Endocrine Flashcards
what is the most common cause of hyperthyroidism
graves disease
what causes graves disease
autoimmune disorder in which autoantibodies attach to thyroid stimulating hormone (TSH) receptors and stimulate thyroid hyperfunctioning
who is graves common in
women 20-40 years old
what other autoimmune disorders is graves associated with?
pernicious anemia, cardiomyopathy, myasthenia gravis, DM
what is a person with graves at risk of
Addisons, alopecia, celiac, cardiomyopathy, hypokalemic periodic paralysis
what are symptoms of thyrotoxicosis
heat intolerance, sweating, weight loss, increased appetite, nervousness, loose stools, frequent urination, muscle cramps, irritability, fatigue, weakness, dyspnea on exertion and menstrual irregularities
Patients could have tachycardia, or A fib or other cardiac arrhythmias
hyperthyroidism with graves disease
patient have a goiter with a bruit
20-40% of patients will have mild opthalmopathy (chemosis, conjunctivitis or proptosis
Pretibial myxedema
what are complications of thyrotoxicosis
A fib, hypercalcemia, osteoporosis, impotence, nephrocalcinosis, decreased libido, gynecomastia, decreased sperm count
what can chronic thyrotoxicosis cause
osteoporosis, clubbing and finger swelling
what is thyroid storm
follows stressful illness, thyroid surgery, or radioactive iodine administration
how does thyroid storm present
high fever, tachycardia, vomiting, diarrhea, dehydration, marked weakness, and muscle wasting, extreme restlessness, confusion, delirium
what laboratory studies are noticed in primary hyperthyroidism
TSH is low
serum T4, T3 Free T4, free T4 index and thyroid resin uptake usually will be elevated
ESR may be elevated
what antibodies are found in thyrotoxicosis
TSH receptor antibody and antithyroglobulin or antithyroperoxidase are usually high graves disease
what do thyroid radioactive iodine uptake scan reveal in graves
high iodine uptake and toxic multinodular goiter
what is the treatment for graves disease
B-blocker (propranolol)
Thiourea drugs (methimazole or propythiouracil)
they are taken for 12-24mths
useful in preparing patient for surgery or radioactive iodine Tx
which thiourea drugs is used in a pregnant patient or breast feeding with thyrotoxicosis.
Propythiouracil
what is the benefit of thiourea drugs
lower risk of post treatment hypothyroidism
what is the preferred treatment for permanent control of thyrotoxicosis
radioactive iodine ablation especially in the elderly
its CI in pregnancy patients with large goiters and when malignancy is likely
how do you treat ophthalmopathy in thyrotoxicosis
responds best to IV methylprednisolone
hypothyroidism general characteristics
almost always results from autoimmune thyroiditis, previous thyroid surgery or radiation therapy
what are the clinical features of hashimotos thyroiditis
fatigue, lethargy, anorexia, constipation, depression and menstrual abnormalities, muscle stiffness, memory impairment, cold intolerance and dry skin
peripheral edema, weight gain, thinning hair, weakness, hypotension, bradycardia, hyporeflexia, dementia and psychosis
what will laboratory studies look like in primary disease
TSH will be elevated in primary disease
Low T4 and Free T4 and T3 may be normal
general characteristics of hashimotos
most common thyroid disorder in the US and maybe associated with other autoimmune or polyglandular
its more common in women and patients with hep C
increased frequency is increased with excess dietary iodine supplementation and exposure to head and neck radiation during childhood
what drugs can cause thyroiditis
amiodarone, interleukins, and interferon
what are clinical features of hypoparathyroidism
tetany, carpopedal spams, cramping, convulsions, cirucumoral and distal extremity tingling and irritability
postive chvostek’s sign
how is hypoparathyroidism diagnosed
corrected serum calcium, urinary calcium and PTH are low
Serum phosphate will be high
what is the treatment for hypoparathyroidism
IV calcium gluconate in severe cases or
just oral calcium gluconate and vitamin D
What are clinical features of hyperparathyroidism
stone bone abdominal groans and psychiatric overtones
Renal stones, bone pain and arthralgias, increase in fractures, depression, increased need for sleep, muscle weakness
what causes secondary hyperparathyroidism
malignant tumors of the breast, lung , pancreas, uterus
how is hyperparathyroidism diagnosed
Hypercalcemia
low serum phosphate
elevated PTH
what is the treatment for hyperparathyroidism
surgical
what is addisons disease
autoimmune destruction of the cortex of the adrenal gland
clinical features of addisons
fatigue, weakness, weightloss, salt craving, delayed deep tendon reflexes, hyper pigmentation
lab finding with addison’s disease
Hyperkalemia, hyponatermia, hypoglycemia, hypercalcemia
