CECIL THYROID Flashcards
Which psychiatric drug may block thyroid hormone release?
Lithium
Which sort of situations may increase the TBG
Pregnancy Exposure to estrogens Hepatitis Familial TBG escess 5FU Tamoxifen Methadone
but T4 and T3 remain constant
Decreased TBG levels may occur with
Systemic illness Severe hepatic disease Nephrotic syndrome Androgens Glucocorticoids Slow-release nicotinic acid
but T4 and T3 remain constant
Deiodinases (T4 to T3) may be inhibited by
Systemic illness
Iodide-containing compounds (amiodarone, radiocontrast)
Glucocorticoid
Selenium deficiency
What does T3 do to LDL levels?
It results in accelerated LDL clearance
What effect does aging have on TSH?
Aging is associated with increased serum TSH concentrations with no change in free T4 levels
What sort of antibodies may confirm the diagnosis of autoimmune thyroiditis?
Antithyroid peroxidase and
Atithyroglobulin aitbody
Causes of primary Hypothyroidism
Hashimoto's Scleroderma Amyloidosis Amiodarone Lithium
Secondary Hypothyroidism
Sheehan
Inflammation (sarcoidosis, vasculitis)
Infiltration (hemochromatosis, tuberculosis, fungal infection)
Tumor (lymphona, germinoma, glioma)
Hypothyroidism Epidemio
Women
Whites and Latin Americans
Polyglandular autoimmune syndrome type 2
Hypothyroidism
DM1
Adrenal insuficciency
Polyglandular autoimmune syndrome type 1
Hypothyroidism
Adrenal insufficiency
Hypoparathyroidism
Chronic mucocutaneous candidiasis
Which sort of drug may cause autoimmune thyroiditis?
Infereron-alpha
Riedel’s thyroidism
Fibrous Thyroiditis
Infiltrative disorder
Infiltrative disorders affecting the hypothalamus
Sarcoidosis
Hemochromatosis
Hitiocytosis
Clinical manifestations of Hypothyroi..
Hoarseness Constipation Myalgias Arthralgias Paresthesias Dry Skin Hair Loss
Females with hypothyroidism may develop
Precocious puberty
Menorrhagia
Amenorrhea
Galactorrhea
Physical findings of hypothyroidism in children
Delayed linear growth despite weigh gain
Precocious or delayed puberty
Pseudohypertrophy of muscle
PFindings of hypothyroidism in adults
Bradycardia
Diastolic hypertension
Mild hypothermia
Routine blood tests in Hypothyroidism
Anemia (which is typically macrocytic) Hyponatremia Hypoglycemia Elevated creatine phosphokinase Elevated Prolactin Elevated Homocysteine Elevated Triglyceride Elevated total and LDL cholesterol
Increased metabolism of thyroxine, including drug interaction
Pregnancy Phenytoin Phenobarbital Carbamazepine Rifampin
In how many weeks should one assess if the treatment was successful? How should one assess?
4-6 weeks
TSH measurement
Once an adequate dose has been established, the TSH level should be checked how often?
Annually
How should be evaluate the success of the treatmente in secondary hypothyroidism?
serum free T4 levels in theupper half of the reference range. 2 to 4 weeks after the thyroxine dose is started
Thyrotoxicosis hyperthyroidism
Graves Toxic adenoma Toxic multinodular goiter Struma ovarii Mtx differentiated thyroid cancer TSH-secreting pituitary adenoma
NOnhyperthyroid thyrotoxicosis
Subacute thyroiditis
Autoimmune thyroiditis
Symptoms of thyrotoxicosis
Weight loss despite a hearty appetite Heat intolerance Palpitations Tremor Hyperdefecation Fatigue Insomnia Anxiety Irritability Weakness Atypical chest pain Dyspnea on exertion
Atypical
Headache
Periodic paralysis
Nausea and vomiting
Apathetic thyrotoxicosis
In the elderly
Weight loss and the absence of sympathomimetic symptoms and signs
Signs of thyrotoxicosis
Resting tachycardia Systolic hypertension with a widened pulse pressure Warm moist skin with a velvety texture Onycholysis Staring gaze with lid lag Deep tendon reflexes (brisk) Proximal muscle weakness
Graves disease Epidemio
Women
30-60a
Clinical manifestations of ocular Graves disease
Ocular irritation Foreign body sensation Dryness Excessive tearing Exophtalmia
Treatment of thyroid eye disease
Moisturizing drops and ointment
Taping the eyelids in bedtime
Selenium supplementation
High-dose systemic GC
Pretibial myxedema, how does it appear and in what disease?
Graves
Mildly pruritic, orange peel-like thickening of the sking along the anterior aspect of the shin
Antibody found in Graves disease
Antithyrotropin
Concerning the T4 and T3 levels, which one is elevated in Graves disease toxicosis?
T3
Antithyroid drug pharmaco class
Thionamide
Which thionamide may be taken as a single daily dose?
Methimazole
In severe complicated thyrotoxicosis, which thionamide is prefered?
PTU
Toxicity of PTU
Hepatotoxicity
How often to check for hypothyroidism in patients treating for hyperthyroidism?
3-12 weeks
Alert QC in patients treating for hyperparathyroidism
Jaundice
High fever
Pharyngitis
Abdominal pain
