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Thyroid Disease Dr John McDermott Consultant Endocrinologist

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

2 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

3 Thyroid Hormones ‘Maintain the level of metabolism in the tissues that is optimal for their normal function’ Small amounts secreted continuously

4 Thyroid Hormones Deficiency or excess of thyroid hormones:
 wide and varied symptoms and physical signs involving any organ system

5 Thyroid Case 33 year old woman Gaining weight
Tired – busy job and 2 young children Rows over thermostat

6 Thyroid Case T4: 6 (normal 9 – 22) TSH: 36 (normal 0.4 – 4)
Diagnosis: Hypothyroidism

7 Other symptoms of hypothyroidism
Constipation Heavy periods Cold dry skin, dry hair, hair loss Muscle pains/stiffness

8 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

9 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

10 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

11 On Examination Pulse 120 regular Tremulous, sweaty hands
Enlarged, rubbery thyroid

12 Thyroid Case [2] T4: 37 (normal 8 – 22) TSH < 0.01 (normal 0.4 – 4)
Anti-TSH receptor antibodies ++ Diagnosis: Graves Disease causing hyperthyroidism, ophthalmopathy

13 Graves Disease Autoimmune condition
Antibodies against TSH receptor – stimulate excess thyroid hormone Antibodies attack back of eye - proptosis

14 Treatment of Hyperthyroidism
Antithyroid drugs: Carbimazole (Neomercazole) Propylthiouracil (PTU) Radioactive Iodine Surgery - thyroidectomy

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

16 Radioactive Iodine Precautions after dose Long-term hypothyroidism

17 Surgery ‘Subtotal’ thyroidectomy Hypothyroidism
Potential other complications

18 Diseases of the Thyroid
Disorders of function: Hyperthyroidism Hypothyroidism Disorders of structure: Goitre Thyroid nodules/cancer

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

20 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

21 Thyroid nodules Risk stratify: risk factors, u/s characteristics, hot or cold Fine needle aspiration Observation, surgery

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

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