Ch 6 Thyroid disorders Flashcards
hypothyroidism clinical presentation
MOM’S SO TIRED (most are women > 50 yrs)
-Memory loss
-Obesity (mostly fluid, < 10 lbs)
-Menorrhagia
-Slowness (mentally/physically)
-Skin and hair dryness
-onset gradual
-Tiredness
-Intolerance to cold
-Raised BP (modest)
-Energy levels fall
-Depression/Delayed relaxation phase of all reflexes, esp patellar, Achilles
most common cause of hypothyroidism?
Hashimotos thyroiditis
-autoimmune, discovered when thyroid is destroyed and nonfunctional
other causes of hypothyroidism?
post radioactive iodine (RAI) treatment
-status post (S/P) graves disease treatment
-S/P thyroid cancer treatment with thyroid ablation which causes hypothyroidism
-meds: lithium, amiodarone, interferon, etc (uncommon)
hyperthyroidism clinical presentation
SWEATING
-Sweating
-Weightloss (~10 lb muscle & fat)
-Emotional liability (mind racing, memory alteration)
-Appetite increased but losing weight
-Tremor/tachycardia
-Intolerance of heat, irregular menstruation
-Nervousness
-Goiter, GI problems (frequent, low volume, loose stools)
most common cause of hyperthyroidism?
Graves disease
-autoimmune, seen with other autoimmune conditions (RA, lupus, vitiligo, celiac disease, T1DM)
-often with new onset tachydysrhythmia, afib, heart failure
other causes of hyperthyroidism?
-Toxic adenoma: benign; metabolically active thyroid nodule; present with palpable unilateral thyroid mass but no exopthalmos
what is the single most reliable test to diagnose all forms of thyroidism?
TSH (0.4-4.0)
when TSH are WNL, thyroid dz ruled out
what follow-up test to confirm of hyper or hypo thyroid?
get Free T4 if abnormal TSH
(high TSH, low T4) intervention
hypothyroidism
-give Levothyroxine (Synthroid, Levoxyl, generic)
when to have follow up on hypothyroidism after treatment given?
~8 weeks after giving levothyroxine therapy (pt usu notes improvements ~ 1 wk)
if TSH STILL elevated after therapy, consider…
-make sure pt takes levo empty stomach, same time everyday
-not be taken w/in 2 hrs of cation (calcium, iron, aluminum, mg, others = reduced drug absorption)
(low TSH, high T4) intervention
hyperthyroidism/throtoxicosis
- Give Beta Blocker (propranolol, nadolol) if not contraindicated for tachycardia/tremor
- PO methimazole (Tapazole) or PTU
once euthyroid, offer radioactive iodine (RAI) use = thyroid ablation for hypothyroidism) - get endo consult bc of med risk
risk of methimazole and PTU use
acute hepatic failure even in healthy liver pts
elevated TSH with NL free T4
intervention
subclinical hypothyroidism
-treat with Synthroid if TSH >5 if have:
-goiter
-elevated TPO antibodies
-have sx of hypothyroidism, infertility, pregnancy , or imminent pregnancy
after 8 wks of levo therapy for hypothyroidism:
if TSH is >4 then…
if TSH is <0.4 then…
if TSH between 0.4 - 4.0…
TSH > 4, not euthyroid, increase dose 12.5-25, check again in 8 weeks
TSH < 0.5, not euthyroid, decrease dose by 12.5-25, check again in 8 weeks
continue dose, measure TSH in 6 months, then yearly or when symptomatic
what is a thyroid nodule?
-palpable thyroid mass, not specific to a diagnosis
>1 cm
