 Hello everyone, welcome back to another session in dentistry and more so we have a topic from physiology that is thyroid gland disorders so Basically it has about three problems One can be the under functioning of thyroid gland that is hyperthyroidism and the over functioning That is hyperthyroidism Then the new plastic changes So hyperthyroidism where the gland is not functioning properly. We have under production of thyroid hormones It can leads to Mixedima Then the chrytinism and thyroiditis Whereas the over protection of thyroid hormone leads to Graves disease or thyroid toxicosis Then we have goiter which is characterized by diffuse and multi nodular pattern and The new plastic process Where it can be a benign one or a malignant? So it is very important for Exam point of view each one can be asked as a short note and this Enter thyroid gland might be a long essay So we'll directly starts from the hyperthyroidism so resulting from reduced level of T3 and T4 So rather causes of hyperthyroidism So there are many causes for hyperthyroidism. It can be classified into primary or secondary reasons So primary causes can be the dietary deficiency that the iodine intake is less Than the normal auto Immune problems such as Hashimoto's thyroiditis Hashimoto's thyroiditis or It can be due to the Drex such as thiocyanates Salfonyl curias or lithium It can be a Nitrogenic reason that is surgical removal of thyroid gland and Maybe due to the radiation treatment then it can be due to Infiltrative disorders or very rarely a congenital one that is the primary Causes for hyperthyroidism. Okay, all these Hashimoto's autoimmune thyroiditis Whereas the secondary reasons can be a pituitary gland destruction Pituitary gland destruction or isolated TSH deficiency Thyroid stimulating hormone deficiency or any hypothalamic disorders or can be a secondary reason for hyperthyroidism So that was all about the reasons. Okay primary and secondary reasons for the hyperthyroidism Now, let's learn one by one That is the first one we have the mixadema, which is very commonly asked question Mixadema is also known as gold disease So hyperthyroidism and developing In adult patient where the deposition of excess muco protein in skin of Forearm leg feet. Okay. So the most striking features are enlargement of the thyroid gland That is a goiter then lack of interest in daily household activities showing off physical and Mental tightness then generalized fatigue very dull look There'll be overweight for the patient decreased shortness that is a shortness of breath and There'll be a constipation and decreased sweating and the skin will be Dry thicken yellow that is the carotene may will be there reduced blood flow So the temperature will be less. There'll be edema puffy face. You can see the picture here peri-obietal swelling and the drooping of upper eyelid, which is known as ptosis and The hair is a little bit of coarse pattern and Broadening of the facial features and last tongue deepening of voice that is a telephonic voice The BMR decreases basal metabolic rate decreases to 32 40 percentage and there'll be Cold intolerant this will be exactly opposite in hyper hyperthyroidism and There'll be history of anemia then menstrual irregularities low blood sugar and Memory loss related to CNS and Knee jerk reaction time will be increased and all those there are many features for mix edema Which is a hypothyroidism condition Whereas a critinism so we were talking about the mix edema now the critinism which is commonly seen in Childhood, this is basically in adults. So Don't get confused mix edema and adults and critinism in childhood both are due to the hypothyroidism So they are like a devoid of any initiatives They are very careless people It is basically due to the maternal identity So there'll be mental retardation It is commonly seen in Identification area just like Himalayan belt China or Africa Clinically, they have impaired skeletal development and CNS development So there'll be definitely mental retardation and Child might be deaf and mute dwarfism and standard growth With thick cores and dry skin protruded abdomen just like a port belly there will be enlarged tongue Failure of sexual developments and all the milestones will be delayed such as the dentition delayed walking delayed sitting up delayed closure of the fontanel is Speech and all will be delayed in critinism. So that was about Critinism Here the hormones the lab finding The TSH that is a thyroid stimulating hormones will be increased whereas the T4 sorry T4 and T3 Will be decreased Now we have the thyroiditis. Okay Thyroiditis, it's a inflammation of thyroid. So one we know that is the Hashimoto thyroiditis Hashimoto thyroiditis So it is a gradual thyroid failure due to the autoimmune destruction of thyroid. It can be mostly seen in 56th decade of life and It has got female predominance that is 10 That's to one female predominance major cause of non-entermic goiter in children and There is a genetic component that is patients with Turner syndrome has high circulating anti thyroid Antibody so the our own body cells acting against our thyroid gland and destroying it So that is a autoimmune condition So clinically there will be progressive depletion of thyroid cells It is replaced by mononuclear cells and fibers. There is a fibrosis happening So it comes to a clinical attention as painless enlargement of the thyroid with some degree of hyper Thyroidism, okay, but still hyperthyroidism is there, but it is slowly replaced by the gland is slowly replaced by the fibrous tissues and mononuclear cells So patient is at risk of developing other autoimmune diseases so But a patient is not having any risk of malignancy and Hashimoto's thyroid is there is a autoimmune disorder One more thyroiditis we have that is D Cubene thyroiditis which is occurs in 30 to 50 year old, but it is Basically less than the Hashimoto's still it has a female Predominance, but it is caused by basically viral As viral infections such as adenoviruses and all those things So that was the the cubane thyroiditis Now we have redal thyroiditis that is a fibrosis of redal Thyroiditis fibrosis of thyroid and neighboring structures and We have sub acute lymphocytic thyroiditis And we may also have