5 - Thyroid Dz Flashcards
causes of goiter
hashimoto’s thyroiditis (early)
grave’s (chronic stimulation of TSH receptor)
chronic iodine excess (too much colloid > can prevent hormone release)
meds (lithium)
neoplasm
ket to determining treatment for goiter
determining thyroid state
risk of malignancy w/ multi node goiter
same as with solitary nodule
do FNA - if neg, follow w/ annual US
if inconclusive or suspicious, excise
tx for non-toxic goiter w/ and w/o compressive sx
w/o compressive sx - US to follow progression, thyroid suppression therapy used in past but recurs when therapy is stopped, surgery if worried about LAN, radiation to cervical region, or rapid enlargement
w/ compressive - RAI ablation, surgery**
what percent of thyroid nodules are malignant?
what about if the nodule is “cold”?
5%
15-20% if cold
who is at higher risk for having a malignant thyroid nodule?
children age 60 hx of head/neck radiation family hx of thyroid CA males
MCC goiter and hypothyroidism in US
hasimoto’s thyroiditis
disease process of hashimoto’s thyroiditis
ab to thyroid peroxidase (TPO) and TBG > progressive autoimmune destruction of gland
clinical features of hashimoto’s thyroiditis
hyper or hypothyroidism, usually nontender gland
subacute (de quervains) thyroiditis
self limited dz of variable duration (usu 4-6 mo) and severity
causes painful thyroid gland 2/2 antecedent viral infxn
dx of subacute thyroiditis
elevated ESR
low TSH, elevated T4 > T3, low anti-TPO/TBG
low RAI uptake
tx of subacute thyroiditis
NSAIDs, salicylates
oral steroids if severe
beta blockers for hyperthyroid sx
silent thyroiditis / post partum thyroiditis - clinical course
painless gland
hyperthyroid sx at presentation
progression to euthyroid > hypothyroid for up to a year
generally resolves on its own
MCC painful thyroid gland
subacute thyroiditis
cause of acute thyroiditis
infectious - mostly bacterial, 15% fungal, common in HIV
