Hyperthyroidism

Question 1

What is another name for hyperthyroid?

Answer 1

thyrotoxicosis

Question 2

What are different causes of hyperthyroid?

Answer 2

• Graves dz (most common hyperT condition)
• toxic multinodular goiter
• toxic adenoma
• carcinoma/pituitary adenoma
• thyroiditis
• thyrotoxicosis factitia (false hyperT caused by exogenous thyroid meds)

Question 3

What are possible sequelae of hyperthyroid?

Answer 3

• increased CV morbidity/mortality: a fib, CHF, MI, angina, sudden death
• osteoporosis

Question 4

What are some symptoms of hyperthyroid?

Answer 4

• weight loss, increased appetite, fatigue
• sweating, heat intolerance
• goiter, bruit
• tremor, hyperreflexive, restless, insomnia
• amenorrhea

Question 5

What part of the HPA axis is affected in primary hyperthyroid? What would the lab results be?

Answer 5

• thyroid related (T3, T4)

- low TSH/TRH

Question 6

What part of the HPA axis is affected in secondary hyperthyroid? What would the lab results be?

Answer 6

• pituitary related (TSH)

- low TRH

Question 7

What part of the HPA axis is affected in tertiary hyperthyroid? What would the lab results be?

Answer 7

• hypothalamus related (TRH)

- all elevated

Question 8

Grave’s Disease

Answer 8

• most common hyperT diagnosis
• autoimmune, familial
• women > men
• 20-40
• associated with other autoimmune disease (type 1 DM, vitiligo, pernicious anemia)

Question 9

Symptoms of Grave’s Dz

Answer 9

• diplopia, blurred vision
• lacrimation
• photophobia
• heat intolerance
• tachycardia

Question 10

Signs of Grave’s Dz

Answer 10

• pretibial myxedema
• exophthalmos, lid lag,
• brisk DTRs
• periorbital edema, papilledema
• goiter, 3x normal size, non-tender

Question 11

Thyroid Storm

Answer 11

• sudden, severe thyrotoxicosis

- fatal if untreated

Question 12

What precipitates a thyroid storm?

Answer 12

• radioactive iodine therapy
• surgery
• infx
• severe stress

Question 13

Symptoms of Thyroid Storm

Answer 13

• dramatic
• fever/flushing/sweating
• severe tachycardia, a fib, cardiac failure
• agitation, delirium, coma

Question 14

Tx of Thyroid Storm

Answer 14

• antithyroid meds
• iodine
• beta blockers
• corticosteroids
• supportive measures

Question 15

Multinodular Goiter

Answer 15

• enlargement of gland
• follicular cell #s increase
• involution can occur
• hormone levels vary
• 10:1 F:M

Question 16

Treatment of Multinodular Goiter

Answer 16

• observation
• radioactive iodine ablation
• surgery if compressive sxs, large gland or pt refuses iodine

Question 17

Thyroid Nodules

Answer 17

• less numerous or solitary compared to multinode goiter

- sxs develop gradually, often asymptomatic

Question 18

Eval/Tx of Thyroid Nodules

Answer 18

• refer to endocrinology!
• US to determine if solid, cystic, mixed and size
• RAIU scan
• often a biopsy

Question 19

Subacute Thyroiditis

Answer 19

• inflammation of thyroid gland often with viral infection
• follicular cell damage
• stored TH released unnecessarily
• hyperT –> euT –> hypoT then 85-95% resolve

Question 20

What is the hallmark sign of subacute thyroiditis?

Answer 20

• tender gland

- sore throat/neck pain with fever

Question 21

What are the lab findings in primary hyperT?

Answer 21

• elevated TH levels: free T4 most common, T3 also possible

- suppression of TSH and TRH (low)

Question 22

What are the lab findings in secondary hyperT?

Answer 22

• elevated TSH
• T3/T4 may also be high
• TRH suppressed/low

Question 23

What are the lab findings in tertiary hyperT?

Answer 23

• elevated TRH

- TSH and T3/T4 can also be high

Question 24

What is diagnosed when IgG thyroid autoantibodies are present?

Answer 24

Graves disease

Question 25

What are treatment options for hyperT?

Answer 25

• antithyroid meds
• radioactive iodine (CI in pregnancy)
• subtotal thyroidectomy
• adjuvant symptomatic tx: beta blockers, iodine, corticosteroids, artificial tears

Question 26

What is a drawback of radioactive iodine therapy?

Answer 26

• often leads to hypothyroidism

- pt then has to go on thyroid meds to stimulate TH production