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Thyroid disorders :balloon: (:thought_balloon: Hypothalamic-Pituitary…
Thyroid disorders :balloon:
:maple_leaf:
Scope
:thought_balloon:
Hypothalamic-Pituitary-Thyroid Axis
and
Thyroid hormone synthesis
HPT axis
Thyroid system embryogenesis
Anatomic
deve of HPT occurs during
1st tri
Thyroid gland: fr Primitive pharyngeal floor, 4th pharyngeal pouch
Anterior pituitary: fr Rathke's pouch
Functional
deve of HPT
Hypothalamus: TRH @ GA 10-12 wks
Pituitary: TSH @ GA 10-12 wks
Thyroid gland:
Iodine conc & iodothyronine synthesis @ GA around 10 wks
Well synthesized thyroid hormone @ GA 18-20 wks
Placental iodine & Thyroid metabolism
Thyroid system maturation
Thyroid hormone synthesis
Tg synthesis
Iodide trapping
Organification & Coupling
Proteolysis of Tg & Deiodination of iodotyrosine
Actions of thyroid hormones
:owl: CNS deve
Stimulation of neuronal cell migration & maturation
:arrow_up:myelinogenesis ➯ smart
:owl: Growth & Deve effects ➯ stimulation of
Pituitary GH synthesis & GH secretion
IGF syntehsis & action
Growth factor proudction
Bone metabolism & growth
:owl: Thermogenic effects ➯ stimulation of
Mitochondrial enz. synthesis
UCP-1, UCP-2 in brown adipose tissue
:owl: Metabolic effects:
Carb, Lipids, Proteins, Nucleic acids, Vitamins & Inorganic ions
:thought_balloon:
Hypo
thyroidism :rainbow-flag:
:large_blue_diamond:
Congenital
hypothyroidism
:large_blue_diamond:
Acquired
hypothyroidism
:thought_balloon:
Hyper
thyroidism
Congenital
Transplacental of maternal stimulating TRAb
or Neonatal thyrotoxicosis?
Neonatal Thyrotoxicosis Def: Transient disorder acquired by transplacental transport of TSH receptor antibodies
Clinical
manifestations
Thyromegaly
Tachycardia
Irritability
Poor feeding
Poor weight gain
Onset
Mayb
within 24 hrs of birth
or
as late as 6 wks after delivery
:leaves:
Dx
A Hx of maternal hyperthyroidism
TFT: :arrow_up:FT4, :arrow_up:T3 and :arrow_down: TSH
:green_apple:
Mx
:warning:
avoid external stimuli
PTU, MMI
(MMI is prefer in child)
Beta-blocker ➯ to :arrow_down: tachycardia
Iodine solution: Lugol's solution
Activating TSH receptor mutation
Acquired
:stars:
:stars:
Graves' disease
:rainbow-flag::
Hashitoxicosis
Subacute thyroiditis
Exogenous thyroxine exposure
McCune-Albright syndrome
TSH dependent hyperthyroidism
TSH receptor mutation