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Endocrine Tutorial
Hyperthyroidism
• Clinical features
Hyperthyroidism
• Clinical features
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CVS: tachycardia, palpitations, atrial fib
CNS: tremor, anxiety, lability, insomnia
Heat intolerance; warm, moist, flushed skin
Weight loss with increased appetite
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
Hyperthyroidism
• Clinical features
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–
–
–
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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Graves disease
Exogenous thyroid hormone
Functioning multinodular goitre/thyroid adenoma
Thyroiditis
Secondary (hypothal/pituitary dysfunction)
Hypothyroidism
• Clinical features
Hypothyroidism
• Clinical features
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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
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
Hypothyroidism
• Clinical features
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–
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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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Hashimoto thyroiditis
Surgery / Radiation / Drug-induced
Infiltration by tumour
Secondary (hypothal/pituitary dysfunction)
Graves disease
• Epidemiology
– What type of people get Graves disease?
Graves disease
• Epidemiology
– Women, 20-40 yrs, (M:F = 1:7)
Graves disease
• Epidemiology
– Women, 20-40 yrs, (M:F = 1:7)
• Pathogenesis
Graves disease
• Epidemiology
– Women, 20-40 yrs, (M:F = 1:7)
• 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
Graves disease
• Gross findings
– Mild symmetrical thyroid enlargement
– Eyes: exophthalmos, lid retraction, lid lag
– Skin: pretibial myxedema
Graves disease
• Microscopic findings
Graves disease
Normal thyroid
Graves disease
• Microscopic findings
Hashimoto Thyroiditis
• Epidemiology
Hashimoto Thyroiditis
• Epidemiology
– Women, 45-65 yrs, (M:F = 1:10 to 20)
Hashimoto Thyroiditis
• Epidemiology
– Women, 45-65 yrs, (M:F = 1:10 to 20)
• Pathogenesis
Hashimoto Thyroiditis
• Epidemiology
– Women, 45-65 yrs, (M:F = 1:10 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
Hashimoto Thyroiditis
• Gross findings
– Enlarged pale thyroid initially
– Atrophic thyroid eventually
Hashimoto Thyroiditis
• Microscopic findings
Hashimoto Thyroiditis
• Microscopic findings
Thyroiditis
• Painful
– Infectious
• Adjacent sinusitis, mycobacteria, fungi
– Subacute (granulomatous)
• Post viral
• Painless
– Hashimoto’s
– Fibrous
• Fibrosis, atrophy, hypothyroidism
Goitre
• What is it?
Goitre
• What is it?
– Enlarged thyroid
– Due to impaired thyroid hormone synthesis
Goitre
• What is it?
– Enlarged thyroid
– Due to impaired thyroid hormone synthesis
• Causes
Goitre
• What is it?
– Enlarged thyroid
– Due to impaired thyroid hormone synthesis
• Causes
– Iodine deficiency
– Goitrogens
– Inherited disorders
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
Goitre
• Gross findings
– Diffuse: Diffuse enlargement without nodules
– Multinodular:
Goitre
• Microscopic findings
– Diffuse (initial hyperplastic stage):
• Hyperplastic and hypertrophied follicles
• Decreased colloid
– Diffuse (involution stage)
• Dilated follicles, atrophic epithelium
• Abundant colloid
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
Thyroid neoplasms
• Risk factors
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M:F = 1:4
Radiation therapy
Hashimoto’s
Multinodular goitre
• Types
– Follicular adenoma
– Carcinoma
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Papillary
Follicular
Anaplastic
Medullary
Follicular adenoma
• Morphology:
Follicular carcinoma
• Morphology:
– Same as follicular adenoma!
BUT
– Vascular / capsular invasion
– Haematogenous mets
Papillary carcinoma
• Morphology:
Papillary carcinoma
• Morphology:
Causes of hyperparathyroidism
Parathyroid hyperplasia
Parathyroid adenoma
Hyperadrenalism
• Presentation
– Cushing’s syndrome
– Conn’s syndrome
• Causes
– Primary
• Hyperplasia, adenoma, carcinoma
– Secondary
• Hypothalamic/pituitary disorders
• Ectopic ACTH secretion
• Activation of renin-angiotensin system
Causes of hyperadrenalism
hyperplasia
carcinoma
adenoma
Causes of hypoadrenalism
haemorrhage
infection (TB)
metastases
Pancreatic islet cell
tumour
+
Pituitary adenoma
+
Parathyroid hyperplasia
=
MEN I
Phaeochromocytoma +
Medullary carcinoma of
thyroid +
Parathyroid hyperplasia =
MEN II