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Thyroid Physiology
To review the anatomy and physiology of the
Thyroid, parathyroid and adrenal glands *Iodine Metabolism – in the stomach and jejunum, iodine is
rapidly converted to iodide and absorbed into the
To determine the clinical features and pathology bloodstream and from there it is distributed throughout the
of the common diseases of above endocrine extracellular space. Iodide is actively transported into the
glands thyroid follicular cells by an ATP dependent process. The
thyroid is the storage site of >90% of the body’s iodine.
To discuss the diagnosis, treatment and surgical
management of these common diseases Thyroid hormone synthesis, secretion and transport – it
consist of several steps
• Hyperthyroidism symptoms:
- heat intolerance
- increased sweating and thirst
- weight loss despite adequate caloric intake
- increased adrenergic stimulation include
palpatations,
nervousness, fatique, emotional lability,
*It is important to distinguish disorders that result
hyperkinesis and tremors
from increased production of thyroid hormone from
- increased frequency of bowel movement and
those disorders that lead to a release of stored
diarrhea
hormone from injury to the thyroid gland or from
- amenorrhea, decreased fertility and increase
other nonthyroid gland-related conditions.
miscarriage
Etiology:
Pathology
• Propylthiouracil
• Methimazole
- Associated with congenital aplasia
*May be treated by any of three treatment modalities: - Goal of thyroidectomy should be the complete
antithyroid drugs, thyroid ablation with radioactive 131I and and permanent control of the disease with
thyroidectomy minimal morbidity
-Based on the current evidence, recently published depression, and cardiovascular and GI
guidelines from the American Thyroid Association (ATA) dysfunction, including hepatic failure
and the American Association of Clinical Endocrinologist
(AACE) recommend TOTAL OR NEAR TOTAL • May be precipated with abrupt cessation of
THYROIDECTOMY as the procedure of choice for the antithyroid medications, infection, thyroid or
surgical management of Grave’s disease nonthyroid surgery, and trauma in patient with
untreated thyrotoxicosis
Toxic Multinodular Goiter
Treatment:
• Occur in older individuals, who have prior history
of nontoxic multinodular goiter • Can be appropriately managed in an ICU setting
• B-blockers
• Can be precipitated by iodine containing drugs • Oxygen supplementation and hemodynamic
such as contrast media and the antiarrhytmic support
agent amiodarone (Jod-Basedow • Nonaspirin componds and Lugol’s iodine or
hyperthyroidism) sodium ipodate (IV)
• Symptoms and signs of hyperthyroidism are • PTU
similar to Grave’s disease but extrathyroidal • corticosteriods
manifestation are absent
• Diagnostic Studies Hypothyroidism
- suppressed TSH level and elevated free T4 or T3 • Deficiency in circulating levels of thyroid
levels hormone
• In neonates, leads to cretinism, which is
-RAI uptake is increased, showing multiple characterized by neurologc impairment and
nodules with increased uptake and suppression of mental retardation.
remaining gland • May occur in Pendred’s syndrome and Turner’s
Syndrome
• Treatment
• Parathyroid Hormone
• Composed of CHIEF cells and OXYPHIL cells - produced by photolysis of naturally occurring
arranged in trabeculae, within a stroma sterol precursors
composed of adipose cells
- further hydroxylation in the kidney results in
• Chief cells produce parathyroid hormone (PTH) 1,25-dihydroxy vitamin D, the most metabolically active
form
• Oxyphil cells, are mitochondria rich, acidophilic –
derive from chief cells Hyperparathyroidism (HPT)
• A third group of cells, known as water-clear cells • Primary HPT arises from increased PTH
are also derive from chief cells production from abnormal parathyroid glands
and results from a disturbance of normal
Physiology and Calcium homeostasis feedback control exerted by serum calcium
• Result from the enlargement of a single gland or - Can lead to fatigue and muscle weakness which is
parathyroid adenoma in 80%, multiple adenoma prominent in the proximal muscle group
or hyperplasia in 15 to 20% and parathyroid
carcinoma in 1% Physical findings
• Also occurs within the spectrum of a number of • May demonstrate evidence of band keratopathy,
inherited disorders such as MEN1, MEN2A, a deposition of calcium in Bowman’s membrane
isolated familial HPT, and familial HPT with jaw- just inside the iris of the
tumor syndrome
Clinical features
• Bone Disease
Hypoparathyroidism
• Cause hypocalcemia
Secondary Hyperparathyrodism
c. Caciphylaxis