congenital Hypothyroidism, okay, so that was about hyperthyroidism now. Let's learn hyperthyroidism and hyperthyroidism It is a condition where the circulating Levels are very increased. Basically it is due to the thyroid type toxicosis Courses can be Graves disease toxic multi nodular goiter toxic adenoma or iodine excess or the Activation of TSH receptors all those things the first one is a very important one Which is known as Graves disease the most common cause of endogenous hyperthyroidism characterized by Hyperthyroidism there is a diffuse enlargement of thyroid gland with lymphocytic infiltration There will be pre TBL mix edema pre TBL Mixed Ema we already know what is mix edema which has seen in Hyperthyroidism, but this is characterized by pre TBL mix edema then the peak incidence is 20 to 40 years with female predilection and Pathogenesis can be it is due to a autoimmune problem or the thyroid stimulating antibody is acting like TSH and All these leads to increased formation of T3 and T4 and There will be growth of increased growth of thyroid gland. So what are the features of Graves disease? So the most striking feature is exopthalmosis Exopthalmos So exopthalmosis is nothing but protrusion of the eyeball with visibility of sclera Between the lower lid and cornea. It is basically due to the retro orbital connected tissue and oculomuscles are Increased and resulting in a protruded appearance. There will be Infremitry edema T-cell infiltration fat infiltration So all these leads to the bulging of eye outward. Okay, just like this picture and The basal metabolic rate is increased all the things which is happening in hyper will be reversed Okay, basal metabolic rate is increased Here we have the heat intolerance, okay Heat here we learned cold intolerance in Hyperthyroidism we have heat intolerance. There will be weight loss There'll be vitamin B and C deficiency tachycardia high cardiac output Then decreased serum lipid levels So it is very easy to learn if you know the hyperthyroidism almost Opposite will be in the hyperthyroidism, but never get confused. Okay, and Regarding CNS, there will be over excitability The warm skin will be there like smooth moist warm skin Overgrowth of nail which is known as acro patchy Which may lift off the nail bit. That is on co on ecolysis Not on co on ecolysis Co lysis So there'll be pre tibial myxodema increased skin pigmentation all those things It was about the grave's disease never forget the X of the most condition. Now we have the pyro toxicosis so the Symptoms are hyperactivity irritability heat intolerance sweating palpitation fatigue weakness diarrhea polyuria sexual dysfunction and All the tachycardia atrial fibrillation all those things the same X of thalamus and pretty me pre tibial myxodema and there'll be increased t3 and t4 in lab finding so it can be a treated based on like reducing thyroid hormone synthesis using radio iodine or by surgical means and All those things we can do to reduce the level of t3 and t4 One more condition. We need to learn in hyperthyroesan that is thyroid storm or Thyro toxic Crisis, so it's a life-threatening exacerbation of Thyro toxicosis accompanied by fever delirium seizures coma vomiting jaundice Mortality rate can be up to 30 percentage It is usually precipitated by acute illness such as stroke infection trauma diabetic ketosis Thyroid storm it's like a prepped onset of onset of severe hyperthyroidism, which is there'll be severe tachycardia All those things now we have the most common thing that is the goiter Goiter Goiter is a diffuse and multi nodular enlargement of thyroid diffuse and Multi nodular enlargement of the thyroid. This is the most common manifestation of thyroid disease most often caused by the dietary iodine deficiency that is the impaired synthesis of thyroid hormone It's a different category Goiter So two types it can be a endemic one or a sporadic one So endemic goiter is endemic to certain geographic areas such as Himalayas Alps there is a deficiency of iodine in that particular area That is which can results from ingestion of certain Goitrogen such as cabbage cauliflower Brussels sprouts turnips So which prevent the incorporation of iodine with thyrosin? So which are known as Goitrogens, okay Goitrogens which prevents the incorporation of iodine with thyrosin It's a basic step of iodine uptake. So this step will be prevented This step will be prevented by the Goitrogens Which are the cabbage cauliflower Brussels sprouts turnips all those things This sporadic goiter is less frequent than endemic one. There'll be female Predilection Whereas a multi nodular goiter it is a recurrent hyperplasia or hypertrophy of the condition all simple non-toxic Goitros evolve into a multi nodular one and this thyroid gland will be asymmetrically enlarged Now lastly we have the neoplasm. That is a benign and malignant one. They are known as adenomas They are the discrete solitary masses Direct from the follicular epithelium. So also known as follicular adenomas So this adenomas usually present as Unilateral pain less mass it take up less radioactive iodine compared to the normal thyroid pattern chemical cells. So this is a cold nodules and this biopsy is a gold standard for diagnosis so Thyroid carcinomas There is a malignant condition. So when our adenomas in carcinoma That can be a papillary one follicular one medullary one anaplastic one with female predominance And it is most common one is the papillary carcinoma papillary one So that was all about the thyroid disorders so we learned the The hypo thyroid condition and hypothyroid condition and neoplastic condition and goiter so most commonly the gravestraces and toxicosis of thyroid storm and hypoplasm mixed retinism and Thyroiditis and in neoplasm. We have adenomas and carcinomas It can be a righty one papillary medullary all those things and a goiter one. It can be Entemic and sporadic one. So it's a very very commonly asked I say a question Physiology or it can be asked as a short note. So there are lots of short notes present here So in each condition you can expect a three or four questions in hypo Hyper all those things who never ever missed this chapter for your exam. So I'll come with a new topic in the industry I know thank you