The thyroid gland
Thyroid follicle
Hypothalamo-hypophyseal-thyroid axis
Anamnesis
• Place of birth, place of living:
• Mountain area – iodine deficit;
• seashore – iodine excess; thyroid autoimmunity
• Familial thyroid diseases :
• Autoimmune disease: more frequent in women (Hashimoto’s thyroiditis
F:M=9:1); mother to daughter transmission;
• Medullary carcinoma of the thyroid may have familial character
Clinical examination
Thyroid disorders
• Hypothyroidism:
• Iodine deficiency: in poor countries
• Autoimmunity: in developed countries
• Thyrotoxicosis
• True hyperthyroidism
• Graves’ disease
• Toxic multinodular goiter
• Toxic uninodular goiter (toxic adenoma)
• thyrotoxicosis due to thyroid tissue destruction: inflammation, infiltration, trauma
• Thyroiditis
• Acute
• Subacute
• Chronic
• Thyroid cancer
• Papillary carcinoma
• Follicular carcinoma
• Medullary carcinoma
• Anaplastic carcinoma
Hypothyroidism
(with red color – the initial event )
Hypothyroidism Thyroid Pituitary hypothalamus
T3/T4 TSH TRH
Primary decreased increased increased
Secondary decreased decreased increased
Tertiary decreased decreased decreased
Hypothyroidism
Hypothyroidism
Congenital hypothyroidism : hoarse cry,
alopecia, umbilical hernia and macroglosia
Severe Myxedema in elderly
Hypothyroidism with goiter in infants: jaundice, flaccid
abdomen, compressive goiter;
(coud be the result of dyshormonogenesis)
Myxedema before after
Myxedema before and after
Myxedema before after
Myxedema before after
Diffuse goiter
Diffuse goiter
Diffuse goiter
Asymmetrical multinodular goiter
Nodular goiter
Multinodular endemic goiter with
compressive manifestations
Multinodular endemic goiter
Consequences of iodine deficiency:
- goiter
- endemic cretinism
Asymmetrical endemic goiter
Endemic cretinism
Endemic cretinism
Endemic cretinism
Congenital hypothyroidism
Hyperthyroidism
(with red color – the initial event )
Hyperthyroidism Thyroid Pituitary hypothalamus
T3/T4 TSH TRH
Primary increased decreased decreased
Secondary increased increased decreased
Tertiary increased increased increased
Graves’ disease – general aspect
Graves ophthalmopathy stages (NO SPECS)
• 0 No symptoms, no signs
• 1 Only signs, no symptoms (upper lid retraction)
• 2 Soft tissue involvement with symptoms(excess lacrimation, sandy
sensation, photophobia)
• 3 Proptosis (protruded eyes)
• 4 Extraocular muscle involvement (usually with diplopia, abnormal
ocular motion, asynergisms)
• 5 Corneal involvement (fissures, ulcers)
• 6 Sight loss (optic nerve damage)
Graves’ disease: stare
Graves’ disease: stare, protrusion
Graves’ disease: severe eye involvement; eyelid
retraction, proptosis, corneal modifications, asynergism
Graves disease:
1. Hyperlacrimation, oedema
2. Ocular asymmetry; right eye lid retraction
Graves’ disease: pretibial myxoedema
Graves disease
Thyroid cancer
Normal thyroid ultrasound
hashimoto ultrasound
hashimoto ultrasound
Thyroid adenoma ultrasound
Thyroid carcinoma ultrasound
Thyroid carcinoma ultrasound
Various types of thyroid nodules
Thyroid egg shell calcification
Thyroid scintigraphy
Thyroid scintigraphy
Graves disease
Toxic adenoma
Thyroid scintigraphy
Retrosternal goiter (CT scan)
Retrosternal goiter (radiograph)
Retrosternal goiter
