1.

Hypothyroidism

A. Definition

Hypothyroidism is the most common disorder arising from thyroid hormone deficiency.
Classification
According to the time of onset it is divided in congenital and acquired
According to the level of endocrine dysfunction in primary and secondary or central
According to the severity into severe/ overt/ clinical and mild or subclinical hypothyroidism.

B. Etiology

When your thyroid doesn't produce enough hormones, the balance of chemical reactions in your body
can be upset. There can be a number of causes, including autoimmune disease, treatment for
hyperthyroidism, radiation therapy, thyroid surgery and certain medications.

Hypothyroidism results when the thyroid gland fails to produce enough hormones. Hypothyroidism may
be due to a number of factors, including:

Autoimmune disease

People who develop a particular inflammatory disorder known as Hashimoto's thyroiditis suffer from
the most common cause of hypothyroidism.

Treatment for hyperthyroidism

People who produce too much thyroid hormone (hyperthyroidism) are often treated with radioactive
iodine or anti-thyroid medications to reduce and normalize their thyroid function. However, in some
cases, treatment of hyperthyroidism can result in permanent hypothyroidism.

Congenital disease

Some babies are born with a defective thyroid gland or no thyroid gland. In most cases, the thyroid
gland didn't develop normally for unknown reasons, but some children have an inherited form of the
disorder. Often, infants with congenital hypothyroidism appear normal at birth. That's one reason why
most states now require newborn thyroid screening.

Iodine deficiency

The trace mineral iodine — found primarily in seafood, seaweed, plants grown in iodine-rich soil and
iodized salt — is essential for the production of thyroid hormones. In some parts of the world, iodine
deficiency is common, but the addition of iodine to table salt has virtually eliminated this problem in the
United States. Conversely, taking in too much iodine can cause hypothyroidism.
Thyroid surgery

Removing all or a large portion of your thyroid gland can diminish or halt hormone production. In that
case, you'll need to take thyroid hormone for life.

Radiation therapy

Radiation used to treat cancers of the head and neck can affect your thyroid gland and may lead to
hypothyroidism.

Medications

A number of medications can contribute to hypothyroidism. One such medication is lithium, which is
used to treat certain psychiatric disorders. If you're taking medication, ask your doctor about its effect
on your thyroid gland.

B. Clinical Manifestation

Symptoms
 Tiredness, weakness
 Dry skin
 Feeling cold
 Hair loss
 Difficulty concentrating and poor memory
 Constipation
 Weight gain with poor appetite
 Dyspnea
 Hoarse voice
 Menorrhagia (later oligomenorrhea or amenorrhea )
 Parasthesia
 Impaired hearing

Signs

 Dry coarse skin, cool peripheral extremities

 Puffy face, hands, and feet (myxedema)
 Diffuse alopecia
 Bradycardia
 Peripheral edema
 Delayed tendon reflex relaxation
 Carpal tunnel syndrome
 Serous cavity effusions\

 C. Diagnosis

 dry skin
 slowed reflexes
 swelling
 a slower heart rate

D. Diagnostic treatment

Standard treatment for hypothyroidism involves daily use of the synthetic thyroid hormone
levothyroxine (Levothroid, Synthroid, others). This oral medication restores adequate hormone
levels, reversing the signs and symptoms of hypothyroidism.

One to two weeks after starting treatment, you'll notice that you're feeling less fatigued. The
medication also gradually lowers cholesterol levels elevated by the disease and may reverse any
weight gain. Treatment with levothyroxine is usually lifelong, but because the dosage you need may
change, your doctor is likely to check your TSH level every year.

E. Prevention

Hypothyroidism cannot be prevented. However, you can watch for symptoms so that the condition
can be treated in a timely manner

2. Hyperthyroidism

A. Definition

Hyperthyroidism, a term for overactive tissue within the thyroid gland, resulting in
overproduction and thus an excess of circulating free thyroid hormones: thyroxine (T4),
triiodothyronine (T3) or both. Thyroid hormone is important at a cellular level, affecting
nearly every type of tissue in the body. It functions as a stimulus tometabolism, and is
critical to normal function of the cell.

