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Prof. H.A. Pavlyshyn Thyroid and Parathyroid gland disorders.

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Prof. H.A. Pavlyshyn Thyroid and Parathyroid gland disorders
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Page 1: Prof. H.A. Pavlyshyn Thyroid and Parathyroid gland disorders.

Prof. H.A. Pavlyshyn

Thyroid and Parathyroid gland

disorders

Page 2: Prof. H.A. Pavlyshyn Thyroid and Parathyroid gland disorders.
Page 3: Prof. H.A. Pavlyshyn Thyroid and Parathyroid gland disorders.

Gl. Thyreoidea (normal)Gl. Thyreoidea (normal)Gl. Thyreoidea (normal)Gl. Thyreoidea (normal)

Page 4: Prof. H.A. Pavlyshyn Thyroid and Parathyroid gland disorders.

Gl. Thyreoidea (pathology-disorder)Gl. Thyreoidea (pathology-disorder)Gl. Thyreoidea (pathology-disorder)Gl. Thyreoidea (pathology-disorder)

Page 5: Prof. H.A. Pavlyshyn Thyroid and Parathyroid gland disorders.

Thyroid hormones affect normal somatic growth and

neurological development in children

Thyroid hormones affect normal somatic growth and

neurological development in childrenFor normal maturation of the

CNSFor normal maturation of the

CNS

Gl. ThyreoideaGl. ThyreoideaGl. ThyreoideaGl. Thyreoidea

ССardio-vascular system ardio-vascular system ССardio-vascular system ardio-vascular system

Skin and hair Skin and hair Skin and hair Skin and hair

GITGIT

Skeletal and muscular systemSkeletal and muscular system

Reproductive functionReproductive functionReproductive functionReproductive function

Page 6: Prof. H.A. Pavlyshyn Thyroid and Parathyroid gland disorders.

Regulation of secretion:TRH - TSH - T4 axis

Page 7: Prof. H.A. Pavlyshyn Thyroid and Parathyroid gland disorders.

Diagnostic of Thyroid gland disease

Visual & palpating method Investigation of thyroid function (basal level of T3, T4 and freeT3 ,freeT4) Functional tests USG, radiography, scanning, etc. Biopsia

Page 8: Prof. H.A. Pavlyshyn Thyroid and Parathyroid gland disorders.

Biopsy (FNAB)

Fine Needle Aspiration Biopsy

Examination methods

Page 9: Prof. H.A. Pavlyshyn Thyroid and Parathyroid gland disorders.

Micro follicular/solid thyroid nodule

Page 10: Prof. H.A. Pavlyshyn Thyroid and Parathyroid gland disorders.

Auto-Ab in diagnostics

(high specificity)

auto-Ab anti-TSH-R binding to different epitops: growth, goiter stimulation ... Graves-Basedow dis. inhibition ... hypothyroid idiopatic myxoedema

auto-Ab anti-microsomal = anti-TPO (thyroid peroxidase)... Hashimoto dis.

auto-Ab anti-Tg (thyroglobulin) ... x pathogeneticauto-Ab anti-T3 ... in 40% autoimmmune thyroiditis

Examination methods

Page 11: Prof. H.A. Pavlyshyn Thyroid and Parathyroid gland disorders.

Examination methods

Page 12: Prof. H.A. Pavlyshyn Thyroid and Parathyroid gland disorders.

Examination methods

Page 13: Prof. H.A. Pavlyshyn Thyroid and Parathyroid gland disorders.

131I scintigraphy:Retrosternal goiter

Examination methods

Page 14: Prof. H.A. Pavlyshyn Thyroid and Parathyroid gland disorders.

Classification of Goiter according Grades Classification Description

Grade 0 No palpable or visible goiter.

Grade 1 Mass in the neck that is enlarged thyroid which is palpable but not visible when the neck is in the normal position. Moves upward in the neck as the patient swallows. Nodular alterations can occur even when the thyroid is not enlarged.

Grade 2 Swelling in the neck that is visible when the neck is in a normal position and enlarged thyroid when the neck is palpated.

From WHO/UNICEF

Page 15: Prof. H.A. Pavlyshyn Thyroid and Parathyroid gland disorders.
Page 16: Prof. H.A. Pavlyshyn Thyroid and Parathyroid gland disorders.

Classification of hypothyroidism

OnsetCongenital Acquired (rare) – when symptoms

appear after the first year of life, it is presumed to be acquired.

Page 17: Prof. H.A. Pavlyshyn Thyroid and Parathyroid gland disorders.

SIGNS OF CONGENITAL HYPOTHYROIDISM

Birth weight and birth length are normal because Thyroid Hormones does not play an important role in prenatal growth.

There is a tendency towards prolonged gestation with 1/3 of pregnancies lasting 42 weeks or more

Page 18: Prof. H.A. Pavlyshyn Thyroid and Parathyroid gland disorders.

SYMPTOMS OF CONGENITAL HYPOTHYROIDISM

Prolonged jaundice

Lethargy Constipation

Feeding problems

Cold to touch

Page 19: Prof. H.A. Pavlyshyn Thyroid and Parathyroid gland disorders.

