Hyperthyroidism « GROUP 1 » OVERVIEW Thyroid Gland Anatomy – Physiology Pathology Definition Epidemiology Pathogen OVERVIEW Management: 6.1 Clinic 6.2 Subclinic 6.3 Treatment 6.4 Complication & Sequela Clinical case Thyroid Gland Anatomy – Physiology Thyroid Gland Anatomy – Physiology Thyroid Gland Anatomy – Physiology Control of thyroid function The synthesis and release of thyroid hormones is regulated by negative feedback mechanism involve: -The pituitary hormone TSH (thyroid stimulating hormone) -The TRH (thyrotropin releasing hormone) Thyroid Gland Anatomy – Physiology The normal thyroid gland produces about 80% T4 and about 20% T3, however, T3 possesses about four times the hormone "strength" as T4 T4 is involved in controlling the rate of metabolic processes in the body and influencing physical development Thyroid Gland Anatomy – Physiology · Increased expression of Na/K ATPase; Tissue effects of T3 include: · increased sarcolemmal calcium uptake · increased beta adrenergic receptor levels in myocardium; · increased hepatic production of sex steroid binding globulin; · Bone: (cartilage ossification, maturation of epiphyses, chondrocyte maturation; - thyroid hormone has a direct effect on bone, and indirect effects through growth hormone release and IGF-1 action); · neuronal: cortical growth, axonal and dendritic growth, myelination; T3 is vital for normal brain development, and fetal TSH secretion starts by about 11-12 weeks The auditory and visual sensory systems appear particularly dependent on T3 · renal: increased renal plasma flow and GFR, Tm in tubules Pathology Hyperthyroidism’s Causes Grave Disease (Basedow ) Pathology Antithyroid drugs • Tác dụng phụ thuốc • Nguy tái phát cao Contraindication • Previous known major adverse reactions to ATDs Indication • Patients with high likelihood of remission (patients, especially females, with mild disease, small goiters, and negative or lowtiter TRAb) • The elderly or others with comorbidities or with limited life expectancy • Limited longevity and are unable to • follow radiation safety regulations • Previously operated or irradiated necks • Lack of access to a high-volume thyroid surgeon • Moderate to severe active • GO Preference • Higher value – Possibility of remission – Avoidance of lifelong thyroid hormone treatment – Avoidance of surgery, and exposure to radioactivity • Lower value – Avoidance of ATD side effects – The need for continued monitoring – The possibility of disease recurrence Thyroidectomy • Khả tái phát thấp • Stress • Nguy nhược giáp cao Indication • • • • • • • • • Symptomatic compression or large goiters (≥80 g) Relatively low uptake of radioactive Iodine Thyroid malignancy is documented or suspected large nonfunctioning, photopenic, or hypofunctioning nodule Coexisting hyperparathyroidism requiring surgery Pregnancy in [...]...2 Pathology Toxic Multinodular Goiter 3 Definition Hyperthyroidism is the overproduction of thyroid hormones by an overactive thyroid 3 Epidemiology 4 : 1 Age: 20 - 40 4 Pathogen • • • • • Basedow Toxic Adenoma Thyroiditis pituitary tumors …………… 4 Pathogen