Laila was losing weight

Laila was losing weight

1. Thyroid gland

   • Anatomy of the thyroid gland
     • Blood supply
     • Lymphatics
       • Upper part of the gland to upper deep cervical nodes via the prelaryngeal, pretracheal & paratracheal nodes.
       • Lower part to lower deep cervical nodes. The lymphatic's form a plexus & lymph can drain in any direction.
     • Nerve supply
       • Supplied by superior, middle & inferior cervical sympathetic ganglia.
       • Fibers: Vasomotor & not secreto-motor
   • Histology of the thyroid gland
   • Hyperthyroidism vs Hypothyroidism
   • Hyperthyroidism
     • What is it?
       • Hyperthyroidism, or overactive thyroid, happens when the thyroid gland produces too much thyroid hormone. This has an impact throughout the body.
     • Causes
       • Graves' Disease
       • Functioning adenoma and toxic multinodular goiter (TMNG
       • Excessive intake of thyroid hormones
       • Abnormal secretion of TSH
       • Thyroiditis (inflammation of the thyroid gland)
       • Excessive iodine intake
     • Risk factors
       • Females
       • Being older than age 60
       • Exposure to radiation in the neck
       • Prior thyroid surgery
       • Having a family history of thyroid disease
       • Having a family history of autoimmune disease
       • Having an autoimmune disease
       • Being of Caucasian or Asian ethnicity
       • Experiencing hormonal changes due to pregnancy, childbirth, or menopause
       • Personal history of lithium use
       • Having chromosomal abnormalities like Down syndrome or Turner's syndrome
     • Sign & symptoms
       • Anxiety \irritability
       • Fine tremors
       • Increase in perspiration or warm, moist skin
       • Weight loss
       • Goiter
       • Change in menstrual cycles
       • Erectile dysfunction or reduced libido
       • Frequent bowel movements
       • Graves' ophthalmopathy
       • Fatigue
       • Graves' dermopathy
       • Palpitations
     • Epidemiology
       • Westernization and nutrition transition in Arab world have increased the burden of adenocarcinomas, including thyroid cancer
       • 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
     • Treatment
       • Pharmacological
         • 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
         • B-Blockers
           • Propanolol
             • Mechanism of action
               • reduce the cardiac manifestations
               • help in relaxing the patient (sedation).
               • the only BB that can inhibit deiodinase enzyme
       • Surgical
         • 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.
     • Prognosis
       • Good with appropriate treatment.
       • Patient should be screened & treated for osteoporosis & atherosclerotic risk factors
       • Increased risk of obesity & insulin resistance Previously treated for hyperthyroidism
     • Types
       • Diffuse toxic goiters- Graves disease
         • Pathophysiology
         • 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
         • Signs & Symptoms
         • Diagnosis
           • TSH is deccreased & free T4 is increased
           • Thyroid auto antibodies
           • Nuclear thyroid scintigraphy (I123, Te99)
       • Thyroditis
       • Pituitary Adenoma (TSHoma)
       • Exogenous Administration (Thyrotoxicosis Factitia)
       • Toxic Multinodular Goiters
     • Diagnosis
       • History taking
       • Physical examination
       • Lab Investigation
         • Blood test
   • Physiology of thyroid gland

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