Leila was losing weight

her glands looked a bit swollen in her neck.
1. she was always hungry & lost weight
  1. Cancer
    1. Eating disorders
      1. Malabsorption
        diabetes
        depression
        stress
  2. signs and symptoms of Hyperthyroidism
2. Dr Kamal ordered a fullset of thyroid function tests (TFTs
  1. wrote on the lab slip his clinical diagnosis of hyperthyroidism
    1. He decided to order an antithyroid peroxidase (aTpo)test and a fullblood examination (FBE).
      1. they could then decide on the best management plan'
        relapsed, had to undergo thyroidectomy
        A thyroidectomy may be recommended for conditions such as:
        Thyroid cancer
        Noncancerous enlargement of the thyroid (goiter).
        Overactive thyroid (hyperthyroidism).
        Overactive thyroid (hyperthyroidism).
        Treatment
    2. types
      1. Diffuse toxic goiters- Graves disease
        An immunoglobulin called thyroid-stimulating immunoglobin (TSI) found in the blood of all patients; TSI binds to the TSH receptor and induce TSH-like effects; TSI effects persist longer than TSH (up to 12 hrs vs. 1 hr respectively) Plasma level of TSH is suppressed due to the high level of thyroid hormones
        females 20-40
        autoimmune
        Diagnosis
        Thyroid auto antibodies
        TSH is deccreased & free T4 is increased
        TSH is deccreased & free T4 is increased
        History taking
        Physical examination
      2. Toxic Multinodular Goiters
        Thyroditis
      3. Pituitary Adenoma (TSHoma)
      4. causes
        Excessive iodine intake
        Abnormal secretion of TSH
        Excessive intake of thyroid hormones
        Thyroiditis (inflammation of the thyroid gland)
  2. TSH,T4 and T3 measurements
    1. thyroid auto-antibody and serum thyroglobulin measurements, thyroid enzyme activities, biopsy of the thyroid, ultrasound and isotopic thyroid scanning
      1. Autoantibodies : TSH receptor autoantibody, Thyroglobulin autoantibody, thyroid peroxidase autoantibody (more common in hypothyroidism)
        Antigen presenting cell presents TSH like antigen activating naïve t cells which activate B cells which produce TSH like autoantibodies
    2. radioactive iodine scan
3. Anatomy of the thyroid gland
  1. Nerve supply
    1. Supplied by superior, middle & inferior cervical sympathetic ganglia.
      1. Fibers: Vasomotor & not secreto-motor
  2. lymphatics
    1. Upper part of the gland to upper deep cervical nodes via the prelaryngeal, pretracheal & paratracheal nodes.
    2. Lower part to lower deep cervical nodes. The lymphatic's form a plexus & lymph can drain in any direction.

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Leila was losing weight

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