Thyroid. Structure and functions. Thyroid thyroid hormones presentation Presentation of thyroid hormones

slide 3

Fascia of the neck. Blood supply to the thyroid gland.

slide 4

Hormones synthesized by thyrocytes.

1) hormones - tetraiodothyronine (thyroxine, T4); triiodothyronine (T3), reverse triiodothyronine (p-T3), diiodothyrosine (DIT) and monoiodothyrosine (MIT); 2) protein compounds - thyroglobulins. The precursor of T3 and T4 is the amino acid L-tyrosine.

slide 5

Chemical structure of thyroid hormones

slide 6

Function of iodine-containing hormones:

1. Activate the processes of energy production, accelerate the catabolism of proteins, fats and carbohydrates (basal metabolism and consumption of O2 increase, protein synthesis and activity of Na *, K *, ATPase are stimulated) 2. Increase glycogenolysis (increase in blood sugar levels) (heart rate and cardiac output increase, nervousness, irritability, muscle tremor appear and muscle hypotrophy occurs)

Slide 7

The mechanism of regulation of the synthesis of thyroid hormones

Slide 8

The main symptoms that characterize the hypofunction of the thyroid gland.

Apathy and drowsiness Decreased memory Chilliness and poor tolerance to cold Weight gain with reduced appetite Pain in the muscles Swelling of the face and extremities Hair loss, brittle nails

Slide 9

The main symptoms that characterize the hyperfunction of the thyroid gland.

Tearfulness and irritability Feeling of heat and poor heat tolerance Weight loss with increased appetite Sweating, palpitations, diarrhea. Tachycardia, tremor, eye symptoms and goiter.

Slide 10

Diagnosis of thyroid diseases

Inspection and palpation

slide 11

Radioisotope scanning (thyroid scintigraphy) (iodine-131, preferably iodine-123 and technetium-99)

slide 12

Radioisotope study of the thyroid gland

slide 13

Ultrasound examination (size, volume of lobes, echostructure) X-ray examination - soft tissue radiography and CT scan of the cervical trachea. (displacement, narrowing of the trachea and esophagus, retrosternal goiter) Biopsy of the thyroid gland (fine-needle, trepan-biopsy) under ultrasound control.

Slide 14

Thyroid ultrasound

slide 15

Study of the functional activity of the thyroid gland

Main markers: total and free thyroxine (T4) total and free triiodothyronine (T3) pituitary thyroid stimulating hormone (TSH) In latent diseases, special functions. tests (stimulating test with thyroliberin, suppression test using triiodothyronine) Achievement of recent years - more sensitive non-isotope technologies of hormonal immunoassay (systems "Amerleit", "Delphia")

slide 16

Classification

I. Congenital anomalies: a) aplasia and hypoplasia (with hypothyroidism or myxidema); b) ectopia of the gland tissue (abberant forms of goiter) c) non-closure of the lingual-thyroid duct (median cysts and fistulas of the neck) II. Endemic goiter: a) 0, I, II st. enlargement of the gland b) in form: diffuse, nodular, mixed c) in terms of functional manifestations: euthyroid, hyperthyroid, hypothyroid III. Sporadic goiter categorized according to the same parameters as endemic goiter

Slide 18

Goiter

Goiter is called an increase in the thyroid gland due to the growth of its tissue, not associated with inflammation, hemorrhage or malignant growth. The occurrence of goiter is a compensatory - adaptive reaction of the body to specific features environment.

Slide 19

Classification of thyroid enlargement

WHO (1992) About Art. - no goiter I st. - dimensions are larger than the distal phalanx of the thumb, the goiter is palpable, but not visible II st. - the goiter is palpable and visible by ultrasound: the volume of the thyroid gland in women is more than 18 ml, and in men it is more than 25 ml - goiter is diagnosed

