THYROID DISORDERS BY ZEYAD AL-RABIAH. OVERVIEW Thyroid gland. Hormone secreted by gland....
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Transcript of THYROID DISORDERS BY ZEYAD AL-RABIAH. OVERVIEW Thyroid gland. Hormone secreted by gland....
THYROID DISORDERSTHYROID DISORDERS
BYBYZEYAD AL-RABIAHZEYAD AL-RABIAH
• OVERVIEW• Thyroid gland .• Hormone secreted by gland .• Triiodothyronine T3 .• Thyroxine T4 .• calctonine .• Action of the thyroid hormone .• calorigenesis• metabolism• brain maturation• behavior• growth and development
Regulation
Thyroid Disease AffectsMany Body Systems and Overall Health
• Depression• Decreased Concentration• General Lack of Interest
Brain
• Decreased Heart Rate• Increased/Decreased
Blood Pressure• Decreased Cardiac
Output
Heart
• Decreased Function• Fluid Retention and
Edema
Kidneys
• Thyroid Disease Can Have Widespread Effects
Thyroid
• Increased LDL Cholesterol
• ElevatedTriglycerides
Liver
• Constipation• Decreased GI
Activity
Intestines
• Decreased Fertility• Menstrual Abnormalities
• May Harm Development of Infant
ReproductiveSystem
Disease of thyroid gland :• Hypothyroidism :Causes :• Non goitrous :1ry :• Idiopathic atrophy .• Iatrogenic .• Postinflammatory thyroiditis .• Cretinism .
2ry :1. TSH .2. TRH .
B. Goitrous :- Dyshormongenesis- Hashimotos Thyroiditis- Drud-induced:(iodides ,lithium ,sulfonylureas ,amiodarone )- Iodide deficiency.
Common Signs and Symptomsof Hypothyroidism
• Symptomes:WeaknessCoold intoleranceHeadachWeight gainDyspneaConstipation
• Signs:GoiterHypertentionBradycardiaPeripheral
edemaPuffy Face and
Eyes
• Laboratory: TT4 +TT3
Cholesterol+TSH+CPK+LDH +ve antibodies
TREATMENT
LEVOTHYROXINE (Synthroid, Levoxyl, Levothroid)•Is drug of choice in hypothyroidism. • converted to T3 in the body.• adult 100-125ug/d , usual increment 25ug Q 6-8 weeks.• elderly 50-100ug/d , if age >60 yr require ≤ 50ug/d.• CAD 12.5-25ug/d , by 12.5-25ug/d Q 2-6 wk as tolerated. • pregnant increase in dose 45% .• pediatric 0-3 mo 37.5-50ug/d , the dose decrease with age.• check TSH after 8 weeks on a stable dose,goal TSH level is 0.5-4.7 mlU/L•Take before breakfast 0.5-1hr with water.
THYROID USP (ARMOUR )
(mixture of L- T4and liothyronine - T3)•not synthetic (from hog ,beef , or sheep thyroid gland).•Dose 1grain
CYTOMEL (liothyronine- T3)• shorter ½ life• may improve mental function andconstitutional symptoms when takenwith L- T4.• dose 25-37.5ug.
LIOTRIX (THYROLAR)• Synthetic ratio T4:T3 in 4:1• Dose 60ug T4:15ugT3 or 50ugT4:12.5ugT3.
• Myxedema ComaIt is the end stage of long-standing uncorrected
hypothyroidism.• Treatment • Give 400ug of L-T4 (200ug in CAD patient).• Decrease in TSH should occur within 24hr.• 50-100mg hydrocortisone Q 6hr to treat
secondary myxedema.
HYPERTHYROIDISM (THYROTOXICOSES)CAUSES :Graves disease .Toxic multinodulare goiter Solitary toxic nodule plummer’s disease De Quervain’s thyroiditisPregnancyExogenous intake of thyroid hormones or iodineDrugs : amoidaroneSecondary ( TSH) it is rare.
Common Signs and Symptomsof Hyperthyroidism
• Nervousness• Irritability• Difficulty Sleeping• Goiter• Rapid Heartbeat• Hypertension
• Increased Sweating• Heat Intolerance• Weight Loss• Menstrual disturbances
(Amenorrhea)• Diarrhea• palpitations
• Laboratory: TT4 +TT3
Cholesterol+TSH +Ve antibodies
• THYROID CRISIS (THYROID STROM) Rare ,mortality 10%. A rapid deterioration of hyperthyroidism with hyperpyrexia (temp
>40°C).• TreatmentThioamide: PTU 600-1200mg/d Q 6hr methimazole 60-120mg/d TID.Iodides: Ipodate 1g/d or lugol’s solution 30 drops/d PO.Propranolol 1mg slow IV push Q5 min until HR 90-110/min maintenance infusion 5-10 mg/hr or 40mg PO Q6hr douple dose Q 12hr until therapeutic response
achieved.Hydrocortisone 100-200mg IV Q 6hr.Supportive therapy.