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Thyroid Disorders PowerPoint Presentation

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Description : Check out this medical PowerPoint presentation titled "THYROID DISORDERS" by Abdelaziz Elamin. MD, PhD, FRCPCH.

This medical PowerPoint presentation talks about thyroid disorders, conditions that affect the thyroid gland, which is a small, butterfly-shaped gland located in the neck. The thyroid gland produces hormones that regulate many important functions in the body, including metabolism, heart rate, body temperature, and mood.

Tags : thyroid gland, metabolism, Hypothyroidism, Hyperthyroidism, Thyroid nodules, Thyroiditis, endocrinology, endocrinology PowerPoint presentation

Published on : Apr 18, 2023 | Views : 2248 | Downloads : 5

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Slide 1-

THYROID DISORDERS Abdelaziz Elamin. MD, PhD, FRCPCH Professor of Child Health Consultant Pediatric Endocrinologist Sultan Qaboos University, Oman
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HYPOTHYROIDISM-EPIDEMIOLOGY Neonatal screening reveals incidence that varies between 1-5/1000 live births The most common cause of preventable mental retardation in children Both acquired & congenital forms are linked to iodine deficiency Diagnosis is easy & early treatment is beneficial
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ETIOLOGY CONGENITAL Hypoplasia & mal-descent Familial enzyme defects Iodine deficiency (endemic cretinism) Intake of goitrogens during pregnancy Pituitary defects Idiopathic
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ETIOLOGY /2 ACQUIRED Iodine deficiency Auto-immune thyroiditis Thyroidectomy or RAI therapy TSH or TRH deficiency Medications (iodide & Cobalt) Idiopathic
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KILPATRIK GRADING OF GOITRE Grade 0: Not visible neck extended & Not palpable Grade 1: Not visible, but palpable Grade 2: Visible only when neck is extended & on swallowing, Grade 3: Visible in all positions Grade 4: Large goiter
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THYROID GLAND Derived from pharyngeal endoderm at 4/40 Migrate from base of the tongue to cover the 2&3 tracheal rings. Blood supply from ext. carotid & subclavian and blood flow is twice renal blood flow/g tissue. Starts producing thyroxin at 14/40.
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OVERVIEW (2) Maternal & fetal glands are independent with little transplacental transfer of T4. TSH doesn’t cross the placenta. Fetal brain converts T4 to T3 efficiently. Average intake of iodine is 500 mg/day. 70% of this is trapped by the gland against a concentration gradient up to 600:1
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THYROID HORMONES Iodine & tyrosine form both T3 & T4 under TSH stimulation. However, 10% of T4 production is autonomous and is present in patients with central hypothyroidism. When released into circulation T4 binds to: Globulin TBG 75% Prealbumin TBPA 20% Albumin TBA 5%
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THYROID HORMONES (2) Less than 1% of T4 & T3 is free in plasma. T4 is deiodinated in the tissues to either T3 (active) or reverse T3 (inactive). At birth T4 level approximates maternal level but increases rapidly during the first week of life. High TSH in the first 5 days of life can give false positive neonatal screening
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TSH Is a Glico-protein with Molecular Wt of 28000 Secreted by the anterior pituitary under influence of TRH It stimulates iodine trapping, oxidation, organification, coupling and proteolysis of T4 & T3 It also has trophic effect on thyroid gland
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TSH (2) T4 & T3 are feed-back regulators of TSH TSH is stimulated by a-adrenergic agonists TSH secretion is inhibited by: Dopamine Bromocreptine Somatostatin Corticosteroids
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THYROID HORMONES (3) Conversion of T4 to T3 is decreased by: Acute & chronic illnesses b-adrenergic receptor blockers Starvation & severe PEM Corticosteroids Propylthiouracil High iodine intake (Wolff-Chaikoff effect)
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THYROXINE (T4) Total T4 level is decreased in: Premature infants Hypopituitarism Nephrotic syndrome Liver cirrhosis PEM Protein losing entropathy
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THYROXINE (2) Total T4 is decreased when the following drugs are used: Steroids Phenytoin Salicylates Sulfonamides Testosterone Maternal TBII
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THYROXINE (3) Total T4 is increased with: Acute thyroiditis Acute hepatitis Estrogen therapy Clofibrate iodides Pregnancy Maternal TSI
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FUNCTIONS OF THYROXINE Thyroid hormones are essential for: Linear growth & pubertal development Normal brain development & function Energy production Calcium mobilization from bone Increasing sensitivity of b-adrenergic receptors to catecholeamines
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CLINICAL FEATURES Gestational age > 42 weeks Birth weight > 4 kg Open posterior fontanel Nasal stuffiness & discharge Macroglossia Constipation & abdominal distension Feeding problems & vomiting
