Transcript Hyperthyroidism

In the name of God
Thyroid Benign Disease
Nazila Abrishami
June 2012
Thyroid benign disease
1)Hyperthyroidism
Diffuse Toxic Goiter
Toxic Multinodular Goiter
Toxic Adenoma
Thyroid Storm
2)Hypothyroidism
3)Thyroiditis
4)Riedels Thyroiditis
5)Goiter
6)Solitary Thyroid Nodule
Hyperthyroidism
This disease result from an excess of circulating thyroid
hormone.that may arise from a number of
condition(graves disease,drug induced,thyroiditis,thyroid
cancer…)
its very important to distinguish disorders:
1.Cause excess production of hormone
such as graves disease
from
2.An other condition which release stored hormone such
as thyroiditis.
First disorder characterized by increasing in radioactive
iodine uptake.
Diffuse toxic Goiter(Graves disease)
Its an autoimmune disease with a strong
familial predisposition.there is a high
incidence in female especially between 40_60
years.
the exact etiology of this disease is not known but
some condition such as iodine excess,lithium
therapy,bacterial & viral infection…suggested
as triggers.genetic factor especially present of
HLADQA1.0501,HLADR3,HLAB8 also play important
role.
The clinical manifestation of graves disease divided
into 2category:
1.those related to hyperthyroidism & 2.those specific
to Graves disease.
Hyperthyroid symptom include:heat
intolerance,incresed sweating & thirst,weight
loss,palpitation,fatigue,diarrhea,increased incidence
of miscarriages,…
Nearly 50% of patiant have ophthalmopathy & 1 to
2% have dermopathy.eye symptoms include lid
lag(von graefes sign),spasm of upper eyelid revealing
the sclera(dalrymple sign),conjunctival swelling &
congestion(chemosis)…
Diagnostic tests:
the diagnosis of hyper thyroidism is made by a
suppressed TSH with or without an elevated free T4
or T3 level.but if eye sign are present other tests are
not needed.in patient with out eye sign (I 123)uptake
with diffusely enlarged gland can confirm diagnosis.
Other tests including:determining T3 level(in T3
toxicosis), anti TG antibodise,TPO antibodies,TSAB
Treatment: graves disease may be treated by any of
3 treatment modalities:
1.Antithyroid drugs 2.radioactive iodine therapy(RAI)
3.thyroidectomy
1.Antithyroid medications:
generally are administered before RAI ablation or
surgery.
Drugs: Propylthiouracil(PTU) have less side effect
Methimazole
the proper dose of drugs depend on TSH & T4 levels.
2.Radioactive iodine therapy:
This method most often used in:
*Older patient with small or moderate sized goiter.
*Patient with relapse after medical or surgical therapy.
*Those in whom 2other method are contraindicated.
Absolute contraindication: pregnancy
3.Surgical treatment
Patients with coexistent thyroid cancer,those who refuse
RAI therapy or have severe ophtalmopathy or have life
threatening reaction to antithyroid medication should
undergo surgery.
Toxic Multinodular Goiter
Occur in older individuals with nontoxic multinodular
goiter,over several years become autonomous and
cause hyperthyroidism.
Sign & diagnostic studies are similar to Graves
disease.
Treatment surgical + thyroid hormone suppression
therapy(to prevent recurrence)
RAI is recommended in patient with high risk for
surgery.
Toxic Adenoma
In this disease hyperfunction of single nodule cause
hyperthyroidism,especially in young patients.
RAI scanning shows a hot nodule with suppression
the rest of thyroid gland.
These nodules are rarely malignant.
Treatment
Small nodule need medication therapy & RAI
Large nodule surgery
Thyroid storm
Is condition of hyperthyroidism accompained by
fever,agitation,cardiovascular dysfunction that may
result from infection , surgery,or trauma.
Treatment:administration of B_blocker,corticosteroid
& Lugols iodine,oxygen supplemention & control of
hemodynamic.
Hypothyroidism
Deficiency in circulating levels of thyroid hormone
lead to hypothyroidism and cause neurologic
impairment and retardation in neonates(cretinism).
hypothyroidism also may occur in Pendreds
syndrome.(associated with deafness) and turners
syndrome.
