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Thyroid gland diseases.
Ethiology. Pathogenesis.
Diagnostics. Clinical pattern.
Complications. Principles of
treatment. The role of a doctordentist in early diagnostics and
prophylaxis
N. Bilkevych
Structure and location of thyroid
gland
Influence of thyroid
hormones on an
organism:
Nervous system and psychic
Cardiovascular system
Digestive system
Reproductive system
Skin and intertguments
Musculosceletal apparatus
Endemic goitre
This is a disease manifested
with thyroid gland enlargement.
It develops in certain
biogeochemical regions
characterized by iodine
deficiency in the environment
Ethiology
• Iodine deficiency is the main obvious factor
• Additional factors:
• deficiency of microelements cobalt, copper, fluorine,
zinc, molybdenum (participate in iodine metabolism);
Influence of strumogens – substances which decelerate
biosynthesis of thyroid hormones
Hypersecretion of thyrotrophic hormone (TTH) by
hypophysis
• Diseases of digestive tract, a liver with disordered iodine
absorption.
Palpation may be
performed, if a doctor
stands behind or
before the patient,
his arms are put at
the zone of projection
of the gland
Classification of thyroid gland
enlargement (WHPO, 2001)
Degree of enlargement – 0
Goitre is absent (sizes of both lobules
don’t exceed medial phalange of human’s
thumb
Degree of enlargement - І
Thyroid gland is palpable but is not
visible in normal position of patient’s
neck: nodal formations which don’t cause
thyroid gland enlargement
Degree of enlargement - ІІ
Thyroid gland is visible in any position of
the patient
Nodal goitre
Treatment
• 1. Thyroid hormones – L-thyroxin - 50-100
мcg/d;
2. Iodinum preparations – 100-200 мcg/d
• Prophylaxis of iodine defficiensy
• Iodinum-containing products (salt, bred, milk);
2. Iodinum preparations:
iodide potassium, lipiodol
100-200 мcg/d.
Diffuse toxic goitre (DTG)
Ethiology and provoking factors
stress;
Infectious diseases;
insolation;
smocking;
Inflammatory processes in thyroid
gland
Hormonal disbalance
heredity
Clinical pattern
Complaints
• Nervous system –tearfulness, depression, deranged
sleep, irritability, oversweating
Cardiovascular system – Permanent palpitation, periodical
intermissions, dyspnea
• Metabolism – poor tolerance to heat, low body weight
while appetite is increased, muscular weakness
Digestive tract - increased appetite; abdominal pain;
periodical diarrhoea
Ophthalmopathy – feeling of protrusion of eyes,
dacryagogue; photophobia
Interguments – brittle hair, loosing hair.
Objective examination
 Red dermographism.
 Cardiovascular system –
tachicardia, extrasystoly, atrial
fibrillation;
 Intensification of
І heart
sound, systolic murmur,
 Heart failure;
 Systolic arterial hypertension
 Sex glands – Disorders of
menstrual function and
problems with pregnancy in
females, impotence in males
 Nervous system – Emotional
lability, irritability;
 Tremor of the body (symptom
of «telegraph post»)
especially nails of hands (Mary
symptom).
• Metabolism – subfebrile body temperature,
skin is warm
Low body weight.
Ostheoporosis.
Skin is warm and moist, mild, velvet-like;
Pretibial myxedema
• Thyroid gland is enlarged, of solid-elastic
consistency, systolic murmur above it
• Sex glands – mastopathy, gynecomastia
Ophthalmopathy
• Exophthalmos
* Dalrimpl’s sign (wide eye slits)
* Graefe’s sign
• * Mebius sign (convergention disorders)
* Elinek’s sign (hyperpigmentation)
* Stellwag’s sign (rare blinking)
* Rosenbach’s sign (tremor of closed
eyelids)
* Kocher’s sign
Laboratory and instrumental
examination
• ECG: synus tachicardia, extrasystoly,
paroxysmal tachycardia, atrial fibrillation;
Ultrasound examination of a heart: high heart
output;
Rogr - cardiomegaly
• Metabolism – Increased serum Ca, excretion
of Ca with urine
• Digestive tract – Changes of indexes of liver
function
Diagnostics of DTG
Anamnesis
Provoking factors
Clinical pattern
Signs of thyrotoxicosis and diffuse enlargement of thyroid
gland
Laboratory tests
1) Common and free Т3 і Т4 are increased;
2) Increased level of common Т3 and normal Т4 (Т3 –
thyrotoxicosis)
3) Decreased level of thyrotrophic hormone (TTH)
4) Increased consumption of radioactive iodinum J131 with
thyroid gland
5) High level of antibodies to TTH receptors
Instrumental diagnostics
1) Ultrasound examination of thyroid gland
(enlargement and diffuse
decreased density);
2) Scintigraphy (insuspiction on retrosternal
goitre and in nodal goitre)
3) Puncture biopsy of thyroid gland is
executed for diagnostics of all nodal
formations in the gland
Laboratory and instrumental
examination
• ECG: synus tachicardia, extrasystoly,
paroxysmal tachycardia, atrial fibrillation;
Ultrasound examination of a heart: high heart
output;
Rogr - cardiomegaly
• Metabolism – Increased serum Ca, excretion
of Ca with urine
• Digestive tract – Changes of indexes of liver
function
Ultrsound examination of thyroid
gland
Radioisotopic scanogrm of thyrid
gland
Puncture biopsy of thyroid gland
Treatment
Antithyroid preparations
(propilthiouracil, tiamazol (merkasolil)
within 1-2 years
Mercasolil (5 mg) – 30-60 mg per os,
gradually decrease dosage till 5-15
mg.
