Laila was losing weight

Thyroid gland
1. Anatomy of the thyroid gland
  2. Blood supply
  3. Lymphatics
    1. Upper part of the gland to upper deep cervical nodes via the prelaryngeal, pretracheal & paratracheal nodes.
    2. Lower part to lower deep cervical nodes. The lymphatic's form a plexus & lymph can drain in any direction.
  4. Nerve supply
    1. Supplied by superior, middle & inferior cervical sympathetic ganglia.
    2. Fibers: Vasomotor & not secreto-motor
2. Histology of the thyroid gland
3. Hyperthyroidism vs Hypothyroidism
4. Hyperthyroidism
  1. What is it?
    1. Hyperthyroidism, or overactive thyroid, happens when the thyroid gland produces too much thyroid hormone. This has an impact throughout the body.
  2. Causes
    1. Graves' Disease
    2. Functioning adenoma and toxic multinodular goiter (TMNG
    3. Excessive intake of thyroid hormones
    4. Abnormal secretion of TSH
    5. Thyroiditis (inflammation of the thyroid gland)
    6. Excessive iodine intake
  3. Risk factors
    1. Females
    2. Being older than age 60
    3. Exposure to radiation in the neck
    4. Prior thyroid surgery
    5. Having a family history of thyroid disease
    6. Having a family history of autoimmune disease
    7. Having an autoimmune disease
    8. Being of Caucasian or Asian ethnicity
    9. Experiencing hormonal changes due to pregnancy, childbirth, or menopause
    10. Personal history of lithium use
    11. Having chromosomal abnormalities like Down syndrome or Turner's syndrome
  4. Sign & symptoms
    1. Anxiety \irritability
    2. Fine tremors
    3. Increase in perspiration or warm, moist skin
    4. Weight loss
    5. Goiter
    6. Change in menstrual cycles
    7. Erectile dysfunction or reduced libido
    8. Frequent bowel movements
    9. Graves' ophthalmopathy
    10. Fatigue
    11. Graves' dermopathy
    12. Palpitations
  5. Epidemiology
    1. Westernization and nutrition transition in Arab world have increased the burden of adenocarcinomas, including thyroid cancer
    2. The review showed that the prevalence of different types of thyroid disease varied between the reported studies in Arab world ranging from 6.18 to 47.34% prevalence of goiter reported by several studies conducted in Arab world, such as Egypt, Algeria and Bahrain with 25.25, 86 and 1.7%, respectively
  6. Treatment
    1. Pharmacological
      1. Thionamides
        General Pharmacokinetics:
        Rapidly absorbed orally.
        Half life 1-6 hours.
        Metabolized by the liver
        Excreted in the urine
        Both cross the placenta and appear in breast milk
        Methimazole
        Propylthiouracil
        Comparision
        Dosing
        Usual starting dose – Carbimazole(derivative of methimazole) 30 – 60 mg a day or propylthiouracil 50-100 mg/day
        The dose and frequency should be reduced after 4-6 weeks
        Usual maintenance dose of carbimazole is 2.5 – 15 mg/day.
        Side effects
        Agrancylocytosis
        The patient have to stop the medications if he developed fever –sore thorat –mouth ulcers
        Vasculitis –hepatitis-lupus like syndrome
      2. B-Blockers
        Propanolol
        Mechanism of action
        reduce the cardiac manifestations
        help in relaxing the patient (sedation).
        the only BB that can inhibit deiodinase enzyme
    2. Surgical
      1. Thyroidectomy
        What is it?
        Removal of all or part of your thyroid gland.
        Used to treat thyroid disorders, such as cancer, noncancerous enlargement of the thyroid (goiter) and overactive thyroid (hyperthyroidism).
        Indications
        Thyroid cancer
        Goiter
        Hyperthyroidism
        Contraindications
        Uncontrolled severe hyperthyroidism (ie, Graves disease) --> intraoperative or postoperative thyroid storm.
        Long term effect
        Partial thyroidectomy
        The remaining portion typically takes over the function of the entire thyroid gland, and you might not need thyroid hormone therapy.
        Complete thyroidectomy
        Without replacement you'll develop signs and symptoms of underactive thyroid (hypothyroidism). As a result, you'll need to take a pill every day that contains the synthetic thyroid hormone levothyroxine.
  7. Prognosis
    1. Good with appropriate treatment.
    2. Patient should be screened & treated for osteoporosis & atherosclerotic risk factors
    3. Increased risk of obesity & insulin resistance Previously treated for hyperthyroidism
  8. Types
    1. Diffuse toxic goiters- Graves disease
      1. Pathophysiology
      2. What is it?
        Autoimmune disorder
        An immunoglobulin called thyroid-stimulating immunoglobin (TSI) found in the blood of all patients; TSI binds to the TSH receptor and induce TSH-like effects; TSI effects persist longer than TSH (up to 12 hrs vs. 1 hr respectively) Plasma level of TSH is suppressed due to the high level of thyroid hormones
        Females are more at risk
      3. Signs & Symptoms
      4. Diagnosis
        TSH is deccreased & free T4 is increased
        Thyroid auto antibodies
        Nuclear thyroid scintigraphy (I123, Te99)
    2. Thyroditis
    3. Pituitary Adenoma (TSHoma)
    4. Exogenous Administration (Thyrotoxicosis Factitia)
    5. Toxic Multinodular Goiters
  9. Diagnosis
    1. History taking
    2. Physical examination
    3. Lab Investigation
      1. Blood test
5. Physiology of thyroid gland

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Laila was losing weight

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