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....
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THYROID DISORDERSTHYROID DISORDERS
BYBYZEYAD AL-RABIAHZEYAD AL-RABIAH
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• 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
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Regulation
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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
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Disease of thyroid gland :• Hypothyroidism :Causes :• Non goitrous :1ry :• Idiopathic atrophy .• Iatrogenic .• Postinflammatory thyroiditis .• Cretinism .
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2ry :1. TSH .2. TRH .
B. Goitrous :- Dyshormongenesis- Hashimotos Thyroiditis- Drud-induced:(iodides ,lithium ,sulfonylureas ,amiodarone )- Iodide deficiency.
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Common Signs and Symptomsof Hypothyroidism
• Symptomes:WeaknessCoold intoleranceHeadachWeight gainDyspneaConstipation
• Signs:GoiterHypertentionBradycardiaPeripheral
edemaPuffy Face and
Eyes
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• Laboratory: TT4 +TT3
Cholesterol+TSH+CPK+LDH +ve antibodies
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TREATMENT
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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.
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THYROID USP (ARMOUR )
(mixture of L- T4and liothyronine - T3)•not synthetic (from hog ,beef , or sheep thyroid gland).•Dose 1grain
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CYTOMEL (liothyronine- T3)• shorter ½ life• may improve mental function andconstitutional symptoms when takenwith L- T4.• dose 25-37.5ug.
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LIOTRIX (THYROLAR)• Synthetic ratio T4:T3 in 4:1• Dose 60ug T4:15ugT3 or 50ugT4:12.5ugT3.
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• 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.
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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.
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Common Signs and Symptomsof Hyperthyroidism
• Nervousness• Irritability• Difficulty Sleeping• Goiter• Rapid Heartbeat• Hypertension
• Increased Sweating• Heat Intolerance• Weight Loss• Menstrual disturbances
(Amenorrhea)• Diarrhea• palpitations
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• Laboratory: TT4 +TT3
Cholesterol+TSH +Ve antibodies
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• 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.