Beta-adrenobloquers (metoprolol 50200 mg/d, bisoprolol 5-10 mg/d,
propranolol 80-120 mg/d
Hypothyreosis
A disease caused by prolobged
permanent thyroid hormones
deficiency with following
decrease of metabolism and
functional disorders in
different organs and systems
Face in hypothyreosis
Hypothyreosis in bnewborns
Pretibial myxedema
Clinical pattern
Complaints
• Metabolism – body mass gain
• Skin – dryness, induration and
change of color (“wax-like”),
rugged face features,
enlargement of foots, speech is
not clear, decreased hearing.
• Nervous system somnolence, indisposition,
depression, decreased memory
and intellect, frequent
headaches, dizziness;
sensitiveness to cold,
parestesias, deranged vision.
• Musculoskeletal system –
musculaer pains and crumps,
weakness.
• Cardiovascular system – pain
in heart region, dyspnea in
physical load.
• Digestive system –
constipation, decrease
appetite, nausea
• Respiratory system –
frequent bronchitis
exacerbations, pneumonias
(body temperature is normal).
• Urogenital system –
decreased diuresis,
pyelonephritis, decreased
potention in males,
menstrual-ovarial cycle
disorders in females.
Objective examination
• Metabolism - hypothermia,
overweight
Skin – dry, cold, yellow, it is nit
possible to make skin fold,
symptom of dirty elbows and
колін; dryness and brittlessness of
hair, psilosis, loosing of external
parts od eyebroves; nails are sick,
with streaks; face is pastous,
enlarged lips and a tongue with
teeth pattern, hoarse voice
Myxedematous edema
(myxaedema)– accumulation
of gucosaminoglacals
(hialuronic and
chondroitinsulfate acids), with
accumulation of liquid and
sodium in tissues (skin,
subcutaneous fat, vocal slits,
mucous memvranes.
 Nervous system – disordered
coordination, poor vision.
Digestive system –tonque
enlqrgement with teeth patter
on its sides, hepatomegaly,
dyskinesia of bile dicts and
intestine, ascites.
Cardiovascular system bradicardia, extrasystoly
Apex beat is low, relative cardiac
dullness borders are displaced,
weak heart sounds, systolic
murmur at the apex, signs of
heart failure. BP low or
normal.
Respiratory system – superficial
breathing, pleuricy.
Thyroid gland – is of normal size
or slightly enlarged,mild or of
moderat density, painless.
Laboratory and instrumental
diagnostics
• Blood – hyperlipoproteidemia, increased level of
cholesterol and triglicerides. Anemia (normochromic,
hypochromic iron-deffiicency or В12- irondeffiicency)
Nervous system - Eectroencephalography: decreased
amplitude of waves, narroving of vision fields,
increased intraocular pressure.
Musculoskeletal system – osteoporosis, sinovial fluid.
Cardiovascular system - ECG: low voltage, sinus
bradicardia, disordered conduction ( P-Q
prolongation), extrasystoly.

Ultrasound of a heart – pericardial effusion, left
ventricular wall sickness.
Digestive system – achlorhydria and authimmune
gastritis.
Urogenital system - decreased diuresis, renal blood
flow and glomerular filtration, moderate proteinuria.
Dry hear
Falling of external
eyebroves hair
Periorbital edema
Edematous face
dry skin
Diagnostics
Changes of Т3, Т4, ТТH.
Subclinical hypothyreosis – increased TTH,
normal Т4.
Primary hypothyreosis – increased TTH,
decreased Т4.
Secondary hypothyreosis – decreased TTH,
decreased Т4 thyroliberin test is negative
Tertiary hypothyreosis – decreased TTH,
decreased Т4 thyroliberin test is positive
Treatment
Ethiological
treatment of the cause
Pathogenetic
thyroid hormones
1) poor Т4 (levothyroxin, L-thyroxin, euthirox)
– for prolonged замісної treatment;
2) poor Т3 (thriiodtironin) – is used for
diagnostics;
3) Combined preparations (tireocomb,
tireotom, novotirol) – is difficult to choose
proper dosage.
Treatment
1.
Corticosteroids – for prevention of adrenal insufficiency
(hydrocortison 100-150 mg or prednisolon 30-50 mg i/v.
2.
200 мcг of thyroxin, glucous 40% - 60 ml, ISS 500 мл, 5%
ascorbic acid 5 0 i/v.
3.
Oxygen. Artificial lung ventilation.
4.
In edema and high BP – diuretics (lasix 2 ml i/m), in hypotesion
- mesaton 1% - 0,5-1,0 ml i/v, corglivon 0,06% - 1,0.
5.
Antibiotics.
•Thank you!