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Year 2 Endocrine > Hyperthyroidism > Flashcards

Hyperthyroidism Flashcards

1
Q

what are the cardiac symptoms of hyperthyroidism?

A

HTN
tachycardia
increased contractility (increased CO)

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2
Q

what are the sequelae of the cardiac symptoms of hyperthyroidism?

A

atrial fibrillation

high output cardiac failure

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3
Q

what ocular symptoms are specific to graves disease?

A

proptosis
opthalmoplegia
periorbital edema

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4
Q

hyperthyroidism: pathophysiology

A

increased thyroid hormone synthesis

  • primary - inherent thyroid problem
  • secondary - stimulated by TSH

innapropriate leakage of premade T4

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5
Q

causes of hyperthyroidism?

A 
graves disease 
autonomous nodule(s) 
subacute thyroiditis 
iodine-induced hyperthyroidism 
TSH-producing pituitary adenoma 
HCG mediated
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6
Q

what are the lab values for hyperthyroidism?

A

low TSH +/- increased FT4 or FT3

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7
Q

graves disease: pathophysiology

A

antibodies to TSH receptors stimulate growth and hormone production - continuous stimulation of gland to make new hormone

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8
Q

what test is typically best for graves disease?

A

thyroid uptake and scan

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9
Q

what would you NOT expect the uptake to be in graves disease? what does the scan look like?

A

low

scan - homogeneous

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10
Q

generally speaking, what are the treatment strategies for treatment of graves disease?

A
  • slow down new hormone synthesis

- remove source of thyroid hormone

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11
Q

antithyroid medications: MOA

what are the antithyroid medications?

A

temporary treatment to inhibit organification of iodine to iodotyrosine, and coupling

propylthiouracil
methimazole

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12
Q

what are the adverse effects of the antithyroid drugs?

A

hepatitis

agranulocytosis

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13
Q

what is the ultimate goal of radioactive thyroid ablation?

A

render patient hypothyroid (patient is then given levothyroxine for life)

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14
Q

why treat with SSKI a week prior to surgery?

A
  • trying to decrease T4 concentration

- also decreases vascularity

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15
Q

autonomously functioning nodules: pathophysiology

A

hyperplasia of follicular cells, overproduction of T4 independent of TSH

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16
Q

what do autonomously functioning nodules look like on uptake and scan?

A

focal areas of hyperactivity, while normal thyroid is suppressed

17
Q

what is the preferred treatment for hot nodules? why?

A

radioactive ablation - preferentially targets hyperfunctioning areas

18
Q

thyroiditis: pathophysiology

A

leakage of preformed hormone (not a condition of thyroid hormone synthesis)

19
Q

what is the etiology of thyroiditis?

A

viral, radiation, iodine exposure, postpartum

20
Q

what is the uptake for thyroiditis? why? what is the appearance?

A

low - not making new hormone

patchy appearance

21
Q

what is the treatment for thyroiditis?

A

mainly supportive

NSAIDs if there is some pain

22
Q

what is the natural history of thyroiditis in terms of hormone levels?

A

hyperthyroid - euthyroid - hypothyroid

23
Q

why dont antithyroids work very well with thyroiditis?

A

antithyroids work by slowing down hormone production, but in thyroiditis the production is already slow

24
Q

iodine induced hyperthyroidism: pathophysiology

A

more substrate - making more T4 (think jod basedow)

25
Q

what drug can cause iodine induced hyperthyroidism? how?

A

amiodarone

increased synthesis
thyroiditis

26
Q

what are the diagnostic challenges to amiodarone induced hyperthyroidism?

A

thyroid uptake and scan

  • competitive binding between I123 and iodine, uptake is invariably low
  • US may show increased vascularity in type 1
27
Q

what are the therapeutic challenges to amiodarone induced hyperthyroidism?

A

antithyroids?
I131?
glucocorticoids - prednisone for type 2

28
Q

what are the clinical features of a TSH producing pituitary adenoma?

A

hyperthyroidism
goiter
+/- visual fields defects

29
Q

what is HCG mediated hyperthyroidism?

A
  • in pregnancy, HCG levels increase exponentially, peaks at week 12
  • HCG stimulates thyroid
30
Q

what is the treatment for thyroid storm?

A
  • supportive - sedation, fluids, oxygen, cooling
  • treat precipitating cause
  • beta blockers
  • glucocorticoids
  • antithyroids
  • iodine
31
Q

what is considered the etiology of euthyroid sick syndrome?

A

body’s response to major illness (not hyperthyroidism)

Year 2 Endocrine (33 decks)

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