Enfermedad Tiroidea

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Enfermedad Tiroidea

• Dr. José C. Trejos A.

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Eje Hipotálamo-Hipófisis-Tiroides
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Structure and interrelationships between the
principal iodothyronines activated or inactivated
by the selenoideiodinases.
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Factors That Influence Thyroid Radioiodine uptake
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Factors That Influence Thyroid Radioiodine uptake
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• Synthesis and secretion
• Iodinated drugs (incl. amiodarone)
• lithium salts
• cytokines (IFN, IL)
• Transport
• steroids - NSAID
• diuretics - heparin
• FFA
• Metabolism
• P450 inducers (antiepileptics, rifampicin)
• 5 DI inhibitors PTU, ? -blockers,
  dexamethasone, iodinated drugs
• Action
• Amiodarone
• phenytoin

Thyroid
T4
T3
Liver (5 D1)
Target Organs
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Bocio causas y mecanismos patogénicos
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Bocio causas y mecanismos patogénicos
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Causes of Thyrotoxicosis
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Causes of Elevated Serum Thyroxine
Concentrations
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Common Clinical Manifestations of Thyrotoxicosis

• Symptoms
• Nervousness
• Fatigue
• Weakness
• Increased perspiration
• Heat intolerance
• Tremor
• Hyperactivity
• Palpitation
• Appetite change (usually increase)
• Weight change (usually weight loss)
• Menstrual disturbances
• Signs
• Hyperactivity
• Tachycardia or atrial arrhythmia
• Systolic hypertension
• Warm, moist, smooth skin
• Stare and eyelid retraction
• Tremor

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Clinical Manifestations of Specific Causes of
Thyrotoxicosis
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Causes of Thyrotoxicosis, separated into those
with high uptake and those with low uptake
Thyrotoxicosis with High Uptake
Thyrotoxicosis with High Uptake

• Autonomous gland
• Graves disease
• Toxic nodular goiter
• Multinodular gland
• Single autonomous nodule
• Gland stimulated by excess
• TSH or TSH like hormone
• TSH secreting pituitary tumor
• Placental tumors
• Hydatidiform mole
• Choriocarcinoma
• Ectopic source of hormone
• secretion
• Widespread functioning
• thyroid cancer (usually follicular
• cancer)
• Struma ovari

• Thyroiditides
• Subacute thyroiditis
• Silent thyroiditis
• Postpartum thyroiditis
• Exogenous thyroid
• hormone
• Factitious thyrotoxicosis
• Thyrotoxicosis medicamentosa
• Hamburger Thyrotoxicosis
• Excess Iodine exposure.

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Causes of Hypothyroidism
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Laboratory Assessment of hypothyroidism
Serum TSH and Free Thyroxine
TSH ? Free T4 ?
TSH ? Free T4 normal
TSH normal ? Free T4?
TSH normal Free T4 normal
Central hypothyroidism Nonthyroidal illness Drug
effect
Primary hypothyroidism
Mild or subclinical hypothyroidism
Normal
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Hallazgos clínicos en el hipotiroidismo del
adulto (mixedema)
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Hallazgos clínicos en el hipotiroidismo del
adulto (mixedema)
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Precipitants of Thyroid Storm
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Drugs and Doses in Thyroid Storm
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Differential Diagnosis of the Painful Anterior
Neck Mass
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Comparison Between Subacute and Acute Infectious
Thyroiditis
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Common Clinical Features of Subacute Thyroiditis
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Types of Thyroid nodules

• Benign
• Adenomatous nodule (also called colloid nodule
  and hyperplastic nodule)
• Follicular adenoma
• Hurthle - cell adenoma
• Lymphocytic thyroiditis
• Thyroglossal duct cyst
• Malignant
• Carcinomas of thyroid follicular cell origin
• Papillary carcinoma
• Follicular carcinoma
• Hurthle cell carcinoma
• Anaplastic carcinoma
• Carcinoma of C cell origin
• Medullary carcinoma
• Lymphoma
• Cancer metastatic to the thyroid
• Non thyroid lesions
• Parathyroid cyst and adenoma
• Lymph node

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Changes in Serum Thyroid Hormone and Thyrotropin
Concentrations in Patients with Nonthyroidal
Illness
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