Clinical situation 6

A 30 years of women complains on the general weakness, change of appearance, obesity, hirsutism, acne on the face, edema, hypertension and frequent infections, headache.

Examination of patient: there is a redistribution of body fat (obesity) more fat is deposited in the back of the neck, the abdomen, face and buttocks. The fathering of face leads to the so- called moon face, slit eyes and fish mouth. Distension of the skin leads to purplish stria on the lower abdomen. Edema, hypertension, deformation of bones. Susceptibility to fractures is much increased may be kyphosis, due to reduction of Ca level in the bone. Will be a decreased resistance to infection, are appeared the acne, boils on the skin. There is excessive amount of adrenal androgens with appearance of excessive growth hair especially on the chest, face and lips (hirsutism) atrophy of the breast, uterus. Excess of glucocorticoids leads to increased of permeability of membranes to glucose hyperglycemia, steroid diabetes is developed.

1. Which metabolic processes are damaged?

2. With which pathological condition it may be?

3. What is the mechanism of these malfunctions?

4. How is called this disease?

Clinical satiation 7

Patient 40 years old has cramps of symmetrical muscles, spasms of the smooth muscle, lesions in ectodermal and mental symptoms. tissues of face muscles / sardonic grin / , cramps in muscles of upper extremities. The hands and feet are drawn in typical attitudes, which are called carpopedal spasms. The hands show Accoucheur’s appearance or obstetrician’s hands. In this case the wrist is flexed and so are the metacarpophalangeal joints but the interphalangeal joints are extended; thumb is adducted into the palm. In case of feet the toes are plantar flexed but the ankles are extended. Tetany may develop, this are generalized convulsions ( or opisthotonus) .

Blood test:

Ca – 1,7 mmol/l

Inorganic phosphates – 3 mmol/l

What are the changes in blood test?

Which metabolic processes are damaged?

With which pathological conditions it may be?

What is the mechanism of these malfunctions?

Clinical situation 8

Patient 40 years, complains: Thirst ( polydipsia), profound diuresis (polyuria), weakness and loss of weight, pains in the bones and loss of tooth, spontaneous fractures and non healing a long time , wadding (goose ) gait.

Blood test:

1. Ca – 3,3 mmol/l

2. Inorganically phosphate – 0,5 mmol/l

Urine test:

Daily diuresis 10 l amount of phosphate – 33 mmol/day

Specific gravity – 1, 005

pH – basic

1. What are the changes in blood and urine tests?

2. Which metabolic processes are damaged?

3. With which pathological condition it may be?

4. What is the mechanism of these malfunctions?

5. How is called this disease?

Clinical situation 9

Patient, 30 year old man complains of weakness, low appetite, nausea, weight loss, darkness of skin, often ills. At examination are pigmentation of skin, mucosal layer of oral cavity, cheeks; hypertension (due to decrease of systolic pressure), weak and soft pulse, dyspepsia of gut.

Blood test:

Hematocrit 55%

Hemoglobin 174 g/l

Protein (total) 95 g/l

Urea 9 mmol/l

Na 100 mmol/l

K 6 mmol/l

Bicarbonates 19 mmol/l

1. What are the changes in blood and urine test?

2. Which metabolic processes are damaged?

3. With which pathological condition it may be?

3. What is the mechanism of these malfunctions?

Clinical situation 10

Patient, 60 year old man, complains on the skin dryness and mouth dryness, thirst (polydipsia), profound diuresis ( polyuria), polyphagia, weakness, weight loss, itch, sleeplessness, decrease in energy working ability.

Blood test:

Glucose 20 mmol/l

Lactate 1,8 mmol/l

NEFA 1000 mcmol/l

Ketone bodies 12 mmol/l

Cholesterol 9 mmol/l

Urea 9 mmol /l

Bicarbonates 15 mmol/l

Urine test:

