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Endocrine Tutorial

Endocrine Tutorial. Hyperthyroidism. Clinical features. Hyperthyroidism. Clinical features CVS: tachycardia, palpitations, atrial fib CNS: tremor, anxiety, lability, insomnia Heat intolerance; warm, moist, flushed skin Weight loss with increased appetite. Hyperthyroidism.

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Endocrine Tutorial

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  1. Endocrine Tutorial

  2. Hyperthyroidism • Clinical features

  3. Hyperthyroidism • Clinical features • CVS: tachycardia, palpitations, atrial fib • CNS: tremor, anxiety, lability, insomnia • Heat intolerance; warm, moist, flushed skin • Weight loss with increased appetite

  4. Hyperthyroidism • Clinical features • CVS: tachycardia, palpitations, atrial fib • CNS: tremor, anxiety, lability, insomnia • Heat intolerance; warm, moist, flushed skin • Weight loss with increased appetite • Causes

  5. Hyperthyroidism • Clinical features • CVS: tachycardia, palpitations, atrial fib • CNS: tremor, anxiety, lability, insomnia • Heat intolerance; warm, moist, flushed skin • Weight loss with increased appetite • Causes • Graves disease • Exogenous thyroid hormone • Functioning multinodular goitre/thyroid adenoma • Thyroiditis • Secondary (hypothal/pituitary dysfunction)

  6. Hypothyroidism • Clinical features

  7. Hypothyroidism • Clinical features • CVS: bradycardia, cardiomegaly, pericardial effusion • CNS: slowed mental activity, apathy, fatigue, cretinism • Cold intolerance; cool skin; myxedema; hair loss • Weight gain with decreased appetite • Coarsening of features

  8. Hypothyroidism • Clinical features • CVS: bradycardia, cardiomegaly, pericardial effusion • CNS: slowed mental activity, apathy, fatigue, cretinism • Cold intolerance; cool skin; myxedema; hair loss • Weight gain with decreased appetite • Coarsening of features • Causes

  9. Hypothyroidism • Clinical features • CVS: bradycardia, cardiomegaly, pericardial effusion • CNS: slowed mental activity, apathy, fatigue, cretinism • Cold intolerance; cool skin; myxedema; hair loss • Weight gain with decreased appetite • Coarsening of features • Causes • Hashimoto thyroiditis • Surgery / Radiation / Drug-induced • Infiltration by tumour • Secondary (hypothal/pituitary dysfunction)

  10. Graves disease • Epidemiology • What type of people get Graves disease?

  11. Graves disease • Epidemiology • Women, 20-40 yrs, (M:F = 1:7)

  12. Graves disease • Epidemiology • Women, 20-40 yrs, (M:F = 1:7) • Pathogenesis

  13. Graves disease • Epidemiology • Women, 20-40 yrs, (M:F = 1:7) • Pathogenesis • Autoimmune disorder • Activation of thyroid by thyroid autoantibodies • Anti-TSH R, anti-thyroglobulin, anti-T3/T4 • Associated with certain HLA types • Associated with other AI disorders • Hashimoto thyroiditis, pernicious anaemia, rheumatoid arthritis

  14. Graves disease • Gross findings • Mild symmetrical thyroid enlargement • Eyes: exophthalmos, lid retraction, lid lag • Skin: pretibial myxedema

  15. Graves disease • Microscopic findings Graves disease Normal thyroid

  16. Graves disease • Microscopic findings

  17. Hashimoto Thyroiditis • Epidemiology

  18. Hashimoto Thyroiditis • Epidemiology • Women, 45-65 yrs, (M:F = 1:10 to 20)

  19. Hashimoto Thyroiditis • Epidemiology • Women, 45-65 yrs, (M:F = 1:10 to 20) • Pathogenesis

  20. Hashimoto Thyroiditis • Epidemiology • Women, 45-65 yrs, (M:F = 1:10 to 20) • Pathogenesis • Autoimmune disorder • Destruction of thyroid by thyroid autoantibodies • Anti-TSH R, anti-thyroglobulin • Associated with certain HLA types • Associated with other AI disorders • SLE, pernicious anaemia, rh. Arthritis, Sjogrens, IDDM, Graves • May cause transient hyperthyroidism in early stages • Gradual destruction and fibrosis  hypothyroidism

  21. Hashimoto Thyroiditis • Gross findings • Enlarged pale thyroid initially • Atrophic thyroid eventually

  22. Hashimoto Thyroiditis • Microscopic findings

  23. Hashimoto Thyroiditis • Microscopic findings

  24. Thyroiditis • Painful • Infectious • Adjacent sinusitis, mycobacteria, fungi • Subacute (granulomatous) • Post viral • Painless • Hashimoto’s • Fibrous • Fibrosis, atrophy, hypothyroidism

  25. Goitre • What is it?

  26. Goitre • What is it? • Enlarged thyroid • Due to impaired thyroid hormone synthesis

  27. Goitre • What is it? • Enlarged thyroid • Due to impaired thyroid hormone synthesis • Causes

  28. Goitre • What is it? • Enlarged thyroid • Due to impaired thyroid hormone synthesis • Causes • Iodine deficiency • Goitrogens • Inherited disorders

  29. Goitre • Pathogenesis • Hyperplasia of follicular epithelium • Increased thyroid hormone release (decreased colloid) • Involution of follicles when enough thyroid hormone released • Accumulation of colloid • Two forms: • Diffuse • Multinodular

  30. Goitre • Gross findings • Diffuse: Diffuse enlargement without nodules • Multinodular:

  31. Goitre • Microscopic findings • Diffuse (initial hyperplastic stage): • Hyperplastic and hypertrophied follicles • Decreased colloid • Diffuse (involution stage) • Dilated follicles, atrophic epithelium • Abundant colloid

  32. Goitre • Microscopic findings • Multinodular goitre: • Recurrent episodes of stimulation and involution • Hyperplastic and hypertrophied follicles with decreased colloid • Dilated follicles with atrophic epithelium and abundant colloid • Haemorrhage, fibrosis, calcification, cyst formation

  33. Thyroid neoplasms • Risk factors • M:F = 1:4 • Radiation therapy • Hashimoto’s • Multinodular goitre • Types • Follicular adenoma • Carcinoma • Papillary • Follicular • Anaplastic • Medullary

  34. Follicular adenoma • Morphology:

  35. Follicular carcinoma • Morphology: • Same as follicular adenoma! BUT • Vascular / capsular invasion • Haematogenous mets

  36. Papillary carcinoma • Morphology:

  37. Papillary carcinoma • Morphology:

  38. Causes of hyperparathyroidism Parathyroid hyperplasia Parathyroid adenoma

  39. Hyperadrenalism • Presentation • Cushing’s syndrome • Conn’s syndrome • Causes • Primary • Hyperplasia, adenoma, carcinoma • Secondary • Hypothalamic/pituitary disorders • Ectopic ACTH secretion • Activation of renin-angiotensin system

  40. Causes of hyperadrenalism hyperplasia carcinoma adenoma

  41. haemorrhage metastases infection (TB) Causes of hypoadrenalism

  42. Pancreatic islet cell tumour + Pituitary adenoma + Parathyroid hyperplasia = MEN I

  43. Phaeochromocytoma + Medullary carcinoma of thyroid + Parathyroid hyperplasia = MEN II

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