroidism results from excess thyroid hormone in the blood and common causes include Graves' disease, toxic adenomas, and thyroiditis. Symptoms include nervousness, rapid heart rate, weight loss, and eye changes. Diagnosis involves thyroid function tests and treatment options are anti-thyroid medications, radioactive iodine, beta blockers, or surgery.
Hypothyroidism is caused by an underactive thyroid gland and risks factors include older age and autoimmune diseases. Symptoms are fatigue, weight gain, dry skin and constipation. Diagnosis is via thyroid hormone levels and treatment is thyroid hormone replacement medication.
Hyperthyroidism refers to overactivity of the thyroid gland resulting in excessive secretion of thyroid hormones throughout the body. Some common causes include Graves' disease, toxic adenomas, and thyroiditis. Symptoms include nervousness, palpitations, heat intolerance, tremor, and weight loss. Diagnosis involves tests of thyroid and pituitary hormones. Treatment options are radioactive iodine to destroy the thyroid gland, anti-thyroid medications, beta-blockers to control symptoms, or surgery to remove part or all of the thyroid. Nursing care focuses on managing nutrition, activity tolerance, risk of injury from eye involvement, and hyperthermia due to the increased metabolic rate.
Thyrotoxicosis and other thyroid diseases is a document discussing various thyroid conditions including hyperthyroidism, Graves' disease, toxic multinodular goiter, toxic adenoma, subacute thyroiditis, hypothyroidism, autoimmune thyroiditis, and other causes of hypothyroidism. It provides details on the epidemiology, etiology, clinical features, pathophysiology, diagnosis, differential diagnosis and management of these conditions.
This document provides an overview of thyrotoxicosis, including its epidemiology, pathophysiology, causes, clinical manifestations, diagnosis, and management. Some key points:
- Thyrotoxicosis is defined as thyroid hormone excess and can be caused by hyperthyroidism, thyroiditis, or excess hormone ingestion. The major causes of hyperthyroidism are Graves' disease, toxic multinodular goiter, and toxic adenomas.
- Clinical manifestations depend on severity and duration of thyrotoxicosis, and include symptoms like palpitations, sweating, weight loss as well as signs like goiter, tremor, eye changes. Diagnosis involves testing thyroid function through TSH,
1) The document discusses hyperthyroidism and hypothyroidism, which are conditions caused by abnormal thyroid hormone levels. Hyperthyroidism is caused by excess thyroid hormone production, while hypothyroidism is caused by insufficient hormone production.
2) Common causes of hyperthyroidism include Graves' disease, toxic multinodular goiter, and toxic adenoma. Hypothyroidism is commonly caused by iodine deficiency, autoimmune thyroiditis, and treatment for hyperthyroidism.
3) Symptoms and signs of the conditions vary but include changes in appetite, weight, and mood. Diagnosis involves thyroid function tests measuring TSH, T4, and T3 levels
This document discusses benign thyroid conditions. It covers thyroid anatomy, hormone synthesis, the hypothalamic-pituitary axis regulation of the thyroid gland, effects of thyroid hormones, and disorders like hypothyroidism and hyperthyroidism. It also describes investigations for thyroid function including TSH, T4, T3, thyroid antibodies, radioactive iodine uptake studies, TRH stimulation tests, T3 suppression tests, FNAC, and thyroid scans.
Hyperthyroidism is a condition characterized by excessive secretion of thyroid hormones from the thyroid gland, causing a hypermetabolic state in the body. Common symptoms include rapid or irregular heartbeat, sweating, nervousness, weight loss despite increased appetite, and eye bulging. Treatment options include antithyroid medications to reduce hormone production, radioactive iodine to destroy thyroid tissue, or surgery to remove part or all of the thyroid gland. Nursing care focuses on managing symptoms, maintaining nutrition and fluid balance given increased metabolic rate, promoting rest, and addressing anxiety related to the condition and its treatment.
This document summarizes acute leukaemias, including their epidemiology, etiology, clinical features, investigations, classification, treatment, and special considerations. Acute leukaemias result from malignant transformation of haematopoietic stem cells and can be myeloid, lymphoid, or biphenotypic. Risk factors include genetic syndromes, radiation, chemicals, and viruses. Treatment involves supportive care, chemotherapy consisting of induction and consolidation phases, and sometimes stem cell transplant. Prognosis has improved with advances in diagnosis and therapy but acute leukaemias still require rapid assessment and treatment initiation.
This document provides an overview of renal tubular acidosis (RTA). It defines RTA as a condition where the kidneys are unable to appropriately acidify the urine, resulting in acid accumulation in the body. There are four main types of RTA - type 1 involves a defect in the distal tubule, type 2 involves a defect in the proximal tubule, type 3 is a combined defect, and type 4 involves hyperkalemia. The document outlines the pathophysiology, clinical features, diagnostic testing and management considerations for each type of RTA.
