(A Project of National Medical Centre Karachi)

Disorder of Thyroid Gland.

(Hypothyroidism)

BY:
Shahzad Bashir
Lecturer, nmc ion.

1
2/14/2019
Shahzad
Bashir.
 OBJECTIVES.
 By the end of this lecture, the students will be able to:
2

 Review the anatomy & physiology of thyroid &

Parathyroid gland & review hypothalamic pituitary
feed back system.
 State the functions of thyroid hormone.
 Understand the pathologic mechanism of
hypothyroidism interm of :
 Goiter (Non-Toxic).
 Cretinism.

 Myxedema.

 Hashimoto’s disease.
Shahzad Bashir. 2/14/2019
 THYROID GLAND

•On each side of trachea is lobe of thyroid

3
•Weighs 1 oz & has rich blood supply Shahzad Bashir. 2/14/2019
 HISTOLOGY OF THYROID GLAND
4

 Follicle = sac of stored

hormone (colloid)
surrounded by follicle
cells that produced it
 T3 & T4.
 Inactive cells are short.
 In between cells called
parafollicular cells.
 Produce calcitonin.

Shahzad Bashir. 2/14/2019

5 Shahzad Bashir. 2/14/2019
6 Shahzad Bashir. 2/14/2019
 THYROID-STIMULATING HORMONE
7

 TSH stimulates the synthesis and secretion of the two thyroid hormones,
triiodothyronine (T3) and thyroxine (T4), both produced by the thyroid
gland.
 Thyrotropin-releasing hormone (TRH) from the hypothalamus controls
TSH secretion.
 Release of TRH in turn depends on blood levels of T3 and T4.
 High levels of T3 and T4 inhibit secretion of TRH via negative feedback.
 There is no thyrotropininhibiting hormone.
 Hypersecretion called Hyperthyroidism. Grave’s Disease, Goiter(Toxic).
 Hyposecretion called Hyporthyrodism. Goiter (Non-Toxic), Cretinism
& Myxedema.
 PRINCIPLE FUNCTION:
 Stimulates synthesis and secretion of thyroid hormone by thyroid gland.

Shahzad Bashir. 2/14/2019

 CONTROL OF T3 & T4
SECRETION.

•Negative feedback
system.
•Low blood levels of
hormones stimulate
hypothalamus.
•It stimulates pituitary to
release TSH.
•TSH stimulates gland to
raise blood levels.

8 Shahzad Bashir. 2/14/2019

9 Shahzad Bashir. 2/14/2019
 FORMATION OF THYROID
HORMONE.

•Iodide trapping by follicular

cells.
•Synthesis of thyroglobulin
(TGB).
•Release of TGB into colloid.
•Iodination of tyrosine in colloid.
•Formation of T3 & T4 by
combining T1 and T2 together.
•Uptake & digestion of TGB by
follicle cells.
•Secretion of T3 & T4 into blood.

10 Shahzad Bashir. 2/14/2019

 ACTIONS OF THYROID HORMONES

 T3 & T4 = thyroid
hormones responsible for
our metabolic rate,
synthesis of protein,
breakdown of fats, use of
glucose for ATP production
 Calcitonin = responsible
for building of bone &
stops reabsorption of bone
(lower blood levels of
Calcium)
Shahzad Bashir. 2/14/2019
18-11
12 Shahzad Bashir. 2/14/2019
 PARATHYROID GLANDS
18-13

 4 pea-sized glands found on back of thyroid gland.

Shahzad Bashir. 2/14/2019

 HISTOLOGY OF PARATHYROID GLAND.
14

 Principal cells
produce parathyroid
hormone (PTH).
 Oxyphil cell function
is unknown.

Shahzad Bashir. 2/14/2019

 PARATHYROID HORMONE
15

 Raise blood calcium levels:

 Increase activity of osteoclasts.
 Increases reabsorption of Ca2+ & Mg2+ by kidney.

 Inhibits reabsorption of phosphate (HPO4)2-.

 Promote formation of calcitriol (vitamin D3) by kidney

which increases absorption of Ca2+ and Mg2+ by
intestinal tract.
 Opposite function of calcitonin.

Shahzad Bashir. 2/14/2019

REGULATION OF CALCIUM BLOOD LEVELS

 High or low blood levels of Ca2+ stimulate the release of

16 different hormones --- PTH or CT.
Shahzad Bashir. 2/14/2019
FUNCTION OF THYROID & PARATHYROID GLAND.

