Endocrinology- Thyroid & Parathyroid Flashcards
S&S thyroid storm
Severe Hypertension, Tachycardia New-onset fever Agitation Tremulousness
Common precipitants of thyroid storm
Nonadherence medications
Acutely stressful events (surgery, trauma, infection)
Childbirth
Iodine contrast
Hemodynamics changes of thyroid storm
↓SVR
↑CO (↑Stroke volume & ↑HR)
↑ Pulse pressure & ↑BP
High Venous O2 and return
↑pulmonary capillary wedge pressure
essentially: high-output heart failure
Tyrotoxicosis with normal of ^ RAIU
Graves Disease
Toxic Multinodular goiter
Toxic nodule
Thyrotixicocisis with decreased RAIU
Painless autoimmune thyroiditis (silent thyroiditis)
Subacute (de Quervain) thyroiditis
Amiodarone or Iodine Induced Thyroiditis
Extensive thyroid cancer metastasis
S&S hyperthyroidism
Fatigue Weight Loss Tremor Decreased TSH Elevated T3 & T4
Most Common cause of hyperthyroidism and diferenciación
Graves’ disease
Painless autoimmune thyroiditis
Differentiate with RAIU
Postpartum thyroiditis
A form of PAINLESS autoimmune thyroiditis the can occurs within 12 months of delivery.
Symptoms can be hyperthyroid, hypothyroid or combined.
Diagnosis postpartum thyroiditis
Positive thyroid peroxidase antibody
S&S Subacute granulomatous Thyroiditis (de Quervain)
Symptoms of hyperthyroidism
Prodrome URI
Severely PAINFUL, tender goiter
S&S HYPOthyriodism
Fatigue Concentration Difficulties Constipation Weight Gain Dry Skin/ coarse hair Hoarseness
Amiodarone effects on thyroid
amIODarone has a high iodine content and has an intrisic effect on thyroid metabolism.
Decreased peripheral T4 conversion
Inhibition of thyroid synthesis
Amiodarone- induced thyrotoxicosis
Diagnosis: Worsening fatigue, difficulty concentrating, abdominal pain, weight gain, Hx of cardiomyopathy with left ventricular systolic dysfunction and a-fib. Dry skin, elevated AST, ALT, and all phos.
HYPOTYROIDISM due to Amiodarone toxicity!
Mechanism of AIT (Amiodarone induced thyrotoxicosis)
Type 1: iodine induced hormone synthesis. Common in pts with nodular and Graves.
Type 2: destructive thyroiditis
Treatment of Amiodarone effects on thyroid
Stop Amiodarone.
Hypo: Levothyroxine
AIT type 1: Antithyroid drug
AIT type 2: Glucocorticoids
Estrogen effect on thyroid metabolism
Estrogen up regulates the productions of thyroxine-binding globulin (TBG). Increased TBG cause a reduction in free T4 and T3
ADR methimazole
Agranulocytosis
1st trimester teratogen
cholestasis
ADR PTU
Agranulocytosis
Hepatic failure
ANCA- associated vasculitis
Mechanism of hoarseness in hypothyroidism
matrix glycosaminoglycan accumulation in tissue interstitial spaces (also causes coarse hair and skin)
S&S neonatal thyrotoxicosis
Warm moist skin Tachycardia Poor feeding/ weight gain Irritability Low birth weigh/ premie
Management neonatal thyrotoxicosis
Self resolved by 3mo
Methimazole plus B-blocker (severe symptomatic)
Mechanism of neonatal thyrotoxicosis
transplacental passage of maternal anti-TSH receptor antibody
