abnormalities of thyroid function dr. shaikh mujeeb ahmed assistant professor almaarefa college endo...
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ABNORMALITIES OF THYROID FUNCTION
Dr. Shaikh Mujeeb AhmedAssistant ProfessorAlMaarefa College
ENDO BLOCK 412
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Objectives
• The student should be able to:• Describe the etiology, symptoms and
treatment of thyrotoxicosis and hypothyroidism.
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Abnormalities
• Hypothyroidism– Deficient thyroid hormone secretion
• Hyperthyroidism• Excess thyroid hormone secretion
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Hypothyroidism
• Primary failure of thyroid gland itself• Secondary to deficiency of TRH, TSH or both.• From an inadequate dietary supply of iodine.
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Clinical features• The symptoms of hypothyroidism are largely caused by a
reduction in overall metabolic activity. • Reduced BMR (less energy expenditure at rest); • Displays poor tolerance of cold (lack of the calorigenic effect); • Tendency to gain excessive weight (not burning fuels at a normal
rate); • Easily fatigued (lower energy production); • Slow, weak pulse (caused by a reduction in the rate and strength
of cardiac contraction and a lowered cardiac output); and• Exhibits slow reflexes and slow mental responsiveness (because
of the effect on the nervous system). The• Mental effects are characterized by diminished alertness, slow
speech, and poor memory.
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Causes of congenital hypothyroidism
• Maternal iodine deficiency• Fetal thyroid dysgenesis• Inborn errors of thyroid hormone synthesis• Maternal antithyroid antibodies that cross the
placenta • Fetal hypopituitary hypothyroidism
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MYXEDEMA (Adult Hypothyroidism)
Puffy appearance, primarily of face, hands, and feet
Caused by infiltration of skin with complex water retaining carbohydrate molecules.
Symptoms: The patient becomes sluggish both mentally and physically and often feels cold. The hair becomes dry and the skin becomes dry and waxy. The tissues of the face swell.
Treatment: – If diagnosed early, can be treated by
administrating of T4. – Exception, if hypothyroidism caused by
iodine deficiency; treated by dietary iodine.
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Cretinism• Results from hypothyroidism from birth • Characterized by dwarfism & mental retardation as
well as other general symptoms of thyroid deficiency. • At birth, child appears normal because thyroxine is
received from mother through placenta • Symptoms: growth retardation, abnormal bone
development, low body temperature, lethargy, severely mentally retarded (short limbs, a large protruding tongue, coarse dry skin, poor abdominal muscle, tone and an umbilical hernia).
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Cretinism
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HYPERTHYROIDISM
• The most common cause of hyperthyroidism is Graves’ disease.• immune disease• thyroid-stimulating immunoglobulin (TSI), also known as long-acting thyroid
stimulator (LATS),• ↑ BMR • poor tolerance of heat• Increased appetite • body weight• muscle weakness • Muscle termers• Sleep• ↑ Heart rate• ↑COP• Irritable, tense, anxious• Exophthalmos (bulging eyes) (grave’s disease)
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Fig. 19-4, p. 696
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Fig. 19-5, p. 697
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• Anti thyroid drugs• Surgical removal• Administration of radioactive iodine
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GOITER
• A goiter is an enlarged thyroid gland.
• Occurs when either TSH or TSI excessively stimulates the thyroid gland.
• The most common cause of goiter worldwide is a lack of iodine in the diet.
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Causes of Goiter
• Iodine deficiency• Graves' disease• Hashimoto's disease• Multinodular goiter• Solitary thyroid
nodules• Thyroid cancer• Pregnancy• Inflammation
Fig. 19-6, p. 697
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Table 19-1, p. 696
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Synthesis, storage, and secretion of thyroid hormone
Thiocynate
XX
Thiouracil
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Antithyroid Substances
• Thiocyanate Ions – Decrease Iodide Trapping– inhibition of the iodide-trapping mechanism
• Propylthiouracil – Decreases Thyroid Hormone Formation
Propylthiouracil & similar compounds as– methimazole and carbimazole– block the peroxidase enzyme
• Iodides in high concentrations decrease thyroid activity and thyroid gland size
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19
References
Human physiology, Lauralee Sherwood, seventh edition.
Text book physiology by Guyton &Hall,11th edition.
Text book of physiology by Linda .S .Costanzo third edition