This document summarizes acute leukaemias, which result from malignant transformation of haematopoietic stem cells. It covers the epidemiology, etiology, clinical features, investigations, classification, cytogenetics, risk factors, and treatment of both acute myeloid leukaemia and acute lymphoblastic leukaemia. Remission induction chemotherapy is the primary treatment, while stem cell transplant may be used in some cases. Overall survival has improved with recent advances, though acute leukaemias still require rapid assessment and treatment.
Snake bites are a major public health problem affecting millions each year, especially in rural areas of developing countries. Common symptoms include local swelling, bleeding disorders, paralysis, and kidney injury. Treatment involves supportive care, antivenom therapy, and monitoring for complications. Early administration of the correct antivenom within 4 hours of the bite is important to prevent mortality and morbidity from snake envenomation.
Disorders of Acid-Base Balance 2022 with narration.pdfAdamu Mohammad
This document discusses disorders of acid-base balance. It begins by introducing buffers that help maintain pH levels, such as bicarbonate and proteins. It then covers different types of acid-base imbalances including respiratory and metabolic acidosis and alkalosis. Key points include how to interpret arterial blood gases and identify the underlying cause of imbalances. Compensation mechanisms and features of acute vs chronic disorders are described. Various metabolic acidosis etiologies are outlined including renal tubular acidosis. Treatment principles focus on addressing underlying causes and correcting acidemia with alkali therapy.
This document discusses communication skills and ethics in clinical practice, with a focus on end-of-life care. It outlines the need for effective communication skills when interacting with patients, families, and colleagues. Key principles of medical ethics around autonomy, informed consent, privacy, and justice are also covered. The document then examines approaches to communicating with patients and obtaining consent. It provides examples of communicating in difficult situations and applying ethical considerations. Finally, it discusses end-of-life care, including identifying patients nearing end of life, components of end-of-life care, common problems, and ensuring quality care through the dying process.
July 2022 - ATYPICAL PRESENTATIONS Prof. A.E.A. Jaiyesimi.pdfAdamu Mohammad
The document discusses atypical presentations of diseases in the elderly. It notes that diseases may present differently in older patients compared to textbook descriptions. Conditions can manifest as falls, confusion, or worsening of other diseases, rather than typical symptoms. It is important for clinicians to consider any changes from an elderly patient's baseline as a potential medical problem. Misdiagnosis is common if presentations are not recognized as atypical. A thorough assessment accounting for multiple conditions and medications is crucial for accurate diagnosis and treatment of disease in older patients.
This document discusses investigations for kidney diseases. It describes various urine, blood, and radiological investigations that can help diagnose kidney diseases, identify risk factors, grade severity, and monitor treatment. Urine investigations include urinalysis, urine protein-creatinine ratio, and microscopic examination of urine sediments. Blood investigations include electrolytes, lipids, serology tests, and full blood count. Radiological tests discussed are ultrasound, CT, MRI, nuclear scintigraphy, and renal biopsy. The document provides details on the procedures and clinical indications for many of these important investigations in nephrology.
THERAPEUTIC DRUG MONITORING- NPMCN 260722.pdfAdamu Mohammad
This document discusses therapeutic drug monitoring (TDM), which involves measuring drug concentrations in the body to optimize pharmacotherapy. TDM includes monitoring the pharmaceutical, pharmacokinetic, pharmacodynamic, and therapeutic effects of drugs. It is useful for individualizing drug therapy, assessing compliance, diagnosing and preventing toxicity, and detecting drug interactions. Drugs that are good candidates for TDM have a narrow therapeutic index, variable pharmacokinetics, and a reasonable relationship between concentrations and effects. Common drugs monitored include antibiotics, anticonvulsants, cardiac glycosides, and immunosuppressants. Proper sample collection and interpretation considering the patient's details and potential confounders are important for TDM to effectively guide treatment decisions.
Mechanical ventilation & Pulmonary Rehabilitation -1.pdfAdamu Mohammad
Mechanical ventilation is used to support patients with respiratory failure by controlling parameters like tidal volume, respiratory rate, and pressure. It requires careful setting and monitoring to prevent complications. Modes include controlled, assisted, and combined settings. Pulmonary rehabilitation uses exercise, education, and breathing techniques to improve symptoms and quality of life for patients with chronic lung disease.
