Hyper and hypothyroid Flashcards
what type of HS rxn is graves
type II- Ab dependent cytotoxicity
what HLA is associated with graves
HLA-DRB1 and DR8 MCH class II cell surface R
MHC class II
via CD4:
TH2 -> AbS
TH1 -> macros
MCH class I
A,B, C
via CD8
what drives the thyroid disease in graves?
TH2 -> activate TSH R
what drives the pretibial myxedema and exopthalamos in graves?
TH1 -> secrete cytokines -> cytotoxic T cells, NK cells -> glycosaminoglycans -> deposit -> skin changes
other HLA-DR disease that graves patients may get
alopecia areata PA anti-phospholipid Ab syndrome DM RA RHS PBC MG SLE IgA nephropahty MS hashimotos
causes of clubbing
cardiac pulmonary (lung CA, CF) GI (chrons, cirrhosis, celiac) renal failure thyroid disease (graves) malignancies (HL) idiopathic
random symptoms of graves
gynecomastia
increased vaginal bleeding
thyrotoxic cadriomyopathy
AF with CHF
pulmonary HTN in 50% of people with hyperthyroidism
WIDE PULSE PRESSURE
euthyroid graves orbitopathy
HLA-B40 DQw3
wolff-chaikoff effect
transient blockage of TH synthesis after large dose of iodine
jod-basedow effect
hyperthyroidism d/t increased iodine
amiodarone can cause this
high TBG
drugs- amphetamines, opiates, 5-FU hereditary estrogens- prego AIDs liver- hepatitis
decreased conversion of T4-> t3
Drugs- amiodarone, propanolol, steroids, PTU
stress- acute medical illness
low TSH
drugs- sterioid, CaCh blockers, dopamine, opiates, NSAIDs
elderly euthyroid
pregnancy or hCG decretion
severe non-thyroidal illness
causes of pansystolic murmur
mitral regurg
tricuspid regurg
VSD
causes of AF
MISS CH ATRIEL
MVP
idiopathic
sick sinus syndrome
sick
congestive cardiomyopahty HTN and hypoxia arteriosclerosis, ASD, alcohol, aminophylline and drugs thyrotoxicosis Rheumatic heart disease infilitrative diseases embolus, emphysema lone a-fib
apathetic hyperthyroidism
apathy, weigh loss, angina, AF, CHF
NOT automimmune
somatic mutationi n TSH R G alpha protein
amiodarone can set off
can be due to toxic adenoma or toxic multinodular goiter
type I amiodarone
thyrotoxicosis
can be graves or non-autoimmune (TMNG)
type II amiodarone
thyroiditis
causes of increases RAIU
graves
adenoma
inappropriate secretion of TSH (pit adenoma, rare)
TMNG
trophoblastic- secretes hCG which binds TSHR
risks of subclinical hyperthyroidism
AF and diastolic dynsfunction
osteoporosis
dementia
Tx with RAI r small dose antithyroid drug or beta blockers
thyroid storms
fever >102 tachy tachypnea hypotensive very sick
Tx of thyroid storm
methamizole or PTU iodides metopropolol hydrocortisone plasmaphoresis
neurological malignant syndrome
rare, but potentially life threatening rxn to antipsychotics or tranquilizers
high fever, stiffness of mm, altered mental status, autonomic dysfunction
thyrotoxic periodic paralysis
channelopathy with mm weakness
increased N/K ATPase activity (driven by thyroxine) -> hyperpolarization and hypokalemia
occurs with heavy meal or exercise in asian men
what causes decreased RAIU
DIET Drugs- THYROXINE Iodine- jod-bassedow, amiodarone type I ectopic thyroiditis- painful (dequervains disease), painless- postpartum, lymphocytic
ten hypos of hypothyroidism
hyporeflexia hypopigmentation hypothermia hypoventilation hypotension or diastolic HTN hypohemoglobinemia hypoglycemia hyponatremia hypometabolism hypocortisolism hypoadrenalism
HLA of hashimotos
HLA-DR5 (MCH II)
risks of subclinical hypothyroidism
elevated lipids and decreased cardiac filling
imparied memory, depression
when to Tx subclincial hypothryoidism
Abs and TSH >7
no Abs and TSH >10
prego with TPO Abs and TSH >2.5
what else can cause hypothyroidism
drugs
hep C
other signs of hypothyroidism
gallaverdin phenomenon (apex systolic murmur) queen annes sign diastolic HTN alopecia elevated MCV- macrocytosis braducardia elevated CPK-MB
myxedema crisis
DO NOT GIVE OPIATES
Tx with hydrocortisone first then TH
decreased TBG
familial TBG deficiency severe illness acute psychiatric problems cirrhosis nephrotic syndrome catabolic states, malnutrition drugs
decreased binding of TBG
ASAs
phenytoin
euthyroid sick syndrome
low TH
high T3 uptake
high rT3
low TSH
low TSH in euthyroid sick syndrome
d/t steroids, amphetamine, CaCH blockers, dopamine, NSAIDs, opiates
increases IL1 and IL6 and TFN alpha
