THYROID DISORDERSTHYROID DISORDERS

BYBYZEYAD AL-RABIAHZEYAD AL-RABIAH

• OVERVIEW• Thyroid gland .• Hormone secreted by gland .• Triiodothyronine T3 .• Thyroxine T4 .• calctonine .• Action of the thyroid hormone .• calorigenesis• metabolism• brain maturation• behavior• growth and development

Regulation

Thyroid Disease AffectsMany Body Systems and Overall Health

• Depression• Decreased Concentration• General Lack of Interest

Brain

• Decreased Heart Rate• Increased/Decreased

Blood Pressure• Decreased Cardiac

Output

Heart

• Decreased Function• Fluid Retention and

Edema

Kidneys

• Thyroid Disease Can Have Widespread Effects

Thyroid

• Increased LDL Cholesterol

• ElevatedTriglycerides

Liver

• Constipation• Decreased GI

Activity

Intestines

• Decreased Fertility• Menstrual Abnormalities

• May Harm Development of Infant

ReproductiveSystem

Disease of thyroid gland :• Hypothyroidism :Causes :• Non goitrous :1ry :• Idiopathic atrophy .• Iatrogenic .• Postinflammatory thyroiditis .• Cretinism .

2ry :1. TSH .2. TRH .

B. Goitrous :- Dyshormongenesis- Hashimotos Thyroiditis- Drud-induced:(iodides ,lithium ,sulfonylureas ,amiodarone )- Iodide deficiency.

Common Signs and Symptomsof Hypothyroidism

• Symptomes:WeaknessCoold intoleranceHeadachWeight gainDyspneaConstipation

• Signs:GoiterHypertentionBradycardiaPeripheral

edemaPuffy Face and

Eyes

• Laboratory: TT4 +TT3

Cholesterol+TSH+CPK+LDH +ve antibodies

TREATMENT

LEVOTHYROXINE (Synthroid, Levoxyl, Levothroid)•Is drug of choice in hypothyroidism. • converted to T3 in the body.• adult 100-125ug/d , usual increment 25ug Q 6-8 weeks.• elderly 50-100ug/d , if age >60 yr require ≤ 50ug/d.• CAD 12.5-25ug/d , by 12.5-25ug/d Q 2-6 wk as tolerated. • pregnant increase in dose 45% .• pediatric 0-3 mo 37.5-50ug/d , the dose decrease with age.• check TSH after 8 weeks on a stable dose,goal TSH level is 0.5-4.7 mlU/L•Take before breakfast 0.5-1hr with water.

THYROID USP (ARMOUR )

(mixture of L- T4and liothyronine - T3)•not synthetic (from hog ,beef , or sheep thyroid gland).•Dose 1grain

CYTOMEL (liothyronine- T3)• shorter ½ life• may improve mental function andconstitutional symptoms when takenwith L- T4.• dose 25-37.5ug.

LIOTRIX (THYROLAR)• Synthetic ratio T4:T3 in 4:1• Dose 60ug T4:15ugT3 or 50ugT4:12.5ugT3.

• Myxedema ComaIt is the end stage of long-standing uncorrected

hypothyroidism.• Treatment • Give 400ug of L-T4 (200ug in CAD patient).• Decrease in TSH should occur within 24hr.• 50-100mg hydrocortisone Q 6hr to treat

secondary myxedema.

HYPERTHYROIDISM (THYROTOXICOSES)CAUSES :Graves disease .Toxic multinodulare goiter Solitary toxic nodule plummer’s disease De Quervain’s thyroiditisPregnancyExogenous intake of thyroid hormones or iodineDrugs : amoidaroneSecondary ( TSH) it is rare.

Common Signs and Symptomsof Hyperthyroidism

• Nervousness• Irritability• Difficulty Sleeping• Goiter• Rapid Heartbeat• Hypertension

• Increased Sweating• Heat Intolerance• Weight Loss• Menstrual disturbances

(Amenorrhea)• Diarrhea• palpitations

• Laboratory: TT4 +TT3

Cholesterol+TSH +Ve antibodies

• THYROID CRISIS (THYROID STROM) Rare ,mortality 10%. A rapid deterioration of hyperthyroidism with hyperpyrexia (temp

>40°C).• TreatmentThioamide: PTU 600-1200mg/d Q 6hr methimazole 60-120mg/d TID.Iodides: Ipodate 1g/d or lugol’s solution 30 drops/d PO.Propranolol 1mg slow IV push Q5 min until HR 90-110/min maintenance infusion 5-10 mg/hr or 40mg PO Q6hr douple dose Q 12hr until therapeutic response

achieved.Hydrocortisone 100-200mg IV Q 6hr.Supportive therapy.