Thyroid Disease

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Thyroid Disease

• Dr John McDermott
• Consultant Endocrinologist
• Connolly Hospital Blanchardstown
• Hermitage Medical Clinic
• Royal College of Surgeons in Ireland

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Thyroid Hormones

• Thyroid gland manufactures and releases thyroid
  hormones
• Thyroid hormones are iodine containing amino
  acids
• 3, 5, 3 triiodothyronine T3
• 3, 5, 3,5 tetraiodothyronine T4

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Thyroid Hormones

• Maintain the level of metabolism in the tissues
  that is optimal for their normal function
• Small amounts secreted continuously

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Thyroid Hormones

• Deficiency or excess of thyroid hormones
• ? wide and varied symptoms and physical signs
  involving any organ system

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Thyroid Case

• 33 year old woman
• Gaining weight
• Tired busy job and 2 young children
• Rows over thermostat

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Thyroid Case

• T4 6 (normal 9 22)
• TSH 36 (normal 0.4 4)
• Diagnosis Hypothyroidism

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Other symptoms of hypothyroidism

• Constipation
• Heavy periods
• Cold dry skin, dry hair, hair loss
• Muscle pains/stiffness

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Hypothyroidism

• Joseph Fourier, a French mathematician
• began to suffer from a strange disease, whose
  main effect was to render him extremely sensitive
  to cold.caused him to wrap up in many layers of
  heavy clothing, and live in a highly heated room
  from which he seldom ventured forth, even in
  summer heatwaves.

Paul Strathern, Napoleon in Egypt
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Treatment of Hypothyroidism

• Thyroid hormone, T4 (Eltroxin)
• Aim to abolish symptoms
• Aim to achieve a high normal T4 and low-normal
  TSH
• NB Pregnancy issues

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Thyroid Case 2

• 26 year old woman
• Noticed prominence of right eye x 3 weeks
• Increased appetite but weight decreasing
• Difficulty getting out of the bath

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On Examination

• Pulse 120 regular
• Tremulous, sweaty hands
• Enlarged, rubbery thyroid

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Thyroid Case 2

• T4 37 (normal 8 22)
• TSH lt 0.01 (normal 0.4 4)
• Anti-TSH receptor antibodies
• Diagnosis Graves Disease causing
  hyperthyroidism, ophthalmopathy

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Graves Disease

• Autoimmune condition
• Antibodies against TSH receptor stimulate
  excess thyroid hormone
• Antibodies attack back of eye - proptosis

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Treatment of Hyperthyroidism

• Antithyroid drugs
• Carbimazole (Neomercazole)
• Propylthiouracil (PTU)
• Radioactive Iodine
• Surgery - thyroidectomy

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Radioactive Iodine

• Commonly prescribed treatment for hyperthyroidism
• Orally-administered I131
• Concentrated in thyroid gland, radiation destroys
  thyroid tissue

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Radioactive Iodine

• Precautions after dose
• Long-term hypothyroidism

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Surgery

• Subtotal thyroidectomy
• Hypothyroidism
• Potential other complications

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Diseases of the Thyroid

• Disorders of function
• Hyperthyroidism
• Hypothyroidism
• Disorders of structure
• Goitre
• Thyroid nodules/cancer

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Goitre

• Enlarged thyroid
• Symptoms Cosmetic concerns, obstructive symptoms
• Toxic Multinodular Goitre hyperthyroidism

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Thyroid nodules

• 5 of population have palpable thyroid nodules
• 30-40 of popn have non-palpable nodules
  detectable on ultrasound
• Thyroid cancer in 8 of palpable thyroid nodules
• Differentiated cancers slow growing, good
  prognosis

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Thyroid nodules

• Risk stratify risk factors, u/s characteristics,
  hot or cold
• Fine needle aspiration
• Observation, surgery

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Summary

• Thyroid disease common but treatable, wide and
  varied complaints
• Disorders of function Hypo/Hyper, diagnosis TFTs
• Disorders of structure Goitre, nodules