Hyperthyroidism Flashcards
WHat are the general effects of Hyperthyroidism?
Simialr to Caffeine... HTN Tachycardia Diaphoresis Oncholysis Warmth Hair Loss Graves Dermopathy
What are the Eye Symptoms in Graves Disease?
Lid Lag Lidretraction Proptosis Opthalmoplegia Periorbital edema
What are the different causes of Hyperthyroidism?
Graves' disease Autonomous nodules Subacute thyroiditis Iodine induced hyperthyroidism TSH-producing pituitary adenoma HCG-mediated
WHat is seen on labs in Hyperthyroidism?
Dec TSH +/- Inc FT4 or FT3
Ab testing- TSI
Radionucleide Scanning- thyroid uptake and scan
WHat are the features of Graves’ disease?
Most common cuse of Hyperthyroidism More females Ab to TSH receptors stimulate growth and homrone production -TRAb, TSIg -Family predisposition
WHat is seen on PE in Graves’ Disease
Goiter, diffusely enlarged Hyperthyroidism, TSI Uptake and scan -not low -scan homogenous
WHat is the general Tx of Graves’ disease?
Underlying issue is continuous stim. of the gland
Simp: Beta Blockers, steroids
Specific Tx: Slow down new hormone synth or remove source of Thyroid Horm.
What are the Antithyroid medications used in Graves’ disease?
MOA: inhib orgnification of iodine to iodotyrosine, and coupling
Adverse Effects: Hepatitis, agranulocytosis
Montior thyroid function, CBC, transaminases
How is the Thyroid Tx with Radioactive Ablation?
Iodine 131 give in single dose
Taken up by thyroid
-tissue destruction and ablation
Renders Pt Hypothyroid
What are the precautions with radiations in Thyroid Ablation?
Cant be preggo No sexual activity sleep alone food prep Flush twice, etc Can transiently worsen hyperthyroid
What is the Pre-Op for Thyroidectomy Tx?
Antithyroid SSKI 10 drops daily x1week Decrease T4 and vacularity Beta Blockers Indications -Personal -Preggo -large goiter -Exposure to iodine
What are the diseases with Autonomously functioning nodules?
Single: hot nodule
Multiple: Toxic multinodular goiter
More common in older Pts >50yo
WHat is the Tx of Hot Nodules?
Unlike Graves’ toxic nodules will preferentially take up I131
Won’t spontaneously resolve
most Pts become euthyroid
What causes symptoms in Thyroiditis?
Inflammation of thyroid tissue, leakage of preformed hormone
not increased synthesis
What are causes of Thyroiditis?
Viral, radiation, iodine exposure, post-partum
What is seen on PET scan of Thyroiditis?
Low uptake of contrast
Patchy and faint
What is the Tx of thyroiditis?
Supportive: NSAIDS
- Prednisone
- Beta Blockers
- Antithyroids wont work too well
- I131 won’t do anything…
Who is more likely to get Iodine induced Hyperthyroid?
High Dose Iodine
AMIODARONE
Iodine can cause Thyroiditis
Inc Synth. Jod Basedow phenom
What is the Tx of Amiodarone induce Hyperthyroidism?
Thyroid uptake and scan comes back low
Iodine binding sites SATURATED!!!
Antithyroid
I131 doesn’t work well
Surgery may be needed
Amiodarone often can’t be stopped for Cardiac reasons
What form of iodine is used for Thyroid uptake scan? Ablation?
Iodine 123
Iodine 131
What is seen in TSH producing Pituitary Adenoma?
Increased T4 with nonsuppressed or increased TSH
Hyperthyroidism
Goiter
Visual field defect
What is the Tx of TSH producing Pit Adenoma?
Surgery
Octreotide
What are the Dangers of Thyroid Storm?
Medical Emergency Tachycardic Hyperthermia N/V, diarrhea Mental status changes
What is the Tx of Thyroid Storm?
Supportive with Fluid replacement, sedation, fluid, oxygen, cooling, Tx underlying cause Tx ALGORITHM: BB Glucocorticoids: Dexamethasone Antithyroids Iodine
What is Euthyroid Sick syndrome?
Hormones Fluctuate, more so in systemic/mental illness
Not due to Thyroid problems.
Will improve as systemic illness improves.