Diuresis 5 l

Color pale

pH acidic

Specific gravity 1,045

Glucose 1%

Ketone bodies positive

1. What are the changes in blood and urine test?

2. Which metabolic processes are damaged?

3. With which pathological condition it may be?

4. What is the mechanism of these malfunctions?

Аnswer 1

These phenomena’s can be observed at hypothyroidism. The deficiency of action of thyroid hormones results in infringement of all kinds of an metabolism : carbohydrates metabolism (increase of tolerance to carbohydrates, bent) predisposition to hypoglycemia), water-salt metabolism (delay of water and sodium chloride in tissues), lipids metabolism (increase of the contents in blood lipoproteins, cholesterol), proteins metabolism (decrease of speed of protein synthesize of tissue respiration, decrease of basic metabolism. The specified phenomena’s cause slackness, apathy, sluggishness, sleepiness, deterioration of memory, bradycardia. Has swelled tissues connect with lymphostasis. In consequence of reduction of contractile ability of lymphatic vessels serum albumin accumulated outside of vessels.

Answer 2

These phenomena’s could be observed in hyperthyroidism; could be caused hormones, excess of cathecholamines. An excess of thyroid hormone’s action leads to enhance of a protein catabolism, inhibition of carbohydrates transformation into fats.

Also it leads to increased fat mobilization (enhance of sympathetic nerve endings’ sensitivity in fat tissue for adrenaline influence); fastening of ill person. The excess of thyroid hormones metabolism products disunite tissue digestions; oxidative phosphorylation processes , that causes ATP deficiency, muscles weakness, subfibrility (stimulation of hypothalamic centers also take place in caring out of subfibrility). As a result of ATP deficiency increased heart tissues sensitivity for cathecholamines (the excess of thyroid hormones depresses monoxides activity of heart tissue). Tachycardia , dyspnea, degenerative defeat of heart muscle are developed. As pointed above effects defeats of motor neurons cause to muscle weakness, shimmering of limbs. Ecophtalmic effects is wrote upon derivate of thyreotropic hormone molecule that lacking of thyreo-stimulating properties.

Answer 7

The following effects can be observed in hypoparathyroidism. Deficiency of parath hormones action leads to of calcium receivement from bone tissue into blood; metabolism of phosphorus reabsorbtion in proximal parts of kidney’s channels, that cause hipocalciemia hyperphosphatemia. As a result of hipocalcemia balance between potassium sodium ions disturbs and also Ca, Mg that in it’s order leads to sharp increase nerve – muscle excretion.

Hypoparathyroidism in man is mostly due to accidental damage to the parathyroid glands during the operation of thyroidectomy. The symptoms that accompany are due to reduction in ionized calcium concentration in plasma. The total plasma calcium may reduce to 4-8 mg per 100 ml and the level of ionized calcium to 3 mg per 100 ml.

Injection of PTH to a patient with hypothyroidism may lead to the following sequence of events:

a) increased excretion of phosphorus in urine,

b) decreased concentration of phosphate in serum,

c) resorption of phosphorus and calcium from bones,

d) increased urinary excretion of calcium,

e) increase in the concentration of calcium in the serum,

f) further resorption of phosphorus and calcium from bones with consequent

weakening of the skeleton.

The symptoms after parathyroidism are due to hypocalcemia. The effects of hypoxalcemia are exerted on peripheral nerves and on the central nervous system. The treatment consists in giving parathyroid hormone by injections for short periods to raise the serum calcium level; by intravenous injections of soluble calcium salts which raises the serum calcium level temporarily; and large doses of calcium along-with very large doses of vitamin D (2.5 mg daily) which is 100 times the therapeutic dose in rickets) promote greater absorption of calcium from the intestine.

Hypothyroidism : Growth and morphogenesis.

Greater is the severity of the effects of thyroid insufficiency, the earlier in age that it sets in. During foetal life or during the fist months after birth, the effects of insufficiency are especially severe. Lack or inadequacy of iodine in the diet makes the insufficiency more pronounced. The severity varies with species. Man is more vulnerable to insufficiency and suffers most from thyroid deficiency.

