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Explore the physiology and pathologies of the thyroid gland, including hyperthyroidism, hypothyroidism, thyroiditis, and neoplasms. Learn about Graves' Disease, Hashimoto's thyroiditis, pituitary disorders, and more.
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Thyroid Physiology: Hypothalamus TRH T3, T4 Pituitary TSH Thyroid
Disorders of Thyroid: • Hyperthyroidism • Hypothyroidism • Thyroiditis • Diffuse multinodular Goiter. • Neoplasms – adenoma/carcinoma. • Congenital – Thyroglossal cyst/duct.
Hyperthyroidism • Thyrotoxicosis – High T3/T4, low TSH • Diffuse toxic hyperplasia (Graves) • Toxic multinodular goitre • Toxic adenoma • Thyroiditis • Functioning thyroid carcinoma • TSH secreting pituitary adenoma
Graves Disease: • Common (2%F) • Females, 20-40y, Autoimmune. • Triad of clinical features, • Hyperthyroidism • exopthalmos • Pretibial myxedema. • Ab to TSH receptor – LATS. • Diffuse hyperplasia, tall columnar cells, papillary folds. • Scalloped, pale, scanty colloid.
Hypothyroidism • Cretinism / Myxedema – Low T3/T4, High TSH • Causes: • Hashimoto’s thyroiditis - autoimmune • Iodine deficiency • Drugs – PAS, iodides, lithium • Developmental – Atrophy, hypoplasia Pituitary disorders • Radiation/Surgery
Hypothyroidism • ‘Cretin’ism (child) • Impaired cns & bone growth • Mental retardation • Short stature • Coarse facial features • Protruding tongue • Umbilical hernia • Myxedema (adult) • Slow physical and mental activity • Cold intolerance • Over weight • Low cardiac output • Constipation and decreased sweating • Cool pale thick skin
Hashimoto Thyroiditis • Common non endemic goitre. • females more common 45-65y. • Autoimmune HLA-DR5, DR3. • Antithyroglobulin antibody • Firm diffuse goitre. • Follicle atrophy with lymphocytes. • Hürthle cells – eosinophilic ep. cells. • Initial hyperthyroidism. • High risk of B cell lymphoma.
Granulomatous Thyroiditis: • Subacute or DeQuervain thyroiditis. • Less common, Females, 30-60 years • Pain, fever, fatigue, myalgia. • Post viral syndrome. • Genetic association - HLA B35 • Patchy microabscess, granulomas with giant cells. • Hyperthyroidism. • Heals with normal thyroid function.
Diffuse Multinodular goitre • Endemic & sporadic types • Cassava – thiocyanate – iodide transport. • Sporadic – rare, females, young. • Hyperplastic stage & Colloid stage. • Repeated attacks multinodular. • Hyperplasia, fibrosis, cystic, necrosis • Mass effect, dysphagia, airway obstruction • Rarely toxic hyperthyroidism plummer syndrome.
