ENDOCRINOLOGY

Hormones
A hormone may be defined as a chemical substance synthsized by
special cells and secreted directly into the blood stream in small
amounts and carried in the blood to other organs where it exerts its
physiological effects
Introduction
• What is an endocrine gland?
‘DUCTLESS’ glands whose secretions directly enter the blood
Functions

• Growth & development

• Metabolism of carbohydrates, proteins,& fats
• Reproductive function
• Control of secretions of hormones
• Meeting stress & emergency situations
• Intercellular communication
THYROID GLAND
• Thyroid gland
moves with
deglutition
Thyroid gland secretes
• T3 – tri iodothyronine
• T4 – tetra iodothyronine(thyroxine)
• Reverse T3 ( biologically inactive)

Parafollicular C-Cells secrete

• Calcitonin
Functions
• Growth
• Brain growth
• Calorigenesis
• Effects on Carbohydrate metabolism
• Effects on protein metabolism
• Effecs on fat metabolism
• Effects on calcium metabolism
• Conversion of carotene to vitamin A
• Erythropoeisis
• Increases beta receptors in the heart
• Skeletal function
• Enhances the reproductive system
• Enhances Lactation
• Thryoid secretion is controlled by TSH from anterior pituitary which in
turn is controlled by TRH from Hypothalamus
• >99% of Thyroid hormones are transported in the blood by binding
with Thyroxine binding globulin(TBG),thyroid binding prealbumin
(transthyretin), and albumin
Metabolism of thyroid hormones
• Deiodination in tissues
• Conjugation in the liver
• Sidechain modification
Reference ranges
• T3 -1.2-3.1 nmol/L (120-190 ng/dl)
• T4 -55-150 nmol/L (5-12 mcg/dl)
• TSH - 0.5-5.5 IU/ml
• Free T3 – 3-9 nmol/L
• Free T4 – 8-26 nmol/L
Hyperthyroidism
-common complaints by the patient
• Increased appetite
• Loss of weight
• Excessive sweating
• Heat intolerance
• Palpitations
• Tremors
• Diarrhoea
• Abnormal mestruation
• Neck swelling
• Insomnia
Thyrotoxicosis

(Increased
T3,T4)
• Thyroid acropachy
in hyperthyroidism
Thyroid storm
• Fever
• Agitation
• Tachycardia
• Atrial fibrillation
• Cardiac failure
Treatment
Rehydration, antibiotic, Propranolol 80mg 6 hourly or 1-5 mg iv 6 hourly.
Sodium ipodate 500 mg per day
Dexamethasone 2 mg 6 hourly
Oral carbimazole 40- 60 mg daily
Hypothyroidism
-Common complaints by the patient
• Loss of appetite
• Hair loss
• Weight gain
• Irregular menstruation
• Cold intolerance
• Constipation
• Hoarsness of voice
• Swelling of legs
• Neck swelling
• Somnolence
• Headache
• Numbness in extremities
Hypothyroidism
(Decreased
T3,T4)
Pseudomyotonic jerk
(woltman sign)
Myxoedema coma
• Hypothermia
• Convulsions
• Altered conciousness

Treatment
20 mcg triiodothyronine iv
Followed by 8 th hourly injection of 20 mcg triiodothyronine
After 48-72 hours switch to oral thyroxine
Injection hydrocortisone 100 mg iv
Treatment of Hypothyroidism
• Tab.Levothyroxine 50 – 100 mcg once a day before food
Investigation
• T3,T4,TSH levels
• TRab (thyroid receptor stimulating antibodies)
• Anti thyroid peroxidase antibody
• ECG
• Ultrasonography
• Thyroid scintigraphy
Thyroid
scintigraphy
(technetium 99)
Treatment options for hyperthyroidism
• Antithyroid drugs
. Methimazole
. Carbimazole
Propylthiouracil

• Radioiodine ‘I-131’
• Surgery
Special conditions
• Hypothyroidism in pregnancy
• Hypothyroidism in Ischemic heart disease
• Thyrotoxicosis in pregnancy
Asymptomatic abnormal thyroid function test
• Subclinical thyrotoxicosis
• Subclinical Hypothyroidism
• Sick euthyroidism
Thyroid enlargement
• Diffuse goitre
• Multinodular goitre
• Solitary thyroid nodule

Investigation:
TFT
Ultrasonography
FNAC
Isotope scanning
Autoimmune thyroid disease
• Grave’s disease

• Hashimoto’s disease
Graves’s disease
-IgG antibodies against the TSH receptor in thyroid gland which stimulate the gland
-Associated with HLA b8,DR2,DR3
-more common in women 30 to 50 years of age
-features of hyperthyroidism

Treatment:
• Antithyroid drugs
• Radioiodine I-131
• Subtotal thyroidectomy
Grave’s opthalmopathy
Hashimoto’s thyroiditis
• Destructive lymphoid infiltration of the thyroid gland
• Increased thyroid peroxidase antibodies
• More common in women
• Initially hyperthyroidism then hypothyroidism
Transient thyroiditis
• Subacute (de Quervain’s) thyroiditis
• Postpartum thyroiditis

Iodine associated thyroid disease

• iodine deficiency
• Iodine induced thyroid dysfunction
(jade basedow effect)
• Amiodarone induced thyroid dysfunction
Thyroid neoplasia
• Toxic adenoma
• Differentiated carcinoma
-Papillary carcinoma
-Follicular carcinoma

• Anaplastic carcinoma
• Lymphoma
• Medullary carcinoma
• Reidel’s thyroiditis
Congenital thyroid disease
• Dyshormonogenesis
• Thyroid hormone resistance
Thank you

By
Dr.L.M.Vignesh Raja Ayyanar
MBBS