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Prof. H.A. Pavlyshyn

Thyroid and Parathyroid gland disorders. Prof. H.A. Pavlyshyn. Gl. Thyreoidea (normal). Gl. Thyreoidea (pathology-disorder). Thyroid hormones affect normal somatic growth and neurological development in children. For normal maturation of the CNS. Gl. Thyreoidea. С ardio-vascular system.

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Prof. H.A. Pavlyshyn

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  1. Thyroid and Parathyroid gland disorders Prof. H.A. Pavlyshyn

  2. Gl. Thyreoidea (normal)

  3. Gl. Thyreoidea (pathology-disorder)

  4. Thyroid hormones affect normal somatic growth and neurological development in children For normal maturation of the CNS Gl. Thyreoidea Сardio-vascular system GIT Reproductive function Skin and hair Skeletal and muscular system

  5. Regulation of secretion:TRH - TSH - T4 axis

  6. Diagnostic of Thyroid gland disease • Visual & palpating method • Investigation of thyroid function (basal level of T3, T4 and freeT3 , freeT4) • Functional tests • USG, radiography, scanning, etc. • Biopsia

  7. Examination methods Biopsy (FNAB) Fine Needle Aspiration Biopsy

  8. Micro follicular/solid thyroid nodule

  9. Examinationmethods Auto-Ab in diagnostics (high specificity) auto-Ab anti-TSH-R binding to different epitops:  growth, goiter  stimulation ... Graves-Basedow dis.  inhibition ... hypothyroid idiopatic myxoedema auto-Ab anti-microsomal = anti-TPO (thyroid peroxidase) ... Hashimoto dis. auto-Ab anti-Tg (thyroglobulin) ... x pathogenetic auto-Ab anti-T3 ... in 40% autoimmmune thyroiditis

  10. Examination methods

  11. Examination methods

  12. Examination methods 131I scintigraphy: Retrosternal goiter

  13. Classification of hypothyroidism Onset Congenital Acquired (rare) – when symptoms appear after the first year of life, it is presumed to be acquired.

  14. SIGNS OF CONGENITAL HYPOTHYROIDISM • Birth weight and birth length are normal because Thyroid Hormones does not play an important role in prenatal growth. • There is a tendency towards prolonged gestation with 1/3 of pregnancies lasting 42 weeks or more

  15. SYMPTOMS OF CONGENITAL HYPOTHYROIDISM • Prolonged jaundice • Lethargy • Constipation • Feeding problems • Cold to touch

  16. SIGNS OF CONGENITAL HYPOTHYROIDISM • Skin mottling and Dry skin • Umbilical hernia and Distended abdomen • Macroglossia • Large fontanels • Wide sutures • Hoarse cry • Muscle Hypotonia • Slow reflexes

  17. Treatment L-thyroxin • Preterm 8 – 10 μg/kg • 0-12mo 6 – 10 μg/kg • 1-3years 4 – 6 μg/kg • 3-10years 3 – 4 μg/kg • 10-15years 2 – 4μg/kg • > 15years 2 – 3 μg/kg

  18. Graves disease (symptoms) • The onset of symptoms is insidious. • Emotional lability, altered mood, nervousness, hyperactivity, irritability, heat intolerance, poor sleeping; • Tremor, hyperkinesias, tremor of outstretched fingers, fidget, psychosis (rare) • Deterioration of behavior and school performance; • Fatigue, weakness, • Increased appetite and weight loss, frequent loose stool (diarrhea); • Goiter - thyroid enlargement

  19. Graves disease (symptoms) Goiter

  20. Graves disease (symptoms) Goiter

  21. Graves disease (sings) • Heart failure, palpitations, tachycardia and hypertension • Warm, flushed, moist skin, increase sweating • Hair loss • Muscle weakness (loss of muscle mass) & wasting • Accelerated bone maturation • Dyspnoe

  22. Treatment of Grave’s disease: • Antithiroid agents- methimazole (Tapazole), propylthiouracil (PTU), mercasolil. The beginning dose of methimazole is not less then 15-20 mg/m2 daily, gradually it becomes lower; • mercasolyl 0.3-0.5 mg/kg divided 2 -3 times 14-21 days, than supportive dose – 2.5-7.5 mg/daily 1 time; • Beta-adrenergic blockers (propranolol (10-20 mg/four times daily), anaprilin (1-2 mg/kg divided 3 times), • Sedatives are necessary to use also • Corticosteroids (sometimes in severe cases • Radioactive iodine (RAI) (in adults mainly) • Euthyrosis – mercasolyl 5-10 mg/daily with L-thyroxin 25-50 μg/daily • Surgical treatment (Sub-total thyroidectomy)

  23. Clinical features of hypoparathyroidism Convulsive syndrome(titanic more typical), karpopedal spasm, paresthesiae, muscle weakness, tiredness, Trousseau and Hvostek symptoms) ↓Ca2+ + ↑PO4 → neuromuscular hyperactivity Manifestation depends on actual Ca2+ levels Paresthesia (tingling around mouth, fingers) Tetany (attack begins with paresthesias … painful spasms of extremities and face … flexion of the wrist … Adrenergic reaction (tachycardia, sweating)

  24. Clinical features of hyperparathyroidism • Bone syndrome (diffuse bone pain, pathological fracture, osteoporosis - RTG, densitometry) • Renal syndrome (polyuria, polydipsia, lithiasis, nefrocalcinosis) • GIT syndrome (constipation, nausea, vomiting) • Neuromuscular syndrome (muscular weakness, ECG - bradycardia, arrythmia) • Neuropsychical syndrome (psychosis, somnolence, coma)

  25. Hyperparathyroidism Increased parathyroid activity leading to characteristic subperiosteal resorption „Salt and peper“ scull

  26. Hyperparathyroidism The bone changes are partially reversible The same finger pre- and post-treatment for hyper-PTH. Images were taken 6 months apart.

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