Transcript Nervous system - Semmelweis Egyetem

Hyperthyroidism, hypothyroidism,
endocrine ophthalmopathy
Dr. Peter Lakatos
1st Department of Medicine, Semmelweis University
Capacity of specialized tissues to
function in an integrated
fashion made possible by:
•
Nervous system (electrochemical signals)
•
Endocrine system (chemical signals – hormones)
•
Immune system
Endocrinology - Starling, Croonian Lectures, 1905
Evolution of hormones
•
Alpha factor of yeast – GnRH
•
Glucagon of tobacco hornworm
•
VIP in earthworm
•
Cholecystokinine in hydra
•
PTHrp in fish
Distinction Between Elevated Serum T4 of Thyrotoxicosis and
Euthyroid Hyperthyroxinemia
Increased binding proteins
Estrogen
Infectious hepatitis
Opiates
Genetic
Anti-thyroxine antibodies
Thyroid hormone resistance
Amiodarone
Porphyria
Hyperemesis gravidarum
Acute psychiatric disorders
Causes of Transient or Permanent Hyperthyroidism
Graves-Basedow disease
Toxic goiter (autonomous adenoma)
Toxic multinodular goiter
Struma ovarii
Iatrogen
Thyroiditis (subacute)
Differentiated thyroid tumors
Rare causes
Common Symptoms of Graves' Thyrotoxicosis
Symptom
Frequency, %
Nervousness, jitteriness, irritability
Increased perspiration
Easy fatigability
Heat intolerance
Weight loss
Tachycardia
Muscle weakness
Insomnia
Increased appetite
Reduced job performance; marital discord
Eye complaints
Hyperdefecation
Anorexia
Constipation
99
91
88
89
85
82
70
65
65
58
54
33
9*
4*
*May be due to associated hypercalcemia.
Causes of Transient or Permanent Hypothyroidism
Destructive
Postoperative
Radioactive iodine
External radiation to neck
Infiltrative disease (eg, sarcoidosis, amyloidosis, lymphoma, metastatic carcinoma)
Autoimmune
Hashimoto's disease
Following Graves' disease
Thyroiditis (subacute, silent, postpartum)
Drug-induced (iodides, lithium, thionamides)
Hereditary or congenital
Enzyme deficiency affecting thyroid hormone biosynthesis
Agenesis
Hormone resistance
Endemic cretinism
Hypothalamic-pituitary disorders
Thyrotropin-releasing hormone deficiency
Thyroid-stimulating hormone deficiency
Idiopathic
Goitrous and nongoitr. primary hypothyroidism with negative anti-thyroid antibodies
Clinical Presentation of Thyroid Hormone Deficiency
Symptoms
Signs
General
Cold intolerance
Fatigue
Mild weight gain
Nervous system
Lethargy
Memory defects
Poor attention span
Personality change
Weakness
Muscle cramps
Joint pain
Gastrointestinal system
Nausea
Constipation
Cardiorespiratory system
Decreased exercise tolerance
Reproductive system
Decreased libido
Decreased fertility
Menstrual disorders
Skin and appendages
Dry, rough skin
Puffy facies
Hair loss
Brittle nails
Hypothermia
Mild obesity
Hoarse voice
Somnolence
Slow speech
Myxedema wit
Psychopathology: myxedema madness
Diminished hearing and taste
Cerebellar ataxia
Delayed relaxation of deep tendon refl.
Carpal tunnel syndrome Musculoskeletal
Normal strength
Normal joint examination
Large tongue
Ascites
Bradycardia
Mild hypertension
Pericardial effusion
Pleural effusion
Normal secondary sex characteristics
Nonpitting edema of hands, face, ankles
Periorbital swelling
Pallor
Yellowish skin (due to carotenemia)
Coarse hair
Dry axillae
Type of Derangement
Clinical Status
Serum TSH
Serum Free Thyroxine
Hypothalamic failure or tumor
Hypothyroid
Usually normal
Decreased
Pituitary failure or tumor
Hypothyroid
Usually normal
Decreased
Resistance to thyroid hormone
Variable
Usually normal
Increased
Resistance to thyroid-stimulating hormone (TSH)
Euthyroid
Increased
Normal
Treated primary congenital hypothyroidism
Euthyroid
Increased
Normal
TSH-secreting pituitary tumors
Hyperthyroid
Increased
Increased
Serious organic nonthyroidal illnesses
Euthyroid
Variable
Normal or increased
Acute psychiatric disorders
Euthyroid
Normal
Normal or increased
Recovery from recent hyperthyroidism
Hypothyroid or euthyroid
Decreased
Decreased or normal
TSH suppression, dopamine
Euthyroid
Decreased
Usually normal
TSH suppression, glucocorticoids
Euthyroid
Normal or decreased
Usually normal
Non-steady state thyroxine administration
Variable
Variable
Variable
Treated primary congenital hypothyroidism
Euthyroid
Increased
Normal
Acute salsalate/salicylate loading
Euthyroid
Decreased then increased
Increased then normal
Long-term derangements:
Transient derangements: