CLINPHAR

• Endocrine System


  Responsible for secreting hormones, usually have different purposes although the mechanisms are the same
• Thyroid Gland


  A butterfly-shaped organ located in front of the throat, Responsible for secreting thyroid, which is a hormone for regulating metabolic processes, Two types of hormones: T3 (more active, less stable) and T4 (less active, more stable)
• Thyroid Disorders


  • Hyperthyroidism
  • Hypothyroidism
  • Goiter
• Hyperthyroidism


  Aka "thyrotoxicosis"; high levels of thyroid hormone
• Hypothyroidism


  Low levels of thyroid
• Goiter


  Swelling of the neck due to thyroid dysfunction (hyper- or hypo- thyroidism)
• Causes of Hyperthyroidism


  • Problem in the pituitary gland (tumor) – resulting in continuous production of T3 and T4
  • Constant conversion of T4 to T3
• Manifestations of Hyperthyroidism


  • Grave's Disease
  • Multinodular Goiter
  • Toxic Adenoma (tumor)
  • Granulomatous Thyroiditis
  • Painless Thyroiditis
• Effects of Hyperthyroidism


  • Goiter
  • Increased metabolism
  • Increased appetite
  • Weight loss
  • GIT hypersensitivity
  • Diarrhea
  • Tachycardia
  • Exophthalmos (bulging from sockets)
• Risk Factors of Hyperthyroidism

  • >60 years old
  • Family history
  • Type I diabetes
  • Increased iodine consumption

  
• Laboratory and Diagnostics


  • Thyroid Ultrasound
  • Thyroid Scan (radioactive with I131)
  • Blood tests for measuring TSH and thyroid hormones
• Typical Values for Thyroid Function Tests

  Total Thyroxine (T4), Total Triiodothyronine (T3), Free T4 (FT4), Free T3 (TS3), Thyrotropic Hormone (TSH), Iodine uptake at 24 hours, Antithyroglobulin Antibodies (Tg-Ab), Thyrodine Peroxidase Antibodies (TPA), Isotope Scan with Iodine or Pertechnetate (TcO4), Fine-Needle Aspiration Biopsy (FNA), Serum Thyroglobulin, TSH receptor-stimulating Antibody or Thyroid-stimulating immunoglobulin (TSI)
• Clinical Manifestations of Hyperthyroidism

  • Thyroid Storm – Exacerbation of symptoms
  • Soft, Warm, and Flushed Skin
  • Retraction of Upper Eyelid
  • Exophthalmos (Enlargement of eyes)
  • Agitation, Nervousness
  • Diarrhea, Hypermotility of GIT
  • Menstrual Irregularities
  • Irregular Heartbeat
  • Weight Loss
• Goals of Treatment


  • Eliminate and reduce excess thyroid hormone
  • Manage symptoms and improve prognosis
  • Individualized therapy
• Thyroidectomy


  Surgical removal of the thyroid gland, Considered in large thyroid, Ineffective pharmacological therapy, Will be treated with thyroid hormone-increasing drugs
• PHARMACOLOGICAL Treatment


  • Thioamides/Thioureas
  • Iodides
  • Propranolol
  • Radioactive Iodine (RAI)

  
• Hypothyroidism


  Low thyroid levels, It may be subclinical (unmanifested), More prevalent in women, Caused by functional or structural derangement with the thyroid gland
• Pathophysiology of Hypothyroidism


  • Primary Hypothyroidism
  • Secondary Hypothyroidism
• Physical Manifestations


  • Atrophy of Thyroid
  • Compensatory Thyroid Gland Enlargement
• Etiology


  • Congenital Hypothyroidism
  • Autoimmune Hypothyroidism (Hashimoto's disease)
  • Iatrogenic Hypothyroidism
  • Secondary/Central Hypothyroidism
  • Cretinism
  • Myxedema
• Risk Factors of Hypothyroidism