Slide 20

endemic goiter

According to WHO, about 1 billion live in endemic areas. About 7% of the world's population suffers from endemic goiter. Endemic areas in Russia: central part, Ural, North Caucasus, Siberia, Far East

slide 21

Etiology and pathogenesis

The main reason is iodine deficiency Consumption of less than 150-300 micrograms per day leads to a decrease in the production of thyroid hormones The feedback principle causes an increase in TSH secretion Proliferation of the thyroid epithelium is stimulated (to ensure required level secretion of thyroid hormones) Compensatory increases in thyroid mass

slide 22

MorphologyThree forms of endemic goiter: diffuse, nodular (adenomatous) and mixed Histologically - diffuse micro - or macrofollicular goiter Colloidal Vascular

slide 23

Clinic

It is determined by: The functional state of the thyroid gland The size of the goiter Localization (There is no correlation between the size of the goiter and the degree of functional changes)

slide 24

With a significant iodine deficiency, hypothyroidism appears (the disease develops gradually)

Complaints: Lethargy, drowsiness, apathy, sluggishness, chilliness, memory loss, constipation On examination: "Puffiness" of the face with poor facial expressions Edema on the body and extremities Bradycardia, decreased blood pressure Inhibition of nonspecific defense factors (Hypothyroidism in early childhood can lead to a decrease in mental development up to cretinism)

Slide 25

Diagnostics

Living or living in areas of iodine deficiency In primary hypothyroidism, the level of TSH is increased The content of T3 and T4 is reduced The test with thyroliberin is positive.

slide 26

Treatment

Methods of treatment depend on the size, morphological changes and functional state of the thyroid gland Diffuse goiter - conservative treatment (thyroidin, triiodothyronine) Surgical treatment: Nodular and mixed goiter (large size, impaired function of neighboring organs) - hemithyroidectomy Multinodular or mixed goiter - subtotal resection of the thyroid gland

Slide 27

sporadic goiter

The etiology has not been finally established (the separation of sporadic and endemic is conditional) It is assumed: 1. A number of genetic factors lead to a deficiency of triglycerides 2. Food rich in strumogens-thiocyanates (cabbage, turnips, soybeans, etc.) contributes - the content of iodine and the synthesis of triglycerides decreases The lack of triglycerides includes the same mechanism for the development of thyroid hyperplasia as in endemic goiter.

Slide 28

Diagnostics

Enlarged thyroid gland (presence of a node) Palpation data Puncture with nodular goiter Additionally Functional state(T3, T4, TSH) If it is not possible to detect the location of the thyroid gland in a typical place during p / n or its unusual growth is noted - ultrasound, CT, isotope study

Slide 29

Treatment

The principles of treatment of sporadic goiter do not differ from the principles of treatment of endemic goiter. As much as possible, unchanged thyroid tissue is preserved.

slide 30

thyrotoxicosis syndrome

The term thyrotoxicosis refers to persistent hyperfunction of the thyroid gland associated with hyperproduction of thyroid hormones (T4 and T3) and endogenous intoxication Causes of thyrotoxicosis 1. Diffuse toxic goiter, as one of the manifestations of Greevs' disease (Graves' goiter) (1835 - the disease was described by Greevs; 1821 . - Peri, 1840 - Karl Basedow) 2. Toxic adenoma of the thyroid gland - Plummer's disease. 3. Multinodular toxic goiter (Greevs' disease) is a multisystem, autoimmune disease that proceeds according to the type of delayed-type hypersensitivity.

Slide 31

Diffuse toxic goiter

Occurs ubiquitously Affects predominantly females (female to male ratio 10:1) Age 20 to 50 years Autoimmune disease (occurs in individuals with a congenital defect in immune control - an inherited special recessive gene) The basis of the disease is a defect in T-suppressors Causes: infection, insolation, severe emotional stress

slide 32

T-helpers stimulate B-cells, thyroid-stimulating antibodies (TSaB) are produced. With an excess of cortisol, the control of T-suppressors is impaired

TSaB “sit” on receptors, the gland becomes under the control of antibodies Growth of the gland is stimulated More T3 and T4 are produced

Slide 33

Clinic.

