disorder of thyroid functions

7/25/2019 Disorder of Thyroid Functions

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DISORDERS OF

THYROID

FUNCTIONSYUNIADI SUTOWO


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THE THYROIDGLANDCongenital diseasesInfammationFuntional a!no"malit#

Di$use and %ultinodula"goite"s

NEO&LASIA


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THYROID DISORDERS

H#'ot(#"oidism Unde"ati)e t(#"oid

H#'e"t(#"oidism O)e"ati)e t(#"oid

Goite" T(#"oid enla"gement


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CAUSES OFHY&ERTHYROIDIS%

*+ G"a)es Disease , Di$use To-i Goite"

.+ &lumme"/s Disease , To-i %ulti NodulesGoite"

0+ To-i '(ase o1 Su! Aute T(#"oiditis 2 SAT3+ To-i Single Adenoma , STA

4+ &ituita"# Tumou"s , e-ess TSH

5+ %ola" '"egnan# 6 C(o"ioa"inoma 7889 HCG:

;+ %etastati t(#"oid ane"s 71untioning:


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1.

LH, HCg, TSH DAN FSHSTRUCTURE

2. The sub unit of hCG is identical with

the sub unit of LH, TSH and FSH

The sub unit of hCG is identical with the


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E'idemiolog# o1G"a)es/ Disease

- Cause of 50 !0" of cases of h#$e%th#%oidis&

- '%e(alence) 0.*" of $o$ulation

- +ncidence) 0.5000#ea%

- Fe&ale&ale %atio) 5 0

- +ncidence) 20 0 #ea%s of a/e- Conco%dance %ate) &ono#/otic twins 15"

di#/otic twins 1"

- '%edis$osition) 34" /enetic 2" non/enetic

- Fe&ale siblin/sand fe&ale child%enha(e 5 !"


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DISEASE Assoiations>

=i"al?!ate"ialin1etions

Stress E-'osu"e to iodide


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Ne")ousness?T"emo"

%ental Distu"!anes?

I""ita!ilit#

Di@ult# Slee'ing

ulging E#es?Un!linBing

Sta"e? =ision C(angesEnla"ged T(#"oid 7Goite":

%enst"ualI""egula"ities

F"euentoel

%o)ementsWa"m %oist &alms

Fi"st2T"imeste" %isa""iage?

E-essi)e =omiting in &"egnan#

Hoa"seness?

Dee'ening o1 =oie&e"sistent D"# o" So"e

T("oatDi@ult# Salloing

&al'itations?

Ta(#a"dia

Im'ai"ed Fe"tilit#

Weig(t Loss o" Gain

Heat Intole"aneIn"easedSeating

Famil# Histo"# o1

T(#"oid Disease

or Diabetes

SIGNS AND SY%&TO%S OFHY&ERTHYROIDIS%

Sudden &a"al#sis


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SIGNS AND SY%&TO%S T"emulousness o" itte"iness E-o'(t(almos Weig(t loss des'ite e-ellent a''etite ,

(#'e"meta!oli state Insomnia Fatigue

&al'itations Heat intole"ane Seating Dia""(ea Dete"io"ation in (and"iting %enst"ual i""egula"ities

%usle eaBness E#e s#m'toms (i( ma# inlude 'ain o" di'lo'ia Ne")ousness Ta(#a"dia Goite" Ele)ated 'lasma le)els o1 t(#"o-in and?o"

t"iiodot(#"onine


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thyrotoxicosis (Grave's

disease) It is (#'e"1untion o1 t(#"oidgland due to autoimmune

disease in (i(autoanti!odies called t(#"oidstimulating immunoglo!ulins,

actiateTSH receptors !rod"ci#ge$cessie se"etion o1 thyroidhormones alt(oug(TSH

hormone itself is low.


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MAN!"STAT#NS

E-o'(t(almos di'lo'ia In"eased %R and (eat intole"ane+ Ca"dio)asula" s#m'toms ta(#a"dia

a""(#t(mias

liBe +At"ial !"illation a"dia is(emia and (ig(

a"dia out'ut 1ailu"e+ Insomnia i""ita!ilit# and (#'e""efe-ia

ne")ousness %entall# and '(#siall# (#'e"ati)e

Loss o1 eig(t and in"ease 1ood intaBe. %ala!so"!tion and dia""(ea De"mo'at(# 7 '"eti!ial m#-edema : in a mino"it#

o1

'atients


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GRA=E/S DISEASE($AS"%#&)