17

ENDOCRINE HORMONE. FUNCTION.

GLAND.
Regulate metabolic rate.
T3 & T4. Regulate physical & mental
growth & development.
THYROID
Decrease serum Ca by increasing
bone deposition.
CALCITONIN.

PARA- PTH, Increase serum calcium by

(Parathyroid promoting bone decalcification.
THYROID Hormone)
Shahzad Bashir. 2/14/2019
 THYROID HORMONE
18

 Thyroid hormone increases the metabolism and

protein synthesis in almost all body tissues.
 It is also necessary for brain development and
growth in infants for 6 months.

Shahzad Bashir. 2/14/2019

 HYPOTHYROIDISM
19

 Underactive state of the thyroid gland hyposecretion

of thyroid hormone.
 Most common in women, middle-age.
 Primary function is to control the level of cellular
metabolism by secreting thyroxin (T4) and triiodothyronine
(T3).

 Hypothyroidism can occur as a

 Congenital.
 Acquired.

Shahzad Bashir. 2/14/2019

HYPOTHYROIDISM
A state of low serum TH levels
or cellular resistance to TH.
Iodine deficiency.
Autoimmune. Oncologic.
Developmental. Drugs.
Dietary. Iatrogenic.
Non-thyroidal.
Endocrine.
PATHOPHYSIOLOGY

 Inadequate secretion of thyroid hormone  general

slowing of all physical and mental process.
  Metabolic rate.
  Oxidation of nutrients for energy.
  Heat production.
 CONGENITAL HYPOTHYROIDISM
23

Causes:
 Lackof TSH.
 Abnormal biosynthesis of thyroid hormone.
 Congenital Hypothyroidism is the cause of
preventable mental retardation.
 It is present at birth.
 The manifestations of untreated is referred as
cretinism(Severe physical & mental retardation resulting from severe
deficiency of thyroid in infancy or childhood)

Shahzad Bashir. 2/14/2019

 Conti…
24

 Untreated congenital hypothyroidism impairs body

growth and mental retardation.
 Require lifetime hormone replacement.
 Antithyroid drugs Carbimazole and methimazole
can easily cross the placenta and block the fetal
thyroid function.

Shahzad Bashir. 2/14/2019

 ACQUIRED HYPOTHYROIDISM/ MYXEDEMA.
25

 Hypothyroidism in adults causes the Myxedema.

 Slow the metabolic process.
 Non pitting edema.
 It is normal and few sign and symptoms.
 Myedematous coma is life threating.
 Myedematous coma is dysfunction of thyroid gland.
 MYXEDEMA COMA- A condition resulting from
persistent low thyroid production.

Shahzad Bashir. 2/14/2019

 Conti….
26

 Causes:
 Thyriodectomy.
 Lithiumbicarbonate.
 Carbimazole and methimazole.
 Amiodarone.

Shahzad Bashir. 2/14/2019

28 Shahzad Bashir. 2/14/2019
 TREATMENT.

Med. Mgt. – Thyroid replacement therapy.

Levothyroxine (Synthyroid) , liothyronine.
Expected effects: diuresis, puffiness,
improved reflexes and muscle tone, PR.
 HASHIMOTO’S THYRIODITIS.
30

 Hakaru Hashimoto, a Japanese surgeon working in

Berlin, Germany. His report, published in 1912.
 It is most commonly caused by autoimmune.
 Thyroid gland may be totally destroyed by
immunologic process.
 It is major cause of goiter and hypothyroidism.

Shahzad Bashir. 2/14/2019

 Conti…
 Fatigue
31
 Depression
 Weight gain
 Cold intolerance
 Excessive sleepiness
 Dry, coarse hair
 Constipation
 Dry skin
 Muscle cramps
 Increased cholesterol levels
 Vague aches and pains
 Swelling of the legs
Shahzad Bashir. 2/14/2019
32 Shahzad Bashir. 2/14/2019
 REFERENCES
33

Porth, M. C. (2009). Pathophysiology Concepts of

altered health states (7th ed.). USA: New York,
Lippincott Williams & Wilkins.

 Tortora, G. J. & Grabowski, S.R. (2000).

Principles of anatomy and physiology (12th ed.).
New York: John Wiley & sons Inc.

Shahzad Bashir. 2/14/2019

34

Shahzad Bashir. 2/14/2019