Thyroid Disorders

Presented by:- Drashti Chudasama

Guided by:-Dr. Milan sir
 Thyroid gland

• Largest endocrine
gland which
found in neck
below Thyroid
cartilage
• Butterfly shape
• 2 lobes
• Weight --25 g
 Thyroid Disorders

hyperthyroidism
Physiological -----

hypothyroidism
2 types

Anatomical ----goiter
 Hyperthyroidism

• Also known as thyrotoxicosis

• Defination:-
it is an over activity of thyroid which is characterized by clinically
by high level of T3 & T4 & lower level of TSH

• Types:-
1. Grave's diseases
2. Toxic nodular goiter
3. Thyroiditis
4. Thyrotoxis crisis
 Primary hyperthyroidism
1.Grave’s diseses:--
• autoimmune disorder in TSI binds to TSH receptors & cause excessive secretion
of thyroid hormone
• antibody attach to TSH receptor& stimulate thyroid & release T3&T4
• The most common cause of hyperthyrodism
• where the thyroid is overactive, producing an excessive amount of thyroid
hormones (a serious metabolic imbalance known as hyperthyroidism and
thyrotoxicosis)
• More common in young adults
• May lead to destruction of thyroid tissue
Complication-
• Goiter
• Thyroid eye disorder--grave's opthalmopathy
• Skin thickening (peritibial myexedema)
• Treatment :-
• radioactive iodine . If likely to achieve remission :
thionamides ; carbimazole •
• -If concerns regarding possible compression or malignancy ,
first - line treatment should be thyroidectomy
 2. Toxic nodular goiter
• involves an enlarged thyroid gland that contains a small rounded
mass or masses called nodules, which produce too much thyroid
hormone
• Also known as:- Toxic adenoma , Toxic multinodular goiter;
Plummer's disease.
• second most common cause of hyperthyroidism (after
Graves' disease)
• Iodin level decreased
• Thyroid level decresed
• Mostly benign
• Melignant nodules:- usually hard & painless
• Diagnostis:-
• Us
• Us guided FNA
• Thyroid scan
• Treatment:-
• Unilateral to total thyroidectomy
 3.thyroiditis
Acute illness with pain

2 types:-
1. Hashimoto's disease
2. DeQuerviand(Subacute or granulomatous)
 A) Hashimoto's disease:-
• Chronic autoimmune disease
• inflammation of the thyroid causes a leak resulting in excess
thyroid hormones (hyperthyroidism). Over time, the
inflammation prevents the thyroid from producing enough
hormones (hypothyroidism).
• Most common cause of hypothyroidism
• non-Momedian inheritance
• 45-65 years
• F:M = 10-20:1
 B)DeQuervians:-

• a health condition involving the thyroid gland that usually

resolves spontaneously without treatment.
 4.thyrotoxis crisis
• Also known as thyroid storm
• Rare but danger
• when your thyroid suddenly produces and releases large amounts
of thyroid hormone.
• Causes:- sudden event or illness such as surgery or an infection.
• Diagnosis:-
• Low TSH
• High T4
Systemic symptoms:-
• Tachycardia
• Hyperthermia
• Delirium
 Ayurved chikitsa--:
• Sanshamna chikitsa-:. Samshodhan chikitsa:
• बलामूल क्वाथ. गो-घृत नस्य
• अश्वगंधा चूर्ण शीरोधारा
• शंखपुष्पी चूर्ण विरेचन
• ब्राम्हि चूर्ण
• शतावरी चूर्ण
• जटामांसी चूर्ण
• शंशमनी वटी
• ब्रम्ह रसायन
 Galaganda
• ननफद्धः श्वमथुमयस्म भुष्कवल्रम्फते गरे |
• भहान्वा मदद वा ह्रस्वो गरगण्डं तभाददशेत्||१||
• A swelling in the neck, big or small hanging like the scrotum
has been defined as Galaganda.
• Tyes:-
• Vataj
• Kaphaj
• Medoj
 Treatment:-
• 1. वातज गलगण्ड चिकित्सा 
• नाडीस्वेद with एरण्डादी वातहर औषधि
• रक्तमोक्षण (blood letting)
• उपनाह with तिल, अतसी, मूलक, , कांजी
• 2. कफज गलगण्ड चिकित्सा 
• स्वेदन
• लेप with अजगंधा,कु ष्ठ etc.
• पिप्पलयादि कफहर पंचलवणयुक्त तैलपान
• 3. मेदोज गलगण्ड चिकित्सा 
• रक्तमोक्षण
• गो-मूत्रपान
 Gandamala
• The disease condition in which multiple swellings or lumps
of size of a small or big goose berry ( small - Karkandhu or
big- Kola or a fruit of Amalakai acute externally at axilla ,
sides of neck , throat , called as Gandamala .
• Treatment:-
• रक्तमोक्षण
• विरेचन
• नस्य
 Hypothyroidism
• A clinical and biochemical syndrome that results from
a deficiency in thyroid hormone secretion from thyroid
gland or in the action
• Prevalence:-
• It is a common disorder with prevalence ranges from
2-15%
• ♀>♂
• Female : male =10:1
• 2 types

