This document discusses disorders of the thyroid gland, including hypothyroidism, hyperthyroidism, and specific conditions like Graves' disease and thyroid storm. It outlines the steps of thyroid hormone synthesis and describes the causes, signs and symptoms, diagnostic evaluation, and treatment approaches for various thyroid disorders.
This document discusses disorders of the thyroid gland, including hypothyroidism, hyperthyroidism, and specific conditions like Graves' disease and thyroid storm. It outlines the steps of thyroid hormone synthesis and describes the causes, signs and symptoms, diagnostic evaluation, and treatment approaches for various thyroid disorders.
This document discusses disorders of the thyroid gland, including hypothyroidism, hyperthyroidism, and specific conditions like Graves' disease and thyroid storm. It outlines the steps of thyroid hormone synthesis and describes the causes, signs and symptoms, diagnostic evaluation, and treatment approaches for various thyroid disorders.
This document discusses disorders of the thyroid gland, including hypothyroidism, hyperthyroidism, and specific conditions like Graves' disease and thyroid storm. It outlines the steps of thyroid hormone synthesis and describes the causes, signs and symptoms, diagnostic evaluation, and treatment approaches for various thyroid disorders.
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Disorders of the
Thyroid Gland Steps on Thyroid hormone synthesis
1. Taken up by NIS ( Na Iodine symporter)
2. Oxidized to I2 by Thyroid peroxidase
3. Organification – I2 add to tyrosine molecules sitting on thyroglobulin
to create MIT and DIT ( Mono-iodotyrosine and Di-iodothyroxine by Thyroid peroxidase
4. Coupling by Thyroid Peroxidase to form T3 and T4
Hypothyroidism Autoimmune Hypothyroidism • The mean annual incidence rate of autoimmune hypothyroidism is up to 4 per 1000 women and 1 per 1000 men Laboratory Evaluation Treatment • 50–100 g levothyroxine (T4) daily. The dose is adjusted on the basis of TSH levels, with the goal of treatment being a normal TSH, ideally in the lower half of the reference range
• The clinical effects of levothyroxine replacement are slow to appear.
Patients may not experience full relief from symptoms until 3–6 months after normal TSH levels are restored. Myxedema coma • Clinical manifestations include reduced level of consciousness, sometimes associated with seizures, Hypothermia can reach 23°C (74°F • usually precipitated by factors that impair respiration, such as drugs (especially sedatives, anesthetics, antidepressants), pneumonia, congestive heart failure, myocardial infarction, gastrointestinal bleeding, or cerebrovascular accidents. Sepsis should also be suspected. Exposure to cold may also be a risk factor. • Levothyroxine can initially be administered as a single IV bolus of 500 g, continued at a dose of 50–100 g/d • liothyronine (T3) intravenously or via nasogastric tube-10 to 25 g every 8–12 h. • levothyroxine (200 g) and liothyronine (25 g) as a single- levothyroxine (50–100 g/d) and liothyronine (10 g every 8 h). • External warming is indicated only if the temperature is <30°C • Parenteral hydrocortisone (50 mg every 6 h) should be administered, because there is impaired adrenal reserve in profound hypothyroidism • Any precipitating factors should be treated, including the early use of broad-spectrum antibiotics, pending the exclusion of infection. • Ventilatory support with regular blood gas analysis is usually needed during the first 48 hours Thyrotoxicosis • the state of thyroid hormone excess and is not synonymous with hyperthyroidism, which is the result of excessive thyroid function • the major etiologies of thyrotoxicosis are hyperthyroidism caused by Graves' disease, toxic MNG, and toxic adenomas Graves' Disease • accounts for 60–80% of thyrotoxicosis • occurs in up to 2% of women but is one-tenth as frequent in men • typically occurs between 20 and 50 years of age; it also occurs in the elderly Clinical Manifestations • features that are common to any cause of thyrotoxicosis & those specific for Graves' disease
• In the elderly, features of thyrotoxicosis may be subtle or
masked, and patients may present mainly with fatigue and weight loss, a condition known as apathetic thyrotoxicosis. • The most common cardiovascular manifestation is sinus tachycardia
• Atrial fibrillation is more common in patients >50 years of age
• Diffuse alopecia occurs in up to 40%
Graves' ophthalmopathy • Many scoring systems have been used to gauge the extent and activity of the orbital changes in Graves' disease. The "NO SPECS" scheme is an acronym derived from the following eye changes: • 0 = No signs or symptoms • 1 = Only signs (lid retraction or lag), no symptoms • 2 = Soft-tissue involvement (periorbital edema) • 3 = Proptosis (>22 mm) • 4 = Extraocular-muscle involvement (diplopia) • 5 = Corneal involvement • 6 = Sight loss Treatment • The hyperthyroidism of Graves' disease is treated by reducing thyroid hormone synthesis, using antithyroid drugs, or reducing the amount of thyroid tissue with radioiodine (131I) treatment or by thyroidectomy Thyrotoxic crisis, or thyroid storm • A life-threatening exacerbation of hyperthyroidism, accompanied by fever, delirium, seizures, coma, vomiting, diarrhea, and jaundice. • precipitated by acute illness (e.g., stroke, infection, trauma, diabetic ketoacidosis), surgery (especially on the thyroid), or radioiodine treatment of a patient with partially treated or untreated hyperthyroidism • Management requires intensive monitoring and supportive care, identification and treatment of the precipitating cause, and measures that reduce thyroid hormone synthesis. • Large doses of propylthiouracil (600 mg loading dose and 200–300 mg every 6 h) should be given orally or by nasogastric tube or per rectum; the drug's inhibitory action on T4 T3 conversion makes it the antithyroid drug of choice. A saturated solution of potassium iodide (5 drops SSKI every 6 h) Propranolol , Additional therapeutic measures include glucocorticoids (e.g., dexamethasone, 2 mg every 6 h), antibiotics if infection is present, cooling, oxygen, and intravenous fluids.