  • Increases with age
  • More common in women than in men
  • Increases during pregnancy and post-partum
  • Common in whites and Asians
  • With another autoimmune disorder
  • Thyroidectomy
  • Down syndrome
• Effects of Hypothyroidism


  • Goiter
  • Decreased metabolism
  • Decreased appetite
  • Weight loss
  • Constipation
  • Peristalsis
  • Bradycardia
  • Lethargy
• Signs and Symptoms


  • Slower metabolism
  • Pale, cool, puffy, yellowish skin
  • Decreased heart rate
  • Decreased appetite
  • Lethargy and fatigue
  • Neuropathies
  • Menorrhagia
  • Anemia
• Goals of Treatment


  • Restore thyroid hormone concentration
  • Provide symptomatic relief
  • Reverse biochemical abnormalities
  • Prevent neurologic deficits
• PHARMACOLOGICAL Treatment


  • Levothyroxine (T4)
  • Thyroid USP (Desiccated Thyroid)
  • Liothyronine (Synthetic T3)
  • Liotrix (Synthetic T4:T3 (4:1))
• Diabetes – siphon; Mellitus – sweet, Increased specific gravity of urine, State of elevated blood sugar, Metabolic disorders sharing the common feature of "hyperglycemia", Results in defects in insulin secretion, insulin action or both

  
• Insulin


  Promotes storage of fat and glucose, Influences growth and metabolic functions, Facilitates storage of glycogen, TG in liver, adipose cells and muscles, Release is stimulated by blood glucose

  
• Glucose Transporters


  • GLUT 1
  • GLUT 2
  • GLUT 3
  • GLUT 4
  • GLUT 5
• Insulin Action


  • Increases the rate of glucose transport into certain cells in the body
  • Increasing a major source of energy
  • In muscle, glucose is stored as glycogen or oxidized to generate ATP
  • In adipose tissue, glucose is stored as a lipid

  
• Pathophysiology of Diabetes


  • Insulin Resistance
  • β-Cell Dysfunction

  
• Etiology of Diabetes


  • Type I Diabetes Mellitus (Insulin Dependent DM)
  • Type II Diabetes Mellitus (Insulin Non-dependent DM)

  
• Lipase


  Enzyme found in adipose tissue
• β-Cell Dysfunction


  • Inadequate insulin secretion
  • Excess free fatty acids that compromise β-cell function
  • Abnormal incretin effect leading to reduced GLP-1 secretion (promoted insulin release)

  
• Etiology of Diabetes


  • Type I Diabetes Mellitus (Insulin Dependent DM)
  • Type II Diabetes Mellitus (Insulin Non-dependent DM)

  
• Type I Diabetes Mellitus


  • Autoimmune mediated destruction of beta-cells of Islets of Langerhans in the pancreas
  • 126 mg/dL
  • Mediated by macrophages and T-lymphocytes
  • No insulin production
  • 5-10% of total cases
  • Needs exogenous insulin
  • Develops in childhood or early adulthood

  
• Type II Diabetes Mellitus

  • Insulin resistance and relative insulin deficiency
  • Interplay of genetic and environmental factors
  • Manifests by increase lipolysis and free fatty acid production with increase glucose production and decreased uptake of glucose
  • Insulin resistance associated with obesity induced by inflammatory factors in adipose tissue
  • Under secretion
  • Tx: OHA
  • Prediabetes, 100-125 mg/dL

  
• Risk Factors for Type I Diabetes

  • Family history
  • Develops in children, teens or young adults
• Risk Factors for Type II Diabetes

  • Prediabetes
  • Overweight, sedentary lifestyle
  • 45 years and older
  • Family history of Type II DM
  • Genetics: African Americans, Hispanic, Indian Americans
• Laboratory and Diagnostic Tests for Diabetes

  • Glycated Hemoglobin (HbA1C)
  • Fasting Plasma Glucose
  • OGTT – 75g anhydrous glucose in water
  • Random Plasma Glucose

  
• Criteria for Diagnosis


  • Diabetes
  • Impaired glucose tolerance (Prediabetes)