Thyroid disorders
Hypothyroidism (2% of UK population); Hyperthyroidism/thyrotoxicosis (1% of UK population)
10x common F > M
Hypothalamus (TRH) Ant. Pituitary (TSH) Thyroid (T3 +T4)
Classification
Hypothyroidism Hyperthyroidism
Primary problem w/ gland itself e.g. autoimmune Primary majority of cases
Secondary disorder w/ pituitary gland/lesion compressing the Secondary < 1% of cases
pituitary gland Congenital not seen
Congenital thyroid dysgenesis/dyshormonogenesis
Aetiology
Hypothyroidism Hyperthyroidism
1. Hashimoto disease 1. Grave’s disease
Autoimmune disease associated w/ Type Autoimmune + thyroid eye disease
1 DM, Addison’s/pernicious anaemia (exophthalmos, conjunctival oedema, optic
May cause transient thyrotoxicosis in the discs swelling, ophthalmoplegia, ptosis) +
acute phase other signs e.g. pretibial myxoedema
5-10 times more common in females Associated w/ other AI e.g. pernicious anaemia
2. De Quervain’s thyroiditis 2. Toxic multi-nodular goitre + toxic solitary
3. Riedel thyroiditis nodule goitre
Fibrous tissue replacing the normal Autonomously functioning thyroid nodules that
thyroid parenchyma causing a painless secrete excess thyroid hormones
goitre 3. De Quervain’s thyroiditis
4. Postpartum thyroiditis Transient hyperthyroidism that develops after
5. Drugs Lithium, Amiodarone a viral infection. Goitre is often painful, a period
6. Iodine deficiency common in of hypothyroidism may follow
developing world
Signs + symptoms
Genera Weight gain, lethargy, cold Weight loss, manic/restlessness, heat intolerance
l intolerance
Cardia - Palpitations, arrhythmias e.g. AF
c
Dry, cold, yellowish, non-pitting Increased sweating, pretibial myxoedema:
Skin oedema, dry, coarse scalp hair, loss erythematous, oedematous lesions above the lateral
of lateral aspect of brows malleoli
Thyroid acropatchy: clubbing
GI Constipation Diarrhoea
Gynae Menorrhagia Oligomenorrhoea
Neuro Reduced tendon reflexes + CTS Anxiety, tremor
Ix Thyroid antibodies
Thyroid function tests 3 main types:
Dx TSH Free T4 Anti-thyroid peroxidase (anti-TPO)
Thyrotoxicosis ↓ ↑ TSH receptor Abs 90-100% pts w/ Grave’s
Thyroglobulin Abs 70% Hashimoto’s; 30%
Primary
Grave’s
hypothyroidis ↑ ↓ USS nodules fine needle aspiration of solitary
m
nodules
Secondary Isotope scan hot/cold thyroid nodules
hypothyroidis ↓ ↓
m Mx
Sick Hypothyroidism Thyroxine e.g. Levothyroxine
euthyroid* ↓ ↓
Hyperthyroidism
Subclinical Propranolol control thyrotoxic Sx e.g.
thyroidism ** ↑ Normal
tremor
Poor Carbimazole blocks thyroid peroxidase
compliance w/ ↑ Normal from coupling + iodinating the tyrosine
Thyroxine residues on thyroglobulin reduced thyroid
* Common in hospital No Rx needed hormone production
** Patients on the way to developing Radioiodine
hypothyroidism but still have normal thyroxine
levels
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