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Endocrinology > Clinical Approach Hyperthyroidism and Hypothyroidism > Flashcards

Clinical Approach Hyperthyroidism and Hypothyroidism Flashcards

1
Q

What is the approach to the diagnosis of thyroid disease?

A
  • H&P
  • inspection, palpation, and auscultation of the thyroid.
  • delphian lymph node
  • thyroglossal cyst’
  • pemberton’s sign= the presence of facial congestion, cyanosis, and respiratory distress after approximately one minute of having the patient elevate both arms until they touch the sides of the face.
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2
Q

Who are candidates for thyroid disease screening?

A
  • those with autoimmune disease (DM, pernicious anemia).
  • first-degree relative with thyroid disease
  • history of surgical removal of thyroid tissue or tx with sodium iodide I 131.
  • history or radiation to the neck.
  • those treated with Amiodarone
  • pts over 60 (esp. women)
  • psychiatric pts treated with lithium
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3
Q

*** What are the 3 most common thyroid function tests?

A
  • ultrasensitive TSH (best)
  • free T4
  • free T3
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4
Q

How sensitive is TSH regulation to T3 and T4 levels?

A
  • VERY; when T4/T3 is high, TSH is low, and when T4/T3 is high, TSH will be low
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5
Q

What is subclinical hypothyroidism?

A
  • mildly elevated TSH (5-7) with a NORMAL T4

* may need treatment with Levothyroxine

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6
Q

What is subclinical hyperthyroidism?

A
  • mildly lowered TSH (0.4-5) with a NORMAL T4.
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7
Q

What drugs will decrease TSH secretion?

A
  • dopamine
  • glucocorticoids
  • octreotide
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8
Q

What drugs will decrease thyroid hormone secretion?

A
  • lithium
  • iodide
  • amiodarone
  • aminoglutethimide
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9
Q

What drugs will increase thyroid hormone secretion?

A
  • iodide

- amiodarone

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10
Q

What is iodide inducing hyperthyroidism?

A
  • Jod basedow phenomenon
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11
Q

What is iodide inducing hypothyroidism?

A
  • wolff chaikoff pheonomenon
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12
Q

What drugs can decrease the absorption of thyroid hormone?

A
  • colestipol
  • cholestyramine
  • aluminum hydroxide
  • ferrous sulfate
  • sucralfate
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13
Q

What is thyroiditis?

A
  • inflammation of the thyroid gland.
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14
Q

** What is the most common cause of inherited hypothyroidism (thyroiditis) in the U.S.?

A
  • Hashimoto’s thyroiditis (struma lymphomatosa)= autoimmune destruction of the thyroid gland.
  • thyroid peroxidase antibody
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15
Q

** What is subacute granulomatous (De Quervain) thyroiditis?

A
  • granulomatous thyroiditis (hypothyroidism) that follows a viral infection.
  • presents as a tender thyroid with transient hyperthyroidism.
  • self-limited
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16
Q

Is hypothyroidism insidious?

A
  • YES
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17
Q

What are the symptoms of hypothyroidism?

A
  • tiredness, lethargy, weight gain
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18
Q

Can Hashimoto thyroiditis present with a goiter?

A
  • YES, but it does not have to.
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19
Q

What is the most common acquired form of hypothyroidism?

A
  • postablative hypothyroidism

* aka a pt becomes hypo by treating hyperthyroidism.

20
Q

What are the cardiovascular effects of hypothyroidism?

A
  • increased peripheral resistance (due to lack of vasodilation via thyroid hormone)= cool distal extremities.
  • elevated diastolic BP
  • decreased HR
  • “Myxedema heart” (pericardial effusion).
21
Q

What is Myxedema?

A
  • hypothyroidism in older children or adults.

- dough-like feeling and hyperpigmentation of extremities due to lymph-edema (not vascular edema).

22
Q

What are the respiratory signs of myxedema (hypothyroidism)?

A
  • pleural effusion

- CO2 retention

23
Q

What are the alimentary tract signs of myxedema (hypothyroidism)?

