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Clinical Application Hypothyroidism and Hyperthyroidism

Clinical Application Hypothyroidism and Hyperthyroidism. Gail Nunlee-Bland, M.D. Hypothyroidism. Clinical condition associated with decreased function of the thyroid gland and a decrease in the circulating level of thyroid hormones. Hypothyroidism Causes. Three categories

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Clinical Application Hypothyroidism and Hyperthyroidism

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  1. Clinical ApplicationHypothyroidism and Hyperthyroidism Gail Nunlee-Bland, M.D.

  2. Hypothyroidism • Clinical condition associated with decreased function of the thyroid gland and a decrease in the circulating level of thyroid hormones

  3. HypothyroidismCauses • Three categories • permanent loss or atrophy of thyroid tissue (primary hypothyroidism) • compensatory thyroid enlargement due to transient or progressive impairment of hormone biosynthesis (goitrous hypothyroidism) • insufficient stimulation of a normal gland as a result of hypothalamic or pituitary disease (secondary hypothyroidism)

  4. Primary Atrophic Hypothyroidism • Autoimmune thyroiditis (Hashimoto’s disease) • Postablative I 131 or surgery • Athyreotic due to ageneisis or dysplasia • Unresponsivenes to TSH

  5. Goitrous Hypothryoidism • Hashimoto’s thyroiditis • Endemic iodine deficiency • Iodine-induced • Antithyroid agents

  6. Central Hypothyroidism • Secondary (pituitary) hypothyroidism • Panhypopituitarism • Isolated TSH deficiency • Abnormal TSH synthesis or receptor defect • Hypothalamic hypothyroidism

  7. Autoimmune Thyroiditis • More common in women • Thyroid autoantibodies present • autoantibodies to thyroid peroxidase (TPOAB) • autoantibodies to thyroglobulin (TgAb) • May be associated with other autoimmune diseases

  8. Postablative Hypothyroidism • Common cause of thyroid failure in the adult • Follows total thyroidectomy secondary to thyroid cancer or subtotal thyroidectomy for Graves’ disease • Following treatment with radioactive iodine

  9. Athyreotic Hypothyroidism • Development defects of the thyroid • Incidence 1 in every 4000 newborns • Defects • complete absence • failure of thyroid to descend properly during embryologic development

  10. Hashimoto’s Thyroiditis • Most common cause of goitrous hypothyroidism in iodine sufficient areas • Autoimmune

  11. Endemic Goiter • Environmental iodine deficiency • Affects more than 200 million people throughout the world • Most common in mountainous areas - Alps, Himalayas, and Andes • Consumption of cassava meal may aggravate

  12. Antithyroid Agents • Lithium • Para-aminosalicylic acid • Phenylbutazone • Topically applied resorcinol • ethionamide • Soybean in infant formulas

  13. Iodine-induced • Chronic administration of large doses of iodine • may be seen when potassium iodide, radiographic contrast medium, or amiodarone • May occur in newborns when women given large quantities of iodine during pregnancy

  14. Central Hypothyroidism • Due to hypothalamic or pituitary disease • May be associated with other pituitary hormone deficiencies • May precipitate adrenal crises if thyroid hormone is replaced before hydrocortisone

  15. Clinical Features

  16. Clinical Features

  17. Clinical Features

  18. Clinical Features

  19. Cardiovascular • Cardiac output is decreased • Peripheral vascular resistance is increased • Blood volume is reduced • Elevated cholesterol • Increased blood pressure • Cardiomegaly • Bradycardia

  20. Alimentary System • Modest weight gain • Decreased appetite • Constipation

  21. Nervous System • Essential for development of central nervous system in fetus and newborns • Slowing of intellectual functions • Psychiatric disorders • Myxedema coma • Hearing loss • “hung-up reflexes”

  22. Muscular/Skeletal System • Muscle aches and stiffness • Increased muscle mass • Growth failure in children • Delayed maturation of bone

  23. Fluids/Electrolytes • Decreased renal blood flow • Delay in water excretion • Hyponatremia

  24. Hematopoietic System • Normocytic normochromic anemia • High incidence of pernicious anemia associated with hypothyroidism

  25. Reproductive Function • Sexual immaturity • Delayed or precocious puberty • Galactorrhea • Diminished libido • menorrhagia

  26. Laboratory • Free T4 • TSH • Thyroid antibodies • Thyroid peroxidase antibodies (microsomal antibodies) • Thyroglobulin antibodies

  27. Radioactive T3 T4 TBG Resin

  28. Euthyroid T4 TBG Resin

  29. Hypothyroid T4 T3RU  TSH  TBG Resin

  30. TBG Deficiency T4 T3RU  TSH N TBG Resin

  31. Primary Hypothyroidism

  32. TBG Deficiency

  33. Treatment • Oral L-thyroxine therapy • 5-10 ug/kg in newborns • 1-2 ug/kg in adults

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