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
acute thyroiditis dx
warm tender enlarged thyroid
FNA to drain abscess, get culture
RAIU normal (unlike subacute)
further imaging if suspected thyroglossal duct cyst infection
acute thyroiditis tx
high mortality w/o prompt tx!
IV abx
search for pyriform fistulae
usually make complete recovery
Reidel’s thyroiditis - basic dz process
fibrosis of thyroid
dx of reidel’s thyroiditis
thyroid abs present in 2/3
painless goiter w/ “woody” texture
often need biopsy to confirm
assoc w/ focal sclerosis syndromes
tx of reidel’s thyroiditis
resect if compressive sx
steroids may be effective
thyroid hormone if hypo
