Hyperthyroidism Flashcards
What is another name for hyperthyroid?
thyrotoxicosis
What are different causes of hyperthyroid?
- Graves dz (most common hyperT condition)
- toxic multinodular goiter
- toxic adenoma
- carcinoma/pituitary adenoma
- thyroiditis
- thyrotoxicosis factitia (false hyperT caused by exogenous thyroid meds)
What are possible sequelae of hyperthyroid?
- increased CV morbidity/mortality: a fib, CHF, MI, angina, sudden death
- osteoporosis
What are some symptoms of hyperthyroid?
- weight loss, increased appetite, fatigue
- sweating, heat intolerance
- goiter, bruit
- tremor, hyperreflexive, restless, insomnia
- amenorrhea
What part of the HPA axis is affected in primary hyperthyroid? What would the lab results be?
- thyroid related (T3, T4)
- low TSH/TRH
What part of the HPA axis is affected in secondary hyperthyroid? What would the lab results be?
- pituitary related (TSH)
- low TRH
What part of the HPA axis is affected in tertiary hyperthyroid? What would the lab results be?
- hypothalamus related (TRH)
- all elevated
Grave’s Disease
- most common hyperT diagnosis
- autoimmune, familial
- women > men
- 20-40
- associated with other autoimmune disease (type 1 DM, vitiligo, pernicious anemia)
Symptoms of Grave’s Dz
- diplopia, blurred vision
- lacrimation
- photophobia
- heat intolerance
- tachycardia
Signs of Grave’s Dz
- pretibial myxedema
- exophthalmos, lid lag,
- brisk DTRs
- periorbital edema, papilledema
- goiter, 3x normal size, non-tender
Thyroid Storm
- sudden, severe thyrotoxicosis
- fatal if untreated
What precipitates a thyroid storm?
- radioactive iodine therapy
- surgery
- infx
- severe stress
Symptoms of Thyroid Storm
- dramatic
- fever/flushing/sweating
- severe tachycardia, a fib, cardiac failure
- agitation, delirium, coma
Tx of Thyroid Storm
- antithyroid meds
- iodine
- beta blockers
- corticosteroids
- supportive measures
Multinodular Goiter
- enlargement of gland
- follicular cell #s increase
- involution can occur
- hormone levels vary
- 10:1 F:M
Treatment of Multinodular Goiter
- observation
- radioactive iodine ablation
- surgery if compressive sxs, large gland or pt refuses iodine
Thyroid Nodules
- less numerous or solitary compared to multinode goiter
- sxs develop gradually, often asymptomatic
Eval/Tx of Thyroid Nodules
- refer to endocrinology!
- US to determine if solid, cystic, mixed and size
- RAIU scan
- often a biopsy
Subacute Thyroiditis
- inflammation of thyroid gland often with viral infection
- follicular cell damage
- stored TH released unnecessarily
- hyperT –> euT –> hypoT then 85-95% resolve
What is the hallmark sign of subacute thyroiditis?
- tender gland
- sore throat/neck pain with fever
What are the lab findings in primary hyperT?
- elevated TH levels: free T4 most common, T3 also possible
- suppression of TSH and TRH (low)
What are the lab findings in secondary hyperT?
- elevated TSH
- T3/T4 may also be high
- TRH suppressed/low
What are the lab findings in tertiary hyperT?
- elevated TRH
- TSH and T3/T4 can also be high
What is diagnosed when IgG thyroid autoantibodies are present?
Graves disease
What are treatment options for hyperT?
- antithyroid meds
- radioactive iodine (CI in pregnancy)
- subtotal thyroidectomy
- adjuvant symptomatic tx: beta blockers, iodine, corticosteroids, artificial tears
What is a drawback of radioactive iodine therapy?
- often leads to hypothyroidism
- pt then has to go on thyroid meds to stimulate TH production
