020415 hyperthyroidism in adult

Question 1

most common type of hyperthyroidism

Answer 1

Graves disease

Question 2

is hyper or hypo thyroidism more common?

Answer 2

hypo

Question 3

symptoms of hyperthyroidism

Answer 3

palpitations
voracious appetite, weight loss
heat intolerance
fine tremor
fine, moist skin
lid lag
proptosis/stare (Graves dis)
tachycardia
etc

Question 4

can you get goiter in hypothyroidism?

Answer 4

yes, in inflam-Hashimoto’s-b/c inflammed, thyroid can get big

Question 5

complications around the eye with Grave’s disease

Answer 5

enlargement of extraocular muscles

compression of optic nerve (can lose vision)

Question 6

exophthalmos and pretibial myxedema

Answer 6

Graves disease

Question 7

exophthalmos and pretibial myxedema in Graves dis is mediated by

Answer 7

TSH receptor activation resulting in glycosaminoglycan buildup, inflam, fibrosis, and edema

Question 8

what is the radiotracer uptake and scan used for

Answer 8

to determine what type of hyperparathyroidism it is

used after getting TSH and thyroid hormone

Question 9

patterns of radiotracer uptake

Answer 9

increased uptake that is homogeneous (Graves)

solitary toxic nodule (follicular adenoma)

toxic multinodular goiter (mlutiple functioning thyroid nodules)

or if see nothing-could be painless thyroiditis causing hyperthyroidism that then becomes hypothyroidism (you see nothing on the scan b/c the thyroid is damaged during hyperthyroidism and see nothing)

Question 10

tx for hyperthyroidism

Answer 10

methimazole (inhibits synthesis of thyroid hormones by blocking oxidation of iodine in thyroid gland)

propylthiouracil (PTU)-don’t use as much b/c it’s 3x/day. use is for 1st trimester of pregnancy or an ICU pt w thyroid storm

iodide–use for preoperative period or thyroid storm or to protect thyroid from radioactive iodine fallout after a nuclear accident

radioactive iodine–use for thyroid destruction of overactive or enlargd thyroid and used for thyroid cancer

Question 11

MOA of propylthiouracil

Answer 11

inhibits synthesis of thyroid hormones by blocking oxidation of iodine in the thyroid gland. ALSO partially inhibits peripheral deiodination of T4 to T3 (that’s why it’s used for thyroid storm pts)

Question 12

MOA of iodide

Answer 12

inhibits hormone release by thyroid

also decreases vascularity, size and fragility of hyperplastic gland, making drugs valuable as preoperative prep

Question 13

TSH and T4 levels for thyroiditis, Graves dis, toxic multinodular goiter, solitary toxic nodule

Answer 13

TSH is low

T4 is high

Question 14

tx for thyroiditis as opposed to Graves, toxic multinodular goiter, and solitary toxic nodule

Answer 14

for thyroiditis, it’s supportive care. may be beta blockers

for the others, it’s methimazole, radioactive iodine, or surgery

Question 15

prevalence of secondary hyperthyroidism

Answer 15

VERY RARE

Question 16

thyroiditis

Answer 16

generic term referring to destruction of thyroid from inflam

includes:

• subacute/viral (deQuervain’s) thyroiditis
• silent/painless thyroiditis

Question 17

after getting TSH and T4/T3, to further support the diagnosis of Graves dis, or if imaging studies can’t be obtained, what should you do?

Answer 17

TSI measurement (not always positive in Graves dis pts, but if positive, very specific for Graves)