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The diseases of thyroid презентация
Содержание
- 1. The diseases of thyroid
- 2. The anatomy and function
- 3. Thyroid structure
- 4. Blood vessel Thyroid
- 5. Thyroid hormones
- 6. Regulation of thyroid function
- 7. Hyperthyroidism overproduction of thyroid
- 8. Subclinical hyperthyroidism: TSH low,
- 9. The main causes of thyrotoxicosis
- 10. Thyrotoxicosis symptoms and signs
- 11. Apathetic thyrotoxicosis Old patients Weakness, weight
- 12. Graves‘ disease 2% ♀, ♀:♂=10:1,
- 13. Clinical picture of Graves’ diseases Graves' Ophthalmopathy (10%) Thyroid dermopathy (
- 14. Nuclear imaging Tc99-m
- 15. Treatment of Graves’ disease Beta-blockers for
- 16. Multinodular toxic goiter Diffuse thyroid enlargement
- 17. Nuclear imaging Tc99-m
- 18. Autonomous toxic adenoma Single autonomic thyroid nodule
- 19. Subacute thyroiditis (painful or viral thyroiditis)
- 20. Nuclear imaging Tc99-m
- 21. Thyroid Storm (Thyrotoxic Crisis) Sever and life
- 23. Hypothyroidism decreased level
- 24. Subclinical hypothyroidism: TSH high,
- 25. The main causes for hypothyroidism Primary
- 26. Hypothyroidism symptoms and signs
- 27. Clinical picture subclinical hypothyroidism: 6%-8% ♀, 3%♂
- 28. Endemic Iodine deficiency According to WHO:
- 29. Congenital Hypothyroidism 1:4000 newborns, ♂:
- 30. Hashimoto‘s (goitrous) thyroiditis 4:1000 ♀ 1:1000, ♂
- 31. Myxedema Coma Old undiagnosed patients Precipitated
- 32. Sick Euthyroid Syndrome Abnormal level of
- 33. Questions
The anatomy and function
In the prenatal period and childhood: cells differentiation and growth In
Слайд 2The anatomy and function
In the prenatal period and
childhood: cells
differentiation and growth
In adults: thermoregulation,
basal metabolic rate,
carbohydrate’s and protein’s
metabolism
differentiation and growth
In adults: thermoregulation,
basal metabolic rate,
carbohydrate’s and protein’s
metabolism
Слайд 4Blood vessel
Thyroid cell
I-
Na+
TPO
I-
I2
Thyrosin
+
Thyroglobuline
lysosome
T4
T3
Synthesis of
thyroid hormones
Colloid
Слайд 7
Hyperthyroidism
overproduction
of thyroid hormones by the thyroid
Thyrotoxicosis
the condition of thyroid hormone
excess, not always due to overproduction
Слайд 8Subclinical hyperthyroidism:
TSH low, FT4&FT3 normal, no symptoms
Clinical hyperthyroidism:
TSH low, FT4&FT3 high
Classification
Слайд 9The main causes
of thyrotoxicosis
Primary hyperthyroidism
(TSH↓,FT4&FT3↑)
Graves’ disease
Multinodular toxic
goiter
Autonomous toxic adenoma
Iodine overload, Procor
Secondary hyperthyroidism
(TSH↑,FT4&FT3↑)
TSH-producing pituitary adenoma
Thyroid hormone resistance
Gestational thyrotoxicosis
Thyrotoxicosis without hyperthyroidism
Sub acute thyroiditis
Silent thyroiditis
Thyrotoxicosis facticia
Autonomous toxic adenoma
Iodine overload, Procor
Secondary hyperthyroidism
(TSH↑,FT4&FT3↑)
TSH-producing pituitary adenoma
Thyroid hormone resistance
Gestational thyrotoxicosis
Thyrotoxicosis without hyperthyroidism
Sub acute thyroiditis
Silent thyroiditis
Thyrotoxicosis facticia
+
+
-
Слайд 11Apathetic thyrotoxicosis
Old patients
Weakness, weight loss
Depression,
pseudo-dementia
Cardiac arrhythmias
CHF exac.
