*Thyroiditis Differentials:

HYPO - THYROIDISM in adults --> 2 groups

--> Inflammatory Granuloma formatiion enlarged thyroid
--> Autoimmune Hashimoto enlarged thyroid

• Thyroiditis type 1 = Inflammatory Granuloma formatiion enlarged thyroid
  --> presents as PAINFUL enlarged thyroid
  --> POST VIRAL thyroiditis
  --> HYPER thyroid dominant symptoms dominate at first
  --> HYPO thyroid dominant symptoms dominate second
• Thyroiditis type 2 = Autoimmune Hashimoto enlarged thyroid
  --> PAINLESS enlarged thyroid
  --> NO illness or preceding event
  --> HYPO thyroid dominant symptoms
  
  

HYPER - THYROIDISM in adults --> 2 groups

HYPOTHYROIDISM in adults --> 2 groups

• Thyroiditis type 1 = Inflammatory Granuloma formatiion enlarged thyroid
  --> presents as PAINFUL enlarged thyroid
  --> POST VIRAL thyroiditis
  --> HYPER thyroid dominant symptoms dominate at first
  --> HYPO thyroid dominant symptoms dominate second
• Thyroiditis type 2 = Autoimmune GRAVES disease enlarged thyroid
  

Primary vs Secondary Hypothyroidism

• primary organ = thyroid gland
  --> classic low T4 high TSH
• secondary hypothyroidism = Hypothal or Pituitary
  --> low levels of TRH, and all other downstream hormones

Primary Hypothyroidism

• primary organ = thyroid gland
• classic low T4 high TSH

Secondary = CENTRAL Hypothyroidism

• secondary hypothyroidism = Hypothal or Pituitary
  --> low levels of both t4 and TRH
  --> also all other downstream hormones
• main other hormones affected = ACTH
  --> this is key and can give alopecia since ACTH is a derivative of POMC that effects melanocytes
• also low levels of sex hormones like DHEA from the ant pit can give
  --> alopecia = hair loss

*Hashimoto HYPO thyroidism:

• Thyroiditis type 2 = Autoimmune Hashimoto
  --> enlarged thyroid
  --> PAINLESS enlarged thyroid
  --> NO illness or preceding event
  --> HYPO thyroid dominant symptoms
  
  

*Inflammatory Granuloma POST VIRAL thyroidism:

• POST VIRAL Thyroiditis = Inflammatory Granuloma formatiion enlarged thyroid
  --> presents as PAINFUL enlarged thyroid
  --> following a Viral illness
  --> HYPER thyroid dominant symptoms
  
  

THYROID STORM GOD wrecking havoc on all the people down below and how they DEFEATED HIM

-

*Anatomy of Thyroid

• arteries and nerves to the thyroid gland
• recurrent laryngeal loop around and enter the thyroid area from below
  --> it then goes into the thyroid and arytenoid cartilage to supply all the laryngeal muscles of the vocal cords etc.

*Blood vessels and nerve of the Thyroid

• arteries and nerves to the thyroid gland
• recurrent laryngeal loop around and enter the thyroid area from below
  --> it then goes into the thyroid and arytenoid cartilage to supply all the laryngeal muscles of the vocal cords etc.
  --> note ONLY the cricothyroid is supplied by the ?
• inferior thyroid artery runs right by the recurrent laryngeal

*T3 and T4 - Thyroid Hormones production

• thyroglobulin is a protein that gathers BOTH iodine and tyrosine
  --> binds tyrosine to iodine
  --> makes both DIT = diiodotyrosine + MIT = monoiodotyrosine
• T3 = MIT + DIT
• T4 = DIT + DIT

HASH TAG MOTO with THIGHS THIGH DROID is battling the other THIGH DROIDs in the MOTO ARENA

other THIGH DROIDS in the battle are

• ANTI TPO THIGH DROID who uses H2O2 GUNS to kill the other THIGH DROIDS
• then there is ANTI THIGH DROID GOBLIN who is a sneaky GOBLIN driver
  
  

in the STANDS watching the HASHTAG MOTO THIGH DROIDS battle are the NUNTENDER LARGE THYROID NUN

• NUNTENDER LARGE THYROID NUN is crazy and loves watching HASH TAG MOTO THIGH DROIDS battle each other
• NUNTENDER LARGE THYROID NUN sits on her NUN HODGE KING with LIME FOAM
  --> increase NUN HODGE KING LIME FOAM cancer in HASTAG MOTO
• NUNTENDER LARGE THYROID NUN is also HIGH FIVING a HULA HOOPING HIGH 5 DR
  --> HLA DR5 in HASH TAG MOTO

Diffuse lymphocytic infiltration of thyroid with WELL developed GERM CENTRES

• seen in autoimmune Hashimoto HYPO thyroidism

*Hypercholesteremia in HYPOthyroid

• there is a decrease in LDL receptors in HYPOthyroid
• think in HYPO thyroid everything gets BIGGER, SLOWER, and KEPT IN the body
  --> weight gain
  --> constipation
  --> tired and fatigued
• the 2 exceptions though are:
  --> menorrhagia in women (blood leaves the body)
  --> get lower LDL receptors leading to HYPERcholesterol