Hi'e"ti"oid > se"ing te"adi 'adaanita

Etiologi > otoimn Geala > erat adan intoleransi hawa panas

*si+,mental hipera+tif

(tremor,nervos) tachycardia- arhythmia

aal /antn

+erinat anya+


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%&'&1(Dr. )o*a+ed -ad

1

Lid %et%action and eo$hthal&os in

$atient with G%a(e6s disease


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at

accumulation

behind eyes

High TSH

Patient

previously had

a

Exothalamia


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/RETI0IAL )YEDE)A


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G"a)es/ disease 7anti2t(#"oidstimulating (o"mone "ee'to" anti2TSHR:

In G"a)es/disease t(eanti!odies do

not dest"o#t(e t(#"oid !utat as i1 t(e#a"e TSH 7i+e+

t(e# !ind and

No"mal


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TSI -sec%eted b# l#&$hoc#tes in all$atients with G%a(e6s disease+

- +t has the sa&e action of TSH on

the th#%oid /land.

- Can c%oss the $lacenta and

sti&ulate the fetal th#%oid /land.


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Autoanti!odies 7IgG: an "oss t(e'laenta and a$et t(e 1etus

G"a)es/ disease is an autoimmune1o"m o1 (#'e"t(#"oidism

&lasma'(e"esisis 2 t(e "emo)al

t"eatment and "etu"n o1 7om'onents o1:!lood lasma3ro+ !lood i"ulation

*J *. HOURS
http://en.wikipedia.org/wiki/Blood_plasmahttp://en.wikipedia.org/wiki/Circulatory_systemhttp://en.wikipedia.org/wiki/Circulatory_systemhttp://en.wikipedia.org/wiki/Blood_plasma


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*J2*. HOURS IN %OUSE ASSAY.+STRUCTURE AND GLYCO&ROTEIN+GG

%OLECULAR %ASS 0J+JJJ*4J+JJJ0+ INHIITION ACTI=ITY Y ANTI TSHY ANTI

SERU%IGG SERU%3+ SOURCE ANT+ &ITUITARYLY%&HOCYTE4+ ACTION STI%ULATED

STI%ULATEDTHYROID

THYROID5+ CIRCULATING LE=EL THYROID

HIGH DOSES

CO%&ARATION OF TSH ATSI


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Hyperthyroid

Diffuse

Graves disease

Nodular

Plummers disease

Age Young age Elderly

Onset abrupt Gradual

Course Remissions &ea!erbations

"teady !ourse

Nervoussymptoms

### #

$etaboli!

manifestations

### #

Eye signs ### # false

C% manifestations # ###

'yroid gland Diffuse Nodular


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In se)e"e ase

thyroid crisis

( fever -consciosness 0

arr thmia


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FINDING

Laboratory findings in Gravesdisease include Elevatedfree T4and

T3levels and depressedTSH

levelsThyroid-stimulatingimmunoglobulins

Radioactive iodine uptakeis

increased diffusely

In light hyperthyroid !T3


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1N%"2 S"32"T#N #! TH42#% H#2M#N"S (H45#TH42#%SM)

Dened as lo 1"ee T3 le)el it( a no"mal o" (ig( TSH+

Types of hypothyroidism

*25rimary 6 T(#"oid gland d#s1untion

%ost ommon >

*2 3onenital hypothyroidism (in neonates)

.2 3hronic lymphocytic thyroiditis (Hashimoto7s thyroiditis) Autoimmune disease o1 t(#"oid

T(#"oid gland is enla"ged

02 odine de*ciency

32 Thyroid srery

42 2adioactive iodine treatment

.2 Secondary 6&ituita"# d#s1untion 7hypopititarismdue to

"adiation t(e"a'# o" dest"ution o1 t(e

'ituita"#:

0+ Te"tia"# > H#'ot(alami d#s1untion


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ETIOLOGY

*+ CONGENITALH#'o'lasia

Familial enK#me de1etsIodine deien# 7endemi"etinism:

IntaBe o1 goit"ogens du"ing'"egnan#

&ituita"# de1etsIdio'at(i


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.+ ACUIREDIodine deien#Auto2immune t(#"oiditisT(#"oidetom# o" RAIt(e"a'#

TSH o" TRH deien#%ediations 7iodide 6Co!alt:

Idio'at(i


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Ti"edness

Fo"get1ulness?Sloe" T(inBing

%oodiness? I""ita!ilit#

De'"ession

Ina!ilit# to Conent"ate

T(inning Hai"?Hai" Loss

Loss o1 od# Hai"

Dr4, &at(# SBin

Weig(t Gain

Cold

Ele)ated C(oleste"ol

Famil# Histo"# o1 T(#"oid

Disease o" Dia!etes

%usle WeaBness?

