Hyperthyroidism Vs Hypothyroidism Flashcards
Hyperthyroid Causes
**Graves’ disease is the most common presentation
More common in women 8:1
Onset most Commonly between 20 and 40 years of age
Other causes of hyperthyroidism include toxic adenoma, subacute thyroiditis, thyroid stimulating hormone secreting tumor of the pituitary, how does amiodarone
Hyperthyroid Signs/Symptoms
Nervousness Anxiety Increased sweating Fatigue Emotional lability Fine tremors Hyperreflexia of DTRs Increased appetite Weight loss Smooth, warm, moist velvety skin Fine thin hai Exophalmos Lid lag Tachycardia Heat intolerance Increased incidence of afib
Hypothyroid Causes
Primary disease of the thyroid gland Pituitary deficiency of TSH Hypothalamic deficiency of thyrotropin releasing hormone Iodine deficiency **Hashimoto’s thyroiditis Idiopathic causes Damage to the glands
Hypothyroidism Signs/Symptoms
Extreme weakness Muscle fatigue Arthralgia Crams cold intolerance Constipation Weight gain Dry skin Hair loss Brittle nails Puffy eyes Edema to hands and face Brady Slowed DTRs Hypoactive bowel
Hyperthyroid Lab/Diagnostics
TSH assay is the most sensitive test and low in most cases
Serum T3 increased
Serum ANA is usually elevated without evidence of lupus or other collagen diseases
Thyroid radioactive iodine uptake and scan usually performed to establish ideology of hyperthyroidism
- High uptake is consistent with Graves’ disease
- A low uptake is consistent with subacute thyroiditis
MRI of the orbit is the preferred choice for visualizing graves ophthalmopathy
Hyperthyroid Management
Specialist referral as needed, especially with patients who have comorbidities
Propanolol for symptomatic relief: begin dosing with 10 mg PO, may go up to 80 mg four times daily
Thiourea drugs For patients with mild cases, small goiters or fear of isotopes
Radioactive iodine 131 – one used to destroy quarters
Thyroid surgery must be euthyroid preop
Lugol’s solution 2–3 jobs PO every day times 10 days to reduce vascularity of the gland
Patience with subacute thyroiditis or best treated symptomatically with propanolol
Thiourea Drugs
Methimazole 30-60mg every day in 3 divided doses
Proplthiouricil (PTU) 300-600mg daily in 4 divided doses
Hypothyroid Lab/Diagnostics
TSH Elevated
T4 low or low normal
Hyponatremia
Hypoglycemia
Hypothyroid Management
Levothyroxine 50-100mcg every day, increasing dosage by 25 mcg every 1-2 weeks until symptoms stabilize;
>60 years of age, decrease dosage; initial hair loss may occur
Treatment of Thyroid Crisis
PTU 150-250mg every 6 hours
OR
Methimazole 15-25mg every 6 hours WITH the following in one hour:
Lugol’s solution 10gtts TID
OR
Sodium iodide 1pm slow IV along WITH
Propanolol 0.5-2gm IV every 4 hours or 20-120mg PO every 6 hours
Avoid ASA
Inpatient Management of Myxedema Coma
Protect airway Fluid replacement as needed Levothyroxine 400 mcgIV times one then 100 mcg every day Supportive hypotension Slow rewarming with blankets Symptomatic care
