Presentation is loading. Please wait.

Presentation is loading. Please wait.

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

Similar presentations


Presentation on theme: "Thyroid Disease Dr John McDermott Consultant Endocrinologist Connolly Hospital Blanchardstown Hermitage Medical Clinic Royal College of Surgeons in Ireland."— Presentation transcript:

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 I 131 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


Download ppt "Thyroid Disease Dr John McDermott Consultant Endocrinologist Connolly Hospital Blanchardstown Hermitage Medical Clinic Royal College of Surgeons in Ireland."

Similar presentations


Ads by Google