The clinical picture of diffuse toxic goiter is diverse. It is determined by the severity of thyrotoxicosis. Classic Graves' triad: exophthalmos, tachycardia, goiter

slide 34

The severity of thyrotoxicosis

Mild form: moderate weight loss (by 10-15% of body weight) Nervous excitability Pulse no more than 100 beats per minute without disturbing the rhythm and function of other organs and systems Basic metabolism does not exceed + 30% Some decrease in working capacity

Slide 35

Thyrotoxicosis of moderate severity

More significant weight loss Increased nervous excitability (mild irritability, tearfulness) Tachycardia up to 100-120 beats per minute Short-term rhythm disturbances Increased systolic blood pressure, Hc I Changes in carbohydrate metabolism Gastrointestinal disorders (frequent loose stools) Basic metabolism increased to +60 %. Significant performance degradation

slide 36

Severe (visceropathic) form of thyrotoxicosis

Sharply increased nervous excitability Significant loss of body weight up to cachexia Tachycardia over 120 beats. 1 min, atrial fibrillation Heart failure, Hc-II-III Basal metabolic rate exceeded up to + 60%. Manifest changes in the cardiovascular and nervous systems Complete loss of working capacity

Slide 37

The main clinical manifestations of thyrotoxicosis

Complaints about: a feeling of heat (a lot of thermal energy is formed) Sweating, skin is hot, moist Feeling of internal trembling, trembling of hands (a small tremor of outstretched arms, eyelids with closed eyes is typical) Fussiness, anxiety, quick speech, irritability, touchiness, tearfulness, bad dream

Slide 38

Changes in the cardiovascular system:

Tachycardia An increase in systolic and a decrease in diastolic blood pressure Left ventricular hypertrophy Atrial fibrillation Eye symptoms: exophthalmos, Stelvag, Dalrymple, Kraus, Graefe, Kocher, Mobius (damage to retrobolbubar tissue)

Slide 39

Criteria for the diagnosis of "diffuse toxic goiter":

1. High level of thyroid hormones and normal or reduced levels of thyrotropin in the blood 2. Presence of thyroid-stimulating antibodies and antibodies to thyroglobulin and microsomal fraction of the thyroid gland in the blood 3. Diffuse enlargement of the thyroid gland, determined by palpation 4. Increase in volume and diffuse decrease in the echogenicity of the thyroid tissue glands on ultrasound

Slide 40

Treatment (conservative therapy is a preparation for surgery)

Emotional and physical rest Thyrostatic drugs: a) methylmazol derivatives (mercasolil, metatilin, methylmazol) b) thiuracil derivatives (propylthiuracil) Radioactive iodine (I131) after 35-40 years Inorganic iodine (Lugol's solution) Beta-blockers

Slide 41

Indications for surgical treatment

1. Failure of conservative treatment 2. Large goiter that disrupts the function of neighboring organs 3. Young age of patients 4. Intolerance to antithyroid drugs 5. Retrosternal forms of toxic goiter 6. Toxic adenoma (nodular toxic goiter)

Slide 42

Surgical treatment of thyrotoxic goiter

The amount of thyroid tissue left after resection should be individual With the removal of most of the hyperfunctioning follicular cells, the mass of the antigen decreases. The mass of the thyroid residue ranges from 3-4 to 7-8 g. The more severe thyrotoxicosis, the more glandular tissue is removed

slide 43

Operation of choice - subtotal subfascial strumectomy according to Nikolaev

Slide 44

Complications

Rare: asphyxia in tracheomalacia; air embolism; pneumothorax; infectious complications Typical: damage to the laryngeal nerves; recurrent nerve (vocal cord paresis, impaired phonation and breathing) Hypoparathyroidism Bleeding Thyrotoxic crisis

View all slides

"Endocrine system" - The cortical substance includes: glomerular bundle and reticular zones. In the neurohypophysis, oxytocin and antidiuretic hormone (vasopressin) are deposited. Lymph-epithelial organ located in the chest cavity above the heart. Pituitary. Men's. Major groups of hormones. Adrenals. epiphysis Hypothalamus.

"Glands of internal secretion and hormones" - Glands of internal secretion and hormones. Neurohormones. glands. Intrasecretory functions of the adrenal glands. The value of the activity of the pituitary gland. humoral regulation. Significance of the activity of the thyroid gland. Intrasecretory functions of the pancreas. Reference summary on the topic of the lesson. regulation of bodily functions.

"Humoral regulation" - 5. What properties are endowed with hormones? "Hormone of action". Objectives: The role of hormones in metabolic processes. 1. What is humoral regulation? 3. Endocrine glands. 2. What is the human endocrine apparatus represented by? 6. Why is the concept of neurohumoral regulation quite often used? "A growth hormone".