1. Primary Hypothyroidism:- Disease of

the thyroid gland
2. Secondary Hypothyroidism:-
Hypothalamic-pituitary diseases
(reduced TSH)
 CAUSES OF HYPOTHYROIDISM
• Congenital
• Agenesis
• Ectopic thyroid remnants
• Defects of hormone synthesis
• Iodine deficiency
• Dyshormonogenesis
• Antithyroid drugs
• Other drugs (e.g. lithium, amiodarone,interferon)
• Autoimmune
• Hashimoto's thyroiditis
• Atrophic thyroiditis
• Postpartum thyroiditis
• Post-irradiation (Post-surgery)
• Radioactive iodine therapy
• Infiltration
• Tumour
• Invesigation:
• Serum TSH:-
• The investigation of choice.
• A high TSH level confirms primary
• hypothyroidism. (NR-0.4 mU/L to 4.0 mU/L)
• Serum T4:-
• low free T4 level confirms the hypothyroid state.
• Thyroid peroxidase and Antithyroglobulin Antibodies.n
Treatment:-
• Replacement does of levothyroxine(T4 stimulate) in adults
range from 0.05 to 0.2 mg / d . It varies according to the
patient's age and body weight .
• In young children : 4-5 μg / kg / d
• In adults : average 1.7 μg / kg / d
• In elders , start with lower dose , ex . 0.025mg daily ,
increase the dose at 4- to 6 - week intervals based on serum
FT4, and TSH levels
• Dose should be increased about 25 % during pregnancy
T4 only medications:-
- Levothroid , Levoxyl , Synthroid , Unithroid
T3 only medications
- Liothyronine ; cytomel
T4 / T3 combo medications
- Liotrix Euthroid , Thyrolar
Ayurveda chikitsa-:
• Samshaman chikitsa:-. Samshodhan-:
• वर्धमान पिप्पली. .विरेचन with एरंड तैल

• गौमूत्र हरीतकी
• वरुण शिगुरु क्वाथ
• फला त्रिकदि क्वाथ
• चित्रकादि वटी
• विडंगा चूर्ण
• आरोग्य वर्धिनी
• कांचनार गुग्गुलु
Parathyroid disorders
• around 4-6 in number,
• are usually located in the neck behind the thyroid
• Size of a grain of rice.
 1. Hyperparathyroidism

• Primary - PTH secretion is disproportionately high in relation To

the serum calcium concentration.
• Secondary to kidney failure, severe vitamin D and calcium
• deficiency.
• Tertiary - is excessive autonomous secretion of parathyroid
• hormone after a long period of secondary hyperparathyroidism.
Sign & symptoms:-
• Weak bones that break easily (osteoporosis)
• Kidney stones.
• Excessive urination.
• Stomach (abdominal) pain.
• Tiring easily or weakness.
• Depression or forgetfulness.
• Bone and joint pain.

• Complication:-
• Osteoporosis
• Renal stones
• Pathological fracture
• LVH --left ventricular hypertrophy
 Diagnosis:-
• appropriate biochemical testing.
• PHPT is associated with hypercalcemia and elevated level of parathyroid hormone.
• X-ray, BMD
• USG, CT-SCAN
Treatment:-
• First line therapy - maintain hydration with isotonic 50/- 2.5
- 4 L/24 hr
• Frasamide - 80-100 mg IV every 2 hr
• Glucocorticoid
• Biphosphonate - 7.5 mg/kg body wt in 4 hrs
• If pt. Not responding - mithramycine 25 μg /kg - IV
• secondary depend on cause
• 1) if pt. Decrease vit. D level - vit. D
• 2) surgery - cancer
• 3) Avoid phosphate in diet
 2. Hypoparathyroidism

Hypoparathyroidism is the state of decreased secretion or activity of parathyroid hormone (PTH).

This leads to decreased blood levels of calcium
(hypocalcemia) and increased levels of blood
phosphorus (hyperphosphatemia).
Sign & symptoms:-
• a tingling sensation (paraesthesia) in your fingertips, toes and lips.
• muscle pains or cramps, particularly in your legs, feet or tummy.
• tiredness.
• mood changes, such as feeling irritable, anxious or depressed.
• dry, rough skin.
• Complication:-
• Hypocalcemia
• Convulsive disorders
 Diagnosis:-
• 1. Blood tests:
• ↓ calcium levels
• ↑ phosphorus levels
• ↓ PTH levels (but normal or elevated in pseudohypoparathyroidism)
• 2. 24 urine low calcium excretion
• 3. Imaging tests if necessary:
• • X-ray and CT may reveal calcifications in the basal ganglia of the brain and
• other soft tissue and the density of the bone structure
• • Renal ultrasoud
• 4. Consultations with an ophthalmologist (cataract) and neurologist
• 5. ECG: prolonged QT interval
Treatment:-
• high-calcium and low-phosphorous diet
• Calcium carbonate 1-3 g/d orally, during and between
meals
• Vitamin D supplementation 0.5-3 μg/d to patients
• intake, a sodium-restricted diet
• Magnesium supplementation in case of deficiency
• Skeletal deformity:-surgical intervention