Common Geriatric Syndromes - July 2022 Dr. A.E.A. Jaiyesimi.pdfAdamu Mohammad
This document discusses geriatric syndromes and the increasing burden of diseases affecting the elderly population in Nigeria. It notes that life expectancy has improved worldwide, leading to an aging population. In Nigeria, reliable data is lacking but estimates suggest around 3.1% of the population is aged 65 and over, a proportion that is increasing. Common geriatric conditions discussed include stroke, Parkinson's disease, dementia, cancers, cardiovascular diseases, diabetes, arthritis, and renal diseases. The document emphasizes that geriatric syndromes can impact quality of life and notes some key problems to assess in elderly patients like falls, memory issues, incontinence, pain, mobility and more. Early detection of these conditions is important for treatment and rehabilitation.
This document provides an overview of chronic diarrhea and malabsorption syndrome. It discusses the pathophysiology of chronic diarrhea including osmotic, secretory, inflammatory, and motility disorders. Common causes are then outlined for both infectious and non-infectious etiologies. Management involves fluid/electrolyte replacement, treating the underlying cause, and symptomatic relief. Malabsorption syndrome and its causes relating to the pancreas, liver, intestine, and motility are also reviewed. Specific conditions like celiac disease and Whipple's disease are described.
Approach to the diagnosis and management of primary headache disorders-GP-rec...Adamu Mohammad
The document discusses the approach to diagnosing and managing primary headache disorders. It begins with an introduction to headaches and classification. It then covers the diagnostic criteria and treatment approaches for common primary headaches like migraine, tension-type headache, and cluster headache. The diagnosis involves taking a thorough headache history, performing an exam, and considering red flags for secondary headaches. Treatment involves both pharmacological options like triptans, beta-blockers, and oxygen for cluster headaches as well as non-pharmacological strategies like lifestyle modifications and avoiding triggers. The overall approach involves classifying the primary headache disorder and then selecting appropriate treatment strategies.
This document discusses chronic kidney disease (CKD), including its definition, staging, epidemiology, causes, progression, complications, and non-dialytic management. CKD is defined based on kidney damage or decreased glomerular filtration rate below 60 mL/min/1.73m2 for over 3 months. Common causes include hypertension, diabetes, glomerulonephritis, and HIV. Progression is monitored using GFR and proteinuria levels, with faster progression seen in diabetes. Complications involve fluid/electrolyte disorders, bone disease, cardiovascular issues, and others. Non-dialytic management focuses on treating the underlying cause, controlling blood pressure and other risk factors, and preparing for renal replacement
EPILEPSY CLASSIFICATION, PATHOENESIS, AND MANAGEMENT.pdfAdamu Mohammad
The document summarizes key aspects of epilepsy classifications, pathogenesis, and management. It describes:
1. The ILAE's 2017 classification system which focuses on seizures, epilepsies, and epilepsy syndromes, introducing new terminology like focal impaired awareness and focal to bilateral tonic-clonic.
2. Factors in epilepsy pathogenesis including neurotransmission pathways, molecular/genetic mechanisms, neurogenesis/rewiring, and inflammation. Epileptogenesis involves increased neuronal excitability.
3. Epilepsy categories of idiopathic, acquired, and cryptogenic based on identifiable brain lesions, and management considers seizure type, age of onset, family history, and test results.
This document provides an overview of sleep disorders and approaches to common sleep disorders. It defines sleep and the stages of sleep, including non-REM sleep divided into stages N1-N3 and REM sleep. It describes the brain mechanisms that generate wakefulness, non-REM sleep, and REM sleep through interconnected neural circuits. These circuits can become dissociated, causing parasomnias or overlap of sleep and wake behaviors. Recommended sleep durations are provided across the human lifespan. Common sleep disorders discussed include insomnia, narcolepsy, restless leg syndrome, and circadian rhythm disorders.
This document discusses the evaluation and management of chronic diarrhea and malabsorption syndrome. It begins with an introduction to chronic diarrhea and outlines the pathophysiology, including osmotic, secretory, inflammatory, and motility disorders. Common causes are then reviewed including infections, malignancies, celiac disease, tropical sprue, and short bowel syndrome. Management involves fluid/electrolyte replacement, treating the underlying cause, and symptomatic relief. Malabsorption syndrome and its specific etiologies like celiac disease, Whipple's disease, and tropical sprue are also summarized. The document stresses the importance of a thorough clinical evaluation to identify the cause and guide appropriate investigations and therapy.
This document provides a literature review on myasthenia gravis (MG). MG is an autoimmune disease that affects the neuromuscular junction. Some key points:
- The first accounts of MG were in the late 1800s and early 1900s by researchers like Erb, Goldman, and Jolly. The immunological nature was established in the 1970s.
- Prevalence is about 20 per 100,000 people. It is more common in women under 40 and men over 50. Thymic abnormalities like hyperplasia or tumors are associated with age of onset.
