- - .

98.5% T4
1.5% T3

Albumin 15%
Thyroid Binding Globulin 70%
Transthyretin 10%

Hypothalamus
,

T3

TSH

TRH
T4, T3

1.

2.

Thyroid Peroxidase (TPO)

Apical membrane protein

Antagonized by
methimazole, PTU

3.
(
T3 T4)
4.
T4 T3

TRH
TSH
Total T3, T4
Free T3, T4
RAIU
Thyroglobulin
Antibodies: Anti-TPO, Anti-TSHr

,
,,
4%

-26%

63%

75-80%
10-20%
3-5%
1-2%
-
2-3% -.

Graves Disease

(Hashimotos) Thyroiditis
(De Quervains) Thyroiditis
Riedels Thyroiditis

TBG
(pregnancy, Tamoxifen)
-

TBG
Androgens or anabolic steroids
-

NSAIDs
Furosemide IV
Anticonvulsants (Phenytoin, Carbamazepine)

, ,
, ,

,
,,,
, myxedema
, ,
,

Thyroid gland
Pituitary
Hypothalamic

Hashimotos thyroiditis

I131

- (PTU, Methimazole, Lithium, Interferon)

Postpartum
Thyroiditis

Hashimoto

FT4, TSH (Primary, check for
antibodies)
FT4, TSH (Secondary or Tertiary,
TRH stimulation test, MRI)

Levothyroxine (T4)
Treatment prevents bone loss, cardiomyopathy,
myxedema

to TPO, TBG
30-50

TSH
T4
Anti-TPO Ab
Anti-TBG Ab

Levothyroxine

:


-

80%


,
19%

.
2-5 %
, 5
,
20 40 .

,
,
,
, ,

,, .

Class one: spasm of upper

lids with thyrotoxicosis
Class two: periorbital
edema and chemosis
Class three: proptosis
Class four: extraocular
muscle involvement
Class five: corneal
involvement
Class six: loss of vision due
to optic nerve involvement

Beta blockers
Thionamid
6-8
40% - 60%
20%
0.5%
Radioiodine
10% 1
55% - 75% 10


,
50% - 60%

<2 cm

>3 cm

-
60.-

3 cm (?)

hyperthyroidism

thyrotoxicosis

(Amiodarone)

thyrotoxicosis

,
,,
,

-
SH multiple
nodules

TSH, T4, T3
Overt hyperthyroidism (TSH low, T3/T4 high)
Subclinical hyperthyroidism (TSH low, T3/T4 normal)

Determination of thyroid state is key in determining

treatment

follow-up

50%

Suspicious neck lymphadenopathy
History of radiation to the cervical region
Rapid enlargement of nodules
Papillary histology
Microfollicular histology (?)

RAI ablation

Volume reduction 33% - 66% in 80% of patients

Improvement of dysphagia or dyspnea in 70% - 90%
Post RAI hypothyroidism 60% in 8 years
Post RAI Graves disease 10%
Post RAI lifetime cancer risk 1.6%

Surgery
Most commonly recommended treatment for healthy
individuals

Graves disease

(Pretibial myxedema, Opthalmopathy)

Anti-TSH receptor Ab
High RAUI
Thyroiditis

Clinical findings (painful thyroid in Subacute thyroiditis)

Low RAUI

Amiodarone
IV contrast

Atrial fibrillation
Congestive Heart Failure

Amiodarone (37% iodine)

- betablockers, barbiturates
:
beta-blockers, calcium
channel blockers, PTU, methimazole,
digitalis or diuretics for heart failure,
fluid and electrolyte management

68% (S. aureus, S. pyogenes)

15%
9%

HIV

,,

IV
Nafcillin / Gentamycin

Acute Thyroiditis

,,

Nafcillin / Gentamycin

De Quervain's thyroiditis




hyperthyroidism

hypothyroidism;

NSAIDs and salicylates.

Beta blockers
PTU

Riedels Thyroiditis

2/3

Tamoxifen, Methotrexate,