"Hormones of the brain" - Hormones of the pineal gland. Pituitary. Neurohormones of the hypothalamus. Getting to know the central authorities endocrine system. Hormones of the neurohypophysis. Hypothalamus. action of melatonin. The harmony of the activity of the epiphysis, pituitary gland and hypothalamus. epiphysis Functions of the epiphysis. Secretory activity of melatonin. Acromegaly. Solar disease.

"Glands of internal secretion" - Insulin Adrenaline Thyroxine Norepinephrine Vasopressin Estradiol Testosterone Endorphin. Test. Glands of external secretion. Pituitary. regulation of the functions of the pituitary gland. Hormones secreted by the glands of our body. ENDOCRINE SYSTEM. The concept of the endocrine system. Endocrine glands. Creative task. Lesson plan.

"Human Endocrine System" - Glands. Tissue growth. Enzymes. Functions of hormones. Hormones. The hypothalamic-pituitary system. The relationship between the nervous and endocrine systems. Parathyroid gland. Sex glands. Pituitary. Structure and functions of the endocrine system. Glands of mixed secretion. Glands of external secretion. Extraction of a secret.

Clinical manifestations of thyroid diseases are due either to excessive or insufficient production of thyroid hormones, or excessive production of calcitonin and prostaglandins (for example, in medullary carcinoma of a calcitonin-producing tumor), as well as symptoms of compression of the tissues and organs of the neck of an enlarged thyroid gland without impaired hormone production (euthyroidism). PATHOLOGY

About the degree of iron is not visible during examination and is not determined by palpation; I degree when swallowing, the isthmus is visible, which is determined by palpation, or one of the lobes of the thyroid gland and the isthmus are palpated; II degree, both lobes are palpated, but on examination, the contours of the neck are not changed; III degree the thyroid gland is enlarged due to both lobes and the isthmus, visible when viewed as a thickening on the anterior surface of the neck (thick neck); Grade IV goiter of large size, not sharply asymmetric, with signs of compression of nearby tissues and organs of the neck; V degree goiter is extremely large. Five degrees of enlargement of the thyroid gland:

The cause of thyroid diseases is stress, an increased level of solar activity, hereditary predisposition, iodine deficiency, premature or late puberty, menstrual disorders, anovulation, infertility, miscarriage, pathology of the fetus and newborn.

Clinical manifestations of thyrotoxicosis syndrome include damage to various organs and systems. - Heart rhythm disturbances (tachycardia, extrasystole, - paroxysmal atrial fibrillation) - Arterial hypertension - Increased excitability, tearfulness - Sleep disorder - Tremor of the fingers of outstretched hands, tremor of the whole body - Unstable stool, abdominal pain - Weight loss - Subfebrile body temperature (increase temperatures up to °C) - Hot skin, sweating - Increased appetite - Muscle weakness - Violation of the menstrual cycle - Impaired glucose tolerance - Exophthalmos (protrusion of the eyeball) - Diffuse alopecia Thyrotoxicosis (hyperthyroidism)

Diffuse toxic goiter (Graves-Basedow's disease) Graves' disease is a systemic autoimmune disease characterized by a persistent pathological increase in the production of thyroid hormones, usually in combination with diffuse enlargement of the thyroid gland and extrathyroid disorders (endocrine ophthalmopathy).

Clinical picture -Puffiness of the face -Edematous tongue, with imprints of teeth along the edges -Alopecia (hair loss on the head), thinning of the eyebrows, -eyelashes -Childness -Puffiness of the legs -Disturbances in fat metabolism (increased levels of triglycerides, LDL) -Irregular menstruation -Constipation Hypothyroidism Syndrome - Reduced Hormone Production The most common cause of hypothyroidism is chronic autoimmune thyroiditis. a consequence of operations on the thyroid gland, radiation, lack of iodine, taking certain medications. Hypothyroidism

Thyroid nodules result from iodine deficiency. They are distinguished by their autonomy, since the hormones of the pituitary and hypothalamus do not act on them. Often, such autonomous nodes synthesize hormones with increased activity, then symptoms similar to Graves' disease develop. If the nodule is very small, conservative treatment is prescribed. In severe cases, surgery or radioactive iodine treatment is performed. nodular goiter