- MG causes fluctuating muscle weakness that worsens with activity. Common early symptoms include ptosis, diplopia,
Infective endocarditis is a bacterial or fungal infection of the heart valves or inner lining of the heart. It typically presents with fever and evidence of infection on echocardiogram or blood cultures. Underlying heart valve abnormalities predispose individuals to the condition by allowing bacteria to attach. Common causes include Staphylococcus aureus and various streptococci. Left untreated, it can cause heart valve damage, systemic embolisms, and death. Diagnosis involves identifying symptoms of infection along with testing like echocardiography and blood cultures to detect the infecting organism.
This patient likely has constrictive pericarditis based on the following:
1) Refractory edema despite diuretics suggesting impaired cardiac filling
2) History consistent with an etiology of post-pericarditis from RA
3) Clear lung fields on CXR rule out heart failure as cause of edema
- Video recording of this lecture in English language: https://youtu.be/Pt1nA32sdHQ
- Video recording of this lecture in Arabic language: https://youtu.be/uFdc9F0rlP0
- Link to download the book free: https://nephrotube.blogspot.com/p/nephrotube-nephrology-books.html
- Link to NephroTube website: www.NephroTube.com
- Link to NephroTube social media accounts: https://nephrotube.blogspot.com/p/join-nephrotube-on-social-media.html
The skin is the largest organ and its health plays a vital role among the other sense organs. The skin concerns like acne breakout, psoriasis, or anything similar along the lines, finding a qualified and experienced dermatologist becomes paramount.
Adhd Medication Shortage Uk - trinexpharmacy.comreignlana06
The UK is currently facing a Adhd Medication Shortage Uk, which has left many patients and their families grappling with uncertainty and frustration. ADHD, or Attention Deficit Hyperactivity Disorder, is a chronic condition that requires consistent medication to manage effectively. This shortage has highlighted the critical role these medications play in the daily lives of those affected by ADHD. Contact : +1 (747) 209 – 3649 E-mail : sales@trinexpharmacy.com
These lecture slides, by Dr Sidra Arshad, offer a simplified look into the mechanisms involved in the regulation of respiration:
Learning objectives:
1. Describe the organisation of respiratory center
2. Describe the nervous control of inspiration and respiratory rhythm
3. Describe the functions of the dorsal and respiratory groups of neurons
4. Describe the influences of the Pneumotaxic and Apneustic centers
5. Explain the role of Hering-Breur inflation reflex in regulation of inspiration
6. Explain the role of central chemoreceptors in regulation of respiration
7. Explain the role of peripheral chemoreceptors in regulation of respiration
8. Explain the regulation of respiration during exercise
9. Integrate the respiratory regulatory mechanisms
10. Describe the Cheyne-Stokes breathing
Study Resources:
1. Chapter 42, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 36, Ganong’s Review of Medical Physiology, 26th edition
3. Chapter 13, Human Physiology by Lauralee Sherwood, 9th edition
Travel Clinic Cardiff: Health Advice for International TravelersNX Healthcare
Travel Clinic Cardiff offers comprehensive travel health services, including vaccinations, travel advice, and preventive care for international travelers. Our expert team ensures you are well-prepared and protected for your journey, providing personalized consultations tailored to your destination. Conveniently located in Cardiff, we help you travel with confidence and peace of mind. Visit us: www.nxhealthcare.co.uk
8 Surprising Reasons To Meditate 40 Minutes A Day That Can Change Your Life.pptxHolistified Wellness
We’re talking about Vedic Meditation, a form of meditation that has been around for at least 5,000 years. Back then, the people who lived in the Indus Valley, now known as India and Pakistan, practised meditation as a fundamental part of daily life. This knowledge that has given us yoga and Ayurveda, was known as Veda, hence the name Vedic. And though there are some written records, the practice has been passed down verbally from generation to generation.
