THYROID
GLAND
History Taking
Endocrine and Metabolism System
2011-2012
The basic concept of the
function of thyroid hormones


Up-regulate the function of other
hormones e.g. growth hormone &
catecholamines
They heat up the other endocrinal
functions
Thyroid Disorders affect Peoples’
Health and Quality of Life
Hypothyroidism
Hyperthyroidism
The Thyroid Gland is
- as important as your heart decreased
Thyroid hormones
increased
Thyroid hormones
Hypothyroidism
Hyperthyroidism
Hypothyroidism is much more common than Hyperthyroidism
Effects of Thyroid Hormones
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
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Fetal brain and skeletal maturation
Cardiovascular system (Inotropic and
chronotropic effects on heart)
Muscle function
Brain, nervous system
Increase sensitivity to catecholamines
Stimulate gut motility
The thyroid: the “heart” of metabolism
Involvement of thyroid function:




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Growth and development, fertility
Energy metabolism
Protein and carbohydrate metabolism
Fat metabolism
Bone metabolism
Cardiovascular system
Muscle function
Brain, nervous system, psyche larynx
trachea
thyroid gland
Effects Of Thyroid Hormones On
The Cardiovascular System



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
Increase heart rate
Increase force of cardiac contractions
Increase stroke volume
Increase Cardiac output
Up-regulate catecholamine receptors
The Respiratory System



Increase resting respiratory rate
Increase minute ventilation
Increase ventilatory response to hypercapnia and
hypoxia
On The Renal System


Increase blood
flow
Increase
glomerular
filtration rate
On Oxygen Carrying Capacity
*Increase RBC mass
*Increase oxygen dissociation
from hemoglobin
On Intermediary Metabolism



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Increase glucose absorption from
the GI tract
Increase carbohydrate,lipid and
protein turnover
Down-regulate insulin receptors
Increase substrate availability
On Growth And Tissue Development


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Increase growth and maturation of bone
Increase tooth development and
eruption
Increase growth and maturation of
epidermis,hair follicles and nails
Increase rate and force of skeletal
muscle contraction
Inhibits synthesis and increases
degradation of mucopolysaccharides in
subcutaneous tissue
On The Nervous System
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Critical for normal CNS neuronal
development
Enhances wakefulness and alertness
Enhances memory and learning
capacity
Required for normal emotional tone
Increase speed and amplitude of
peripheral nerve reflexes
On The Reproductive System

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Required for normal follicular
development and ovulation in the
female
Required for the normal maintenance
of pregnancy
Required for normal spermatogenesis
in the male
Two young women with goiter
History Taking
INTRODUCTION HISTORY TAKING
 Greet the patient and introduce the
examiner’s name

Ask the patient’s identity :
- The patient’s name, age, occupation,
and patient’s residence
CHIEF COMPLAINT
-
-
Ask the patient why she/he come to clinic
Ask the date of onset
(The onset was sudden or insidious)
- Ask the symptoms
Thyroid Hypo function
-
coldness
weight gain
constipation
menstrual irregularities
muscle cramps.
malaise
fatigue
Hypothyroidism
before and
after treatment
Thyroid Hyper function:
- palpitations
- heat intolerance
- nervousness
- easy fatigability
- restlessness
- diarrhea.
- excessive sweating.
- preference to cold.
- weight loss without loss appetite.
- emotional instability
Past History
 Exposure to ionizing radiation in childhood
 Surgery
 Thyroiditis
 Drugs:
- Amiodarone
- IV Contrast agent
- Lithium
 Family history of Thyroid disease
 History of other autoimmune diseases like:
- Diabetes
- Rheumatoid arthritis
- Vitiligo
- Pernicious anaemia
Prevalence of thyroid abnormalities in
general population:
Total study
population
(n=25862)
Subjects taking
thyroid
medication
(n=1525)
Euthyroid
88.3 %
60.1 %
Hypothyroid *
0.4 %
0.7 %
Subclinical
hypothyroid
9.0 %
17.6 %
Hyperthyroid
0.1 %
0.9 %
Subclinical
hyperthyroid
2.1%
20.7 %
* probably underestimated (assessed by TT4)
Canaris GJ et al. (2000)
Prevalence of thyroid dysfunction in
elderly population (age > 35 yrs.)
Condition
Hypothyroidism
Reported prevalences
in adult population, %
2
Mild (subclinical)
hypothyroidism
Hyperthyroidism
5- 17
Mild (subclinical)
hyperthyroidism
0.1- 6.0
(TSH<0.1, normal T4,T3)
(Adapted from Vanderpump and Tunbridge, 2000)
0.2
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