Hyperthyroid, Thyroid storm Flashcards
What are the different types of hyperthyroid
AI: Graves disease
Autonomous thyroid tissue: Toxic adenoma/multinodular goiter
TSH mediated hyperthyroid: TSH producing pituitary adenoma, non-neoplastic
HCG mediated hyperthyroid (pregnancy)
Hyperthyroid symptoms include
Skin changes (warm and sweaty) Stare and lid lag CV (tachy, AFib) Low total and HDL cholesterol Impaired glucose tolerance Dyspnea, DOE weight loss normochromic, normocytic anemia bone changes neuropsych changes Vasodilation diarrhea, tremors, clubbed fingers
What symptoms are specific to graves disease
Exopthalmos and EOM difficulties
Diagnostic hyperthyroid labs show
TSH: low
T3 T4: high
*Make sure to order a TSH receptor antibody; will be elevated in graves disease!
How do you read a 24 hour iodine uptake and scan for hyperthyroid
High uptake: increased hormone synthesis
Low uptake: inflammation and destruction of the gland caused thyroid to release all it’s hormones (hyperthyroid labs)
**DO NOT DO in pregnant or breastfeeding women
What are your pharm treatment options for hyperthyroid
Beta blockers (Sx control)
Thionamides (block thyroid hormone synthesis)
Radioiodine ablation
Surgery
What are the thionamides
Methimazole
Propylthiouracil (pregnancy preferred)
What is Subacute thyroiditis (de Quervain’s)
Common in young-middle aged females, and associated with viral illness; lasts weeks-months
Silent or acute Sx (painful glandular enlargement w/ dysphagia)
Followed by hypothyroidism for a few weeks before returning to euthyroid
How do you diagnose and treat subacute thyroiditis
Labs; low uptake RAI 2/2 inflamed/destroyed thyroid
Tx: anti-inflammatories (ASA, NSAID, prednisone) and Sx management
What are the types of thyroiditis
Subacute granulomatous (de Quervain) Painless thyroiditis (silent, lymphocytic) Postpartum Amiodarone induced (iodine induced) Radiation thyroiditis Palpation thyroiditis
What can cause exogenous thyroid hormone intake
Excess replacement therapy
Intentional suppressive therapy
What is a thyroid storm
Rare endocrine emergency with high mortality (recognize and treat ASAP!)
results form an ACUTE event
RF for thyroid storm are
surgery trauma iodine administration infection childbirth withdrawal of antithyroid meds MI, CVA, PE
How does thyroid storm present
tachycardia, CHF, hypotension, arrhythmia fever n/v/d, abd pain goiter hand tremor, anxiety, agitation ophthalmopathy, lid lag
How do you diagnose thyroid storm
clinical presentation (severe Sx) PLUS
low TSH, high free T3/T4
*but; level of free T4 elevation is not indicative of a thyroid storm