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2. Objectives
• To give an overview of thyroid disorders
• To discuss approach to management of some of them
3. Outline
• Introduction
• Brief Anatomy
• Functions
• Regulation of hormone production
• Classification of disorders
• Hyperthyroidism
• Hypothyroidism
• Goitres –non functional
4. Introduction
• Thyroid disorders are common in endocrinology
• These disorders affect most of the systems of the body
• Complications are usually difficult to manage
8. The thyroid gland
• 2 lobes connected in the middle by an isthmus
• Produces thyroxine (T4) & triidothyronine (T3)
• T4 secreted > than T3 ; T3 more biologically potent
• Most T3 derived from extrathyroidal conversion of T4
9. Functions of the thyroid gland
Thyroid hormones play critical role in:
• Cell differentiation during development
• maintaining thermogenesis
• metabolic homeostasis
13. Thyrotoxicosis
• results from exposure of body tissues to excess circulating levels of thyroid
hormones
• Several disorders cause Thyrotoxicosis
• Hyperthyroidism: a subset of thyrotoxicosis
• accounts for major aetiologies of thyrotoxicosis in which there is excess synthesis
& secretion of thyroid hormone by the thyroid gland
16. Thyrotoxicosis contd
• Thyrotoxicosis with high RAIU indicates de novo synthesis of hormone
• Thyrotoxicosis with low RAIU indicates either:
• Inflammation & destruction of thyroid tissue with release of preformed
hormone into the circulation
or
• extrathyroidal source of thyroid hormone
18. Graves disease
• Most common cause of thyrotoxicosis (50- 80%)
• Autoimmune disorder resulting from TSH receptor antibodies (a.k.a. thyroid-
stimulating immunoglobulins), which activate receptor & stimulate thyroid gland
growth & thyroid hormone synthesis
• Characterized by a variety of circulating antibodies to thyroid components
including:
• TSH-R-stimulating Ab – specific for Graves disease
• anti-thyroid peroxidase (anti-TPO)
• antithyroglobulin (anti-TG) antibodies
19. Graves disease
• TSH-R-Ab is directed toward epitopes of the TSH receptor & acts as a
TSH-receptor agonist
• Similar to TSH, TSH-R-Ab binds to the TSH receptor on the thyroid
follicular cells to activate thyroid hormone synthesis, release &
thyroid growth
20. Graves disease
Consists of
• Hyperthyroidism
• Goiter
• Ophthalmopathy
• & occasionally a dermopathy (pretibial or localized myxedema)
21. Graves disease
• Peak incidence: 20-40yrs
• Prevalence varies among populations - areas of high iodine intake ass
with ↑ prevalence of Graves’
• Female:Male ratio reported as ~ 5-10:1
• Combination of genetic & environmental factors → ↑ susceptibility to
Graves’ disease
22. Graves disease: Precipitating factors
• Genetic susceptibility
• Abundant epidemiologic evidence in support
• Stress:
• Often hx of psychological stress before onset of dx. Suppression of
stress followed by immunologic hyperactivity → disease in
genetically susceptible
• Pregnancy: a time of immune suppression, with rebound post partum
23. Precipitating & Predisposing factors
• Sex steroids
• estrogen enhances immunologic activity
• Smoking
• Drugs: Iodine & iodine containing drugs may ppt disease in
susceptible individual
• may also damage thyroid cell directly & release thyroid antigens to
immune system
• Interferon α treatment of patients with hepatitis C infection
• Infections:
• Possible infections of the thyroid gland could initiate class II
molecule expression
24. Graves disease continued
• Usually thyroid gland palpable with diffusely enlarged smooth goitre,
initially soft
• May become progressively firmer
• Nodular Graves (Marine-Lenart syndrome)
• Graves disease in association with thyroid nodules reportedly increases risk of
thyroid carcinoma
25. Symptoms in thyrotoxicosis
• Tremors
• Heat intolerance
• Hyperkinesis
• Irritability, nervousness
• Jitteriness
• increased sweating
• Increased appetite
• Palpitations
• Eye symptoms (staring
gaze, increased
protrusion, pain, redness)
• Diarrhea /
Hyperdefaecation
• Weight loss despite good
or appetite
• Dyspnoea on exertion
• Itching
• Muscle weakness/wasting
•may manifest as
exercise intolerance or
difficulty climbing stairs
• Menstrual irregularities
• Reduced libido/ED
26. Signs may include:
General /skin
• Fine tremor
• Evidence of weight loss
• Warm, moist skin
• Fine silky hair ± alopecia
• Hyperhidrosis
• Sweaty palms
• Palmar erythema
• Onycholysis
27. Signs in thyrotoxicosis
Eye signs
• Lid lag, Lid retraction
• Exophthalmos (Graves disease)
• Cranial nerve palsy
• Goitre
• Thyroid bruit
31. Other findings in thyrotoxicosis
• Osseous-osteoporosis
• Reproductive - gynecomastia, sub-fertility
• Hematopoietic- normochromic, normocytic anemia, lymphocytosis,
lymphadenopathy, thymus enlargement, splenomegaly
• Neurologic: Choreoathetosis
• Others: Syncope, Delirium, stupor, coma, vomiting, (in severe cases)
32. Thyroid eye disease
• Clinically evident in 20-25 %
• More may have evidence on USS, CT, MRI (enlarged retro-ocular
muscles)
• appears before, concurrently or after treatment in Graves
• most patients with ophthalmopathy have evidence of thyroid disease,
but absent in ~ 10% of patients
•“Euthyroid graves”
• Ophthalmopathy may occur in chronic autoimmune thyroiditis
(Hashimoto's) & may have TSHR receptor Ab (blocking )
34. Thyroid eye disease
• Look out for: redness, congestion, periorbital oedema conjunctival
injection & oedema, proptosis, ophthalmoplegia
• Failure of lid apposition promotes drying & ulceration of cornea
• Objective measurement of degree of proptosis using an hertel’s
exophthalmometer
• measurement of distance b/w lateral angle of bony orbit &
imaginary line tangent to most anterior part of cornea
• upper limit of normal: 20 mm in whites; 22 mm in blacks
• Visual acuity, visual fields & color vision
35.
