thyroid gland 2

Question 1

what is the cause of the grave disease ?

Answer 1

the hypertrophy and hyperplasia of the gland is related to TSH -rab that bind to TSH receptor and stimulate the recepotors and usually the stimulation is more

16-24 h for trab
1.5-3 h for TSH

Question 2

whats the differance between the diffuse and toxic nodular goiter?

Answer 2

-diffuse (grave) its sudden onset -and attack the younger group
espacialy the female
-and only grave have eye signs and skin signs as pertibial myxedema

-and the hyperthyrodism is more sever

while the toxic nodular is insidious and attack the old and middle age

Question 3

what the grave presented with and what the toxic nodular goiter presented with ?

Answer 3

grave – have eye sign and skin sign

toxic nodular –have heart faliure and aterial fiberaltion

Question 4

what the cause of toxic nodule ?

Answer 4

its autonomos and its not from TSH-rab
and the high level of the thyroid hormone supress the TSH

in the thyroid scan its appear as hot nodule

Question 5

what re the clincial features (syptomas) of the hyperthyrodism ?

Answer 5

1-palptation and tremor
2-loss of weight with good apptitie 
3-sweating 
4-pt is anxois 
5- amenorrhea and incrase the incidance of mis carge

Question 6

whatre the signs of hyperthyrodism ?

Answer 6

true exopthamus is proptosis because of inflteration of poly mucoschride in the extra ocular muscle

lid spasm becaus eof the sympathtic overactivty on the levator palpbrae superioris

Dipolpia cant see up and lateral due to weakness of the extra ocular muscle (inf /med rectus muscle )

lid lag means dely the lid with the eye ball mvement

lid retraction see the upper sclera

eye swelling and ulceration

hands

• hot and moist hand
• tremor
• myopathy
• hyperactive tendon reflex
• thyroid acropachy (subperi-osreal bone formation )
• onycholysis seperation fingernail from their bed

foot 
-----
peritibial myxdema
dermopathy --skin is thickned because of the deposition of the glycosaminoglycan
in the dorsum of the foot

Question 7

thyrotoxisi should be considered in which conditions ?

Answer 7

1-childern with rapid growth
2-elderly with tachycardia or arythemia

3-diarrhea
4-loss weight

Question 8

how to dignosis the thyrotoxsis?

Answer 8

1-TFT
2- autoantibody
3-thyroid scan

Question 9

which is type of iodine is used ?

Answer 9

I 123 — for investigation البديل التكنيشيم

I 131 — for Treatment
we us esacn in toxic and recurrance

Question 10

when we use the antithyroid ?

Answer 10

• we use the carbimezole and propylthiouracil in younger wmen who wnt childern
• pregnent lady in the 1st term
• childern also given until the late teens
• diffus etoxic goiter given anti -thyroid and radioiodine for relapse

Question 11

when the antithryroid work ?

Answer 11

after 2weeks of taking medication the syptomas will improve but TFT not noraml so in these 2 week pt will be given Beta-blocker

after8-12weeks the TFT will be normal

Question 12

how the radioactive iodine works ?

Answer 12

by derstoy the thyrodal tissue
but no contact with childern or the pregnent lady

high dose of radioiodine lead to thyroid faliure

Question 13

how to treat diffuse toxic ?

Answer 13

inatially with antithroid and radioiodine

then if pt refuse the radtion or or pergnent or eye signs treated surgical

Question 14

toxic nodule TRT ?

Answer 14

is surgery

Question 15

TRT of reccurance after surgery ?

Answer 15

radioiodine is TRT of ckoice

if young or pregnent antithyroid

Question 16

TRT of pergnent with hyperthyrodism ?

Answer 16

antithyrodism in the 1st term

Question 17

childern TRT?

Answer 17

antithyroid until late teen then either total or near total thyrroidoctomy

Question 18

how to prepare pt before the surgery ?

Answer 18

pt should be eurthyroid
1-antithyroid carbimzole 30-40mg
2-beta blocker ونخلي على العلاج حتى بعد سبع ايام من العمليه
3-iodine given for 10 days befor surgery

if we dont prepare the pt will have throid crisis