5- palpitations Flashcards
CV causes of palpitations
Arrhythmia, cardiomyopathy, hypovolemia
psych causes of palpitations
Anxiety, panic attacks
meds causes of palpitations
Caffeine, stimulants, theophylline, and albuterol use
substances causes of palpitations
Tobacco, caffeine, alcohol intoxication or withdrawal, cocaine
endocrine causes of palpitations
Hyperthyroidism, pheochromocytoma, hypoglycemia
Hematologic causes of palpitations
anemia
infectious causes of palpitations
Febrile illness
are cardiac arrythmias associated with associated with systemic symptoms such as weight loss, oligomenorrhea, and loose stools,
no
In patients under the age of 50, the most common signs and symptoms of hyperthyroidism are:
Heat intolerance (92%) Tachycardia (96%) Fatigue (84%) Weight loss (50%) Tremor (84%) Increased sweating (96%) Exertional dyspnea
Depression and hyperreflexia are less common but can be present.
Diarrhea and light periods can also occur with hyperthyroidism.
causes of goiter
A. Lack of iodine B. Hypothyroidism C. Hyperthyroidism D. Nodules E. Cancer F. Pregnancy G. Thyroiditis
What is the most common cause of hyperthyroidism in adults and children?
Toxic diffuse goiter (Graves disease)
Toxic nodular goiter
Causes about 5% of cases of hyperthyroidism.
common, but most are not symptomatic, and only 4% to 5% are cancerous.
Thyroid nodules are more common in patients over 40.
These older patients more often have multi nodular disease, whereas, solitary nodules are seen more often in younger patients and can be associated with iodine deficiency.
thyroiditis
Thyroid hormone leaks from an inflamed thyroid.
Happens after a viral illness or pregnancy.
Studies to Determine the Etiology of Hyperthyroidism
Radioactive iodine uptake (RAIU) test and scan
Anti-thyrotropin releasing antibodies (TRAb)
Radioactive iodine uptake (RAIU) test and scan
measures the amount and pattern of radioactive iodine taken up by the thyroid in the 24 hours following ingestion of a set dose.
Normal RAIU uptake is 15% to 30% of the ingested dose.
Anti-thyrotropin releasing antibodies (TRAb)
pathologic mechanism for Graves disease and can be detected in the vast majority of patients with this condition
A thyroid ultrasound is used in the evaluation of
thyroid nodules and thyroid enlargement
“Cold” (non-thyroxine producing) nodules can be caused by
cancer
Diffuse increased uptake suggests
graves (as opposed to nodular)
examples of High RAIU (>30%) thyroid problems
Graves multi nodular goiter toxic solitary nodule TSH secreting pituitary tumor HCG secreting tumor
examples of Low RAIU (<15%) thryoid problems
sub acute thyroiditis Silent thyroiditis iodine induced Exogenous L-Thyroxine struma ovarii Amiodarone
which antibodies in graves disease
thyrotropin receptor antibodies (also called thyroid stimulating immunoglobulins)
ages in graves
40-60
graves triggers
stressful life events, high iodine intake, or a recent pregnancy
eyes in graves
ophthalmopathy (eye problems) are eyelid retraction and exophthalmos.
related to corneal irritation from eyelid retraction.
mostly bilateral, can be unilateral.
most commonly used medication to suppress thyroid hormone production.
Methimazole
how many months to suppress thyroid production
3, but start to notice improvement after 1
rare serious side effect of methimazole
agranulocytosis
alternative med: radioactive iodine but popular in US
During the course of a few months the iodine destroys most of the overactive thyroid cells and the level of thyroid hormone falls and the thyroid gland shrinks in size.
Eventually most people who have this treatment start
having too little thyroid in their bloodstream so that they need to start taking small doses of thyroid hormone to replace it.
come in less frequently for bloodwork
what do you need to obtain before initiating radioactive iodine treatment.
pregnancy test
dont even be near pregnant women with this med
radioactive iodine side effects
transient soreness of the neck or brief worsening of symptoms but they should resolve within a few days. Furthermore, people with ophthalmopathy can have worsening of eye symptoms.
is fatigue common in hyper or hypothyroidism
both
A typical starting dose of thyroxine in primary hypothyroidism
1.5 to 1.8 mcg per kilogram.
TSH should be repeated after starting thyroid replacement therapy after how many weeks
6
then once stable, 1-2 a year
why is Gynecomastia seen in 10% to 40% of patients with Graves disease
sex hormone binding globulins being increased in Graves disease.
why would you have palpitations with this presentation: abdominal pain, weakness, tachycardia, diastolic murmur, and tar-like stools
anemia from GI blood loss
how much time would it take to feel symptoms of hypothyroidism after radioactive iodine treatment
few months
what med helps with the symptoms of hyperthyroidism
propranolol
