1. THYROID DISORDERS BY ZEYAD AL-RABIAH

2. OVERVIEW Thyroid gland. Hormone secreted by gland. Triiodothyronine T 3. Thyroxine T 4. calctonine. Action of the thyroid hormone. calorigenesis metabolism brain maturation behavior growth and development

3. Regulation

4. Thyroid Disease Affects Many 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 Elevated Triglycerides Liver Constipation Decreased GI Activity Intestines Decreased Fertility Menstrual Abnormalities May Harm Development of Infant Reproductive System

5.  Disease of thyroid gland : Hypothyroidism :  Causes : Non goitrous : 1 ry : Idiopathic atrophy. Iatrogenic. Postinflammatory thyroiditis. Cretinism.

6. 2 ry : 1. TSH. 2. TRH. B.Goitrous : -Dyshormongenesis -Hashimotos Thyroiditis -Drud-induced: (iodides,lithium,sulfonylureas,amiodarone ) -Iodide deficiency.

7. Common Signs and Symptoms of Hypothyroidism Symptomes: Weakness Coold intolerance Headach Weight gain Dyspnea Constipation Signs: Goiter Hypertention Bradycardia Peripheral edema Puffy Face and Eyes

9. Laboratory:  TT4 +TT3  Cholesterol+TSH+CPK+LDH  +ve antibodies

10. TREATMENT

11. 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.

12. THYROID USP (ARMOUR ) (mixture of L- T4and liothyronine - T3) not synthetic (from hog,beef, or sheep thyroid gland). Dose 1grain

13. CYTOMEL (liothyronine- T3) shorter ½ life may improve mental function and constitutional symptoms when taken with L- T4. dose 25-37.5ug.

14. LIOTRIX (THYROLAR) Synthetic ratio T 4 :T 3 in 4:1 Dose 60ug T 4 :15ugT 3 or 50ugT 4 :12.5ugT 3.

15. Myxedema Coma It 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.

16. HYPERTHYROIDISM (THYROTOXICOSES) CAUSES : Graves disease. Toxic multinodulare goiter Solitary toxic nodule plummer’s disease De Quervain’s thyroiditis Pregnancy Exogenous intake of thyroid hormones or iodine Drugs : amoidarone Secondary ( TSH) it is rare.

17. Common Signs and Symptoms of Hyperthyroidism Nervousness Irritability Difficulty Sleeping Goiter Rapid Heartbeat Hypertension Increased Sweating Heat Intolerance Weight Loss Menstrual disturbances (Amenorrhea) Diarrhea palpitations

19. Laboratory:  TT4 +TT3  Cholesterol+TSH  +Ve antibodies

20. THYROID CRISIS (THYROID STROM) Rare,mortality 10%. A rapid deterioration of hyperthyroidism with hyperpyrexia (temp >40°C). Treatment Thioamide: 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.