Losing Weight

Losing Weight

1. Laila

   • presented with
     • GOITER
       • Is an enlargement of the thyroid gland.
       • Can be physiological due to increased demand of the thyroid hormone as in puberty, or due to mali- gnant disease which needs urgent diagnosis and treatment
       • causes
         • Simple (non-toxic) goitre
           • Simple hyperplastic goitre
             • Multinodular goitre
         • Neoplastic goitre
           • Malignant
             • Papillary
               • Follicular
                 • Anaplastic
                   • Lymphoma
                     • Medullary
           • Benign
             • Adenoma
         • Autoimmune
           • Hashimoto's thyroidits
         • Inflammatory
           • de Quervain's thyroditis
             • Riedel's thyroiditis
         • Toxic goitre
           • Graves' disease
             • Toxic nodule
               • Toxic multinodular goitre
   • Later diagnosed with thyrotoxicosis
     • Graves' Disease
       • Definition
         • Graves disease is the most common cause of endogenous hyperthyroidism.
       • Pathogenesis
         • Graves disease is an autoimmune disorder in which a variety of antibodies may be present in the serum, including antibodies to the:
           • Autoantibodies to the TSH receptor are central to disease pathogenesis and they include:
             • Thyroid-stimulating immunoglobulin
               • Thyroid growth-stimulating immunoglobulins (TGIs)
                 • TSH-binding inhibitor immunoglobulins (TBII)
           • TSH receptor
             • Thyroid peroxisomes
               • Thyroglobulin
       • Morphology
         • Diffusely hyperplastic thyroid in a case of Graves disease. The follicles are lined by tall, columnar epithelium. The crowded, en- larged epithelial cells pro- ject into the lumens of the follicles. These cells actively resorb the colloid in the centers of the follicles, resulting in the scalloped appearance of the edges of the colloid.
         • Hyperemic “juicy” appearance. The gland is usually smooth and soft, and its capsule is intact.
       • Risk factors
         • occurs more often in women, mostly 20-40 years old
       • Characterised by a triad of
         • Thyrotoxicosis, caused by a diffusely enlarged, hyperfunctional thyroid, is present in all cases.
           • An infiltrative ophthalmopathy with resultant exophthalmos is noted in as many as 40% of patients.
             • A localized, infiltrative dermopathy (sometimes designated pretibial myxedema) is seen in a minority of cases.
       • Laboratory Findings
         • Elevated serum free T4 and T3
           • depressed serum TSH
             • radioactive iodine uptake is increased
               • Because of ongoing stimulation of the thyroid follicles by thyroid-stimulating immunoglobulins
       • Treatment
         • 1- Propranolol
           • 2- Thiourea drugs (Antithyroid drugs)
             • 3- Iodinated contrast agents
               • 4- Radioactive iodine
                 • 5- Thyroid surgery
                   • Laila finally required
                     • Thyroidectomy
                       • Indications
                         • Developmental Thyroid Abnormalities
                           • Hyperthyroidism
                             • Thyroiditis
                               • Thyroid Nodules
                       • could be
                         • either
                           • Subtotal thyroidectomy: Bilateral removal of >50% of each lobe and an isthmusectomy
                         • or
                           • Total thyroidectomy: Complete removal of both thyroid lobes, isthmus, and pyramidal lobe
     • Hyperthyrodism
       • Signs & symptoms

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