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Thyroid Gland Disorders: Overview and Clinical Manifestations

Gain insight into hyperthyroidism, hypothyroidism, Grave's disease, and thyroiditis. Explore causes, symptoms, and pathology related to thyroid disorders. Discover adrenal gland diseases like Cushing syndrome and hyperaldosteronism.

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Thyroid Gland Disorders: Overview and Clinical Manifestations

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  1. Endocrine Pathology Dr. Tariq Aldily

  2. Thyroid gland • Diseases of the thyroid are divided into: 1- Hyperthyroidism and thyrotoxicosis 2- Hypothyroidism.

  3. Thyrotoxicosis: Causes • Thyrotoxicosis is a hypermetabolic state due to elevated circulating levels of free T3 and T4. I. Associated with hyperthyroidism (Thyroid hyperfunction): 1. Primary: a. Grave’s disease (autoimmune) b. Hyperfunctioning thyroid adenoma 2. Secondary: TSH-secreting pituitary adenoma (rare) II. Not associated with hyperthyroidism Such as in thyroiditis early stage

  4. Clinical manifestations • Constitutional symptoms: heat intolerance and excessive sweating are common. Weight loss despite increased appetite. • Gastrointestinal: Stimulation of the gut results in hypermotility, malabsorption, and diarrhea. • Cardiac: Palpitations, tachycardia, arrhythmia • Neuromuscular: nervousness, tremor, and muscle weakness (thyroid myopathy). • Exophthalmous: a wide, staring gaze and lid lag are present because of sympathetic overstimulation of the ocular muscles • Skin: soft, warm, and flushed

  5. Grave’s Disease • Autoimmune disease • Autoreactive T-lymphocyte, activates B-lymphocytes to secret: Thyroid Stimulating Immunoglobulin (TSI), which mimics the function of normal hormone TSH • Thyroid is diffuse enlarged, soft, warm • Microscopic: follicular crowding, small papillae, lymphoid follicles

  6. Hypothyroidism Causes : 1. Worldwide, the most common cause is dietary deficiency of iodine. 2. In developed nations – autoimmune Hashimoto thyroiditis. 3. Genetic defects such as thyroid dysgenesis or dyshormogenticgoiter are rare

  7. - Endemic cretinism: common in areas of the world where dietary iodine deficiency is endemic, - Sporadic cretinism: enzyme defects that interfere with thyroid hormone synthesis

  8. Clinical manifestations • Cretinism : Hypothyroidism developing in infancy or early childhood. • Impaired development of the skeletal system and central nervous system, with severe mental retardation, short stature, coarse facial features, a protruding tongue, and umbilical hernia..

  9. Hypothyroidism symptoms Also known as: Myxedema • occurs in older children and adutts • Generalized apathy and mental sluggishness, may mimic depression • Cold intolerant • Obesity • Bradycardia • Anemia • Mucopolysaccharide-rich edematous fluid accumulates in skin, subcutaneous tissue, and a number of visceral sites, with resultant broadening and coarsening of facial features, enlargement of the tongue, and deepening of the voice • Bowel motility is decreased, resulting in constipation

  10. Thyroiditis A. Chronic lymphocytic (Hashimoto) thyroiditis : • Most common cause of hypothyroidism in areas where iodine is sufficient • Gradual thyroid failure secondary to autoimmune destruction of the thyroid gland • More common in women • Diffuse symmetric painless enlargement of the thyroid

  11. B. Subacute granulomatous thyroiditis - Caused by viral infection and patients have history of upper respiratory tract infection - Acute onset with pain in the neck, fever, and variable enlargement of the thyroid - Transient hyperthyroidism may occur - Self-limited

  12. Multinodular goiter • Goiter: thyroid enlargement • most common manifestation of thyroid disease • mostly caused by dietary iodine deficiency • Impaired thyroid hormone synthesis >> compensatory rise in the serum TSH>>> gross enlargement of the thyroid gland • Compensatory increase in functional mass >>>euthyroid metabolic state • With repeated attacks, the thyroid becomes asymmetrically enlarged (multinodular) 1. Endemic goiter: Iodine deficient areas 2. Sporadic goiter: less common, more in females, peak in puberty or young adult life

  13. Adrenal gland diseasesAdrenocorticalhyperfunction 1. Hypercortisolism---Cushing syndrome - Most cases due to exogenous glucocorticoids(steroids) - The remaining are endogenous A. ACTH-secreting- pituitary adenoma Cushing disease , more than half of the cases of endogenous Cushing syndrome B. Adrenal adenoma, carcinoma and hyperplasia 20% of cases of endogenous Cushing syndrome . ACTH-independent Cushing syndrome

  14. Clinical manifestations of Cushing syndrome • Hypertension • Weight gain • Truncal obesity • Moon facies • Hyperglycemia • Risk of infection • Hirsuitism and menstrual cycle abnormalities

  15. 2. Hyperaldosteronism Sodium retention and potassium execretion, with resultant hypertension and hypokalemia Can be primary or secondary 1. Primary hyperaldosteronism Primary autonomous overproduction of aldosterone (80% are due to adrenal adenoma (Conn syndrome) 2. Secondary type: activation of the renin-angiotensinsystem. - It is characterized by high levels of plasma renin, due to kidney ischemia, results in increased fluid reabsorption, tissue edema and hypertension

  16. 2-ADRENAL INSUFFICIENCY I-Acute Adrenocortical Insufficiency : a. Rapid withdrawal of exogenous steroid b. Massive adrenal haemorrhage, occurs in patients with hemophilia, bacterial infection (NeisseriaMeningitidis) II-Primary Chronic Adrenocortical Insufficiency (Addison Disease) a. Autoimmune adrenalitis Accounts for 60% to 70% of cases and is the most common cause of primary adrenal insufficiency in developed countries. b. Infections : mainly tuberculosis c. Metastatic neoplasms involving the adrenal mainly carcinomas of the lung

  17. Clinical Features • Hyponatremia, hyperkalemia, hypoglycemia, water depletion • Hypotension • Progressive weakness, anorexia, vomiting, weight loss • Hypoglycemia • Death if not treated

  18. Pituitary gland • Divided into : • Anterior pituitary • Posterior pituitary • Diseases include: • Hyperpituitarism • Hypopituitarism • Local mass effect

  19. HYPERPITUITARISM • The most common cause of hyperpituitarism is a pituitary adenoma arising in the anterior lobe • Pituitary adenomas are classified on the basis of hormone(s) produced by the neoplastic cells • Functional and non-functional adenomas usually composed of a single cell type • Pituitary adenomas can be macroadenomas (>1 cm) or microadenomas (<1 cm)

  20. 1. Prolactinomas • Are the most common type of hyperfunctioning adenoma. • Hyperprolactinemia causes: amenorrhea, galactorrhea, loss of libido, and infertility

  21. 2. Growth Hormone-Producing Adenomas • Second most common type of functional pituitary adenoma,excessive growth hormone production • In prepubertal children, gigantism العملقة: generalized increase in body size, with disproportionately long arms and legs • In adults after closure of the epiphyses, acromegaly تضخم النهايات • Growth is most conspicuous in soft tissues, skin, and viscera • Jaw enlargement, protrusion and separation of the teeth • Enlarged hands and feet, with broad sausage-like fingers • Enlarged visceral organs, hypertention, diabetes

  22. 3. ACTH Adenomas (ACTH-Producing) • Causes hypercortisolism • Stimulatory effect of ACTH on the adrenal cortex, Cushing disease

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