Thyroid disorders
Prepared by
Mr. Shrikant Gaikwad
Lecturer
Definition
Hyperthyroidism Hypothyroidism
• Hyperthyroidism is a condition • Hypothyroidism is a condition
where the thyroid gland where the thyroid gland is
produces excessive amounts of underactive and does not produce
thyroid hormones. This leads to enough thyroid hormones. This
can lead to a slowed metabolism
an overactive metabolism and
and a range of symptoms,
symptoms like weight loss,
including fatigue, weight gain, and
rapid heartbeat, and irritability.
sensitivity to cold.
Etiopathagenesis
Hyperthyroidism Hypothyroidism
Autoimmune disorders Primary hypothyroidism
• Graves' disease is an autoimmune disorder that's the most
• The most common cause of hypothyroidism, this is
common cause of hyperthyroidism in the United States. In
Graves' disease, thyroid-stimulating antibodies activate thyroid- when the thyroid gland itself is diseased and doesn't
stimulating hormone (TSH) receptors, which triggers the produce enough thyroid hormones. The most
synthesis of thyroid hormones. Risk factors for Graves' disease common cause of primary hypothyroidism is
include being female and having a family history of autoimmune Hashimoto's disease, an autoimmune disorder that
disorders.
destroys the thyroid gland with antibodies and
lymphocytes.
Excessive iodine
• Hyperthyroidism can be caused by excessive iodine intake from
diet or medications like amiodarone or contrast media. Secondary hypothyroidism
• This is caused by pituitary disorders that decrease the
Thyroiditis release of thyroid-stimulating hormone (TSH) and
• Thyroiditis can cause destructive changes to the thyroid that levels of T3 and T4.
lead to the release of thyroid hormones without increased
synthesis.
Iodine deficiency
Drugs and antineoplastic agents • This can cause endemic goiter and goitrous
• Various drugs and antineoplastic agents can cause thyroid hypothyroidism. In areas with severe iodine
dysfunction deficiency, congenital hypothyroidism can be a major
cause of intellectual disability.
Clinical manifestation
Non pharmacological management of hyperthyroidism
Diet
• You can try eating a healthy diet that's low in iodine, which can increase the effectiveness of medical
treatment. You can also try eliminating foods you suspect are allergens, like dairy, wheat, soy, corn, and
preservatives. You can also try eating foods rich in B vitamins and iron, like whole grains, fresh vegetables,
and sea vegetables.
Stress management
• You can try to manage stress through relaxation techniques like meditation, yoga, Tai Chi, or deep
breathing. You can also try taking a short walk outside.
Supplements
• You can try taking supplements like selenium, zinc, and vitamin B12. Selenium can help balance T3 and T4
levels, zinc can improve thyroid function, and vitamin B12 can help repair damage caused by
hypothyroidism.
Eye care
• If you have Graves' disease that causes eye problems, you can try wearing sunglasses to protect your eyes
from the sun and wind. You can also try using eye drops to relieve dryness and scratchiness. You can also
try raising the head of your bed to lessen swelling and ease pressure on your eyes.
Non pharmacological management of hypothyroidism
• Lifestyle changes
• Getting enough sleep, exercising, and reducing stress can help manage hypothyroidism. Some recommend
sleeping at the same time every night and early in the evening. Exercises like swimming, walking, Pilates, and
Zumba can also help.
• Nutrition
• Reducing sugar and processed foods, and increasing vitamin B12 and selenium intake may help. Some natural
remedies include ashwagandha, gum guggul, and coleus forskohlii.
• Complementary and alternative medicine (CAM)
• Some CAM practices that may help include:
• Herbs: Can help strengthen and tone the body's systems
• Homeopathy: May be useful as a supportive therapy
• Contrast hydrotherapy: Applying hot and cold to the neck and throat may stimulate thyroid function
• Acupuncture: May help correct hormonal imbalances
Pharmacological management of hyperthyroidism
Pharmacological treatment for hyperthyroidism aims to reduce the overproduction of
thyroid hormones and manage symptoms. The main options include:
1. Antithyroid Medications:
• Methimazole (Tapazole): This drug inhibits thyroid hormone synthesis by blocking the
enzyme thyroid peroxidase. It is commonly used due to its effectiveness and generally
better side effect profile compared to propylthiouracil (PTU). Dose: Starting dose is 10-
30mg /day and maintenance dose is adjusted based on thyroid function tests.