36. Thyroid eye disease
• N –No signs or symptoms 0
• O – only symptoms 1
• S – soft tissue involvement 2
• P – proptosis 3
• E – Extraocular muscle involvement 4
• C- corneal involvement 5
• S – sight loss 6
37. Pretibial myxoedema
• Accumulation of fluid & mucopolysaccharides in pretibial region
• Mild
• Severe
• Incapacitating
May appear as:
• Non pitting oedema
• Nodular
• Plaques
40. Toxic multinodular goitre
• Orbitopathy, pretibial myxedema, acropachy not observed
• TSH-R antibodies absent
• Size of thyroid gland variable with a dominant nodule or multiple
irregular, variably sized nodules typically present
• Neck USS should help delineate discrete unpalpable nodules
41. Thyroiditis
Causes include:
• Direct chemical toxicity with inflammation (amiodarone)
• Radiation thyroiditis, from external radiation or after radioiodine
therapy
• Palpation thyroiditis e.g occurring during parathyroid surgery
42. Diff diagnosis of thyrotoxicosis
• Single nodule raises possibility of an autonomously functioning thyroid adenoma
• Painful, tender thyroid in subacute granulomatous thyroiditis
• Subacute lymphocytic (usually painless) thyroiditis may have no, minimal, or
modest thyroid enlargement
• Absence of any thyroid enlargement: consider exogenous thyroid hormone ingestion
or ectopic thyroid tissue
43. Investigation of thyroid function
• Sensitive TSH assay
• 3rd gen assays:10 fold greater functional sensitivity than 2nd gen
• Assay of circulating thyroid hormones
• Total (protein bound)
• Free T4/T3
44. Assessment of thyroid function
• Thyroid autoantibody tests
• Thyroid imaging - of value in assessment of thyroid size & differential
diagnosis – Ultrasound scan; CT; MRI
• Nuclear scintigraphy: Radionuclide imaging
• evaluate functional activity of thyroid -hot or cold
• determine location & size of functional thyroid tissue (& to
localize ectopic thyroid tissue)
• Fine needle aspiration cytology
• differentiating benign from malignant disease
45. Biochemical diagnosis of Hyperthyroidism
• Overt: except for lab error, all patients with low/undetectable serum
TSH & high free T4 & T3 concentrations have hyperthyroidism
• In some pts, only serum T3 or serum T4 is elevated
• T3 toxicosis – Low serum TSH; high free T3; normal free T4
• Tends to occur early in course of hyperthyroidism
• T4 toxicosis – Low serum TSH, high free T4, normal T3
• Pattern in pts with hyperthyroidism & non thyroidal illness
• May occur in persons with amiodarone induced thyrotoxicosis
46. Biochemical diagnosis of Hyperthyroidism
• TSH-induced hyperthyroidism: Very rare cause of hyperthyroidism,
due to:
TSH-secreting pituitary adenoma
or
partial resistance to feedback effect of thyroid hormones on TSH
secretion
defects in the T3-nuclear receptor
Normal or high serum TSH despite high free T4 & T3 concn
47. Radioactive I uptake & thyroid scanning
Radionuclide scans provide information
• shape, size of thyroid gland, distribution of tracer activity within gland
• limited role in differentiating benign from malignant nodule
• Thyroid gland selectively transports radioisotopes allowing for thyroid
imaging & quantification of radioactive tracer uptake
• useful to differentiate causes of thyrotoxicosis particularly when
used in conjunction with imaging
• Graves: usually diffuse uptake
• Toxic nodular goiter usually patchy uptake, with areas of
increased & decreased uptake
48.
49. Nuclear scintigraphy
Cold nodule: nonfunctioning thyroid nodule/lump
• doesn't concentrate radioactive isotopes in thyroid scan
• Higher incidence of malignancy
Hot nodule: nodular region of thyroid gland
• takes up large amounts of radioactive iodine relative to rest of thyroid gland,
visualized as "hot spot"
• majority of hot nodules function autonomously
• Much lower malignancy potential
50.