Pathological fractures
Слайд 12Graves‘ disease
2% ♀, ♀:♂=10:1, age 20-50
More frequent in I
sufficient areas
Frequently starts after pregnancy
Smoking is important for ophthalmopathy development
TSI antibodies are produced in thyroid and immune organs
15% spontaneous remission after 10-15 years
Frequently starts after pregnancy
Smoking is important for ophthalmopathy development
TSI antibodies are produced in thyroid and immune organs
15% spontaneous remission after 10-15 years
Слайд 13Clinical picture of
Graves’ diseases
Graves' Ophthalmopathy (10%)
Thyroid dermopathy (
(<1%)
LAB:
TSH ↓ FT4 ↑, FT3 ↑
Anti bodies TSI ↑
anemia, elevation of liver enzimes
Слайд 15Treatment of Graves’ disease
Beta-blockers for tachycardia
Anti-thyroid drugs (Mercaptizole, PTU)
Radio-Iodine ablation
Total/subtotal thyroidectomy
Ophthalmopathy:
stop smoking, artificial tears, GK, operation
Слайд 16Multinodular toxic goiter
Diffuse thyroid enlargement with autonimic nodules
Clinical or subclinical
hyperthyroidism
Goiter is more frequent in I poor regions
Massive I intake leads to thyrotoxicosis
Mass-effect of retrosternal goiter
TSH ↓, FT4 ↑, FT3 ↑↑
Diagnosis: US, Tc scan
Treatment: beta-blocers, antithyroid, operation, I ablation
Goiter is more frequent in I poor regions
Massive I intake leads to thyrotoxicosis
Mass-effect of retrosternal goiter
TSH ↓, FT4 ↑, FT3 ↑↑
Diagnosis: US, Tc scan
Treatment: beta-blocers, antithyroid, operation, I ablation
Слайд 18Autonomous toxic adenoma
Single autonomic thyroid nodule with causes thyrotoxicosis, rest of
the thyroid is depressed
treatment: usually I ablation
Слайд 19Subacute thyroiditis
(painful or viral thyroiditis)
Acute viral infection that leads to
thyroid destruction
Fever, sore throat, sharp pain in the thyroid region, dysphagia, headache, weakness
Diagnosis: ESR↑ and radioiodine uptake ↓
Treatment: high dose NSAIDs, GK
Fever, sore throat, sharp pain in the thyroid region, dysphagia, headache, weakness
Diagnosis: ESR↑ and radioiodine uptake ↓
Treatment: high dose NSAIDs, GK
Слайд 21Thyroid Storm
(Thyrotoxic Crisis)
Sever and life threating TTx
Precipitated factor: infection,
operation, trauma, labor
RAF, CHF, high fever, vomiting,
diarrhea, acute liver failure,
agitation, confusion, coma
Support treatment, treatment of precipitated factor, aggressive reduction of temperature, TTx treatment, beta-blockers, GK, Lughole solution
RAF, CHF, high fever, vomiting,
diarrhea, acute liver failure,
agitation, confusion, coma
Support treatment, treatment of precipitated factor, aggressive reduction of temperature, TTx treatment, beta-blockers, GK, Lughole solution
Слайд 24Subclinical hypothyroidism:
TSH high, FT4&FT3 normal, no symptoms
Overt (clinical)
hypothyroidism:
TSH high, FT4&FT3 low
TSH high, FT4&FT3 low
Classification
Слайд 25The main causes
for hypothyroidism
Primary hypothyroidism
(TSH ↑, FT4 ↓)
Hashimoto's
thyroiditis
Congenital hypothyroidism
Iodine deficiency
Secondary hypothyroidism
(TSH↓, FT4 ↓)
Pituitary/hypothalamic (adenoma, operation,
hemorrhage, inflamation)
Congenital hypothyroidism
Iodine deficiency
Secondary hypothyroidism
(TSH↓, FT4 ↓)
Pituitary/hypothalamic (adenoma, operation,
hemorrhage, inflamation)
Слайд 28Endemic Iodine deficiency
According to WHO:
2 billions people lives
in
I deficient areas
More cases of goiter,
overt hypothyroidism
and cretinism
Iodification of water,
bread, salt
No need in Israel
I deficient areas
More cases of goiter,
overt hypothyroidism
and cretinism
Iodification of water,
bread, salt
No need in Israel
Слайд 29 Congenital Hypothyroidism
1:4000 newborns, ♂: ♀=1:2
85% thyroid agenesis or ectopic
90%
newborns look good first
10% prolonged jaundice,
failure to thrive, hypotonia,
macroglossia, large umbilical
hernia, late fontanelles closure
congenital cardiac anomalies*4
Constant neurological deficit if the treatment delayed
10% prolonged jaundice,
failure to thrive, hypotonia,
macroglossia, large umbilical
hernia, late fontanelles closure
congenital cardiac anomalies*4
Constant neurological deficit if the treatment delayed
Neonatal
Screening Program
Слайд 30Hashimoto‘s (goitrous) thyroiditis
4:1000 ♀ 1:1000, ♂
Slow development, age 60
Small irregular goiter
Clinical
or subclinical hypothyroidism
TSH ↑, FT4 ↓, FT3 ↓
Antibodies anti-TPO (90%)
Treatment: LEVOTHYROXINE
to start with 1.2 mkg/kg/day
TSH ↑, FT4 ↓, FT3 ↓
Antibodies anti-TPO (90%)
Treatment: LEVOTHYROXINE
to start with 1.2 mkg/kg/day
Слайд 31Myxedema Coma
Old undiagnosed patients
Precipitated factor: infection,
operation, hypothermia
Poor prognosis
Confusion, ansarca,
bradycardia,
hypothermia, hypoxia, coma
Treatment: Eltroxine+Liothyronine (T3)
Don’t miss adrenal insuficiency!
hypothermia, hypoxia, coma
Treatment: Eltroxine+Liothyronine (T3)
Don’t miss adrenal insuficiency!
Слайд 32Sick Euthyroid Syndrome
Abnormal level of thyroid hormones without thyroidal disorder in
critically ill patients
TSH low, FT4 normal, FT3 low, rT3 high
Treatment of intercurrent disease
Follow up thyroid functions
TSH low, FT4 normal, FT3 low, rT3 high
Treatment of intercurrent disease
Follow up thyroid functions
