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Eleanor Davis

on 22 November 2012

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Transcript of Thyroid

Clinical Tests Test TSH and T4 (occassionally T3)

Indications for testing thyroid dysfunction:

Clinical features of hyperthyroidism
Palpable Goitre or nodule
Clinical features of hypothyroidism
Family history with mild symptoms (especially in pregnancy)

Unreliable in illness. Anatomy Main site of iodine uptake
Enzyme thyroid peroxidase converts to T3 and T4
T3 is the active hormone (half life 1 day), T4 7 days
99% is bound in the blood, only 1% free Aims Quick Overview of Anatomy and Physiology
Interpreting Thyroid Function Tests
Quiz! Hyperthyroidism Clinical features: weight loss (good appetite), heat intolerance, palpitations, anxiety, dyspnea, irritability, sweating, eye symptoms, hyper defecation, tremor, proximal myopathy, AF, raised ALP, osteoporosis Etiology Graves
Toxic adenoma/multinodular goitre.
Destructive Thyroiditis- DEQUEVAIN's.
Others: HCG, iodine induced, TSH pituitary tumour GRAVES Anti-TSH antibodies
Young Patients
Family History
70% opthalmic involvement- TSH receptors in periporbital muscles
Diagnosed- diffuse radio-iodine uptake, anti-TSH antibodies (not routinely done) (for AMK!) All You Need to Know About
The Thyroid Features and complications Toxic Nodular Older Patients Destructive Thyroiditis No uptake on radioiodine scan Treatment Antithyroid Drugs: carbimizole, propthyluracil Hot nodule on radioiodine uptake- increased uptake in one area or irregular multiple hot spots Palpable nodule 3 types: Postviral, postpartum, amiodarone induced Postviral (Deqeurvains): Painful, raised ESR, fever Postpartum: No pain, reoccurs, Destruction leading to leak of stored hormones Amiodarone induced- consider in patients with history of AF Patients given amiodarone more likely to be pushed into clinical hyperthyroidism Radioiodine Surgery Treat symptoms- b-blockers HYPOTHYROIDISM Features and Complications Weight gain Cold intolerance Depression Cold, dry skin Hair Loss Constipation Muscle pain stiffness cramps Carpal Tunnel Syndrome Tired all the time Etiology Iodine deficiency - either congenital or dietary Iatrogenic- due to treatment of hyperthyroidism, amiodarone, lithium, immunotherapy Hashimoto's Thyroiditis Pituitary origin- secondary. Rare. Would be in combination with other hormone deficiencies Hashimotos Thyroiditis Goitre- non tender. Firm symmetrically enlarged Autoimmune. Family history Most common cause of hypothyroidism in developed world Anti-thyroid peroxidase (Anti-TPO), and fine needle aspirate Associations: Premature grey hair, vitiligo, Vit B12 deficiency 80 x more likely to have lymphoma of thyroid Management Replace- thyroxine. Taken on an empty stomach, 1 hour before food. Do not take with other vitamins or supplements Sub-clinical treat if pregnant, young, previous radio-iodine for graves, goitre, symptomatic, antibodies, other autoimmune disorder, TSH >10 Secondary Hypothyroidism- treat cortisol insufficiency first to avoid adrenal crisis. QUIZ A 46-year-old woman is referred to endocrine with a tender neck swelling. Blood results are as follows:

TSH <0.1 mU/l
T4 188 nmol/l

ESR 65 mm/hr

Radioiodine scan shows decreased uptake globally

What is the most likely diagnosis?

A. Sick thyroid syndrome
B. Acute bacterial thyroiditis
C. Hashimoto's thyroiditis
D. De Quervain's thyroiditis
E. Toxic multinodular goitre Thyroiditis- usually self limiting, Ibuprofen for pain and steroids if severe A 23-year-old woman presents with sweating and tremor. Her thyroid function tests are as follows:

TSH <0.05 mU/l
Free T4 25 pmol/l

What is the most common cause this presentation?

A. Hashimoto's thyroiditis
B. Graves' disease
C. Toxic nodular goitre
D. De Quervain's thyroiditis
E. Toxic adenoma Which one of the following is not an indication for treating a patient with subclinical hypothyroidism?

A. Previous treatment of Graves' disease
B. TSH > 10
C. Raised ESR
D. Positive thyroid autoantibodies
E. Other autoimmune disorder A 33-year-old female is referred by her GP with thyrotoxicosis. Following a discussion of management options she elects to have radioiodine therapy. Which one of the following is the most likely adverse effect?

A. Hypothyroidism
B. Thyroid malignancy
C. Agranulocytosis
D. Oesophagitis
E. Precipitation of thyroid eye disease A 36-year-old woman presents with feeling tired and cold all the time. On examination a firm, non-tender goitre is noted. Blood tests reveal the following:

TSH 34.2 mU/l
Free T4 5.4 pmol/l

What is the most likely diagnosis?

A. Primary atrophic hypothyroidism
B. Pituitary failure
C. De Quervain's thyroiditis
D. Iodine deficiency
E. Hashimoto's thyroiditis
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