T H Y R O I D G L A N D

History Taking

Endocrine and Metabolism System2011-2012

The basic concept of the The basic concept of the function of thyroid function of thyroid

hormoneshormones Up-regulate the function of other Up-regulate the function of other

hormones e.g. growth hormone hormones e.g. growth hormone & catecholamines& catecholamines

They heat up the other They heat up the other endocrinal functionsendocrinal functions

Thyroid Disorders affect Thyroid Disorders affect Peoples’ Health and Quality Peoples’ Health and Quality

of Lifeof LifeHypothyroidism Hyperthyroidism

increasedThyroid hormones

decreasedThyroid hormones

Hypothyroidism Hyperthyroidism

Hypothyroidism is much more common than Hyperthyroidism

The Thyroid Gland isThe Thyroid Gland is - as important as your - as important as your

heart -heart -

Effects of Thyroid Effects of Thyroid HormonesHormones

Fetal brain and skeletal maturationFetal brain and skeletal maturation Cardiovascular system (Inotropic Cardiovascular system (Inotropic

and chronotropic effects on heart)and chronotropic effects on heart) Muscle functionMuscle function Brain, nervous systemBrain, nervous system Increase sensitivity to Increase sensitivity to

catecholaminescatecholamines Stimulate gut motilityStimulate gut motility

The thyroid: the “heart” of The thyroid: the “heart” of metabolismmetabolismInvolvement of thyroid function:Involvement of thyroid function: Growth and development, fertilityGrowth and development, fertility Energy metabolismEnergy metabolism Protein and carbohydrate metabolismProtein and carbohydrate metabolism Fat metabolismFat metabolism Bone metabolismBone metabolism Cardiovascular systemCardiovascular system Muscle functionMuscle function Brain, nervous system, psycheBrain, nervous system, psyche

thyroid gland

larynx trachea

Effects Of Thyroid Hormones Effects Of Thyroid Hormones

OnOn The Cardiovascular SystemThe Cardiovascular System Increase heart rateIncrease heart rate Increase force of cardiac contractionsIncrease force of cardiac contractions Increase stroke volumeIncrease stroke volume Increase Cardiac outputIncrease Cardiac output Up-regulate catecholamine receptorsUp-regulate catecholamine receptors

The Respiratory SystemThe Respiratory System Increase resting respiratory rateIncrease resting respiratory rate Increase minute ventilationIncrease minute ventilation Increase ventilatory response to Increase ventilatory response to

hypercapnia and hypoxiahypercapnia and hypoxia

On The Renal SystemOn The Renal System

Increase blood Increase blood flowflow

Increase Increase glomerular glomerular filtration ratefiltration rate

On Oxygen Carrying CapacityOn Oxygen Carrying Capacity**Increase RBC massIncrease RBC mass*Increase oxygen dissociation *Increase oxygen dissociation from hemoglobinfrom hemoglobin

On Intermediary On Intermediary MetabolismMetabolism

Increase glucose absorption Increase glucose absorption from the GI tractfrom the GI tract

Increase carbohydrate,lipid and Increase carbohydrate,lipid and protein turnoverprotein turnover

Down-regulate insulin Down-regulate insulin receptorsreceptors

Increase substrate availabilityIncrease substrate availability

On Growth And Tissue On Growth And Tissue DevelopmentDevelopment

Increase growth and maturation of Increase growth and maturation of bonebone

Increase tooth development and Increase tooth development and eruptioneruption

Increase growth and maturation of Increase growth and maturation of epidermis,hair follicles and nailsepidermis,hair follicles and nails

Increase rate and force of skeletal Increase rate and force of skeletal muscle contractionmuscle contraction

Inhibits synthesis and increases Inhibits synthesis and increases degradation of mucopolysaccharides degradation of mucopolysaccharides in subcutaneous tissuein subcutaneous tissue

On The Nervous On The Nervous SystemSystem

Critical for normal CNS neuronal Critical for normal CNS neuronal developmentdevelopment

Enhances wakefulness and alertnessEnhances wakefulness and alertness Enhances memory and learning Enhances memory and learning

capacitycapacity Required for normal emotional toneRequired for normal emotional tone Increase speed and amplitude of Increase speed and amplitude of

peripheral nerve reflexesperipheral nerve reflexes

On The Reproductive On The Reproductive SystemSystem

Required for normal follicular Required for normal follicular development and ovulation in the development and ovulation in the femalefemale

Required for the normal Required for the normal maintenance of pregnancymaintenance of pregnancy

Required for normal Required for normal spermatogenesis in the malespermatogenesis in the male

Two young women with goiterTwo young women with goiter

History TakingHistory Taking

INTRODUCTION HISTORY TAKINGINTRODUCTION HISTORY TAKING Greet the patient and introduce the Greet the patient and introduce the

examiner’s nameexaminer’s name

Ask the patient’s identity :Ask the patient’s identity :

- The patient’s name, age, - The patient’s name, age, occupation, and patient’s residence occupation, and patient’s residence

CHIEF COMPLAINTCHIEF COMPLAINT

- Ask the patient why she/he come to Ask the patient why she/he come to clinicclinic

- Ask the date of onsetAsk the date of onset

(The onset was sudden or insidious)(The onset was sudden or insidious)

- Ask the symptoms- Ask the symptoms

Thyroid Hypo functionThyroid Hypo function

- coldness- coldness

- weight gain- weight gain

- constipation- constipation

- menstrual irregularities- menstrual irregularities

- muscle cramps.- muscle cramps.

- malaise- malaise

- fatigue - fatigue

Hypothyroidism Hypothyroidism before and after before and after

treatmenttreatment

Thyroid Hyper function:Thyroid Hyper function:

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

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

Prevalence of thyroid abnormalities Prevalence of thyroid abnormalities in general population:in general population:

Total study Total study population population (n=25862)(n=25862)

Subjects Subjects taking thyroid taking thyroid

medication medication (n=1525)(n=1525)

Euthyroid Euthyroid 88.3 %88.3 % 60.1 %60.1 %

Hypothyroid *Hypothyroid * 0.4 %0.4 % 0.7 %0.7 %

Subclinical Subclinical hypothyroidhypothyroid 9.0 %9.0 % 17.6 %17.6 %

HyperthyroidHyperthyroid 0.1 %0.1 % 0.9 %0.9 %

Subclinical Subclinical hyperthyroidhyperthyroid 2.1%2.1% 20.7 %20.7 %

Canaris GJ et al. (2000)* probably underestimated (assessed by TT4)

Prevalence of thyroid dysfunction Prevalence of thyroid dysfunction in elderly population (age > 35 in elderly population (age > 35 yrs.)yrs.)

ConditionCondition Reported Reported prevalences in prevalences in adult population, adult population, %%

HypothyroidismHypothyroidism 22

Mild (subclinical) Mild (subclinical) hypothyroidismhypothyroidism

5- 175- 17

HyperthyroidismHyperthyroidism 0.20.2

Mild (subclinical) Mild (subclinical) hyperthyroidism hyperthyroidism (TSH<0.1, normal T4,T3)(TSH<0.1, normal T4,T3)

0.1- 6.00.1- 6.0

(Adapted from Vanderpump and Tunbridge, 2000)

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