SIGNS OF CONGENITAL HYPOTHYROIDISM

Skin mottling and Dry skin

Umbilical hernia and Distended abdomen

Macroglossia Large fontanels

Wide sutures Hoarse cry

Muscle Hypotonia Slow reflexes

Page 20: Prof. H.A. Pavlyshyn Thyroid and Parathyroid gland disorders.
Page 21: Prof. H.A. Pavlyshyn Thyroid and Parathyroid gland disorders.
Page 22: Prof. H.A. Pavlyshyn Thyroid and Parathyroid gland disorders.

Treatment L-thyroxin

Preterm 8 – 10 μg/kg 0-12 mo 6 – 10 μg/kg 1-3 years 4 – 6 μg/kg 3-10 years 3 – 4 μg/kg 10-15 years 2 – 4 μg/kg > 15 years 2 – 3 μg/kg

Page 23: Prof. H.A. Pavlyshyn Thyroid and Parathyroid gland disorders.
Page 24: Prof. H.A. Pavlyshyn Thyroid and Parathyroid gland disorders.
Page 25: Prof. H.A. Pavlyshyn Thyroid and Parathyroid gland disorders.
Page 26: Prof. H.A. Pavlyshyn Thyroid and Parathyroid gland disorders.
Page 27: Prof. H.A. Pavlyshyn Thyroid and Parathyroid gland disorders.

The onset of symptoms is insidious. Emotional lability, altered mood, nervousness,

hyperactivity, irritability, heat intolerance, poor sleeping;

Tremor, hyperkinesias, tremor of outstretched fingers, fidget, psychosis (rare)

Deterioration of behavior and school performance;

Fatigue, weakness, Increased appetite and weight loss, frequent

loose stool (diarrhea); Goiter - thyroid enlargement

Graves disease (symptoms)

Page 28: Prof. H.A. Pavlyshyn Thyroid and Parathyroid gland disorders.

GoiterGoiter

Graves disease (symptoms)

Page 29: Prof. H.A. Pavlyshyn Thyroid and Parathyroid gland disorders.

GoiterGoiter

Graves disease (symptoms)

Page 30: Prof. H.A. Pavlyshyn Thyroid and Parathyroid gland disorders.

Graves disease (sings)

Heart failure, palpitations, tachycardia and hypertension

Warm, flushed, moist skin, increase sweating

Hair loss Muscle weakness (loss of muscle mass) &

wasting Accelerated bone maturation Dyspnoe

Page 31: Prof. H.A. Pavlyshyn Thyroid and Parathyroid gland disorders.
Page 32: Prof. H.A. Pavlyshyn Thyroid and Parathyroid gland disorders.

Treatment of Grave’s disease: Antithiroid agents - methimazole (Tapazole),

propylthiouracil (PTU), mercasolil. The beginning dose of methimazole is not less then 15-20 mg/m2

daily, gradually it becomes lower; mercasolyl 0.3-0.5 mg/kg divided 2 -3 times 14-21

days, than supportive dose – 2.5-7.5 mg/daily 1 time; Beta-adrenergic blockers (propranolol (10-20 mg/four

times daily), anaprilin (1-2 mg/kg divided 3 times), Sedatives are necessary to use also Corticosteroids (sometimes in severe cases Radioactive iodine (RAI) (in adults mainly) Euthyrosis – mercasolyl 5-10 mg/daily with L-

thyroxin 25-50 μg/daily Surgical treatment (Sub-total thyroidectomy)

Page 33: Prof. H.A. Pavlyshyn Thyroid and Parathyroid gland disorders.

Clinical features of hypoparathyroidism

Convulsive syndrome (titanic more typical), karpopedal spasm, paresthesiae, muscle weakness, tiredness, Trousseau and Hvostek symptoms)

↓Ca2+ + ↑PO4 → neuromuscular hyperactivity

Manifestation depends on actual Ca2+ levelsParesthesia (tingling around mouth,

fingers)

Tetany (attack begins with paresthesias … painful spasms of extremities and face

… flexion of the wrist …Adrenergic reaction (tachycardia, sweating)

Page 34: Prof. H.A. Pavlyshyn Thyroid and Parathyroid gland disorders.

Bone syndrome (diffuse bone pain, pathological fracture,

osteoporosis - RTG, densitometry) Renal syndrome

(polyuria, polydipsia, lithiasis, nefrocalcinosis) GIT syndrome

(constipation, nausea, vomiting) Neuromuscular syndrome

(muscular weakness, ECG - bradycardia, arrythmia) Neuropsychical syndrome

(psychosis, somnolence, coma)

Clinical features of hyperparathyroidism

Page 35: Prof. H.A. Pavlyshyn Thyroid and Parathyroid gland disorders.

„Salt and peper“ scull

Increased parathyroid activity leading to

characteristic subperiosteal resorption

Hyperparathyroidism

Page 36: Prof. H.A. Pavlyshyn Thyroid and Parathyroid gland disorders.

The bone changes are partially reversibleThe same finger pre- and post-treatment for

hyper-PTH. Images were taken 6 months apart.

Hyperparathyroidism


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