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T10 - Bu Harmayeti - Hipertyroid
T10 - Bu Harmayeti - Hipertyroid
KELENJAR HIPOFISIS =
KELENJAR PITUITARI
Hormon Hipofisis Posterior
Hypothalamus and anterior pituitary
larynx
thyroid
trachea
Thyroid gland selectively uptakes iodine
to produce T3 & T4
• Thyroxine (T4)
• Triiodothyronine (T3)
Both control metabolic rate and cellular
oxidation
Causes:
- Graves disease
- exogenous hyperthyroidism (iatrogenic, iodine induced)
- thyroiditis
- toxic nodular goiter
- thyroid cancer
Goiter = enlarged
thyroid gland
◦ results from dietary
iodine deficiency.
◦ Can’t produce TH,
◦ no feedback to
Pituitary TSH
◦ This causes
hypertrophy of the
thyroid gland.
Goiter
Lack of iodine in diet
hyposecretion of T3 & T4
Cretinism
hyposecretion of
T3 & T4
Myxedema
hyposecretion of T3 & T4
After thyroid
myxedema treatment
Exophthalmos-
hyperthyroidism
The major manifestations of hyperthyroidism
and mechanisms of their onset
a) endokrine:
- enlarged thyroid gland (TG) with systolic or continous bruit over
thyroid due to blood flow
- cortisol degradation – due to metabolic rate
- hypercalcemia and decreased PTH secretion - due to excess bone
resorption
- diminished sensitivity to exogenous insulin- due to hyperglycemia
(glycogenolysis and gluco-neogenesis)
b) reproductive:
- oligomenorrhea or amenorrhe due to hypothalamic or pituitary
disturbances
- impotence and decreased libido in men
c) gastrointestinal:
- weight loss and associated increase in appetite due to increased catabolism
- increased peristalsis less formed and more frequent stools - due to
malabsorption of fat
- nausea, vomiting, anorexia, abdominal pain
- increased use of hepatic glycogen stores and adipose and protein stores
- decrease of tissue stores of vitamins
- hyperlipid – acidemia (due to lipolysis)
d) integumentary:
- excessive sweating, flushing, and warm skin
- heat loss
- hair faint, soft, and straight, temporary hair loss
- nails that grow away nail beds
Mechanisms involved:
- decreased cerebral blood flow cerebral hypoxia
- decreased number of beta-adrenergic receptors
b) endocrine: - TSH production (in primary hypothyroidism)
Mechanisms involved:
- TH TSH
- stimulation of lactotropes by TRH prolactin
- decreased deactivation of cortisol
c) reproductive: - androgen secretion in men
- estriol formation in women due to altered
metabolism of estrogens and androgens
- anovulation, decreased libido
- spontaneous abortion
Mechanisms involved:
Mechanisms involved:
- decreased rate of muscle contraction and relaxation
Mechanisms involved:
AA
Definition
Severe Hypothyroidism.
Hypothermia.
Very high mortality 1:3
Undiagnosed Hypothyroidism
or usually Untreated.
Typical patient: elderly female with
longstanding hypothyroidism.
AA
Essentials of Diagnosis
Lethal Complication of HT.
Typical Stigmata: dry skin, delayed reflex
relaxation, generalized weakness, edema,
transverse scar.
Alterations- mental status.
Hypothemic <35.5◦c
AA
Predisposing Factors
• Burns.
• CO2 retention .
• Gastrointestinal hemorrhage .
• Hypoglycemia.
• Hypothermia .
• Infection (Pneumonia, Influenza, UTI/urosepsis ,
Sepsis ).
• Medications (Amiodarone , Anesthesia, Barbiturates
Beta blockers, Diuretics, Lithium, Narcotics,
Phenothiazines, Phenytoin , Rifampin , Tranquilizers).
• Stroke.
• Surgery.
• Trauma.
AA
History & Physical Exam
AA
Laboratory Findings & Imaging
Emergency Basis.
Low T3/4, High TSH (primary).
Blood / Urinary Cultures.
Arterial blood gases.
Hyponatremia/glycemia.
Enlarged heart, Pneumonia, Pericardial Effusion.
ECG: bradycardia, low QRS, flattened/inversed T,
conduction abnormalities.
AA
Treatment
Stabilization.
Fluids , Electrolytes .
Mech. Ventilation.
Corticosteroids +Thyroid Hormone replacement-
Levothyroxin.
Hypothermia, Regular Blankets.
Medications.
Other precipitating factors.