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Copy of Thyroid abnormalities

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on 25 July 2014

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Transcript of Copy of Thyroid abnormalities

Hyperthyroidism
Hypothyroidism
But first.....
Normal thyroid functioning

Thyroid hormones
Triiodothyronine (T3) and thyroxine (T4), are secreted by the follicular cells of the thyroid gland
Regulated by thyroid-stimulating hormone (TSH) secretion from the anterior pituitary
Lipid soluble and able to cross cell membranes by simple diffusion
Regulators of metabolism

Clinical manifestations:
In INFANTS:
Dull appearance, thick, protuberant tongue, and thick lips result in feeding difficulties
Prolonged neonatal jaundice
Poor muscle tone
Bradycardia, mottled extremities
Umbilical hernia
Hoarse cry
Clinical manifestations:
In CHILDREN and ADULTS
Decreased basal metabolic rate
Weakness, lethargy, cold intolerance, decreased appetite
Bradycardia
Mild/moderate weight gain
Elevated serum cholesterol and triglycerides
Enlarged thyroid, dry skin, constipation
Depression, difficulties with concentration/memory
Menstrual irregularity
Myxoedema
References
http://4.bp.blogspot.com/_cmxzD9d0USM/TQJlWd-0hWI/AAAAAAAAAAs/-xBcT99WtvM/s1600/goitre.jpg
http://www.jcrows.com/hypothyroidismafter3.jpg
http://www.patient.co.uk/images/OM281b.jpg
http://www.dermis.net/bilder/CD033/550px/img0018.jpg
http://img.tfd.com/ElMill/thumb/F0E-07-S2958.jpg
http://bestpractice.bmj.com/best-practice/monograph/32/resources/image/bp/5.html
Thyroid follicular cells
hyperfunction
with
increased
synthesis and secretion of T4 and T3
Ingestion of excessive thyroid hormone or iodide preparation
Multinodular thyroid disease

Clinical manifestations
Changes in behaviour, insomnia, restlessness, tremor, irritability, palpitations, heat intolerance, diaphoresis
Inability to concentrate that interferes with work performance
Increased basal metabolic rate leads to weight loss, although appetite and dietary intake increase
Amenorrhoea/scant menses
And also:
Thyromegaly
Exophthalmos
Widening of the palpebral fissure resulting in exposed sclera
Lid lag, vision changes, photophobia
Allopathic Treatment
Beta-blockers for sympathomimetic symptoms
Antithyroid drugs, thionamides
Radioactive iodine treatment
Surgical removal of the thyroid gland typically reserved for tumors
Pituitary adenoma treated surgically
Grave's disease
most common cause of
hyperthyroidism
prevalent in women in their 30s and 40s
although idiopathic in its primary cause, known to be the result of a type II autoimmune hypersensitivity disorder
characterised by the production of antibodies to the TSH receptor called thyroid-stimulating immunoglobulins (TSI)
antibodies stimulate
hyperplasia
with goiter formation and production of
high
levels of thyroid hormone
feedback on the pituitary to turn off TSH production
thyroid hormone synthesis and release continues because of the presence of the TSI
What happens?
thyroid follicles excrete
excess
thyroid hormone independent of control by the pituitary gland
rest of the thyroid gland decreases its output of hormone
the individual exhibits normal thyroid function (euthyroid)
eventually nodules excrete enough hormone that the signs and symptoms of thyrotoxicosis develop
Also see fig 11-9, p260
inability of the gland to produce thyroid hormone - negative feedback loop to pituitary is insufficient
TSH levels rise
TSH cannot stimulate adequate hormone production but DOES stimulate gland hyperplasia and goiter formation
Inadequate hormone levels have many systemic effects including:
Slow metabolic rate and weight gain
Bradycardia and decreased cardiac output
Hoarseness, cold intolerance
Dry skin and brittle hair
Lethargy and decreased mental acuity
severe hypothyroidism can result in coma
“doughy” oedema throughout the body, called myxoedema.
if tongue and larynx involved, speech is affected
Myxoedema coma most often results from untreated hypothyroidism, especially in the elderly. Severe
hypothyroidism
can lead to significant depression of the central nervous system and even coma.

Myxoedema coma is considered a medical emergency and is associated with:
Hypothermia
Hypoventilation
Hypotension
Hypoglycemia
Inadequate tissue perfusion (lactic acidosis)
Shock and death may occur
Thyroid crisis / storm
Form of life-threatening thyrotoxicosis that occurs when
excessive
amounts of thyroid hormones are acutely released into circulation

Manifestations:
Elevated temperatures, tachycardia, arhythmias
Extreme restlessness, agitation, and psychosis
Vomiting, nausea, diarrhea, and jaundice
Hypothyroidism
Hypothyroidism is a condition that results from
inadequate
levels of thyroid hormone.
It can be caused by primary diseases of the thyroid gland or secondary to pituitary failure.
What are the functions of thyroid hormones?
Regulate rate of overall body metabolism
Calorigenic effects
Stimulate lipolysis and release of free fatty acids and glycerol
Affect cholesterol metabolism
Stimulate metabolism of cholesterol to bile acids
Facilitate rapid removal of LDL from plasma
Generally stimulate all aspects of carbohydrate metabolism and the pathway for protein degradation
Anatomy
Disorders of the
THYROID GLAND
Sudden Paralysis
Signs and Symptoms of
Hyperthyroidism
Family History of Thyroid Disease
or Diabetes
Increased Sweating
Heat Intolerance
Weight Loss or Gain
Impaired Fertility
Palpitations/Tachycardia
Difficulty Swallowing
Persistent Dry or Sore Throat
Hoarseness/
Deepening of Voice
First-Trimester Miscarriage
Excessive Vomiting in Pregnancy
Warm, Moist Palms
Frequent Bowel Movements
Menstrual Irregularities
Enlarged Thyroid (Goiter)
Bulging Eyes/Unblinking Stare/ Vision Changes
Difficulty Sleeping
Mental Disturbances/ Irritability
Nervousness/Tremor
Signs and Symptoms of Hypothyroidism
Puffy Eyes
Enlarged Thyroid (Goiter)
Hoarseness/
Deepening of Voice
Persistent Dry or Sore Throat
Difficulty Swallowing
Slower Heartbeat
Menstrual Irregularities/Heavy Period
Infertility
Constipation
Muscle Weakness/Cramps
Family History of Thyroid Disease or Diabetes
Elevated Cholesterol
Cold Intolerance
Weight Gain
Dry, Patchy Skin
Loss of Body Hair
Thinning Hair/Hair Loss
Inability to Concentrate
Depression
Moodiness/ Irritability
Forgetfulness/Slower Thinking
Tiredness
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