C"am's

Consti'ation

In1e"tilit#

%enst"ual I""egula"ities

Sloe" Hea"t!eat

Di@ult# Salloing

&e"sistent D"# o" So"e T("oat

Hoa"seness?

Dee'ening o1 =oie

Enla"ged T(#"oid 7Goite":

&u$# E#es 'u$# 1ae

CLINICAL FEATURES OFHY&OTHYROIDIS%


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. H45#!1N3T#N #! TH" TH42#%G8AN%

A.Myxedema7M (#'ot(#"oidismin adults:> It is aused !#at"o'(# o1 t(e t(#"oid gland as a"esult o1 disease e+g+ ane" andt(is t#'e is alled'"ima"#(#'ot(#"oidism o" aused !# laBo1 TSH se"etion and t(is isalled seonda"# (#'ot(#"oidism.

MAN!"STAT#NS #!


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MAN!"STAT#NS #!M49"%"MA

D"# #ello sollen sBin+ De"eased %R+ De"eased a"dia '"o'e"ties liBe

de"ease HR and CO&+ De"eased mental 1untions it(

a'at(eti looB+

HusB# and slo )oie+ In"eased !lood (oleste"ol le)el+ De'"essed se-ual 1untions


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5AT"NT &TH M49"%"MA


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$ 32"TNSM (H45#TH42#%SM N3H8%2"N)

It is ommonl# due to eit(e"mate"nal iodine deien# o"ongenital a!no"malit# in t(e

t(#"oid 1untions+ %ani1estations> Dela#ed '(#sial g"ot(>

%ental "eta"dation> om'leteidiot+ Se-ual "eta"dation

Gene"al 1eatu"es> Sollen e#e


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ongenital Hypothyroidism

retinism

Stunted gro!th

"eurological #

cognitivede$ects # mental

retardation

In$antileappearance%

pu$$y $ace &

protuberant

abdomen

5


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5 +THYROIDITIS 7HT: An autoimmune disease and assoiated

it( ot(e" autoimmune diso"de"s 7 lu'us"(eumatoid a"t("itis :

Di$use non2'ain1ul t(#"oid enla"gement

%ost '"e)alent !eteen 34 and 54 #ea"so1 age %o"e ommon in omen t(an in men

it( a 1emale '"edominane o1 *J>* 2

.J>*+ %a# ou" in (ild"en and is a mao" ause

o1 nonendemi goite" in (ild"en

Diagnosis is made !# deteting ele)atedle)els o1 anti2t(#"oid 'e"o-idaseanti!odiesin t(e se"um+
http://en.wikipedia.org/wiki/Anti-thyroid_peroxidase_antibodieshttp://en.wikipedia.org/wiki/Anti-thyroid_peroxidase_antibodieshttp://en.wikipedia.org/wiki/Anti-thyroid_peroxidase_antibodieshttp://en.wikipedia.org/wiki/Anti-thyroid_peroxidase_antibodieshttp://en.wikipedia.org/wiki/Anti-thyroid_peroxidase_antibodieshttp://en.wikipedia.org/wiki/Anti-thyroid_peroxidase_antibodieshttp://en.wikipedia.org/wiki/Anti-thyroid_peroxidase_antibodies


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TIROIDITISHASHI%OTO 2

Hi$oti%oid 7a%ena $%oses imunologik

'%o/nosis 7u%an/ bai7 7%n $%oses

otoimun

Lab )T3 / T4

TSH

antibodi anti peroksidase tiroid

positif


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CYTOTOIC T LY%&HOCYTE7 CTL :

CD M luste" o1

di$e"entiation


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Immune me(anisms ma#inludes>

. C8! 9 c#totoic T cell-&ediated

cell death

2. C#to7ine-&ediated cell death

1. :indin/ of antith#%oid antibodies

; antibod# de$endent cell-

D %ULTINODULAR GOITER


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D+%ULTINODULAR GOITER ENDE%IC OR S&ORADIC OR SI%&LE

It re6ects i+!aired s4#t*esis o3 t*4roid*or+o#s d"e to dietar4 iodi#e de7cie#c4TSH *4!ertro!*4 8 *4!er!lasia o3t*4roid 3ollic"lar cells t*4roid

e#large+e#t 7 di$use nonto-i goite":i3 I s"!!lied or t*e de+a#d decreased i#ol"tio# o3 3ollic"lar e!it*elial cells.