51. Treatment of hyperthyroidism
B-blockers
• relieves many of the symptoms (particularly palpitations, tremor,
anxiety)
• Atenolol – advantage of single daily dose & -1 selectivity
• Propanolol also reduces T4 to T3 conversion
• Contraindicated in asthma; caution in patients with heart
failure
Antithyroid drugs: Carbimazole, Methimazole, Propyl thiouracil
inhibit thyroid hormone biosynthesis & secretion
52. Thionamide therapy in Hyperthyroidism
• Aim: to restore euthyroid state as soon as possible, so as to achieve
lasting remission in patients with Grave's disease or to prepare
patients treatment with radioactive iodine or surgery
• Duration of treatment with drugs:– 12 to 24 months if ablation not
intended
• Reports of permanent remission after discontinuing drugs is achieved
- 15-80%
53. Side effects of Thionamides
• Rash
• Nausea
• Epigastric distress
• Agranulocytosis*
• Hepatitis
• Lupus like syndrome
• Vasculitis
• Polyarthritis
54. Other Medications
Iodides, Ipodate (iodinated radio contrast agent)
• Inhibit thyroid hormone synthesis and secretion
• Useful in lowering T3 & T4
• Can be used to quickly prepare patients for surgery, when there is
insufficient time to give thionamides
• Useful in combination treatment of thyroid storm
55. Radioactive iodine (I 131)
• Treatment of choice in patients with toxic nodular goitre
• 1st line for patients with Graves’ disease in US
• Increasingly used as first-line therapy for adults
• Contraindicated in children, during pregnancy & breast feeding
• Pregnancy contraindicated for 6-12 months after therapy
• Fixed or individualized doses
56. Radioactive iodine (I 131)
• Stop thionamides 3-5 days before RAI, to avoid impairing uptake;
restart few days later
• May aggravate uncontrolled hyperthyroidism
• Small but definite risk of development or worsening of
ophthalmopathy, esp if smoker or high T3 before therapy
• (Tx with prednisolone reported to prevent worsening)
• Toxic nodules require higher doses
• side effect – hypothyroidism, radiation thyroiditis
• life-long follow-up of thyroid function required
57. Thyroidectomy
• Those with very large goiters
• Where there is possibility of malignancy
• Severe or advancing ophthalmopathy
• Patient who relapses after medical therapy
• Pregnant patient on drugs whose disease is hard to control
• Those with severe reactions to antithyroid drugs
• Patients who have refused I 131 therapy
• Woman wishing to achieve a pregnancy in near future
58. Treatment of other causes
Self-limiting causes of thyrotoxicosis: subacute thyroiditis, iodine-
induced, exogenous administration of T4
• Treat symptomatically
• Therapy: beta-blockers for symptomatic control and
antiinflammatory drugs such as aspirin, or nonsteroidal
antiinflammatory drugs, or, in severe cases, prednisone
• Ipodate also useful: blocks conversion of T4 to T3 & reduces the
tissue effects of thyroid hormones
• Thionamides have no role in treatment, since new hormone is
not being synthesized
61. Hypothyroidism
• Diagnosis relies heavily on lab tests
•many of the clinical manifestations non-specific
• Clinical presentation highly variable
•depends on age of onset and duration & severity of disease
•Presentation in adults varies from asymptomatic elevation in TSH
concentration to myxedema coma
64. Transient hypothyroidism
• Sub acute lymphocytic thyroiditis
• Sub acute granulomatous
• Postpartum thyroiditis
• After 131I treatment or subtotal thyroidectomy for Graves’ disease
65. Chronic Autoimmune thyroiditis
• Commonest cause of hypothyroidism in iodine-sufficient areas of the
world
• Commoner in older women
• cellular & antibody-mediated destruction of thyroid tissue
• Goitrous
• Atrophic
• differ in extent of lymphocytic infiltration, fibrosis, & follicular
cell hyperplasia of thyroid, but not in pathophysiology
66. Chronic Autoimmune thyroiditis
Hashimoto’s
• Marked lymphocytic infiltration
CD4+, CD8+ & B cells
Atrophic
• More fibrosis, less lymphocytic
infiltration
• Represents end stage of Hashimoto
thyroiditis
67. Chronic autoimmune (Hashimoto's) thyroiditis
Role for genetic susceptibility
• more likely to have personal or family history of autoimmune
diseases
• Association with Turners syndrome
No well-defined environmental risk factors for chronic autoimmune
thyroiditis
• evidence linking a high iodine intake with this disorder
• serum antithyroid antibody concentrations increase after
dietary iodine intake is increased in endemic goiter regions
• Reports of association between cigarette smoking & risk of
hypothyroidism in pts with autoimmune thyroid disease
68. Hypothyroidism
Symptoms in adults often non-specific:
• Fatigue
• Cold intolerance
• Weight gain
• Constipation
• Myalgia
• Menstrual irregularities
• Slow movement and speech
69.
