Benign Thyroid Disease

Posted by e-Medical PPT Sunday, September 9, 2012
Effects of Thyroid Hormone
Fetal brain and skeletal maturation
Increase in basal metabolic rate
Inotropic and chronotropic effects on heart
Increases sensitivity to catecholamines
Stimulates gut motility
Increase bone turnover
Increase in serum glucose, decrease in serum cholesterol




Benign Nontoxic Conditions
 Diffuse and Nodular Goiter
Benign Toxic Conditions
 Toxic Multinodular Goiter
 Graves’ Disease
 Toxic Adenoma
Inflammatory Conditions
 Chronic (Hashimoto’s) Thyroiditis
 Subacute (De Quervain’s) Thyroiditis
 Riedel’s Thyroiditis

Goitrogenesis
Iodine deficiency results in hypothyroidism
Increasing TSH causes hypertrophy of thyroid (diffuse nontoxic goiter)
Follicles may become autonomous; certain follicles will have greater intrinsic growth and functional capability (multinodular goiter)
Follicles continue to grow and function despite decreasing TSH (toxic multinodular goiter)
Sporadic vs. endemic goiter

Presentation
Usually picked up on routine physical exam or as incidental finding
Patients may have clinical or subclinical thyrotoxicosis
Patients may have compressive symptoms: tracheal, vascular, esophageal, recurrent laryngeal nerve

Treatment of Diffuse or Multinodular Goiter
Suppressive Therapy
Antithyroid Medications
I-131
Surgical Therapy

Graves’ Disease
Most common form of thyrotoxicosis
Autoimmune etiology with familial predisposition
Thyroid receptor stimulating antibody unique to Graves’ disease; other autoantibodies present (TgAb, TPOAb)
Affects females five times more often than males
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