Hyperthyroidism, considered as the second most common endocrine disorder. It

results from an excessive output of thyroid hormones due to abnormal stimulation of the
thyroid gland by circulating immunoglobulin. This disorder affects women eight times
more frequently than men and peaks between the second and fourth decades of life. It
generally occurs between 20 and 40 years old and is more common in females.
B. Etiology

Hyperthyroidism occurs when the thyroid releases too much of its hormones over a short
(acute) or long (chronic) period of time. Many diseases and conditions can cause this
problem, including:
 Getting too much iodine
 Graves disease (accounts for most cases of hyperthyroidism)
 Inflammation (thyroiditis) of the thyroid due to viral infections or other causes
 Noncancerous growths of the thyroid gland or pituitary gland
 Taking large amounts of thyroid hormone
 Tumors of the testes or ovaries

C. Pathogenesis

T3 and T4 regulationThe production of thyroxine and triiodothyronine is regulated by

thyroid-stimulating hormone (TSH), released by the anterior pituitary (that is in turn released
as a result of TRH release by the hypothalamus). Thethyroid and thyrotropes form a
negative feedback loop: TSH production is suppressed when the T4 levels are high,and vice
versa. The TSH production itself is modulated by thyrotropin-releasing hormone (TRH),
which is produced by the hypothalamus and secreted at an increased rate in situations such
as cold (in which an accelerated metabolism would generate more heat). TSH production is
blunted by somatostatin (SRIH), rising levels of glucocorticoids and sex hormones (estrogen
and testosterone), and excessively high blood iodide concentration.

D. Clinical Manifestation

Symptoms
 Difficulty concentrating
 Fatigue
 Frequent bowel movements
 Goiter (visibly enlarged thyroid gland) or thyroid nodules
 Heat intolerance
 Increased appetite
 Increased sweating
 Irregular menstrual periods in women
 Nervousness
 Restlessness
 Weight loss (rarely, weight gain)
  Other symptoms that can occur with this disease:
 Breast development in men
 Clammy skin
 Diarrhea
 Hair loss
 Hand tremor
 Weakness
 High blood pressure
 Itching - overall
 Lack of menstrual periods in women
 Nausea and vomiting
 Pounding, rapid, or irregular pulse
 Protruding eyes (exophthalmos)
 Rapid, forceful, or irregular heartbeat (palpitations)
 Skin blushing or flushing
 Sleeping difficulty

E. Diagnosis

If the diagnosis is hyperthyroidism, a person may be asked to take anti thyroid medication or
iodides before the operation. Continued treatment with anti thyroid drugs may be the
treatment of choice. Otherwise, no other special procedure must be followed prior to the
operation.

Physical examination may reveal thyroid enlargement, tremor, hyperactive reflexes, or an

increased heart rate. Systolic blood pressure (the first number in a blood pressure reading)
may be high.

Subclinical hyperthyroidism is a mild form of hyperthyroidism that is diagnosed by abnormal

blood levels of thyroid hormones, often in the absence of any symptoms.

F. Diagnostic treatment

Blood tests are also done to measure levels of thyroid hormones.

 TSH (thyroid stimulating hormone) level is usually low
 T3 and free T4 levels are usually high

This disease may also affect the results of the following tests:

 Cholesterol test
  Glucose test
 Radioactive iodine uptake
 T3RU
 Triglycerides
 Vitamin B12 (in rare cases)

G. Prevention

Patients being treated for hyperthyroidism need to follow-up with the physician for
regular monitoring. For weight loss, fatigue and other complaints a proper nutritional plan is
essential. To prevent further weakness, bone thinning and to maintain good health, it is
necessary to follow a proper diet plan and healthy routine as advised by the physician.
Taking calcium and vitamin D supplements may be considered with medical advice. Regular
exercise can help to improve bone and heart health.

For those suffering from eye disturbances or Grave’s ophthalmology, special care of the
eyes can help. Some measures include wearing sunglasses, applying cool eye compresses,
using lubricating eye drops and raising the head while sleeping to relieve pressure on the
eyes