THE THYROID GLAND

Anatomy :
The throid is in the superficial anterior neck
Is bilobed, with a connecting isthmus.
The shape Is often described as that of the H of the
Honda car symbol.
Neoplastic or hyperplastic growth may extend inferiorly
(retrosternal),
The adacent anatomy of the laryngeal ner!es and
parathyroid glands is an important surgical
consideration.
In adults it wheighs approximately "#$%# gram.
The thyroid gland has a rich blood suppy
Iodine metabolism
Iodine enters the body in food or water
The thyroid gland concentrates and traps
iothyroglobulin, which compensates for the
scarcity of iodine.
Most of the dietary iodide is excreted in the
urine,
a 24-hour urinary iodide concentration is
excellent index of dietary intake.
Control of thyroid function
(") The classic hypothalamic$ pituitary$thyroid axis,
(%) The pituitary and peripheral deiodinases,
modify the effects of T
&
and T
'
(
(') )utoregulation of hormone synthesis by the thyroid
gland
(&) *timulation or inhibition by T*H receptor
autoantibodies.
The syntheis of T
4
and T
3
by the thyroid gland
involves six major steps;
". acti!e transport of I$ across the basement membrane
into the thyroid cell (trapping of iodide)(
%. oxidation of iodide and iodination of tyrosyl residues in
thyroglobulin(
'. coupling of iodotyrosine molecules within thyroglobulin,
to form T
'
and T
&
&. proteolysis of thyroglobulin, free iodothyronines and
iodotyrosines(
+. deiodination of iodotyrosines within the thyroid cell,
conser!ation, reuse of the liberated iodide(
,. under certain circumstances,
intrathyroidal +-$deiodination of T
&
to T
'
.
Efects of TSH on the Thyroid cell
Changes in thyroid cell morphology
Cell growth
Iodine metabolism
TSH stimulates all phases of iodide
metabolism,
Other efect of TSH
increased secretion of T
4
and T
3
from the
land.
increased acti!ity of type " #$-deiodinase,
conser!in intrathyroidal iodine.
Stimulation of glucose uptake, oxygen
consumption,
The serum le!el of TSH is about %.#-# m&'()
it is increased in hypothyroidism and
decreased in hyperthyroidism
If iodide intake is below +# g.d,
unable to maintain ade/uate hormonal
secretion,
thyroid hypertrophy (goiter)
hypothyroidism
*+ect of ,odide -e.ciency on Hormone /iosynthesis
) diet !ery low in iodine reduces intrathyroidal iodine content 0
increases the intrathyroidal ratio of 1IT to TIT$
increases the ratio of T' to T& $$$
decreases the secreation of T&,$
increases serum T*H.
*truma
DISORDERS OF THE THYROID
0atients 1ith thyroid disease 1ill usually
complain of
".thyroid enlarement, di+use or nodular)
2.symptoms of thyroid de.ciency
2 hypothyroidism3
3.symptoms of thyroid hormone excess
2 hyperthyroidism3 or
4.complications of a speci.c form of
hyperthyroidism e. 4ra!es$ disease
5 prominence of the eyes 2exophthalmos3
and,
5 thyroid dermopathy
yperthyroidism ! thyrotoxicosis
Thyrotoxicosis 2 clinical syndrome that results when
tissues are exposed to high le!els of
circulating thyroid hormone

due to hyperacti!ity of the thyroid gland,

hyperthyroidism
3onditions associated with thyrotoxicosis
". 4iffuse toxic goiter (5ra!es- disease)
%. Toxic adenoma (6lummer-s disease)
'. Toxic multinodular goiter
&. *ubacuta( thyroiditis
+. Hyperthyroid phase of Hashimoto-s thyroiditis
,. Thyrotoxicosis factitia
Difuse Toxic Goiter Gr!"es# Dise!se$
females 6 males 2#3 7 2"3
bet1een 2%-4% years of ae.
8onsists of one or more of the follo1in features 7
2"3 thyrotoxicosis,
223 di+use oiter,
233 ophthalmopathy 2exophthalmos3, and
243 dermopathy 2pretibial myxedema3.
Clinical Features
A% Sy&'to&s
5 palpitations,
5 ner!ousness,
5 easy fatiability,
5 hyperkinesia,
5 diarrhea,
5 excessi!e s1eatin,
5 intolerance to heat,
5 preference for cold.
5 marked 1eiht loss 1ithout loss
of appetite
5 thyroid enlarement,
5 thyrotoxic eye sins
9
tachycardia
9
skin 7 smooth, moist and 1arm
9
.ne tremor of the .ners
5 muscle 1eakness and
5 loss of muscle mass 2
myopathy3
5 atrial .brillation insensiti!e to
dioxin
(% Si)ns
INDE*S +AYNE
Ge,!l! y!n) -!ru
ter,!di
D!n -ert!&-!h -er!t
T!nd!.
t!nd!
/ .
/ .
Ses!0 '!d! 0er,!
(erde-!r.de-!r
Le0!s lel!h
Le-ih su0! h!1!
'!n!s
Le-ih su0! din)in
(er0erin)!t -!ny!0
Gu)u'
N!fsu &!0!n
-ert!&-!h
N!fsu &!0!n
-er0ur!n)
(er!t -!d!n
-ert!&-!h
/2
/3
/4
. 5
/5
/4
/3
/4
. 4
. 4
.
.
.
.
.
.
.
.
.
.
Tiroid ter!-!
(isin) 'e&-uluh
E0so'th!l&us
Retr!0si '!l'e-r!
*el!&-!t!n
'!l'e-r!
Hi'er0inesis
Tre&or ,!ri
T!n)!n '!n!s
T!n)!n le&-!-
Denyut n!di
se1!0tu
6 78 9 &enit
78.:8 9 &enit
; :8 9 &enit
Fi-ril!si !triu&
/4
/3
/3
/3
/2
/<
/2
/3
/2
.4
.
/4
/<
.4
.3
.
.
.
.3
.
.2
.2
.
.
.
.
=u&l!h
Nil!i > 2: > to0si0? 22 @ 2: > EAui"oc!l? 6 22 > non to0si0
"aboratory #indings
High 7T& 8 suppressed T*H (9 #," u:.;)
hyperthyroidism.
8eye signs diagnosis of 5ra!es-
disease can be made without further
tests.
Thyroid imaging
Radiounclide Imaging
< both the si=e and shape of the thyroid gland
< distribution of functional acti!ity in the gland.
3old, warm and hot thyroid nodules
Thyroid ultrasonography or
$ measuring the size of the gland or indi!idual
nodules
- differentiating solid from cystic lesions
MRI $magnetic resonance imaging)
$ excellent image of the thyroid gland,
$ including posterior or substernal extention
Thyroid biopsy
7ine$nndle aspiration biopsy.

%ffect of thyroid hormone in peripheral tissue
basal metabolic rate (>1?).
hypereflexion
Tre!t&ent of Gr!"es# Dise!se
Manaement has been larely directed to1ard
controllin
the hyperthyroidism.
". /lockin of hormone synthesis by antithyroid dru
therapy,
2. 0artial ablation of the thyroid land by surery,
and
3. -estruction of thyroid cells by radioacti!e iodine
therapy.
HYBOTHYROIDISC
*igns and *ymptoms
are the re!erse of thyrotoxicosis
@