disorders of thyroid i.e. hypo and hyper thyroidism with invetigations

1. DISORDERS OF
THYROID GLAND
PRESENTED BY
Shubham Sonwane
B.A.M.S. 3RD YEAR
Batch 2013-14
DIRECTED BY
DR. ARVIND TRIPATHI
M.D. LECTURER
DR. ARCHANA SINGH
M.D. LECTURER
SUBMITTED TO
DR. S.M. KHUJE
M.D. READER H.O.D.

2. Anatomy of Thyroid
Gland

3. Thyroid ~> shield like structure
● butterfly shaped

4. SITUATION
1. Thyroid gland lies infront
and sides of lower part of
neck.
2. In front of the lower part of
the larynx and the upper
part of trachea.
3. The right and left lateral
lobe lies on each side of
trachea.

5. SITUATION
4. Thyroid gland lies
against C5-C6-C7-T1
vertebrae.

6. MEASUREMENTS
• Larger in females than in males
• Increases in size during menstruation and pregnancy
• Each lobe measures about –
Length- 5 cm.
Width- 2.5 cm
Thick- 2.5 cm.
• Isthmus measures about-
Length- 1.2 cm.
Width- 1.2 cm.
WEIGHT – 25 gm.

7. • Structural unit is
follicle or acinus.
• Follicle consist of
layer of simple
epithelium enclosing
cavity called the
follicular cavity.
• The cavity is usually
filled with gellike
viscous iodine-rich
material called
colloid
Histology

8. Physiology of Thyroid
Gland

10. Functions of Thyroid Gland
• T4 (thyroxine/tetraiodothyronine)
production
• T3 (triiodothyronine) production
-Growth & development
-Metabolism
-Body temperature
-Heart rate
• Calcitonin production
-Regulates blood calcium and
phosphate levels
-Effects long bone growth

11. Functional disorders of
Thyroid Gland
Diseases of the thyroid include
functional disorders such as
• Hyperthyroidism
• Hypothyroidism
• Thyroiditis
• Graves' disease
• Goitre

12. Hyperthyrodism
• Hyperthyroidism also called
thyrotoxicosis
• more frequent in females
• associated with rise in both T3 and
T4 levels in blood

13. Causes of
Hyperthyrodism

14. CLINICAL FEATURE of hyperthyrpdism

15. RISK FACTORS
• Family history of autoimmune disease such as
diabetes.
• Stress
• Smoking
• Have been treated with thyroid medication
• Received radiation therepy to the head or neck
region for cancer.

17. Grave‘s disease
• Named after ROBERT GRAVES
• It is an autoimmune disease
• Leads to generalised overactivity of the entire
thyroid gland (hyperthyroidism)

18. Etiopathogenesis

22. GOITRE
Term is from the latin gutteria which means swelling of neck.

23. DIFFUSE GOITRE –
• Diffuse enlargement of thyroid gland.
• TSH are invariably elevated.
• Appears at puberty or in adolescence.
NODULAR GOITRE –
• Regarded as end stage of long
standing simple goitre.
• Most extreme degree of tumour like
enlargement of thyroid gland.

28. SYMPTOMS OF GOITRE

30. HYPOTHYROIDISM
●It is a hypometaboloc clinical state
resulting from inadequate production
of thyroid hormones for prolonged
periods.
●rarely resistance of the peripheral
tissues to the effects of thyroid
hormones.

33. HYPOTHYROIDISM
CRETINISM MYXOEDEMA

35. • The word 'Cretin' is derived from the
French, meaning Christ-like.
• cretinism is a child with severe
hypothyroidism present at birth or
developing within first two years of
postnatal life.
• It is the period when brain
development is taking place, in the
absence of treatment the child is both
physically and mentally retarded.
cretinism

36. • Developmental anomalies
e.g. thyroid agenesis and
ectopic thyroid
• Genetic defect in thyroid
hormone synthesis
Etiopathogenesis

37. SYMPTOMS

38. MYXOEDEMA
The adult-onset severe hypothyroidism causes
myxoedema.
The term myxoedema connotes non-pitting
oedema due to accumulation
of hydrophilic mucopolysaccharides in the
ground substance of dermis and other tissues.

39. Etiopathogenesis
 Ablation of the thyroid by surgery or radiation.
Endemic or sporadic goitre.
Hypothalamic-pituitary lesions.
Thyroid cancer.
Prolonged administration of antithyroid drugs.
Mild developmental anomalies and
dyshormonogenesis.

