Endocrine Tutorial

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Endocrine Tutorial
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Hyperthyroidism

• Clinical features

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Hyperthyroidism

• Clinical features
• CVS tachycardia, palpitations, atrial fib
• CNS tremor, anxiety, lability, insomnia
• Heat intolerance warm, moist, flushed skin
• Weight loss with increased appetite

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Hyperthyroidism

• Clinical features
• CVS tachycardia, palpitations, atrial fib
• CNS tremor, anxiety, lability, insomnia
• Heat intolerance warm, moist, flushed skin
• Weight loss with increased appetite
• Causes

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Hyperthyroidism

• Clinical features
• CVS tachycardia, palpitations, atrial fib
• CNS tremor, anxiety, lability, insomnia
• Heat intolerance warm, moist, flushed skin
• Weight loss with increased appetite
• Causes
• Graves disease
• Exogenous thyroid hormone
• Functioning multinodular goitre/thyroid adenoma
• Thyroiditis
• Secondary (hypothal/pituitary dysfunction)

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Hypothyroidism

• Clinical features

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Hypothyroidism

• Clinical features
• CVS bradycardia, cardiomegaly, pericardial
  effusion
• CNS slowed mental activity, apathy, fatigue,
  cretinism
• Cold intolerance cool skin myxedema hair loss
• Weight gain with decreased appetite
• Coarsening of features

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Hypothyroidism

• Clinical features
• CVS bradycardia, cardiomegaly, pericardial
  effusion
• CNS slowed mental activity, apathy, fatigue,
  cretinism
• Cold intolerance cool skin myxedema hair loss
• Weight gain with decreased appetite
• Coarsening of features
• Causes

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Hypothyroidism

• Clinical features
• CVS bradycardia, cardiomegaly, pericardial
  effusion
• CNS slowed mental activity, apathy, fatigue,
  cretinism
• Cold intolerance cool skin myxedema hair loss
• Weight gain with decreased appetite
• Coarsening of features
• Causes
• Hashimoto thyroiditis
• Surgery / Radiation / Drug-induced
• Infiltration by tumour
• Secondary (hypothal/pituitary dysfunction)

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Graves disease

• Epidemiology
• What type of people get Graves disease?

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Graves disease

• Epidemiology
• Women, 20-40 yrs, (MF 17)

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Graves disease

• Epidemiology
• Women, 20-40 yrs, (MF 17)
• Pathogenesis

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Graves disease

• Epidemiology
• Women, 20-40 yrs, (MF 17)
• Pathogenesis
• Autoimmune disorder
• Activation of thyroid by thyroid autoantibodies
• Anti-TSH R, anti-thyroglobulin, anti-T3/T4
• Associated with certain HLA types
• Associated with other AI disorders
• Hashimoto thyroiditis, pernicious anaemia,
  rheumatoid arthritis

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Graves disease

• Gross findings
• Mild symmetrical thyroid enlargement
• Eyes exophthalmos, lid retraction, lid lag
• Skin pretibial myxedema

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Graves disease

• Microscopic findings

Graves disease
Normal thyroid
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Graves disease

• Microscopic findings

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Hashimoto Thyroiditis

• Epidemiology

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Hashimoto Thyroiditis

• Epidemiology
• Women, 45-65 yrs, (MF 110 to 20)

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Hashimoto Thyroiditis

• Epidemiology
• Women, 45-65 yrs, (MF 110 to 20)
• Pathogenesis

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Hashimoto Thyroiditis

• Epidemiology
• Women, 45-65 yrs, (MF 110 to 20)
• Pathogenesis
• Autoimmune disorder
• Destruction of thyroid by thyroid autoantibodies
• Anti-TSH R, anti-thyroglobulin
• Associated with certain HLA types
• Associated with other AI disorders
• SLE, pernicious anaemia, rh. Arthritis, Sjogrens,
  IDDM, Graves
• May cause transient hyperthyroidism in early
  stages
• Gradual destruction and fibrosis ? hypothyroidism

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Hashimoto Thyroiditis

• Gross findings
• Enlarged pale thyroid initially
• Atrophic thyroid eventually

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Hashimoto Thyroiditis

• Microscopic findings

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Hashimoto Thyroiditis

• Microscopic findings

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Thyroiditis

• Painful
• Infectious
• Adjacent sinusitis, mycobacteria, fungi
• Subacute (granulomatous)
• Post viral
• Painless
• Hashimotos
• Fibrous
• Fibrosis, atrophy, hypothyroidism

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Goitre

• What is it?

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Goitre

• What is it?
• Enlarged thyroid
• Due to impaired thyroid hormone synthesis

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Goitre

• What is it?
• Enlarged thyroid
• Due to impaired thyroid hormone synthesis
• Causes

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Goitre

• What is it?
• Enlarged thyroid
• Due to impaired thyroid hormone synthesis
• Causes
• Iodine deficiency
• Goitrogens
• Inherited disorders

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Goitre

• Pathogenesis
• Hyperplasia of follicular epithelium
• Increased thyroid hormone release (decreased
  colloid)
• Involution of follicles when enough thyroid
  hormone released
• Accumulation of colloid
• Two forms
• Diffuse
• Multinodular

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Goitre

• Gross findings
• Diffuse Diffuse enlargement without nodules
• Multinodular

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Goitre

• Microscopic findings
• Diffuse (initial hyperplastic stage)
• Hyperplastic and hypertrophied follicles
• Decreased colloid
• Diffuse (involution stage)
• Dilated follicles, atrophic epithelium
• Abundant colloid

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Goitre

• Microscopic findings
• Multinodular goitre
• Recurrent episodes of stimulation and involution
• Hyperplastic and hypertrophied follicles with
  decreased colloid
• Dilated follicles with atrophic epithelium and
  abundant colloid
• Haemorrhage, fibrosis, calcification, cyst
  formation

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Thyroid neoplasms

• Risk factors
• MF 14
• Radiation therapy
• Hashimotos
• Multinodular goitre
• Types
• Follicular adenoma
• Carcinoma
• Papillary
• Follicular
• Anaplastic
• Medullary

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Follicular adenoma

• Morphology

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Follicular carcinoma

• Morphology
• Same as follicular adenoma!
• BUT
• Vascular / capsular invasion
• Haematogenous mets

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Papillary carcinoma

• Morphology

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Papillary carcinoma

• Morphology

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Causes of hyperparathyroidism
Parathyroid hyperplasia Parathyroid adenoma
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Hyperadrenalism

• Presentation
• Cushings syndrome
• Conns syndrome
• Causes
• Primary
• Hyperplasia, adenoma, carcinoma
• Secondary
• Hypothalamic/pituitary disorders
• Ectopic ACTH secretion
• Activation of renin-angiotensin system

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Causes of hyperadrenalism
hyperplasia carcinoma adenoma
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Causes of hypoadrenalism
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Pancreatic islet cell tumour
Pituitary adenoma
Parathyroid hyperplasia
MEN I
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Phaeochromocytoma
Medullary carcinoma of thyroid
Parathyroid hyperplasia
MEN II