In adult symptoms are non specific:weight gain,cold
intolerance,constipation,dry skin,dry hair,sever hair
loss….
Laboratory findings: low level of T3 &T4
In primary hypothyroidism raised TSH level
In second hypothyroidism suppressed TSH level
Treatment :administering T4
Dosage depend on condition of patient.
Hypothyroidism
Thyroiditis
Classified into acute,subacute,and chronic forms.
Acute(suppurative)thyroiditis:
Thyroid gland is resistant to infection but some times
infectious agents can seed it
*Via the hematogenous
*After penetrating trauma
*Due to immunosuppression……
This disease is more common in children and
characterized by severe neck pain(radiating to jaws or
ear),fever,chill,odynophagia,&dysphonia.
The diagnosis confirm by leukocytosis on blood tests
and FNAB for Grams stain,culture,and cytology.
Treatment:
Antibiotic + drainage of abscesses.
Subacute Thyroiditis
Can occur in the painful or painless forms.exact
etiology is not known but:
Painful: viral infection,genetic(HLAB35)
In this disease cytotoxic T lymphocytes stimulate and
damage thyroid follicular cell.
Its common in women,characterized by sudden or
gradual onset of neck pain.the gland is large,tender
& firm.(T4,T3.ESR high / TSH low
The disorder progresses through 4stage:
Hyperthyroidism , euthyroidism, hypothyroidism,
euthyroidism.
Treatment
Aspirin,NSAID,thyroid hormone
therapy,& some times thyroidectomy
Painless: may be an autoimmune disease and
especially occur in women after delivery.
symptoms and clinical course are similar to painful
form.
Treatment B-blocker, thyroid hormone, and some
times thyroidectomy or RAI ablation
Choronic thyroiditis lymphocytic
Is an autoimmune process initiated by the activation
of CD4 T helper lymphocytes which destruct
thyrocytes. antibodies directed against 3main Ag:
Tg,TPO,TSH-R
Disease is common in women between 3040years.minimally or moderately enlarged firm
granular gland discover in examination.FNAB can be
useful that in pathology we see follicles lined by
Ashanazy cell.
Diagnostic studies:
Elevated TSH and present of thyroid autoantibody
confirm the diagnosis.
Treatment: thyroid hormone,surgery(for suspicion
of malignancy,or cosmetic deformity)
Riedels Thyroiditis
Is rare variant of thyroiditis which characterized by
replacement of all or part of the thyroid parenchyma
by fibrous tissue.it presents as painless,hard(woody)
neck mass.
Symptom include:
Dysphagia ,dyspnea, hoarsness, choking,
hypothyroidism, hypoparathyroidism…
Biopsy is necessary.
Treatment : surgery
Goiter
Familial goiter resulting from dificiencies in
enzymes necessary for thyroid hormone synthesis
hypothyroidism
Endemic goiter resulting from iodine deficiency
and can be treated by iodine.
Clinical feature:most patients are
asymptomatic,although patients often complain of
pressure sensation in the neck.
We can find soft enlarged gland(simple goiter)or
nodules of various size(in multinodular goiter)
Thyroid tests are usually normal.
Treatment:
Patient with small,diffuse goiter do not need
treatment
In large goiter thyroid hormone therapy can be
useful.
Goiter
Solitary thyroid nodule
History such as time of onset,change in size of
nodule and associated
symptom(pain,dysphagia,dyspnea…) is very
important.
We should ask from ionizing radiation and familial
history of malignancy.
Nodules that are hard,or fixed to surrounding
structure are most likely to be malignant.
Diagnostic investigations
FNAB has become the most important test.
After FNAB nodules can be categorized into:beningsuspicious-malignant
Ultrasound is inexpensive and noninvasive method
that can be helpful for detecting nonpalpable thyroid
nodule,differentiating solid from cystic
nodule.calcification….
Solitary Thyroid Nodule
management
But in patient with history of previous irradiation of
thyroid gland or familial thyroid cancer,
surgery should be done.