2. Introduction.
• Definition & anatomy of
the thyroid gland.
• General function of the
thyroid gland.
• Hormones secreted by
the thyroid gland: T3 &
T4
• Definition of
Hyperthyroidism.
3. Regulation of secretion
• The thyroid gland’s hormones are regulated by:
1- The pituitary gland: Feedback mechanism & Hypothalamus.
2- The hypothalamus: by TRH which increases TSH secretion
from the pituitary gland thus, increases thyroid hormones.
4. Causes of hyperthyroidism
1. Grave’s disease “Diffuse toxic goiter”:
- Caused by a generalized over activity of
the thyroid gland
- Most common cause
- Gland has lost the ability to respond to the
normal control by TSH.
- Common among women more than men.
- Triggered by stress, smoking, radiation to
the neck, medications, and infectious
organisms such as viruses
- It may be associated with Graves'
ophthalmopathy & dermopathy.
5. 2. Toxic nodular goiter ”Multi-nodular goiter”:
- A condition in which one or more nodules of
the thyroid become overactive. The
overactive nodules actually act as benign
thyroid tumors.
- Symptoms of toxic nodular goiter do not
include bulging eyes or skin problems.
3- Thyroiditis:
- Temporary hyperthyroidism then
hypothyroidism.
- 3 types:
1- Hashimoto's Thyroiditis.
2- Subacute Granulomatous Thyroiditis:
associated with fever & sore throat. It is tender
to touch.
3- Silent Lymphocytic Thyroiditis: associated
with accumulation of lymphocytes.
6. 4. Excessive iodine intake:
by medications ” amiodarone” - which is used for treatment
of heart problems - or in diet.
5. Excessive secretion of TSH:
due to a tumor in the pituitary gland. This condition is very
rare and can be associated with other abnormalities of the
pituitary gland.
7. Symptoms of Hyperthyroidism
• The symptoms don’t appear at patients older
than 70 years old & or having mild degree of
hyperthyroidism.
• They are related to increase in body metabolism
generally. They are:
- Excessive Sweating
- Characteristic stare with widened palpebral
fissure.
- Lid lag phenomenon.
- Heat Intolerance
- Exophthalmus
- Increased Bowel Movements
- Tremor (Usually Fine Shaking) Nervousness,
Agitation
- Rapid Heart Rate / Palpitations
8. - Warm and moist skin
- Insomnia
- Breathlessness
- Irregular heart rhythms and heart failure “old
patients”
- Irregular or Scant Menstrual Periods
- Fatigue
- Weight Loss
- Muscle Weakness
- Hair Loss
- Increased basal metabolic rate.
- In most sever cases, "thyroid storm" occurs. It
is a condition involving high blood pressure,
fever, and heart failure. Mental changes, such
as confusion and delirium, also may occur.
9. Diagnosis of Hyperthyroidism
• Hyperthyroidism can be suspected in patients with:
- Tremors
- Excessive
- Sweating
- Smooth velvety skin
- Fine hair
- A rapid heart rate
- Enlarged thyroid gland.
- Puffiness around the eye & characteristic stare.
• However, In all cases, a blood test is needed to confirm the diagnosis.
• The main tool for detection of hyperthyroidism is measurement of the
blood TSH level
• If there is obvious involvement of the eyes, a diagnosis of Graves'
disease is almost certain.
10. PATIENTS WITH GRAVES' DISEASE OFTEN
HAVE SYMPTOMS OF ANXIETY,
NERVOUSNESS, FLUCTUATING MOODS
AND IRRITABILITY THAT RESOLVE WHEN
THYROID HORMONE LEVELS RETURN TO
THE NORMAL RANGE.
How does Hyperthyroidism
Overlap with Psychiatric
Symptoms?!!
11. Treatment of Hyperthyroidism
• The options for treating hyperthyroidism include:
- Treating the Symptoms
- Anti-thyroid Drugs
- Radioactive Iodine
- Surgery
12. • Treating the symptoms
- Immediately treat the symptoms such as rapid heart rate.
- Beta-blockers are widely used “e.g. propranolol &
atenolol”. They act against the increase in body
metabolism but they DO NOT affect the thyroid hormone
levels in the blood.
- The doctor detects the patients who will be treated that
way according to:
- The underlying cause of hyperthyroidism
- The age of the patient
- The size of the thyroid gland
- The presence of coexisting medical illnesses.
13. • Anti-thyroid Drugs:
- There are two main anti-thyroid drugs available
for use methimazole (Tapazole) and
propylthiouracil ( PTU).
- They block the production of thyroid hormones.
- PTU also blocks the conversion of T4 to the more
metabolically active T3 hormone.
- They may suppress production of WBCs.
- The dose is adjusted to maintain the patient in as
close to a normal thyroid state as possible
(euthyroid).
14. • Radioactive Iodine:
- Radioactive iodine is given orally on a one-time basis to
ablate a hyperactive gland.
- The isotope iodine 131 is used in treatment, while for a
routine scan, iodine 123 is used.
- It is picked up by the active cells in the thyroid only and
destroys them without any side effects.
- It can’t be used during pregnancy or breast-feeding
- It is the treatment of choice for recurring Graves' disease
- More than 80% of patients are cured with a single dose of
radioactive iodine.
- Permanent hypothyroidism is the major complication
“after treatment”
15. • Surgery “Partial thyroidectomy”:
- Aims to remove the hyperactive tissue of the gland.
- If too much tissue is removed, hypothyroidism may result, and then
thyroid replacement therapy will begin.
- The major complications are injury of the nerves supplying the vocal
cords or the parathyroid glands.
- Surgery is suitable for:
1- Pregnant patients and children.
2- Patients with very large thyroid glands.
3- Patients having symptoms stemming from compression of
tissues adjacent to the thyroid, such as difficulty swallowing,
hoarseness, and shortness of breath.
