final Flashcards
Tx of hypothyroid
levothyroxine
Goal TSH
0.5-2.5 (LESS than 2.5 if tx hypothyroid)
Do not take levothyroxine at same time as what?
Calcium, multivitamins, food supplements, antacids
If what is high, subclinical hypothyroid will most likely progress to clinical hypothyroid?
If borderline thyroid peroxidase test (high end). Consider tx with levothyroxine
Labs in hypothyroid
elevated TSH, low/normal free T4/3
***A-fib=likely what? (Bush)
hyperthyroid –> tx thyroid and afib will go away
What do these do?
Estrogens. BCPs, Pregnancy, acute liver disease, congenital protein abnormalities, hypothyroidism
Six things that increase binding proteins, thus increase the amount of BOUND/INACTIVE thyroid hormone.
TSH, Free T4, free T3 unaffected).
What do these do?
androgens, steroids, protein malnutrition, nephrotic syndrome, hyperthyroidism
Five things that decrease binding proteins. TSH/Free T4/Free T3 not affected.
What thyroid test most accurately reflects pituitary response to circulating active/free hormone? In what case do you NOT draw this
TSH
Ophthamopathy/lid lag/etc. = ?
Grave’s disease
What autoimmune process is responsible for Grave’s?
Thyrotropin receptor Blocking antibodies (TRAb) = hyperthyroid
Do not tx pregnant woman with hyperthyroid with what two things?
Methimazole and RAI
PTU is ok.
High thyroid uptake - tx with?
Low thyroid uptake - tx with?
- low dose RAI
- PTU (or high dose RAI)
Diffuse uptake seen in?
Patchy uptake seen in?
Low uptake seen in?
**Diffuse RAI uptake = Graves
Patchy RAI uptake = Multinodular goiter
**Low RAI uptake = postpartum thyroiditis
Describe postpartum thyroiditis
Self limiting, decreased uptake, releasing pre-formed thyroid
What drug can cause hypothyroid?
1) amiodarone - high iodine content
(low uptake (bc you have so much already), hyper/hypothyroid)
-PTU to tx
2) lithium (goiter)
***Trust TSH except in: In euthyroid sick, when should you not draw TSH levels, and in what phase will TSH be elevated?
Do not draw in ICU bc:
- Sick phase = TSH low/normal; T3/T4 low (everything shut down)
- Recovery phase = TSH elevated
biopsy based upon what size and type of nodule?
- size: 1+cm
- cold nodule (NOT hot nodule)
Only do RAI in what setting?
hyperthyroid
Two most common causes of hypercalcemia
- primary hyperparathyroidism
2. malignancy
Tetany, carpal pedal spasm, parasthesia of finger/toes, QT interval prolongation, laryngospams, bronchospams, death
HYPOcalcemia
***Evaluate hypocalcemia with
- Chvostek (Facial nerve = mouth mm spasm)
- Trousseau - BP cuff, carpopedal spasm