• Propylthiouracil (PTU): Similar to methimazole, it also inhibits thyroid hormone
synthesis but additionally blocks the conversion of T4 to T3 in peripheral tissues. It is
often used during the first trimester of pregnancy or in cases where methimazole is not
suitable. Dose: Satrting dose is 100-150mg every 6-8 hours. Maintenance dose is
adjusted based on thyroid function tests. PTU is less commonly used due to high risk of
liver toxicity.
2. Beta-Blockers:
• Propranolol, Atenolol, Metoprolol: These are used to
manage symptoms such as rapid heart rate, anxiety,
and tremors. They do not affect thyroid hormone levels
directly but can provide symptomatic relief. Dose:
Propranolol initiated at 20-40mg every 6 hours and
adjusted based on symptoms.
3. Radioactive Iodine Therapy:
• Though not a medication, it involves the oral administration of radioactive
iodine, which is absorbed by the thyroid gland, leading to destruction of
overactive thyroid tissue. This treatment is used for long-term management and
can lead to hypothyroidism, which is then managed with thyroid hormone
replacement therapy. Dose is calculated to achieve therapeutic effect.
• The choice of treatment depends on various factors including the patient’s
overall health, age, presence of other conditions, and the cause of
hyperthyroidism. Regular monitoring and follow-up are essential to assess
treatment efficacy and adjust dosages as needed.
What is Thyrotoxicosis?
• Thyrotoxicosis is a condition caused by excessive levels of thyroid
hormones in the body, leading to symptoms like rapid heartbeat, weight
loss, tremors, and sweating.
• It can result from various disorders, including hyperthyroidism
(overactive thyroid gland), thyroiditis (inflammation of the thyroid), or
excessive intake of thyroid hormone medication.
• It is accompanied by delirium, vomiting, diarrhoea, fever, and coma.
Acute illnesses like stroke, infections, diabetic ketoacidosis, trauma,
patients having surgery, or radiation therapy are the usual causes.
Treatment
• Propylthiouracil tablet: 600 mg loading dose; thereafter, 200-300 mg orally or via Ryle's tube
every 6 hours. or 15-25 mg tablet Carbimazole, taken every 6 hours (antithyroid medication).
• After the initial dosage of the antithyroid medication, administer 5 drops of saturated
solution of potassium iodide (SSKI) every 5 hours, 10 drops of Lugol's iodine three times a
day, or 1 g of sodium iodide intravenously (IV) slowly.
• Propranolol tablet 40-60 mg every 4 hours or intravenous 0.5-2 mg every 4 hours (beta
blocker).
• Injection Dexamethasone 2 mg (IV) 6 hourly. Continue taking dexamethasone and iodides
until a normal metabolic state is reached.
• Provide supportive care, including cooling, antipyretics, intravenous fluids, antibiotics for
infection, etc.
• Once the patient is stable, definitive therapy with radioactive iodine or surgery are explored.
Pharmacological management of hypothyroidism
• Hypothyroidism is treated pharmacologically with lifelong thyroid replacement
treatment. Levothyroxine is the first-line option for replacement therapy; it is a
synthetic version of T4 (thyroxine). The first-choice medication is levothyroxine due
to its uniform potency, lack of antigenicity, chemical stability, and reasonable cost
Use of it during pregnancy is safe.
• Drug: Levothyroxine sodium
• Mechanism of Action: Levothyroxine is a synthetic form of thyroxine (T4), the
inactive thyroid hormone. Once administered, it is converted to triiodothyronine (T3)
in the body. It replaces or supplements the deficient thyroid hormone in patients
with hypothyroidism.
• Dose: The typical starting dose for adults is 25-50 mcg per day, with adjustments
made based on individual response and thyroid function tests. Maintenance doses
vary but are commonly in the range of 75-200 mcg per day.
Thankyou