40. The onset of myxoedema is slow and a fully-
developed clinical syndrome may appear after
several years of hypothyroidism. The striking
features are:-
cold intolerance
mental and physical lethargy
constipation
slowing of speech and intellectual function
puffiness of face
loss of hair
altered texture of the skin.
SYMPTOMS

41. THYROIDITI
S
Inflammation of the thyroid, thyroiditis.
more often due to non-infectious causes
and is classified on the basis of onset and
duration of disease into acute, sub-acute and
chronic

42. CLASSIFICATION
I. Acute thyroiditis:-
Bacterial infection e.g. Staphylococcus,
Streptococcus.
Fungal infection e.g. Aspergillus,
Histoplasma, Pneumocystis.
Radiation injury

43. II.Subacute thyroiditis:-
Subacute granulomatous thyroiditis
(giant cell thyroiditis, viral thyroiditis)
Subacute lymphocytic (postpartum,
silent) thyroiditis
Tuberculous thyroiditis

44. III.Chronic thyroiditis:-
Autoimmune thyroiditis (Hashimoto’s
thyroiditis or chronic lymphocytic
thyroiditis)
Riedel’s thyroiditis (or invasive
fibrous thyroiditis).

45. SIGNS & SYMPTOMS
•Acute suppurative – severe neck pain, fever,
erythema of overlying skin.
•Subacute painful – enlarged, painful, tender gland.
•Subacute painless – without thyroid pain,
tenderness or fever
•Hashimoto’s – moderately sized goiter and firm in
consistency, moveble.
•Riedel’s – dyspnea, dysphagia, hoarseness and a
sensation of chocking.

46. Thyroid function tests (TFTs) is a
collective term for test used to check the
function of the thyroid gland

47. INDICATION
Screening for Thyroid Dysfunction
Thyroid function tests are performed to screen
patients suspected of having thyroid disease. The
indications for screening include:
• Neonates for congenital hypothyroidism
• Patients with autoimmune disease
• Individuals with strong family history of thyroid
diseases
• Patient with suspected
hyperthyroidism/hypothyroidism

48. Monitoring
One of the common reasons for assessing
thyroid function is to monitor therapy.
• Monitoring treatment of hyperthyroidism with
antithyroid drugs.
• Patients with primary hypothyroidism who are
taking thyroxine hormone replacement
therapy.

49. Serum Thyroid Hormones
1. Thyroid Stimulating Hormone/thyrotrophin (TSH)
It is secreted by the anterior pituitary gland. It
increases production and release of thyroxine
(T3 and T4) form the thyroid. It secretion is inhibited
by high levels of T3 and T4. It is stimulated
by high levels of TRH and low levels of T3 and T4.
• Increased:
Primary hypothyroidism
Hashimoto thyroiditis.
• Decreased: In hyperthyroidism TSH level is
suppressed and may be undetectable.

50. Thyroid Hormone Levels
• T4 (Thyroxine): It is produced only by the
thyroid gland. It travels in plasma bound
to protein or in free form.
• T3 (Triiodothyronine): Most of it is transported
in plasma bound to protein and only 0.3% in free
form.
Use: Its level reflects secretory activity.
Increased in hyperthyroidism
Decreased in hypothyroidism

51. Thyrotrophin Releasing Hormone (TRH) Stimulation
Test
• In primary hypothyroidism an exaggerated
prolonged rise of already increased TSH level is
observed.
• In secondary hyperthyroidism (pituitary), there
will be no rise in the decreased TSH level.

52. THYROGLOBULIN
Use: To predict the outcome of therapy for
hyperthyroidism.
• Increased
Well differentiated thyroid carcinoma
Hyperthyroidism
• Decreased: Total thyroidectomy or destruction of
thyroid by radiation.

53. Thyroid Autoantibody Tests
The different types of thyroid autoantibodies
responsible for the autoimmune thyroid disorders are:-
• Anti-thyroid peroxidase antibody (TPOAb): They are
involved in the tissue destructive process associated
with hypothyroidism in Hashimoto and atrophic
thyroiditis.
• TSH receptor (TR) antibody (TRAb): These antibodies
were previously known as thyroid stimulating
immunoglobulin (TSI) found in grave’s disease.

54. Radioactive Iodine Uptake (RAIU)
• Increased: Graves disease, toxic
multinodular goiter and adenoma and
early thyroiditis.
• Decreased: Hypothyroidism, late
thyroiditis.
Contraindication: RAIU is contraindicated
in children and during
pregnancy/lactation.