70. Hypothyroidism
Older children may present on account of:
• Short stature due to linear growth retardation
• Retarded secondary sexual characteristics
• Delayed onset of puberty
• Poor school performance
71. Hypothyroidism
• Delayed relaxation of deep tendon reflexes
• Bradycardia
• Coarse hair and skin, puffy facies, loss of eyebrows, enlargement of
the tongue, voice hoarseness
• Overt muscle weakness
72. Other clinical features
• Entrapment neuropathy of median nerve
• producing paresthesia & weakness of hands
• Obstructive sleep apnoea
• Cardiomegaly: dilation of the heart; pericardial effusion
• Neuropsychiatric manifestations
• Adynamic ileus leading to mega colon & functional intestinal
obstruction
73. Investigations
• Primary hypothyroidsm – low or normal serum FT4 with elevated
TSH
• Secondary hypothyroidsm – low serum FT4 with low or
inappropriately normal TSH
• Subclinical hypothyroidsm – normal serum T4 & elevated serum
TSH (no symptoms or signs usually)
74. Investigation
• Raised TSH, normal free T4 or T3
• Recovery phase of non thyroidal illness
• Intermittent thyroxine therapy in hypothyroidism
• Interfering antibodies
• Drugs-cholestyramine, sertraline
• Congenital
• TSH receptor defects
• TSH resistance syndromes
75. Investigations
• Hyperlipidaemia – occurs with increased frequency in hypothyroidism
• Hyponatraemia – often resulting from inappropriate ADH secretion
• Elevated muscle enzymes (CPK, AST. LDH)
• Anaemia normochronic, normocytic
• E.C.G. changes- bradycardia, low amplitude QRS complexes, evidence
of ischaemic heart disease
• Thyroid autoantibodies (antithyroglobulin antibody, thyroid
peroxidase antibody)
77. Treatment
• If no residual thyroid function, daily replacement of levothyroxine
@~1.6µg/kg( 1-2 µg/kg per day)
• Elderly (> 50-60) years & no evidence of heart disease, stat 50 µg
daily
• Those who have history of CHD initiate at 25 µg /day
• dose can be increased by 25 mcg/day every 3 to 6 wks until replacement
is complete
• Gradual increase, as rapid increase in dose may tax coronary or cardiac
reserve
78. Treatment
• Therapeutic goal: alleviation of clinical syndrome & normalization of
TSH in primary hypothyroidism
• After initiation of T4 therapy, reevaluate
• Serum T4 & TSH measured in 3 to 6 wks (depending upon patient's
symptoms) & dose adjusted accordingly
• process of increasing dose of Levothyroxine should continue,
based upon periodic measurements of serum TSH (& free T4 if
therapeutic goals have not been achieved)
79. Treatment
• Once desired T4 dose is established, annual evaluation
• Changing requirements
• Altered absorption
• Compliance issues
• Monitor for signs of overtreatment
• Life long therapy in majority
• Surgical therapy for huge goiters with compressive symptoms
•Subclinical hypothyroidism: Treat if there is goitre, suggestive
symptoms, low T3, drugs which may potentiate, uncertain follow
up, cholesterol
80. Thyroid cancer
• 95% of thyroid cancer presents as nodule or lump in thyroid gland
• Thyroid cancer may coexist with thyrotoxicosis
• Graves disease in association with thyroid nodules reportedly ↑ risk of
thyroid carcinoma
•
81. • Cold nodules frequent in hyperthyroid patients in endemic iodine-deficient
regions
• 3.8% in GD; 6.4% Toxic multinodular goitre; 12% in thyroid adenoma
• Older patients (>/=50 years) & cold nodules:- significant risk factors for
malignancy in patients with hyperthyroidism
Giles SY et al: Surgery 2008;144: 1028-36
83. Thyroid cancer
Surgery is primary mode of therapy for patients with differentiated thyroid
cancer
• For most patients with papillary or follicular carcinoma:
• Total thyroidectomy followed by I131 ablation
Levothyroxine TSH suppression
• Diff thyroid cancers contain TSH receptors &TSH stimulates their growth
• Reduced recurrence & cancer specific mortality rates
84. Thyroid cancer
Follow-up
• long-term with physical examinations, biochemical testing (including
serum thyroglobulin measurements), radioiodine imaging, ultrasound