THYROID DISORDERS: T H Y R O I D D I S O R D E R S By JISY JOSE 2 nd YEAR MSc NURSING YNC PowerPoint Presentation: Thyroid is a butterfly-shaped gland that sits low on the front of the neck. Thyroid has two side lobes, connected by a bridge (isthmus) in the middle. THYROID GLAND: THYROID GLAND PowerPoint Presentation: Thyroid secretes several hormones, collectively called thyroid hormones . The hormone are thyroxine , also called T4, and triiodothyroxine (T3) and calcitonin . PHYSIOLOGY: PHYSIOLOGY Thyroid hormones influences: Metabolism, Growth and development, and Body temperature. During infancy and childhood, it is crucial for brain development. DISORDERS OF THYROID GLAND: DISORDERS OF THYROID GLAND HYPERTHYROIDISM : HYPERTHYROIDISM Pathologically excessive production of thyroid hormone The condition resulting from excessive activity of thyroid gland characterized by increased basal metabolism HYPOTHYROIDISM : HYPOTHYROIDISM Insufficient production of thyroid hormone This pathological condition may leads to myxedema and cretinism HYPOTHYROIDISM: HYPOTHYROIDISM An abnormality of the thyroid gland characterized by insufficient production of thyroid hormone , which can result in a decreased basal metabolic rate. 1.CONGENITAL HYPOTHYROIDISM: 1.CONGENITAL HYPOTHYROIDISM 1 in 4000 live births. Twice as common in girls than boys. Etiology: Etiology Absent,underdeveloped , ectopic thyroid gland Biochemical defects Maternal intake of medications. Maternal antibiotics . Pathophysiology: Pathophysiology Etiological factors Decreased stimulation by TRH Inadequate secretion of TSH from hypothalamus Thyroid hormone deficiency hypothyroidism clinical features : clinical features Skin mottling Large fontanel,tongue Hypotonia Slow reflexes Distended abdomen Diagnosis: Diagnosis Neonatal screening Thyroid scan. Management: Management Life long thyroid hormone replacement levothyroxine Single daily oral dose Dosage is titrated to maintain TSH & T4 normal level. PowerPoint Presentation: Nursing management 2.ACQUIRED HYPOTHYROIDISM: 2.ACQUIRED HYPOTHYROIDISM Etiology: Hashimoto’s thyroiditis Surgical thyroidectomy Radioactive iodine therapy Radiation therapy Pathophysiology: Pathophysiology Thyroid blocking immunoglobulins TSH receptor sites Decreased production of T3,T4 hypothyrodism Clinical features: Clinical features Goiter Dry,thick skin Coarse,dull hair Fatigue Cold intolerance Constipation PowerPoint Presentation: Weight gain Decreased linear growth Edema of face,eyes & hands Increased sleep. Diagnosis: Diagnosis Elevated TSH level. Low T4 level. Presence of circulating antibodies. Treatment: Treatment Thyroid hormone replacement therapy : levothyroxine Dosage varies with age Dose is titrated. PowerPoint Presentation: Nursing management HYPER THYROIDISM: HYPER THYROIDISM An autoimmune condition in which excessive thyroid hormones are produced by an enlarged thyroid gland. Incidence: Incidence 1 in 5000 Incidence in girls is five times more than boys. 11 – 15 ;peak age 2 nd most prevalent endocrine disorder. Etiology: Etiology Not definite. Familial tendency . Maternal thyrotoxicosis . Excessive ingestion of thyroid hormone. Pathophysiology: Pathophysiology Thyroid stimulating immunoglobulins TSH receptor sites increased production of T3,T4 hyperthyrodism Clinical features: Clinical features PowerPoint Presentation: cardinal signs. Physical signs. Thyroid storm. Diagnostic evaluation: Diagnostic evaluation Thorough history. Laboratory investigations Intravenous iodine intake Detection of immunoglobulins Radiological examination Management: Management Antithyroid drug therapy PowerPoint Presentation: 2.Radioactive iodine treatment PowerPoint Presentation: 3. Surgical management Surgical complications:: Surgical complications: Hemorrhage (bleeding) beneath the neck wound. Thyroid storm. Injury to the recurrent laryngeal nerve. PowerPoint Presentation: Injury to a portion of the superior laryngeal nerve Wound infection Hypoparathyroidism GOITER: GOITER Etiology: Etiology Deficient thyroid hormone production . Hyperthyroidism infection and inflammation Tumor and infiltration Idiopathic iatrogenic Clinical features: Clinical features visible swelling at the base of neck A tight feeling in throat Coughing Hoarseness Difficulty swallowing Difficulty breathing Diagnostic evaluation: Diagnostic evaluation Free thyroxine ( T4 ) Thyroid scan and uptake Thyroid stimulating hormone ( TSH ) Ultrasound of thyroid Treatment: Treatment A goiter only needs to be treated if it is causing symptoms. Treatments for an enlarged thyroid include: Radioactive iodine to shrink the gland, particularly if the thyroid is producing too much thyroid hormone PowerPoint Presentation: Surgery ( thyroidectomy ) to remove all or part of the gland Small doses of Lugol's iodine or potassium iodine solution if the goiter is due to iodine deficiency Treatment with thyroid hormone supplements if the goiter is due to underactive thyroid PowerPoint Presentation: Complications Difficulty swallowing or breathing Hypothyroidism Hyperthyroidism Thyroid cancer Toxic nodular goiter PowerPoint Presentation: INBORN ERRORS OF METABOLISM PHENYLKETOURIA: PHENYLKETOURIA An autosomal recessive disorder causing deficiency of the enyme phenylalanine hydroxylase which is responsible for conversion of phenylalanine to tyrosine in the liver. etiology: etiology Unknown Defect of single enyme,phenylalanine hydroxylase . Symptoms : Symptoms Phenylalanine plays a role in the body's production of melanin , Therefore, infants with the condition often have lighter skin, hair, and eyes than brothers or sisters without the disease. PowerPoint Presentation: Other symptoms may include : Delayed mental and social skills Head size significantly below normal Hyperactivity Jerking movements of the arms or legs PowerPoint Presentation: Mental retardation Seizures Skin rashes Tremors Unusual positioning of hands Diagnostic measures: Diagnostic measures Guthric blood test Ferric chloride test Phenistix test Pneumoencephalography Qualitative flurometric assay Tandem mass spectrometry. treatment: treatment diet that is extremely low in phenylalanine. A special infant formula called Lofenalac is made for infants with PKU. Taking supplements such as fish oil to replace the long chain fatty acids missing from a PowerPoint Presentation: standard phenylalanine-free diet may help improve neurologic development, including fine motor coordination. Other specific supplements, such as iron or carnitine , may be needed. Complications : Complications Severe mental retardation occurs if the disorder is untreated. ADHD appears to be the most common problem seen in those who do not stick to a very low-phenylalanine diet. Prevention : Prevention An enzyme assay can determine if parents carry the gene for PKU. Chorionic villus sampling can be done during pregnancy to screen the unborn baby for PKU.