HYPERTHYROIDISM Flashcards
High or low levels of TSH and T4 or T3 indicate hyperthyroidism?
Low TSH
High T4 and T3
What is the most common cause of hyperthyroidism? Rank the demographics according to their prevalance
Asian, White, African American
Male, White
Grave’s Disease
White > Asian > African American
Women > Men (5:1)
What symptoms are present only in Grave’s disease (compared to just hyperthyroidism)?
Exophthalmos
Pretibial myxedema
What is first line treatment for hyperthyroidism? What are exceptions?
Methimazole (MMI) is first line unless:
- Woman is in 1st trimester of pregnancy (use MMI if 2nd or 3rd)
- Patient has thyroid storm –> follow up with iodide after
In which case you use polythiouracil (PTU)
When would you use radioactive iodine (RAI)?
Anti-thyroid medication relapse
Grave’s Disease
Toxic Autonomous Nodules
Toxic Multinodular Goiter
What is CI in RAI?
Pregnancy
Breastfeeding
When would you consider thyroidectomy?
Severe symptoms such as:
- Large thyroid goiter >80 grams
- Severe ophthalmopathy
- Lack of remission with anti-thyroid drugs
What can be used in hypothyroid patients for symptom relief? (tachycardia, tremor, etc.)
Beta blockers
What can you use to get a patient ready for a thyroidectomy? (less vascularization)
Iodides (Lugol’s solution)
What are some monitoring parameters for hyperthyroid treatment?
TFTs (every 4-8 weeks until euthyroid)
- then check again every 2-3 months
CBC: baseline
LFTs: baseline
You administer methimazole however, TSH levels are not rising immediately. What should you do?
Check T4 and T3 levels. TSH does not change initially.
If a pregnant women really needed a thyroidectomy, when should the procedure be done?
During the second trimester
Regarding pregnancy, what can potentially happen to the fetus if Grave’s disease is not treated?
What should be measured to prevent this?
Antibodies will start attacking the thyroid of the fetus
Prevented by monitoring antibodies at 22 weeks gestational age
