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

Prof. H.A. Pavlyshyn

Thyroid and Parathyroid gland

disorders

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

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

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

Regulation of secretion:TRH - TSH - T4 axis

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

Biopsy (FNAB)

Fine Needle Aspiration Biopsy

Examination methods

Micro follicular/solid thyroid nodule

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

Examination methods

Examination methods

131I scintigraphy:Retrosternal goiter

Examination methods

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

Classification of hypothyroidism

OnsetCongenital Acquired (rare) – when symptoms

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

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

SYMPTOMS OF CONGENITAL HYPOTHYROIDISM

Prolonged jaundice

Lethargy Constipation

Feeding problems

Cold to touch

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

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

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)

GoiterGoiter

Graves disease (symptoms)

GoiterGoiter

Graves disease (symptoms)

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

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)

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)

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

„Salt and peper“ scull

Increased parathyroid activity leading to

characteristic subperiosteal resorption

Hyperparathyroidism

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

hyper-PTH. Images were taken 6 months apart.

Hyperparathyroidism