Hyperthyroidism - Darrow Flashcards
hyperreflexia
hyperthyroid
heat intolerance, palpitations, tachy, irritable, loose stool, tremor, warm skin, hyperreflexia
hypermetabolic state
- anxiety
- pheochromocytoma
- hyperthyroid
goiter, exopthalmos, pretibial myxedema
graves disease
type of hypersensitivity in graves?
type 2
- Ab dependent cytoxicity
- Abs to cell surface receptors
HLA type in graves?
HLA-DRB1
HLA DR8
HLA DR
MHC Class II cell surface repceotor
-in graves disease
T cell in pretibial myxedema and graves orbitopathy?
CD4 Th1 cells
fibrosis and infiltration
macrophages, cytotoxic T cells, NK cells
-produce GAGs
T cell in graves disease on thyroid?
CD4 Th2 cells
-anti-TSH receptor Abs
TSI
TSH receptor Abs
-in graves
CD4 Th2 cells**
type II hypersensitivity
Abs that attach to cell surface components
in autoimmune hemolytic anemia or blood transfusion rxn
also in graves and myasthenia gravis - abnormal physiologic response
strabismus
misaligned eyes
-seen in graves
fibroblast proliferation, GAG deposits, lymphocyte infiltration in muscles around eye
clubbing of fingers
hyperthyroid
hypertrophic osteoarthopathy
thyrotoxic cardiomyopathy
tachycardia
atrial fib
high output failure
pulmonary HTN
calcium elevation with hyperthyroid?
T3 increases bone turnover
factitial thyrotoxicosis
would see NO thyroglobulin present
factitial - induced by human action - ie/ patient takes thyroid pills - gets hyperthyroid
TSH receptor pathway
GPCR
Gs - cAMP - PKA transduction
tx of graves
radioactive iodine - unless pregnant
or antithyroid drugs - PTU and methimazole
or iodine (wolff chaikoff)
or surgery
wolf chaikoff effect
reduction in thyroid levels with ingestion of large amount of iodine
PTU
tx for graves
ok in pregnancy 1st trimester
methimazole
tx for graves
less hepatic necrosis than PTU
causes of low TSH
steroid use
dopamine use
severe non-thyroid illness - ILs and TNF
pansystolic murmur and S3 in hyperthyroid patient
CHF
hyperthyroid sx with no TSI Abs?
apathetic hyperthyroid
-with autonomous functioning thyroid nodule or toxic multinodular goiter
apathetic hyperthyroidism
hyperthyroid due to AFTN or TMNG
mutations of TSH receptor
iodine induced hypethyroid
with amiodarone
excess iodine can cause autonomous thyroid nodules to become toxic MN goiter
jod basedow phenomenon
iodine induced thyrotoxicosis
type I amiodarone thyrotoxicosis
jod basedown
-high iodine induces hyperthyroid
with graves or TMNG
type II amiodarone thyrotoxicosis
thyroiditis
increased I-123 uptake?
GAIT2
graves adenoma - plummer inappropriate TSH (pituitary adenoma) toxic multinodular goiter trophoblastic
tx for AFTN or TMNG
radioactive iodine or surgery
subclinical hyperthyroidism
low TSH but normal T4
risk of osteoporosis and atrial fib
tx with RAI or antithyroid drugs
thyrotoxicosis crisis
or storm
caused by acute illness, thyroid surgery, or RAI therapy in undertreated thyrotoxicosis patient
high fever, tachy, tachypnea, hypothension, V/D, irritable, delirium, coma, death
thyroid storm
tx for thyroid storm
thiourea - methamizole or PTU
iodides started 1 hour after thiourea
also - metoprolol and hydrocortisone
plasmapharesis
muscle pain weakness, ate two pizzas night before, gynecomastia, proximal muscle weakness
thyrotoxic periodic paralysis
thyrotoxic periodic paralysis
channelopathy with muscle weakness
thyroid hormone - increased Na/K ATPase activity - results in hypopolarization and hypokalemia**
after heavy meal or exercise in asian men
after heavy meal or exercise in asian men
look for thyrotoxic periodic paralysis
thyroid hormone increases Na/K ATPase activity
wide pulse pressure
with thyrotoxicosis
tremor
hyperthyroid
hypoglycemia
hyperthyroid with decreased radioiodine uptake?
amiodarone type 1 - jod basedow
ectopic - stuma ovarii (teratoma)
thyroiditis
-de quervains - post viral infection - painful
painless - reidels fibrosis, postpartum, subacute autoimmune
most thyroiditis
produce transient hyperthyroid over few months followed by hypothyroid
high ESR, following upper resp infection
subacute granulomatous hyroiditis
de-quervains
painful
