8 - Thyroid Dz 2 Flashcards
MCC thyrotoxicosis
Grave’s dz
hallmark of Grave’s vs other hyperthyroidism causes
exophthalmos / eye complaints
sx of hyperthyroidism
wt loss inc appetite irritability/restlessness malaise muscle weakness tremor / choreoathetosis palpitations heat intolerance V/D goiter oligomenorrhea / dec libido onycholysis
what meds are given to make hyperthyroid pts euthyroid?
thionamides
tx for grave’s dz
beta blocker tx symptoms
can try thionamides, but high rate of recurrence
radioiodine ablation or surgery are best options
tx for toxic thyroid adenoma
anti thyroid meds (thionamides)
radioiodine (works better when nodule is so active that it is suppressing rest of thyroid)
surgery
tx of thyroid storm
admit to ICU supportive measures beta blockers anti thyroid drugs - Methimazole (given BEFORE iodine) steroids iodine (high doses)
Wolff Chaikoff effect
hyperthyroid pts can be given large doses of iodine which causes the thyroid to produce less hormone
apathetic hyperthryoidism
common in the elderly
lack sx of sympathetic overactivity
sx include: wt loss, anorexia, constipation, tachycardia / afib / CHF/ angina, cognitive dysfn
subclinical hyperthyroidism
dec TSH w/ nl free T3 and T4
often dont progress to overt hyperthyroid
only tx if they have heart dz, are >60 yo, toxic MNG or adenoma, or osteoporosis
amiodarone effect on thyroid
inc iodine pool in body > dec RAIU and dec peripheral deiodination of T4 > T3
can cause either hypothyroid (more common) or thyrotoxicosis
which thyroid hormone do we treat with for hypothyroidism?
T4 (levothyroxine)
“peaches and cream” complexion
hypothyroidism
sx of hypothyroid
tiredness/malaise wt gain / anorexia cold intolerance depression / psychosis puffy eyes dry/brittle hair arthralgia / myalgia constipation irregular periods
lab goal for tx of hypothyroidism
normalize TSH
extreme form of hypothyroidism =
myxedema coma
MC type of thyroid cancer
papillary
thyroid cancer is more common in
women
presentation of papillary thyroid CA
slow growing neck mass, may start to cause compression sx / nerve problems like dysphagia
tx of papillary thyroid CA
thyroidectomy +/- LN dissection followed by radioiodine therapy
course of follicular thyroid CA
invades blood vessels early > lung, bone mets pretty common
mortality of 50% at 10 yrs
medullary thyroid CA originates from what cell?
parafollicular cell
hereditary cause of medullary thyroid CA
MEN 2a/b
anaplastic thyroid CA course
undifferentiated tumors, extremely aggressive w/ mortality approaching 100%. presents as rapidly enlarging neck mass. basically you are screwed.
