T H Y R O I D G L A N D History Taking Endocrine and Metabolism System

The basic concept of the function of thyroid hormones Up-regulate the function of other hormones e.g. growth hormone & catecholamines Up-regulate the function of other hormones e.g. growth hormone & catecholamines They heat up the other endocrinal functions They heat up the other endocrinal functions

Thyroid Disorders affect Peoples’ Health and Quality of Life HypothyroidismHyperthyroidism

increased Thyroid hormones decreased Thyroid hormones Hypothyroidism Hyperthyroidism Hypothyroidism is much more common than Hyperthyroidism The Thyroid Gland is - as important as your heart -

Effects of Thyroid Hormones Fetal brain and skeletal maturation Fetal brain and skeletal maturation Cardiovascular system (Inotropic and chronotropic effects on heart) Cardiovascular system (Inotropic and chronotropic effects on heart) Muscle function Muscle function Brain, nervous system Brain, nervous system Increase sensitivity to catecholamines Increase sensitivity to catecholamines Stimulate gut motility Stimulate gut motility

The thyroid: the “heart” of metabolism Involvement of thyroid function: Growth and development, fertility Growth and development, fertility Energy metabolism Energy metabolism Protein and carbohydrate metabolism Protein and carbohydrate metabolism Fat metabolism Fat metabolism Bone metabolism Bone metabolism Cardiovascular system Cardiovascular system Muscle function Muscle function Brain, nervous system, psyche Brain, nervous system, psyche thyroid gland larynx trachea

Effects Of Thyroid Hormones On The Cardiovascular System Increase heart rate Increase heart rate Increase force of cardiac contractions Increase force of cardiac contractions Increase stroke volume Increase stroke volume Increase Cardiac output Increase Cardiac output Up-regulate catecholamine receptors Up-regulate catecholamine receptors The Respiratory System The Respiratory System Increase resting respiratory rate Increase resting respiratory rate Increase minute ventilation Increase minute ventilation Increase ventilatory response to hypercapnia and hypoxia Increase ventilatory response to hypercapnia and hypoxia

On The Renal System Increase blood flow Increase blood flow Increase glomerular filtration rate Increase glomerular filtration rate On Oxygen Carrying Capacity *Increase RBC mass *Increase oxygen dissociation from hemoglobin

On Intermediary Metabolism Increase glucose absorption from the GI tract Increase glucose absorption from the GI tract Increase carbohydrate,lipid and protein turnover Increase carbohydrate,lipid and protein turnover Down-regulate insulin receptors Down-regulate insulin receptors Increase substrate availability Increase substrate availability

On Growth And Tissue Development Increase growth and maturation of bone Increase growth and maturation of bone Increase tooth development and eruption Increase tooth development and eruption Increase growth and maturation of epidermis,hair follicles and nails Increase growth and maturation of epidermis,hair follicles and nails Increase rate and force of skeletal muscle contraction Increase rate and force of skeletal muscle contraction Inhibits synthesis and increases degradation of mucopolysaccharides in subcutaneous tissue Inhibits synthesis and increases degradation of mucopolysaccharides in subcutaneous tissue

On The Nervous System Critical for normal CNS neuronal development Critical for normal CNS neuronal development Enhances wakefulness and alertness Enhances wakefulness and alertness Enhances memory and learning capacity Enhances memory and learning capacity Required for normal emotional tone Required for normal emotional tone Increase speed and amplitude of peripheral nerve reflexes Increase speed and amplitude of peripheral nerve reflexes

On The Reproductive System Required for normal follicular development and ovulation in the female Required for normal follicular development and ovulation in the female Required for the normal maintenance of pregnancy Required for the normal maintenance of pregnancy Required for normal spermatogenesis in the male Required for normal spermatogenesis in the male

Two young women with goiter

History Taking INTRODUCTION HISTORY TAKING Greet the patient and introduce the examiner’s name Greet the patient and introduce the examiner’s name Ask the patient’s identity : Ask the patient’s identity : - The patient’s name, age, occupation, and patient’s residence - The patient’s name, age, occupation, and patient’s residence

CHIEF COMPLAINT - Ask the patient why she/he come to clinic - Ask the date of onset (The onset was sudden or insidious) (The onset was sudden or insidious) - Ask the symptoms

Thyroid Hypo function - coldness - weight gain - constipation - menstrual irregularities - muscle cramps. - malaise - fatigue

Hypothyroidism before and after treatment

Thyroid Hyper function: - palpitations - palpitations - heat intolerance - heat intolerance - nervousness - nervousness - easy fatigability - easy fatigability - restlessness - restlessness - diarrhea. - diarrhea. - excessive sweating. - excessive sweating. - preference to cold. - preference to cold. - weight loss without loss appetite. - weight loss without loss appetite. - emotional instability - emotional instability

Past History Exposure to ionizing radiation in childhood Surgery Thyroiditis Drugs:- Amiodarone - IV Contrast agent - Lithium Family history of Thyroid disease History of other autoimmune diseases like: - Diabetes - Rheumatoid arthritis - Vitiligo - Pernicious anaemia

Prevalence of thyroid abnormalities in general population: Total study population (n=25862) Subjects taking thyroid medication (n=1525) Euthyroid 88.3 % 60.1 % Hypothyroid * 0.4 % 0.7 % Subclinical hypothyroid 9.0 % 17.6 % Hyperthyroid 0.1 % 0.9 % Subclinical hyperthyroid 2.1% 20.7 % Canaris GJ et al. (2000) * probably underestimated (assessed by TT4)

Prevalence of thyroid dysfunction in elderly population (age > 35 yrs.) Condition Reported prevalences in adult population, % Hypothyroidism2 Mild (subclinical) hypothyroidism Hyperthyroidism0.2 Mild (subclinical) hyperthyroidism (TSH<0.1, normal T4,T3) (Adapted from Vanderpump and Tunbridge, 2000)

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