Chapter 103- Hyperthyroidism Flashcards
__________ has been noted in the settings of chronic lymphocytic (Hashimoto’s) thyroiditis, subacute (granulomatous) thyroiditis, and postpartum thyroiditis.
Transiet hyperthyroidism
Graves Disease, toxic multinodular goiter, toxic adenoma (nodule), excessive ingestion of thyroid hormone, and Jod-Basedown phenomenon are all well recongnized causes due to ___________.
hyperthyroidism
Is hyperthyroidism more common in men or women?
women
___________ is due to mechanisms responsible for this excess include stimulation of thyroid-stimulating hormone, autonomous thyroid hormone production, increased release of thyroid hormone without increased production of TSH, and intake of exogenous hormone.
hyperthyroidism
______ hormone stimulates calorigensis and catabolism and enhances sensitivity to catecholamines.
Thyroid
What will patients with excessive amounts of thyroid hormone experience?
- heat intolerance; nervousness; hyperactivity; tremor; increased appetite; weight loss; excessive sweating; palpitations, lid lag; stare; and muscle weakness.
- Diarrhea, or more precisely, frequent defecation, may also ensue
What will patients with chronic hyperthyroidism experience?
* along with all the manifestations listed on the previous card
- muscle weakness and SEXUAL DYSFUNCTION
* a DOC better not ever MISS a diagnosis of HYPERTHYROIDISM in BRITT!!!!!!!!! fockerFord wouldnt be possible hahaha
A reversible picture of left ventricular dysfunction may emerge, and the risk of _______ is increased in patients with hyperthyroidism.
atrial fibrillation/flutter
Elevations in __________ and ___________ may accompany thyrotoxicosis and persist even after treatment.
alkaline phosphatatse and angiotensin-converting enzyme
In an ELDERLY thyrotoxic patient, the characteristic systemic manifestations of hyperthyroidism may be absent, INSTEAD you commonly see _______, _______, and _______.
Apathy
Weight Loss
Unexplained Atrial Fibrillation
**The condition can mimic depression depression and occult malignancy.
Hyperthyroidism increases sensitivity to catecholamines. What are 5 things that result in a patient because of this?
- Tachycardia
- Tremor
- Sweating
- Stare
- Lid Lag
_______ is due a deficiency of thyroid specific suppressor T cell lymphocytes, which allows a thyroid-stimulating immunoglobulin G antibidy (Tsab) to form; resulting in toxic hyperthyroidism
***Tsab (also called thyrotropin-receptor antibody) binds to TSH receptors on the surface of thyroid cells and triggers the synthesis of excess thyroid hormone.
Graves Disease
______ disease is the most common form of hyperthyroidism.
seen in 90% of cases younger than 40 yrs.old
& 70% of cases older than 60 yrs. old
Graves Disease
What are the eye characteristic manifestations associated with Graves’ disease?
- Patients can have the “thyroid stare”
- Patients can orbital edema and proptosis due to inflammatory infiltrate producing swelling of tissue, which compresses veins
- Inflammation can cause DIPLOPIA
- usually develops CONCURRENTLY in MOST with the onset of hyperthyroidism & change little once established
Manifestations range from lid retraction and stare, mild periorbital edema, and conjunctival inflammation. to extraocular muscle dysfunction, corneal injury, and optic nerve damage in _______ disease.
*Other associated ocular symptoms include pain, diplopia, proptosis, and blurred vision.
Graves
_________ is characterized by the appearance of NONPITTING swelling, indurated nontender plaques (thickening of the skin) with brownish, reddish, dark pink, or purple color and an “orange skin” primarily LOCATED primarily to the skin of the pretibial area.
**Rarely the LOWER LEG can be extensively involved, giving the appearance of ELEPHANT TIASIS!
Pretibial Myxedema - Thyroid Dermapathy
________ is characterized by CLUBBING and soft tissue swelling of the distal fingers and toes, is also rare.
*associated with Graves’ disease, but very rare
Thyroid acropachy
________ = Thyroid gland in Graves’ disease that is DIFFUSELY ENLARGED and a BRUIT may be heart (unusual sound that blood makes when it rushes past an obstruction). The skin is VELVETY and the hair is SILKY. Onycholysis, vitiligo, and gynecomastia are found in some cases and may suggest diagnosis.
Thyrotoxicosis
T/F The clinical course of Graves Disease is one in which if left along it will spontaneously improve.
YEAHHH RIGHT!! NO GIRL NO!
- usually worsens if it untreated
- although patients with mild diseases may have exacerbations and remissions of unpredictable duration
- After many years mild HYPOTHYROIDISM may ensue, especially in patients with small Goiters and mild hyperthyroidism at the time of onset.
_________ = results from diffuse hyperplasia of thyroid follicular cells whose activity becomes independent of TSH regulation. It is MOST COMMON in areas of IODINE deficiency.
Toxic Multinodular Goiter (Plummer’s Disease)
What do most patients present to the clinic with upon diagnosis of Toxic Multinodular Goiter?
- Heart Failure, Atrial Fibrillation, Palpitations, or Angina
- Some patients present with constipation and anorexia
- Lid Lag may be noted on few, BUT EXOPHTHALMOS DOES NOT OCCUR
- **Sometimes, APATHY & WEIGHT LOSS are the most prominent clinical features and can be so profound as to suggest occult malignancy or severe depression
______ = active nodule surrounded by suppressed gland on radioiodine thyroid scan. The LARGER the nodule the GREATER is its propensity to cause thyrotoxicosis. NON CANCEROUS
***OFTEN th eonset of toxicity is FIRST manifested by an isolated increase in ______; later ______ levels rise.
Single Toxic Nodule (HOT NODULE)
T3 serum levels rise first; later T4 rise at onset of toxicity
The larger the SIngle Toxic Nodule (HOT NODULE) the greater is its propensity to cause thyrotoxicosis, with the risk quite high once the nodule reaches ______ in diameter.
3 cm
In Single Toxic Nodule (“HOT” Nodule), sometimes _________ TERMINATES the overproduction of hormone and limits the progression of thyrotoxicosis.
Hemorrhagic Infarction
