June 4, 2023

Thyroid lecture, Hyperthyroidism, Hyperthyroidism, goiter, levothyroxine, USMLE, medical, Roze pharm

Hypothyroidism and hyperthyroidism thyroid the gland is located near the throat thyroid is composed of thousands of follicles which secrete t4 levothyroxine and history triodo thyronine thyroid increases the metabolic rate of the body makes body quicker controls temperature neurological and cardio functions also it secretes calcitonin so this is why in contrast

Pth decreases concetonin thyroid t4 so we can diagnose whether the person has disability or is thick by looking at the tsh hormone the normal range is from 0.4 to 4.0 but in for example this patient has higher tsh so we can suspect the hypothyroidis in here the thyroid and iodine iodine so t4 is level thyroxine composes of 93 percent of total amount it is in

Active form and has longer half-life whereas t3 brand bio-thyronine composes of seven percent of total amount it is active form but short and potent t3 molecule is involved in the thyroid hormone receptor and when gene transcription happens mrna works and synthetics of neoprotein happens so thyroxine is related with growth cns development cardiovascular results

Such as increase in cardiac output tissue body flow raising heart rate heart strength respiration and metabolism so when infants have extreme hypothyroidism which is low thyroid the infant will have suffered from cretinism such as in the picture does iodine matter yes iodine is material of t3 and t4 it is in the food such as bread eggs salt seafood and milk when

Iodine is low so yeah for example during pregnancy diet hormone production is increased by 50 percent the pregnant woman needs to take iodine supplement iodine lack can lead to creativism in child or goiter so when iodine is high for example in high parts thyroidism iodine excess can cause resistance problem so iodine excess can happen because of taking too much

Iodine containing topical drugs such as amyodaran a radiographic contrast agent so let’s compare between hypothyroidism and hyperthyroidism hypothyroidism is a lack of thyroid so the person increases weight there is a bad depression extreme tiredness memory loss and brain fog and yet a person has slow mind swelling of the face slow pulse rate constipation so

These patients need level thyroxine after taking levothyroxine for six months regularly things will start coming back to life and we have drugs such as l-toxin or eutroxic hyperthyroidism yep the most common cause of this is autoimmune disorder called hashimoto’s disease so think hashimoto is slow and tired person the thyroid antibodies from our body takes our

Own thyroid gland literally it is me attacking myself then it reduces the function and capability most commonly targeting thyroid or oxidase other common causes of hypothyroidism include medicines like lithium directly interfere with thyroid hormone secretion and drug that contains iodine such as amiodarone interfere with thyroid hormone synthetes um evolumab

Or other immunomodulators medicines induce autoimmune thyroiditis and surgery such as thyroidectomy or radioiodine treatment reduces the size of thyroid gland this is the picture of hypothyroidism from wikipedia how do we treat hyperthyroidism with t4 the level of thyroxine a half-life of level thyroxine is one week so we need to wait at least four weeks to

Do tft monitoring and recheck starting dose of level tyroxine is 50 to 100 microgram early daily we have to gradually increase by 25 to 50 in four week term if we increase too quickly then it may cause tachycardia because half-life is one week goal of therapy is returning tsh to the normal range and t4 is not reliable so we should diagnosis with t3 not t4 so

The drug includes l-toxin and eutroxic let’s talk about primary hypothyroidism so there’s a dysfunction of the thyroid gland by autoimmune disease or iodine deficiency the thyroid gland is dysfunctional so we have low production of t4 so low t4 is the reason then it tells hypothalamus and ontario pituitary to increase their activities result is the t um trh

Is rising and tsh is also rising so this might result in the enlarged thyroid gland as known as goiter because they keep once the hypothalamus and ontario pituitary to work so it is becoming large let’s talk about second secondary hypothyroidism so for this there’s something wrong with the organs that are upstream so hypothalamus and ontario pituitary there’s

Something wrong so naturally they cannot produce enough trh and tsh it is not stimulating the thyroid gland at all the t4 is low natural defect of trh hormone and tsh hormone is leading to the low lack of t4 it cannot do anything hyperthyroidism let’s talk about primary hyperthyroidism so the cause is the high t4 because thyroid gland is so overactive so it can

Be due to autoimmune conditions or toxic later the increased t4 in blood will do negative feedback to decrease activities of hypothalamus or the ontario pituitary so high t4 results in very low trh and very low tsh secondary hyperthyroidism uh here the ontario pituitary is overactive for any some reason it produces a large amount of tsh the result is increased

T4 liver dioxin production here ontario pituitary is working independently so the result is high tsh and high t4 hyperthyroidism the most common cause is autoimmune disease like graves disease grave is fast and always busy in contrast to hashimoto’s disease the antibodies in graves disease stimulate the tsh receptor to cause an increase in thyroid gland tissue

Called hyperplasia the result is increased thyroid hormone production race disease effect eyes which looks like it’s going to pop out so another common cause of is toxic oil and toxic adenoma here thyroid cell mutation results in higher hyper function nodules that produce increased t3 hormone and increased t4 hormone independent of external tsh effects oil is

Conditioned of enlarged thyroid gland the other causes are the drugs that has excessive iodine for example a meoduran a drug that has destructive thyroiditis such as amiodarone or too much dose of levothyroxine so we treat a hyperthyroidism by anti-thyroid drug and first line is carbimuzole the second line is propyl russell so it prevents the inactive tfl to

Become active t3 in peripheral tissues we take it 300 milligrams early daily however we have the side effect called agranulocytosis or jaundice or lace so if this happens please stop the medicine yep so agronocytosis is the situation that bone marrow cannot produce enough white blood cell so it’s mostly likely to occur in the first months of starting therapy so

If there’s acute malaise fever or infection severe pharyngitis a patient should stop immediately and do not use cavity muscle or prophyla rather in a patient who had passed history but consider the other situation to treat hyperthyroidism such as trio trioidectomy or radioiodine

Transcribed from video
Thyroid lecture, Hyperthyroidism, Hyperthyroidism, goiter, levothyroxine, USMLE, medical, Roze pharm By ROZE PHARM