Aquifer Case 5: Palpitations Flashcards
what are cardiovascular, psychiatric, medications, substances, endocrinology, hematologic, and infectious causes of palpitations?
- arrhythmia, cardiomyopathy, hypovolemia
- psychiatric = anxiety, panic attacks
- medications = caffeine, stimulates, theophylline, albuterol
- substances = tobacco, caffeine, alcohol intoxication or withdrawal, cocaine, amphetamines
- endocrinologic = hyperthyroidism, pheochormocytoma, hypoglycemia
- hematologic = anemia
- febrile illness
why does anemia cause palpitations?
sinus tachycardia due to reduced oxygen carrying capacity in the blood
signs of hyperthyroidism?
- depression
- fatigue
- heat intolerance
- hyperreflexia
- sweating
- tachycardia/palpitations
- tremor
- weight loss
- diarrhea
- hyperreflexia
what can cause can enlarged thyroid?
- cancer
- hyperthyroidism
- hypothyroidism
- hypothyroidism
- lack of iodine
- nodules
- pregnancy
- thyroiditis
what is the most common cause of hyperthyroidism in adults and children?
Graves disease (60-80%)
an autoimmune disease caused by an antibody that acts at the thyroid-stimulating hormone (TSH) receptor and stimulates the gland to synthesize and secrete excess thyroid hormone
what tests can determine the cause of hyperthyroidism?
- anti-thyrotropin receptor antibodies
2. radioactive iodine uptake test and scan
if there is high radioactive iodine uptake, which conditions are in the differential?
- HCG secreting tumor
- TSH secreting pituitary tumor
- toxic solitary nodule
- multionudlar goiter
- Graves disease
if there is low radioactive iodine uptake, which conditions are in the differential?
- subacute thyroiditis
- silen thyroiditis
- iodine deficiency
- exogenous L-thyroxine
- struma ovarii
- Amiodarone
what is Graves disease?
autoimmune disease in which thyrotropin receptor antibodies (also called thyroid-stimulating immunoglobulins) are produced. These antibodies stimulate the thyroid gland to enlarge and to produce more thyroid hormone
incidence is between ages 40 and 60.
describe the eye involvement in Graves disease?
primary symptoms of the eye manifestations of Graves disease, when they occur, are related to corneal irritation from the eyelid retraction
most common manifestations of Graves ophthalmopathy are eyelid retraction and exophthalmos
while most of the time the eye signs and symptoms are bilateral, they can be unilateral
how do you treat Graves?
- methiazole
- oral dose of radioactive iodine
- surgery
how does methimazole treat Graves?
suppresses thyroid hormone production –> takes 3 months but patients see improvement after 1 month
dose fluctuates over time and blood work is needed to monitor
agranulocytosis is a serious side effect
how does oral radioactive iodoine treat Graves?
very few side effects
ionizing destroys most of the overactive thyroid cells and the thyroid hormone levels fall and the gland shrinks
eventually, people will have too little thryoid hormones and might even need to start taking some to replace it
blood labs 1-2 times a year but dose of thyroid replacement stays about the same
what are some symptoms of hypothyroidism?
- cold intolerance
- fatigue
- heavy periods
- pedal edema
- weight gain
what is the starting dose in primary hypothyroidism?
75 mcg (1.5-1.8 mcg per kg)
start the dose low and increase slowly; repeat TSH in 6 weeks
when a stable TSH is achieved, you can check the TSH once or twice annually
