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hosam etman

on 17 September 2013

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Transcript of thyrotoxicosis

anatomy histology para-follicular Iodotyrosin mono di DIT + MIT= T3
DIT + DIT = T4 thyroid peroxidase CVS
- HR .. CO .......systolic pressure
- VD...... PR .....diastoplic pressure brain development Metabolic Rate
O2 consumption essential for growth
effect on GH small dose >>>> +ve N balance .......growth
large dose >>>> -ve N balance (protein) BLood O2 dissociation from Hb

Cholesterol glucose utilization
response to chatecholamine ANS Thyrotoxicosis :- A condition resulting from excessive concentrations of thyroid hormones in the body Thyrotoxicosis •Hyperthyroidism: . excess synthesis and secretion of thyroid hormone by the thyroid gland with hyperfunction without hyperfunction - Graves` disease
- Toxic nodular goiter
- pituitary tumour
- toxic adenoma - thyroditis
- factitious thyrotoxicosis
- sturma ovarii
- Hamburger toxicosis
- metastatic follicular cell
tumor Causes of Thyrotoxicosis Graves` Disease - most common cause - complex autuimmune (parry`s disease) triad of :-
- toxic goiter
- ophthalmopathy
- dermopathy IgG Ab TSH receptor follicular cell Etiology hormone production general :-
1- weight loss despite good appetite
2- intolerance to hot weather (diffuse) - palmar erythema (deep) - Systolic hypertension usually in females ( 30-50) &hyperdefecation Ocular manifestation infiltrative non- infiltrative 1-Exophthalmos 2-external ophthalmoplegia (moebius sign) 1-lid retraction 2-lid lag 3-infrequent blinking (stellwag`s sign) 4-rosenbach`s sign (darlymle`s sign) Von Graeve`s sign Diagnosis Clinical diagnosis Investigations -free T3,T4,TSH
-TSI (thyroid stimulating immunoglobulin)

-Radio-Active Iodine Uptake

-radionuclide scanning

-Doppler study medical Surgery Treatment Radioactive Iodine Treatment of complication - 1st episode

- pregnancy

- pre-operative

- unfit for operation - huge goiter

- malignancy Antithyroid - inhibit the peroxidase enzyme - euthyroid within 4-8 weeks 100 -200 mg/8H 50 mg/8H control within 2 months 4-6 weeks 20-40 mg/d 5-20 mg/d stop when euthyroid on 5mg/d Sedative benzodiazepines Propranolol B-Blocker - sypathetic overactivety

- T4 T3 (more potent on CVS) - patients > 40 yrs
- failure of medical treatment
- unfit to surgery pregnancy I 131 euthyroid within 2-3 months - recurrent after medication

- huge goiter

- malignancy - recurrent after surgery

-dependance of voice before operation - decrease vascularity
- decrease size
- decrease release (give 5% iodine in 10% Potassium iodide ) (10 days before operation) to complications:- - laryngeal nerve palsy
- post operative thyrotoxic crisis ocular complication eye protection & lubrication corticosteroid pretibial myxedema corticosteroid thank you research by
student (226 - 233) presentation by
hossam etman
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