Darrow, hypothyroid Flashcards
What is myxedma in hypothyroid
lymphadema with accumulation of GAGs in skin with doughy feeling on palpation
myxedema with diastolic HTN
hypothyroid
10 hypos hypothyroid
hyporeflexia hypomentia hypothermia hypoventilaion hypotension or diastolic HTN hypoHbinemia hypoglycemia hyponatremia hypometabolism of drugs and lipids (HLD) hypocortisolism hypoadrenalism
causes of hypothyroidism
iodine deficiency and congenital defects in children
chronic lymphocytic thyroiditis (hashimotos in adults)
what is HLA of hashimoto
HLA DR5
patient with large thyroid gland \+FMH celiac and pernicious anemia dry eyes and dry mouth hgih TSH normal T4 additional test to confirm Dx?
TPO Ab
normal T4
hgih TSH
Dx?
subclinical hypothyroidism
risk of subclinical hypothyroidism
eleated lipids
CHF and ASHD
early dementia
poor iron absorption (anemia)
Tx criteria subclinical hypothyroidism
if no TPO Ab but TSH >10 Tx
if TPO Ab and TSH>5 Tx
Tx criteria for pregnant patients with TPO Ab
TSH> 2.5
causes of hypothyroidism
chronic lymphocytic (hashimoto)!! RAI induced!! subacute lymphcytic thyroiditis!! drugs: PTU, iodine, lithium!!, interferon!!, amiodarone!!, thalidomide etc irradiation and thyroidectomy infiltrative diseases Hep C!! central hypothyroidism congenital iodine deficient
other autoimmune diseases assoc with hashimoto
addisons, hypoPTH, DM , PA, sjogrens, vitiligo, PBC and IBD
HLA B8- DR, DQ
65 F nubness in thumbs and index fingers weak and dizzy with chest pain constipation, pedal edema diastolic HTN ywllowing skin speech hoarse bradycardia with II/VI systolic ejection murmur at base with high pitched systolic murmur at apex hair thin and + Tinels sign DTRs 1+ b/l
hypothyroidism
Dec Fe levels increased TIBC
Fe deficiency
what is gallavardin phenomenon
II/VI systolic ejection murmur at base with high pitched systolic murmur at apex
what can cause gallavardin phenomenon
diastolic HTN
hypothyroidism can change Na how
hypotonic euvolemic hyponatremia from decreased NA/K ATPase
urinary Na from hypothyroidism?
Usom?
> 20meq/L
Uosm >150-200 mOsm/L
first line for hypothyroid Tx
L thyroxine 25-75/day unless pregnant or history of CAD
L thyroxine levels for pregnant women
100-150 mcg
what is the euthyroid dose level to stay near in Tx hypothyroidism
1.6 mcg/kg/day
if patient is being Tx for hypothyroid and has TSH <2 and is still tired what shoul dyou look for
anemia, B12 deficiency, sleep apnea
what are modifications in patients being Tx with L thyroxine
monitor oral intake drugs: imatinib, omeprazole and food:soy milk coffee, fiber and Ca
what will precipitate a myxedema crisis
on compliance to meds, surgery, stress, infections
mortality of myxedema crisis
20-50%
Tx mxyedema crisis
hydrocortisone IV
levothyroxine
LT3
what is definition bacterial peritonitis ascites
if there is >250 PMNs in sear from pericentesis
what are common pathogens that cause bacterial peritonitits ascites
E coli and serratia
what do yo worry about if pericentesis shows ?1 bacteria type
bowel perforation
55 y.o M with alcoholic cirrhosis and ascites with encephalopathy has bacteral peritonitis severe hypotension lethargy low TSH Dx?
svere non thyroidal illness (TNF-euthyroid sick syndrome)
What can cause low TSH
Autonomous functioning thyroid nodule
drugs: steroids, amphetamines, Ca Ch blockers, dopamine, NSAIDs, opiates
elderly euthyroid
pregnancy or hCG secretion
causes of euthryoid sick syndrome
non thyroidal illness
major surgery
T3 levels in euthyroid sick syndrome
LOW
what causes low T3 in euthryoid sick syndrome
decreased 5’ deiodinase
increased IL that displaces binding of T4 (increases T3 uptake)
What causes low TSH in euthyroid sick syndrome
severe
drugs: acute steroid, amphetamines, Ca Ch blockers, dopamine, NSAIDs, opiates
increased IL-1, IL-6 and TNF alpha
how do TNF alpha and IL-1 decrease TSH
increast somatostatin which dec TRH so dec TSH
how does IL-6 decrease TSH
increases CRH which inc ACTH which inc cortisol which dec both TRH and tSH
50 y.o F with hoarsness, diminished sense tast and smell, menorrhagia, thinking of eyebrowns, thick tongue, cardiac enlargement and galactorrhea
pituitary enlarged on CT
best approach?
thyroid replacement
TRH activates release of what
TSH and prolactin