Rec"rra#t e!isodes o3 sti+"latio# 8i#ol"tio#multinodula" goite",as4++etricall4 e#larged gla#d, large si9e

:it* 3ocal c4stic c*a#ges 7brosis,

ENDE%IC GOITRE 7GAI GANGGUAN


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ENDE%IC GOITRE 7GAIMGANGGUANAIAT EURANGAN IODIU%:

Hi'oti"oidi )paling sering di Indonesia

Etiologi >tersering defisiensi yodium(penduduk pegunungan)

linis >mudah lelah irama antung

otot antung lemah anemia! rambut rontok berat badan

menorrhagia

impotensia

La!o"ato"# diagnosiS51


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La!o"ato"# diagnosiS

IN HY&OTHYROIDIS%


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La! > T: 0 - FT40 - T;

total

TSH


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Clinical 'ictu%e of Si&$le =odula% Goit%e


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Th%ee wo&en of the hi&ala#as with t#$ical ende&ic


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TH42#% !1N3T#N T"STS

- Tests to establish whethe% the%e isth#%oid d#sfunction

Th#%oid ho%&one > FT1 and FT ?

in the se%u& $las&a , TSH , T@H , :


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TH42#% !1N3T#N T"STS

1. Th#%oid en#&e acti(it#. :io$s# of the th#%oid

5. @A+B , Th#%oid scannin/ , 'e%chlo%ate test

*. CG, Se%u& choleste%ol, Tendon %eflees

3. Th#%oid > T1 ? su$$%ession test, T@HTSH

sti&ulation test

5. +&a/in/ ) BG, CT scan,


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E()L*)TIO" TEST O HYPOTH)L)+*S &

PIT*IT),Y )"- THY,OI- GL)"- '

.' T,H# TEST

.HD'@THD@E+8 ) @S'E=8 T@H TE TSH )

8C@AS E@ =GAT+

2.TE 8+FF@ SCE=8A@D HD'ETHD@E+8 A=8

T@T+A@D HD'ETHD@E+8 .1. '@+


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THERA&Y


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. SB@G@D

2. +SETE' AI

?

1. A=T+ THD@E+8 8@BGA. T+EB@AC+L >TB?, '@E'DLTH+EB@AC+L>'TB?,

A@:+


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RADIOACTI=EIODIDEThe beta %adiations of 1+ dest%o# th#%oid

$a%ench#&a, so dec%easin/ ho%&onal

%elease.

"d#antages$

as# ad&inist%ation >o%all#?.

ffecti(e.+t is not e$ensi(e.

Suitable fo% old a/es and ca%diac

$atients with &ode%ate to se(e%e


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"d#erse effe%tsAs with iodine the%a$#, o(e%doses &a# causeiodism 7metalli taste e-essi)e sali)ation

it( 'ain1ulsali)a"# gland dia""(ea '"oduti)e

oug( "unninge#es 6 nose so"e t("oat and "as(es

mimi (iBen2 'o-:+

E(e%dose is t%eated b# la%/e dose of sodiu& o%$otassiu& iodide to co&$ete with the %adioiodineu$ta7e b# the /land, and then hasten ec%etion b#fluids and diu%etics.Local $ain con/estion at the site of the /land

H#$oth#%oidis&

Indiations 1o" I*0*


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Indiations 1o" I*0*t"eatment

. Se(e%e th#%oca%diac disease

2. Toic nodula% /oite%

1. Ad(e%se %eaction to antith#%oid d%u/

. @ela$se afte% 2 to ! &onths of

antith#%oid d%u/ t%eat&ent


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&ontraindi%ations). '%e/nanc# >t%ou/h $lacenta?

2. Child%en

1. =u%sin/ &othe% >th%ou/h &il7?


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Indiations 1o"

T(#"oidetom# .La%/e /oite% with co&$%essi(e

&anifestations

2.'%e/nant $atient with ad(e%se

%eaction to antith#%oid d%u/

1.Se(e%e infilt%ati(e e#e disease. @ecu%%ence afte% adeMuate the%a$#

5. H#$e%th#%oidis& a%e difficult to cont%olwith anti th#%oid d%u/s

*. Khen T le(el N 30 $ &olL


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THANK YOU

disorder of thyroid functions

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