clinical thyroid Flashcards
what is HP-T axis
hypo(TRH)>pit(TSH)> thyroid T3/4
4 thyroid presentations
- hyper
- hypo
- mass effect
- associated issues
hormones in primary hyper
TSH down, TH up
hormones in secondary hyper
TSH up, TH up
hormones in primary hypo
TSH down, TH up
hormones in secondary hypo
TSH down, TH down
presentation of hyper-thyroid
- hypermatabolism
- overactiv adrenergic system - anxiety etc
- may have orbiopathy if graves
physical appearance in hyper
- general: warm, anxious, silky skin
- vitals: increased HR, syst. hypertension
- Eyes: stare, lid lag
- thyroid: enlarged, bruit
- neuro: tremor, proximal muscle weakness
4 common causes of primary hyperthyroid
- graves disease
- multinodule goiter - benign
- toxic adenoma - benign
- subacute thyroidisitis
how to identify hyper
increased radioactive iodone uptake
what if uptake is low
- PT taking thyroid drugs
2. subacute thyroiditis - leaking
treatment if uptake high
thionamide and B-bloacker
treatment if uptake is low
B-blocker only
4 treatment options for graves
- Thionamide drugs - block t3/4 production
- B-blocker - reduce symp symptoms
- radioactive iodine - kills cells
- surg
hypo presentation
- everything slowed down
- constipation
- dry skin and hair
- swelling around eyes, heart and lung
4 possible causes of primary hypo
- congential
- hashimotos - autoimmune destruction
- subacute thyroiditis
- drug/radiation
treatment for hypothy
l-thyroxine
what is DDx for thyroid mass
- solitary - benign or thyroid cancer
2. multiple - multinodular goiter
approach to thyroid nodule
- asses risk for cancer (fam, growth speed)
- check TSH
- if okay go to 3, if supress radio scan - if hot not cancer - utrasound and fine needle biopsy
best imaging for thyroid
ultrasound
2 types of nodules
- hot - take up isotope - zero cancer risk
2. cold - looks blank - 5% cancer risk
2 structures at risk in thyroid surgery
- parathyroid -PTH
2. recurrent laryngeal nerve - voice
treatment of thyroid cancer (4)
- total thyroidectomy
- RAI to ablate remaining thyroid
- thyroid replacment homrones
- follow levels and neck US