Growth and development are arrested in all young vertebrates by thyroidectomy, the animal fail to attain normal size and do not develop harmoniously. Onset of thyroid deficiency during foetal life or in the first years after birth gives rise to cretinism and dwarfism in animals and man. Their height is subnormal. Ossification is markedly retarded. The bones of the face grow less compared to the cranium, the nose if flattened and the limbs are short. The abdomen is prominent with a protruding umbilicus. The eruption of permanent teeth is retarded, which are often irregularly placed, badly developed and poorly calcified with high incidence of caries. In man, the skin is dry, rough and cold. There is characteristic infiltration of the subcutaneous tissues. This is known as myxedema, which is marked in man and is not seen in other species. In myxedema, the face is round with swollen eyelids. The tongue is swollen, the hair coarse and straight, the eyebrows are thin. Axillae contains little hair. All these disturbances are cured if treatment with thyroid at early age. Delay makes the results less satisfactory.

Basal metabolism

Heat production is markedly decreased following thyroidectomy. The BMR falls 30 to 45 per cent below normal. BMR is restored to normal or even higher in cases of thyroid insufficiency with the administration of thyroid preparations.

Protein metabolism

Nitrogen uptake by animals with thyroid insufficiency is less for the formation of body protein. This is more so in young animals in which growth ceases. Protein catabolism is subnormal.

Fat metabolism

Thyroid insufficiency is accompanied by high lipemia with increase in plasma cholesterol content above normal levels.

Carbohydrate metabolism

Blood sugar and glycogen in liver and muscle are usually normal or subnormal. The intestinal absorption of glucose and galactose is retarded and the blood sugar curves following ingestion of the sugars are flattened and prolonged. Insulin hypoglycemia is more marked and convulsions occur with greater frequency in normal animals.

Mineral and water metabolism

Thyroid insufficiency retards the passage of water through the body, diuresis is delayed on injection of water. Myxedema results from the accumulation of water, sodium chloride and protein (over 13 per cent). Protein-bound iodine in blood is diminished, less of calcium and phosphorus are retained as a result of retarded ossification and underdevelopment of the skeleton. Less than normal amount of radioactive iodine is taken up by the deficient thyroid and more is excreted in the urine.

Blood and circulation

Thyroid insufficiency decrease the circulating blood volume. The circulation is slow and the circulation time is raised. Intracellular and extracellular edema of the heart may occur leading to cardiac dilation and weak heart beat. Changes in blood and circulation respond favorably to thyroid treatment.

Digestive function

Usually a poor appetite and constipation occur in thyroid insufficiency.

Nervous and psychic disturbances.

Thyroid plays an important role in the normal development of central nervous system. People with thyroid insufficiency are apathetic their mental processes become slow, memory poor, muscles weak and speech slow.

Hyperthyroidism +

Excessive thyroid functions in man is associated with the following disturbances.

Basal metabolism

Oxygen consumption and heat production increase in hyperthyroidism. Increase BMR is of great diagnostic and therapeutic value as it is an accurate index of thyroid functions.

Protein metabolism

Protein catabolism is increased and the minimum protein requirement is higher than normal.

Fat metabolism

Rapid loss of fat and ketosis, low blood cholesterol are often observed.

Carbohydrate metabolism

Blood sugar is normal. Ingestion of glucose or galactose gives rise to high and prolonged hyperglycemic curves, which differ from that in diabetes as the blood sugar returns to normal at postabsorptive stage. The incidence of diabetes in hyperthyroid subjects is twice that in general.

Mineral and water metabolism

Diuresis is increased with loss of body weight. Proteinbound iodine in blood is increased. Uptake of radio active iodine is more than normal and urinary excretion of radioactive iodine after 48 to 72 hours of intake is below normal. Elimination of calcium and phosphorus urine and faces is increased accompanied by a negative calcium and phosphorus balance.

Growth

A slight acceleration of growth may take place in hyperthyroidism in infancy and adolescence and the normal height is not generally surpassed. Gigantism never occurs in human or experimental hyperthyroidism.

Blood and circulation

Lymphocytosis often occurs in hyperthyroidism which may be seen in thyroid insufficiency also. Plasmas proteins are lowered and viscosity of blood is subnormal. The circulating blood volume increase and typical disturbances in the heart such as tachycardia, palpitations, are observed.

Nervous and psychic disturbances.

Patients with hyperthyroidism, especially with exophathalmic goiter, are excessively emotional and unstable, accompanied by insomnia, general irritability and nervousness. Hyperthyroid patients are easily fatigued and their muscular efficiency is below normal.