A
  • achlorhydria= low HCl gastric secretions.
  • constipation
  • weight gain (no more than 5 lbs).
  • gastric atrophy (pernicious anemia; autoantibodies against intrinsic factor preventing B12 absorption).
24
Q

What are the neurological signs of myxedema (hypothyroidism)?

A
  • headache
  • somnelescence
  • lethargy
25
Q

What are the muscular signs of myxedema (hypothyroidism)?

A
  • proximal myopathy
  • Kocher-Debre Semelaingne syndrome in newborns
  • Hoffman’s syndrome in adults
26
Q

What is the most severe form of hypothyroidism?

A
  • myxedema coma with profound hypothermia (usually during winter months)
27
Q

When treating myxedema coma, how do we prevent adrenal crisis from occurring?

A
  • give steroids (glucocorticoids) first before giving thyroid hormone (IV levothyroxine) so we don’t increase the demand of the adrenals to the point that they fail.
28
Q

May a goiter be euthryoid, hyperthyroid, or hypothyroid?

A

YES

29
Q

How do we treat Hashimoto thyroiditis?

A
  • thyroid replacement (Levothyroxine)

* early response is loss of edema; diuresis, improved hoarseness, better well being

30
Q

When should thyroid studies be done for Hashimoto thyroiditis?

A
  • every 6 weeks after each titration of dose.
31
Q

What is HYPERthyroidism?

A
  • increased level of circulating thyroid hormone.
32
Q

What is the most common cause of HYPERthyroidism?

A
  • Graves disease
33
Q

What is Graves disease?

A
  • autoantibody (IgG) that stimulates the TSH receptor (type II hypersensitivity), leading to increased synthesis and release of thyroid hormone.
34
Q

What are some clinical signs of Graves disease?

A
  • hyperthyroidism
  • exophthalmos
  • pretibial myxedema (PTM)
  • tachycardia
  • palpitations
  • bounding pulses
  • wide pulse pressure
  • ATRIAL FIBRILLATION
  • high output heart failure
  • dyspnea on exertion
  • amenorrhea
35
Q

(aside) What 2 other conditions can cause high output heart failure?

A
  1. B1 deficiency (BeriBeri)

2. Paget’s disease

36
Q

What dermatologic manifestations will you see with hyperthyroidism?

A
  • warm, smooth, glowing skin

- onycholysis of nails

37
Q

What is Graves dermopathy?

A
  • red, swollen skin, usually on the shins and tops of the feet; otherwise known as pretibial myxedema= deposition of hyaluronic acid.
38
Q

How do you treat Graves disease?

A
  • B-blockers
  • thioamide, methimazol, or PTU
  • radioiodine ablation
39
Q

What is the triad of Graves disease?

A
  1. hyperthyroidism with goiter
  2. exophthalmos
  3. dermopathy
    * may not see this all the time.
40
Q

What is silent thyroiditis?

A
  • mild to moderate hyperthyroidism with absence of viral syndrome or exophthalmos
  • usually no neck pain
  • usually occurs postpartum (3 mon`ths).
41
Q

Are thyroid nodules present in 50% of the population beyond the 5th decade of life?

A
  • YES

* if you see micro-calcifications, think malignancy and biopsy via FNA.

42
Q

*** What is the most common type of thyroid cancer?

A
  • PAPILLARY CARCINOMA
43
Q

What will examination of nodule reveal in thyroid cancer?

A
  • hardness, irregular texture
  • fixation to adjacent structures
  • single nodule
  • local lymph node enlargement
44
Q

What is the exam of choice when examining thyroid nodules for thyroid cancer?

A
  • Ultrasound
45
Q

What is a potential marker for recurrent thyroid cancer?

A
  • thyroglobulin
46
Q

In what age group will you see toxic multinodular goiters (hyperthyroidism)?

A
  • elderly

* opposed to Graves in younger individuals.

Endocrinology (18 decks)

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