Transcript Thyroid Disease

Thyroid Disease
Dr Faiza .A. Qari
Associated professor
FRCP , FACP , ABIM
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Normal Function
 Production , storage and secretion of
thyroid hormone
 Calcitonin is produced by the C cells of
thyroid , no significant effects on Ca
metabolism
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Epidemiology
 Worldwide , endemic iodine deficiency ---- 800 million people (
preventable , low cost , never remains a major public health
challenges )
 Thyroid disease is a very common problem seen in endocrine clinic
; autoimmune thyroid disease alone is more prevalent than DM
 Grave’s disease , Hashimoto’s disease ( commonest )
 Thyroid tumor is 1% of all tumor
 Thyroiditis is rare
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Causes of goiters
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Endemic goiter
Sporadic – non toxic goiter
MNG
Hashimoto’s thyroiditis
Thyrotoxicosis
Solitary nodule ( Follicular adenoma , toxic adenoma ,
thyroid cancer )
 Thyroiditis
 Infiltration
 Goitrogens
 Dyshoromonogenesis
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Hypothyroidism
• Symptoms
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Cold intolerance
Physical and mental slowing
Tiredness and lack of energy
Worsening memory concentration
Deafness , unsteadiness
Wt gain
Constipation
Chest pain
Muscle aches and rheumatism
Pins and needles fingers
Heavy periods
Goiter
Dry skin , hair loss
Psychiatric disturbance
Voice change
Sleeping , snoring
Signs
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Sluggishness in action and
response
Facial puffiness , especially
periorbital oedema
Cold , dry , sallow skin
Loss of hair in scalp and
occasionally body ( not eye brow (
rarely lanugo growth
Goiter
Bradicardia
Hypertension , which is rarely
marked ; occasionally hypotension
Faint hear sound
Mytonic tendon jerks
Galactorrhoea
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Vitiligo affecting the hands of a
patient with Hashimoto’s thyroiditis
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Hypothyroidism in an elderly female
who presented with breathlessness
and pleural effusions
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Complications
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CHD , CHF
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Susceptibility to infection
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Megacolon
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Organic psychoses , paranoid delusions
( myxedema madness )
• Infertality,miscarriage
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stupor , myxedema coma
hypoventilation , hyponatremia , hypoxia , hypercapnia , hypotension ,
convulsions
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Investigations
• FT4, FT3 low , TSH high
• Thyroid antibodies ( thyroperoxidase ,
thyroglobulin AB )
• Cholesterol , CK, prolactin ---high
• Hyponatremia , hypoglycemia , anemia
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Conclusion
• Weakness , fatigue , cold intolerance , constipation , Wt
gain , depression , menorrhagia , hoarseness
• Dry skin , bradycardia , delayed return of deep tendon
reflexes
• Anemia , hyponatremia
• FT4 , FT3 low
• TSH elevated in primary hypothyroidism
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Causes of hyperthyroidism
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Grave’s disease
Toxic MNG
Over treatment with thyroxine
Less common :-
 Toxic adenoma
 Post – partum thyroiditis
 Use of iodine containing drugs in iodine deficiency
Rare :-
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Sub acute and chronic thyroiditis
Very rare : Trophoblastic tumor ( hydatiidiform mole )
 TSH – secreting pituitary adenoma
 Ectopic thyroid tissue ( Struma ovarian, functional metastases )
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Hyperthyroidism
• Symptoms
 Nervousness ,
restlessness and anxiety
 Sweating
 hypersensitivity and
intolerance to heat
 Palpitations
 Fatigue
 Wt loss
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Signs
Tachycardia
Tremor
Thyroid bruit
Eye signs
Atrial fibrillation
Finger clubbing and
pre- tibial myxoedma
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Overactive Thyroid
(Hyperthyroidism)
Under active Thyroid
(Hypothyroidism)
Trouble Sleeping
Sleepiness
Diarrhea
Constipation
Eye protrusion (see picture below)
Puffy face
Nervousness
Lethargy
Hair loss
Thick, rough, dry skin
Weight loss
Weight gain
Intolerance to heat
Intolerance to cold
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Bilateral Exophthalmos
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Grave’s disease
• Most common cause of hyperthyroidism
in patients younger than 40 y old
• Hyperthyroidism , infiltrative
opthalmopathy , diffuse goiter, infiltrative
dermopathy ( myxoedema ) , finger
clubbing ( acropachy )
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Graves’ disease
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Epidemiology of Grave’s disease
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Incidence per annum
Prevalence in F
F:M ratio
Mean age of onset
pernicious anemia
Myasthenia gravis
0.5%
1%
10:1
30-40 y
3%
1%
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Characteristics of Grave’s eye disease
• Lid retraction
• Per orbital soft tissue swelling ( non pitting and boggy )
• Increased volume of orbital connective tissue , muscles and fat ,
proptosis ( ≥ 22 mm is marked )
• Inability to close the eye ( lagopthalmos ) ---- keratitis
• Chemosis , photophobia
• Ophthalmoplegia ---- Tethering of IR, M rectus ------ double vision
particularly on upward gaze
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Investigations
• FT4 , FT3 --- high . TSH suppressed
• TSH-R Ab ( 80% )
• Thyroid scan ---- high radio-active iodine
uptake up-take in Grave’s disease , MNG
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Conclusion
• Sweating , WT change , nervousness , loose
stools , heat intolerance , irritability , fatigue ,
weakness , menstrual irregularity
• Tachycardia ; warm , moist skin , stare , tremor
• Grave’s ( goiter with bruit ) , opthalmopathy
• TSH – suppressed , Increase FT4 , FT3
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