*HYPER thyroidism

• there is an increase in LDL receptors in HYPER thyroid
• think in HYPER thyroid everything gets SKINNIER, FASTER, and LEAVES the body
• HYPERthyroiodism = EVERYTHING a WOMAN WANTS...
  --> weight loss
  --> HOT all the time
  --> diarrhea
  --> anxiety
• the 2 exceptions though are:
  --> amennorhea in women (blood leaves the body)
  --> get higher LDL receptors leading to HYPOcholesterol

*thyroid Peroxidase

• does the 3 main steps of t3/t4 production
• oxidation of iodide
  --> from I- to I2
• organification of I2 into Thyroglobulin
• coupling of MIT and DIT to make either
  --> t3 = 1 MIT and 1 DIT
  --> t4 = 2 DIT
• thyroid peroxidase is blocked by thioamides =
  --> propylthiouracil = PTU

GRAVES TREATMENT leads to a GRAVES DISEASE FRANKENSTEIN that has gotten out of HAND

• he STEPS on the TSH lab BOTTLE
• T3 and T4 FORK JUMP UP HIGH to try and escape the GRAVES DISEASE FRANKENSTEIN
  
  

RADIOACTIVE GUYS get called in to clear up the situation with GRAVES DISEASE FRANKENSTEIN

• RADIOACTIVE IODINE GUYS diagnose GRAVES FRANKENSTEIN first
  --> see if he ABSORBS the IODONE they spray at him
  --> he ABSORBS the RADIOACTIVE IODINE and they confirm he is a GRAVES DISEASE FRANKNSTEIN
• RADIOACTIVE IODINE GUYS then KILL GRAVES FRANKENSTEIN by spraying him with RADIOACTIVE IODINE
  
  

Propanolol in GRAVES for symptomatic treatmnt form high T3 and T4

• t3 t4 cause high BP
  -->> BEta blockers lower BP

GRAVES DISEASE FUNERAL with the young women who PAY the GRAVE DISEASE a 20 to keep CRYING while they drink their 40s at the GRAVES DISEASE FUNERAL

• CRYING with their OPTHALMO and EXTRUDING X EYES
  --> opthalmopathy
  --> exopthalmos
  
  • they want TISSUE and grab the GRAVE FUNERAL ANTI TSH TISSUE BOX receptor who is trying to leave the GRAVE FUNERAL
  • the GRAVE FUNERAL 2 CRYING SISTERS get so DRUNK that they try and bury the THYROOIDS bet GOITRE GOAT with him ALIVE
    
    

meanwhile in the corner of the GRAVES FUNERAL there is a PRAYING TIBETAN MIXER MONK praying for the GRAVE FUNERAL HYPERTHYROID

• PRAYING TIBETAN MIXER MONK at the GRAVES DISEASE THYROID FUNERAL
  --> pretibial mixodema

*Exopthalmos and pretibial myxedema

• note the exopthalmos and the pretibial myxedema are from the excess activity of fibroblasts fromt he IgG stimulating the TSH receptors there
• it is NOT from the excess Thyroid hormone
• the increase in the TSH receptors behind the eyes and in front of the shins = pretibial area
  --> these increase the activity of fibroblasts
  --> fibroblasts relese glycosaminoglycans
  --> this is the main driving factor and causes inflammation and swelling
  --> leads to BOTH exopthalmos and pretibial myxedema

*Exogenous Hyperthyroidism

• you must always consider exogenous hyper thyroid in patients who are anorexic or bulemic or just want to lose weight
  
  • important to know if a close family member has thyroxine tablets that they may steal and use

*POMC and ACTH in hypothyroidism

• ACTH is a derivative of POMC
  --> this is key and can give alopecia since ACTH is a derivative of POMC that effects melanocytes

*Levothyroxine tx for HYPO thyroid

• levothyroxine = T4 analogue
  --> this is important that it is T4 and not T3
  --> since T4 to t3 conversion in peripheral tissues is done by the body so it maintains the proer dose
• note that levothyroxine levels are monitored by the response of TSH to it
  --> so if someone has a hypothyroid and they are on levothyroxine
  --> if their TSH gets way too low, this indicates that you have to lower the t3 levo dose

High Dose levothyroxine

• note that levothyroxine levels are monitored by the response of TSH to it
  --> so if someone has a hypothyroid and they are on levothyroxine
  --> if their TSH gets way too low, this indicates that you have to lower the t3 levo dose
• puts at risk of all the hyperthyroid dangers
  --> atrial fibrillation is the most common and most dangerous one

*Estrogen increases TBG = thyroid binding proteins

• this is the reason for hyperthyroidism during pregnancy
• most women just get an increase in PBGs and
  --> get a slight reduction in free t4
  --> the posterior pit releases more TSH to make more t4 and t3
  --> the extra t4 and t3 saturate the newly made TBPs
  --> free thyroid returns to nromal = euthyroid
  --> then TSH also returns to normal levels

*Investogation and Dx of Thyroid Problems

• always measure TSH levels first before t4 and t3
• small changes in T4 lead to big changes in TSH
  --> thus it is a more sensitive test for BOTH hyper and hypothyroidism