T H Y R O I D G L A N D History Taking Endocrine and Metabolism System 2011-2012

1. T H Y R O I D G L A N DHistory TakingEndocrine and Metabolism System 2011-2012

2. The basic concept of the function of thyroid hormones • Up-regulate the function of other hormones e.g. growth hormone & catecholamines • They heat up the other endocrinal functions

3. Thyroid Disorders affect Peoples’ Health and Quality of Life Hypothyroidism Hyperthyroidism

4. The Thyroid Gland is - as important as your heart - increased Thyroid hormones decreased Thyroid hormones Hyperthyroidism Hypothyroidism Hypothyroidism is much more common than Hyperthyroidism

5. Effects of Thyroid Hormones • Fetal brain and skeletal maturation • Cardiovascular system (Inotropic and chronotropic effects on heart) • Muscle function • Brain, nervous system • Increase sensitivity to catecholamines • Stimulate gut motility

6. The thyroid: the “heart” of metabolism Involvement of thyroid function: • Growth and development, fertility • Energy metabolism • Protein and carbohydrate metabolism • Fat metabolism • Bone metabolism • Cardiovascular system • Muscle function • Brain, nervous system, psyche larynx trachea thyroid gland

7. Effects Of Thyroid Hormones OnThe Cardiovascular System • Increase heart rate • Increase force of cardiac contractions • Increase stroke volume • Increase Cardiac output • Up-regulate catecholamine receptors The Respiratory System • Increase resting respiratory rate • Increase minute ventilation • Increase ventilatory response to hypercapnia and hypoxia

8. On The Renal System • Increase blood flow • Increase glomerular filtration rate On Oxygen Carrying Capacity *Increase RBC mass *Increase oxygen dissociation from hemoglobin

9. On Intermediary Metabolism • Increase glucose absorption from the GI tract • Increase carbohydrate,lipid and protein turnover • Down-regulate insulin receptors • Increase substrate availability

10. On Growth And Tissue Development • Increase growth and maturation of bone • Increase tooth development and eruption • Increase growth and maturation of epidermis,hair follicles and nails • Increase rate and force of skeletal muscle contraction • Inhibits synthesis and increases degradation of mucopolysaccharides in subcutaneous tissue

11. On The Nervous System • Critical for normal CNS neuronal development • Enhances wakefulness and alertness • Enhances memory and learning capacity • Required for normal emotional tone • Increase speed and amplitude of peripheral nerve reflexes

12. On The Reproductive System • Required for normal follicular development and ovulation in the female • Required for the normal maintenance of pregnancy • Required for normal spermatogenesis in the male

13. Two young women with goiter

14. History Taking INTRODUCTION HISTORY TAKING • Greet the patient and introduce the examiner’s name • Ask the patient’s identity : - The patient’s name, age, occupation, and patient’s residence

15. CHIEF COMPLAINT • Ask the patient why she/he come to clinic • Ask the date of onset (The onset was sudden or insidious) - Ask the symptoms

16. Thyroid Hypo function - coldness - weight gain - constipation - menstrual irregularities - muscle cramps. - malaise - fatigue

17. Hypothyroidism before and after treatment

18. Thyroid Hyper function: - palpitations - heat intolerance - nervousness - easy fatigability - restlessness - diarrhea. - excessive sweating. - preference to cold. - weight loss without loss appetite. - emotional instability

19. Past History • Exposure to ionizing radiation in childhood • Surgery • Thyroiditis • Drugs: - Amiodarone - IV Contrast agent - Lithium • Family history of Thyroid disease • History of other autoimmune diseases like: - Diabetes - Rheumatoid arthritis - Vitiligo - Pernicious anaemia

20. Prevalence of thyroid abnormalities in general population: * probably underestimated (assessed by TT4) Canaris GJ et al. (2000)

21. Prevalence of thyroid dysfunction in elderly population (age > 35 yrs.) (Adapted from Vanderpump and Tunbridge, 2000)

24. THANK YOU