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Disorders of the Thyroid Gland

Dr. Othman Al-Shboul Department of Physiology

Thyroid gland
Location: in the neck just below the larynx, on either side of & anterior to the trachea.
One of the largest pure endocrine glands in the body ( 20gms in adults). Formed of 2 lobes (Rt & Lt), that are connected by band of tissue called isthmus.

Not visible under normal conditions, but can be felt during swallowing.
Well-vascularized (rich in blood supply).
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Thyroid gland
Composed of large numbers of closed follicles (the functional units)

Follicles are filled with colloid (secretory substance) and lined with cuboidal epithelial cells (secrete into the interior of the follicles)

The major constituent of colloid is thyroglobulin (glycoprotein containing the thyroid hormones)
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Thyroid Hormones
T3 (Triiodothyronine) & T4 (Thyroxine)
50 milligrams of iodine are required each year for the formation of adequate quantities of thyroid hormone. Both increase the metabolic rate of the body Both are secreted from the Follicular cells Both can be stored in thyroid gland for couple of months (2-3 months).
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Thyroid Hormones
Calcitonin
Important for calcium metabolism
Secreted from Parafollicular cells (or C-cells)

Control & Effect Of Thyroid Hormones

stimulates GH secretion promotes the effects of GH on the synthesis of new structural proteins and on skeletal growth

I - Hyperthyroidism
Hyperthyroidism: overactive tissue within the thyroid gland causing an overproduction of thyroid hormones Gland Signs:
The thyroid gland is increased to two to three times' normal size Hyperplasia and infolding of the follicular cell lining Each cell increases its rate of secretion several folds

I - Hyperthyroidism
Causes:
Graves' Disease (the most common form of hyperthyroidism) Thyroid Adenoma (secretory function in the remainder of the thyroid gland is almost totally inhibited because the thyroid hormone from the adenoma depresses the production of TSH by the pituitary gland)

Thyroiditis; inflammation of the thyroid gland


Taking too much of the synthetic thyroid hormone.
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I - Hyperthyroidism
Symptoms:
High state of excitability Intolerance to heat; feeling of being overheated and leading to heavy sweating Mild to extreme weight loss (sometimes as much as 100 pounds) Varying degrees of diarrhea Muscle weakness Extreme fatigue but inability to sleep Nervousness or other psychic disorders Tremor of the hands
o Optic nerve damage o Eye ulceration & irritation

*** Exophthalmos (protrusion of the eyeballs)


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I - Hyperthyroidism
Diagnosis:
Increased basal metabolic rate

High or high normal T3 and/or T4


Low TSH concentration in the plasma TSI concentration (high in thyrotoxicosis)

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I - Hyperthyroidism
Treatment:
Surgical removal of most of the thyroid gland

Radioactive Iodine, absorbed by the gland and destroys most of the


secretory cells of the thyroid gland blockers

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I Hyperthyroidism . Graves' disease


The most common form of hyperthyroidism
Autoimmune disease in which antibodies called thyroid-stimulating immunoglobulins (TSI) form against the TSH receptors in the thyroid gland continual activation of thyroid gland TSI antibodies have a prolonged stimulating effect on the thyroid gland TSH concentrations are less than normal (The high level of thyroid hormone secretion caused by TSI in turn suppresses anterior pituitary formation of TSH)

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I Hyperthyroidism . Graves' disease

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II. Hypothyroidism
Types of hypothyroidism:

i.

Autoimmune thyroiditis (Hashimoto disease)


autoimmunity against the thyroid gland fibrosis of the gland diminished or absent secretion of thyroid hormone

ii.

Endemic Dietary Iodide Deficiency Mechanism:


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II. Hypothyroidism
iii.
Idiopathic
Exact cause ??? ? Nodular gland; inflamed (thyroiditis) and non-inflamed portions ? abnormality of the enzyme system required for formation of the thyroid hormones Goitrogenic substances (anti-thyroid activity), turnips and cabbages.

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II. Hypothyroidism
Symptoms:
Fatigue and extreme somnolence with sleeping up to 12 to 14 hours a day Extreme muscular sluggishness Slowed heart rate, decreased cardiac output, decreased blood volume Sometimes increased body weight Constipation Mental sluggishness Failure of many trophic functions in the body evidenced by depressed growth of hair and scaliness of the skin Development of a froglike husky voice In severe cases, development of an edematous appearance throughout the body called myxedema Atherosclerosis: increases the quantity of blood cholesterol due to diminished liver excretion of cholesterol in the bile Goiter (not in all cases)

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II. Hypothyroidism
Treatment:
Daily oral ingestion of thyroxine

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Cretinism
A condition of severely stunted physical and mental growth due to untreated congenital deficiency of thyroid hormones (congenital hypothyroidism) usually due to maternal hypothyroidism.

Causes:
Congenital lack of a thyroid gland Failure of the thyroid gland to produce thyroid hormone because of a genetic defect Endemic cretinism; iodine lack in the diet
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Cretinism
Symptoms:
Failure of body growth Mental retardation (retardation of the growth, branching, and myelination of the neuronal cells of the central nervous system) Obese, stocky, and short appearance (skeletal growth in the child with cretinism is characteristically more inhibited than is soft tissue growth) Tongue becomes so large in relation to the skeletal growth
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Goiter
A goiter is an enlarged thyroid gland Palpable and usually highly visible

Occurs whenever either TSH or TSI excessively stimulates the thyroid gland May accompany hypothyroidism or hyperthyroidism, but it need not be present in either condition.
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The END
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