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CLINICAL FEATURES (2) Non pitting edema of lower limbs & feet Coarse features Umbilical hernia Hoarseness of voice Anemia Decreased physical activity Prolonged (>2/52) neonatal jaundice
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CLINICAL FEATURES (3) Dry, pale & mottled skin Low hair line & dry, scanty hair Hypothermia & peripheral cyanosis Hypercarotenemia Growth failure Retarded bone age Stumpy fingers & broad hands
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CLINICAL FEATURES (5) Skeletal abnormalities: Infantile proportions Hip & knee flexion Exaggerated lumbar lordosis Delayed teeth eruption Under developed mandible Delayed closure of anterior fontanel
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OCCASIONAL FEATURES Overt obesity Myopathy & rheumatic pains Speech disorder Impaired night vision Sleep apnea (central & obstructive) Anasarca Achlorhydria & low intrinsic factor
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OCCASIONAL FEATURES (2) Decreased bone turnover Decreased VIII, IX & platelets adhesion Decreased GFR & hyponatremia Hypertension Increased levels of CK, LDH & AST Abnormal EEG & high CSF protein Psychiatric manifestations
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ASSOCIATIONS Autoimmune diseases (Diabetes Mellitus) Cardiomyopathy & CHD Galactorrhoea Muscular dystrophy + pseudohypertrophy (Kocher-Debre-Semelaigne)
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GOITROGENS DRUGS Anti-thyroid Cough medicines Sulfonamides Lithium Phenylbutazone PAS Oral hypoglycemic agents
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GOITROGENS FOOD Soybeans Millet Cassava Cabbage
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CLINICAL FEATURES (4) Neurological manifestations Hypotonia & later spasticity Lethargy Ataxia Deafness + Mutism Mental retardation Slow relaxation of deep tendon jerks
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CONGENITAL HYPOTHYRODISM Primary thyroid defect: usually associated with goiter. Secondary to hypothalamic or pituitary lesions: not associated with goiter. 2 distinct types of presentation: Neurological with MR-deafness & ataxia Myxodematous with dwarfism & dysmorphism
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DIAGNOSIS Early detection by neonatal screening High index of suspicion in all infants with increased risk Overt clinical presentation Confirm diagnosis by appropriate lab and radiological tests
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LABROTARY FINDINGS Low (T4, RI uptake & T3 resin uptake) High TSH in primary hypothyroidism High serum cholesterol & carotene levels Anaemia (normo, micro or macrocytic) High urinary creatinine/hydroxyproline ratio CXR: cardiomegaly ECG: low voltage & bradycardia
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IMAGING TESTS X-ray films can show: Delayed bone age or epiphyseal dysgenesis Anterior peaking of vertebrae Coxavara & coxa plana Thyroid radio-isotope scan Thyroid ultrasound CT or MRI
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TREATMENT (2) L-Thyroxin is the drug of choice. Start with small dose to avoid cardiac strain. Dose is 10 mg/kg/day in infancy. In older children start with 25 mg/day and increase by 25 mg every 2 weeks till required dose. Monitor clinical progress & hormones level
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TREATMENT Life-long replacement therapy 5 types of preparations are available: L-thyroxin (T4) Triiodothyronine (T3) Synthetic mixture T4/T3 in 4:1 ratio Desiccated thyroid (38mg T4 & 9mg T3/grain) Thyroglobulin (36mg T4 & 12mg T3/grain)
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THYROID FUNCTION TESTS 1. Peripheral effects: BMR Deep Tendon Reflex Cardiovascular indices (pulse, BP, LV function tests) Serum parameters (high cholesterol, CK, AST, LDH & carcino-embryonic antigen)
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THYROID FUNCTION TESTS (2) 2. Thyroid gland economy: Radio iodine uptake Perchlorate discharge test (+ve in Pendred syndrome & autoimmune thyroiditis) TSH level TRH stimulation tests Thyroid scan
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THYROID FUNCTION TESTS (3) 3. Tests for thyroid hormone: Total & free T4 & T3 Reverse T3 level T3 Resin Uptake T3RU x total T4= Thyroid Hormone Binding Index (formerly Free Thyroxin Index)
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THYROID FUNCTION TESTS (4) Special Tests: Thyroglobulin level Thyroid Stimulating Immunoglobulin Thyroid antibodies Thyroid radio-isotope scan Thyroid ultrasound CT & MRI Thyroid biopsy
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PROGNOSIS Depends on: Early diagnosis Proper diabetes education Strict diabetic control Careful monitoring Compliance
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MYXOEDMATOUS COMA Impaired sensorium, hypoventilation bradycardia, hypotension & hypothermia Precipitated by: Infections Trauma (including surgery) Exposure to cold Cardio-vascular problems Drugs
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PROGNOSIS Is good for linear growth & physical features even if treatment is delayed, but for mental and intellectual development early treatment is crucial. Sometimes early treatment may fail to prevent mental subnormality due to severe intra-uterine deficiency of thyroid hormones