Endocrine disorders

Syndromes in endocrinology

•Hyperthyroidism

•Thyrotoxicosis

•Hypothyroidism

•Hypercorticism (Cushing`s syndrome)

•Adrenal insufficiency

•Hyperglycemia

•Hypoglycemia

•Metabolic syndrome

Feedback control of target endocrine organs

Thyroid gland: anatomy

Anatomy

Too often when people are feeling for the thyroid, their fingers are nowhere near the thyroid gland. The thyroid cartilage, despite its name, is not where the gland is situated.

Palpation of the thyroid gland

•Place first two digits of both hands just below cricoid cartilage so that left and right fingers meet on the patient’s midline.

•Place thumbs posterior to patient’s neck and flatten all fingers against the neck.

•Use finger pads, not tips, to palpate.

•Identify the isthmus.

•Gently draw fingers laterally 1-2cm.

•Gently palpate lateral lobes.

•NOW ask patient to swallow (give them a glass of water if possible).

•Assess for asymmetrical elevation of lobes (suggests nodularity).

Goiter

Classification of goiter

Laboratory evaluation in thyroid gland diseases

•Measurement of hormones

•Total and free T4 (N- 4,5-12,5 µg/dL)

•Serum T3 (N- 80-220 ng/dL)

•TSH -N- 0,3-6 µU/ml

Relation between target hormone level and trophic hormones level in normal and disease state

Imaging of the thyroid gland

•Ultrasound with Doppler study

•Thyroid scintigraphy (radionuclide 99mTc, 123Iodine

•CT, MRI

•Fine-needle aspiration biopsy

•Direct biopsy in palpable nodule >1 cm