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
what drug can cause iodine induced hyperthyroidism? how?
amiodarone increased synthesis thyroiditis
26
what are the diagnostic challenges to amiodarone induced hyperthyroidism?
thyroid uptake and scan - competitive binding between I123 and iodine, uptake is invariably low - US may show increased vascularity in type 1
27
what are the therapeutic challenges to amiodarone induced hyperthyroidism?
antithyroids? I131? glucocorticoids - prednisone for type 2
28
what are the clinical features of a TSH producing pituitary adenoma?
hyperthyroidism goiter +/- visual fields defects
29
what is HCG mediated hyperthyroidism?
- in pregnancy, HCG levels increase exponentially, peaks at week 12 - HCG stimulates thyroid
30
what is the treatment for thyroid storm?
- supportive - sedation, fluids, oxygen, cooling - treat precipitating cause - beta blockers - glucocorticoids - antithyroids - iodine
31
what is considered the etiology of euthyroid sick syndrome?
body's response to major illness (not hyperthyroidism)