Graves Disease Flashcards
what are 3 things that stimulate the release of TRH by the hypothalamus?
low T3/T4
stress
cold exposure
the enzyme that helps with iodination and conjugation of iodine onto the tyrosine rings through endocytosis
thyroid peroxidase
which thyroid hormone is the greatest concentration in the blood?
T4
what is the major thyroid hormone in the blood?
T3
which thyroid hormone do we measure?
T4
in which gender is hypothyroidism 5-8 times more common in?
females
in which asymptomatic patients should we order a thyroid screening for? (5)
hx of autoimmune dx
family hx of thyroid disease
hx of neck radiation
hx of thyroid sx
radiological abnormality
which screening test is the most sensitive test for primary hypothyroidism and hyperthyroidism?
TSH
if a screened patient has an abnormal TSH, what should we order next?
FT4
what is the most common cause of hyperthyroidism?
graves disease
what are the 6 etiologies of hyperthyroidism? (PETES Grave)
Pregnancy/Postpartum
Exogenous levothyroxine
Toxic multinodular goiter
Excessive iodine
Subacute thyroiditis
Graves disease
what is the pathogenesis of graves disease?
autoantibodies (TRAb) bind to TSH receptors
stimulate thyroid hormone secretion and thyroid growth
what is upper eyelid retraction called?
darymple sign
what is staring appearance called?
kocher sign
what is lid lag with downward gaze called?
von graefe sign
the term used to describe the eye being pushed forward by increased retro-orbital fat
exophthalmos
what are some signs present in patients with Graves disease? (8)
darymple sign
kocher sign
von graefe sign
exophthalmos
diplopia/blurred vision
goiter
pretibial myxedema
sympathetic signs
what are 4 labs to order for a patient suspicious for Graves disease/hyperthyroidism?
TSH
T4
T3
TRAb
what are 2 imagining diagnostics to order for a patient suspicious for Graves disease/hyperthyroidism?
thyroid ultrasound
RAIU scan
what would we expect to see in the labs and RAIU scan of a patient who is positive for Graves disease? (4)
elevated T3/T4
low TSH
elevated RAIU
positive TRAb + ANA
what medication can be used for the symptomatic relief of tachycardia, tremors, diaphoresis, and anxiety in Graves disease?
beta blocker - atenolol or propranolol
what treatment is best for young adults, mild thyrotoxicosis/hyperthyroidism, and small goiters?
methimazole or PTU
if we Rx a patient methimazole or PTU, what should we watch out for in the first 60-90 days?
agranulocytosis
what should we do if a patient who is taking methimazole or PTU begins to experience an infection or abnormal bleeding?
stop drug and send to ER
which thiourea drug is preferred for treatment of Graves disease?
methimazole - less hepatic necrosis
what medication should we give to a pregnant patient or a patient that is nursing, who has Graves disease?
PTU
what is the treatment of choice/first line for Graves disease in adult patients?
radioiodine therapy
in which patients is radioactive iodine therapy contraindicated? (3)
pregnancy
nursing
lack of childcare
what drug can be continued while doing radioactive iodine therapy?
propranolol
how does radioactive iodine therapy treat Graves disease?
it destroys overactive thyroid tissue
a patient has radioactive iodine therapy to treat Graves disease. what will they likely experience after the treatment?
hypothyroidism
what will a patient need after completing radioactive iodine therapy? (2)
lifelong thyroid hormone
calcium monitoring
in which patients would we consider a thyroidectomy to treat Graves disease? (3)
obstructive/very large goiter
pregnant but not controlled with low dose thiourea
women who plan conception soon
what are 2 complications to worry about with a thyroidectomy? what should we monitor after the procedure?
damage to recurrent laryngeal nerve
hypoparathyroidism - monitor calcium
a patient presents with delirium, severe tachycardia, vomiting, diarrhea, dehydration, and a a high fever. what are they likely experiencing?
thyroid storm
what are 4 things that can trigger a thyroid storm?
stress
illness
surgery
RAI
what should we do for a patient that presents with thyroid storm?
send to ER
how will an ER PA treat a patient with thyroid storm? (3)
thiourea drug
lugol solution
hydrocortisone
an iodine overload to attempt to force the body to stop making thyroid hormone
lugol solution
