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Endocrine System > Hypo-Hyperthyroidism > Flashcards

Hypo-Hyperthyroidism Flashcards

1
Q

What is Hypothyroidism

A

A condition in which the thyroid gland does not produce enough thyroid hormones.

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2
Q

List the clinical symptoms of Hypothyroidism

A 
Dry, coarse hair
Loss of eyebrow hair
Puffy Face
Enlarged Thyroid(Goiter)
Slow Heart Rate
Weight Gain
Constipation
Brittle Nails
Arthritis
Cold Intolerance
Depression
Dry Skin
Fatigue
Forgetfulness
Heavy Menstrual Periods
Infertility
Muscle Aches
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3
Q

Myxedema Coma- Definition

A

A rare life-threatening clinical condition which is an end state of, severe, long-standing and untreated hypothyroidism which a mortality of 80%

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4
Q

Myxedema Coma-Associated Symptoms

A

Severe weakness

Hypothermia

Hypoventilation

Hypoglycemia

Shock

Coma and Death

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5
Q

Myxedema Coma- Causes

A

It can be due to a deficiency of thyroid hormones

It can manifest with or without a goiter

In Adults: Autoimmune thyroiditis(Hashimoto’s Disease_

Others: Radiation, Thyroidectomy, Congential

Drugs: Iodides, Lithium, Thiomides, Aminosalicylic
acid, Phenylbutazole, Amiodarone etc.

Dietary deficiency of iodine

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6
Q

Myxedema Coma- Clinical Symptoms

A

Hypothermia

Hypoventilation

Urinary retention

Seizures

Coma

Confusion

Ileus

Bradycardia

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7
Q

Myxedema Coma- Other Clinical Symptoms

A

Coma Status

Hypothermia-Frequently severe, with body temp <33C

Dyspnea

Generalized Oedema with yellow and dry cutis

Macroglossia

Bradycardia

Weak Wrists

Reduced Cardiac Sounds

Overwieght/Obesity

Constipation

Reduced Reflexes

Thin and dry hairs

Focal and general seizures(Rare)

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8
Q

Myxedema Coma-Precipitating Factors

A 
Infection
Exposure to cold temperatures
Trauma
Burns
Cerebrovascular accident
Myocardial infarction
Congestive heart failure
Respiratory acidosis
Medications – sedatives, narcotics, amiodarone, etc.,
GI hemorrhage
Metabolic disturbances
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9
Q

Myxedema Coma-Diagnosis

A

The diagnosis is determined using the Myxedema Coma Scoring System

Serum T4, and T3 (total and free) are usually low

TSH is significantly elevated

Other frequent abnormalities include: Anemia,
Hyponatremia, Hypoglycemia, and elevated serum
levels of cholesterol and creatine kinase (CK).

Carbon dioxide retention and hypoxemia.

ECG: Sinus Bradycardia, Low voltage, and T-wave
flattening.

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10
Q

Myxedema Coma- Treatment

A
  1. Medical emergency in ICU
    • Rewarm the pt.’s body with blankets
  2. Drugs- all to be given intravenously
    -Levothyroxine (T4) (IV/ nasogastric)
    -Liothyronine (T3)
    -Hypertonic saline with glucose
    -Hydrocortisone-in patients having adrenal or
    pituitary insufficiency
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11
Q

What is Hyperthyroidism

A

A condition in which there is increased throid hormone synthesis and secretion from the thyroid gland

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12
Q

What is Thyrotoxicosis

A

Thyrotoxicosis refers to the clinical syndrome of excess circulating thyroid hormones, irrespective of the source.

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13
Q

List the Clinical Symptoms of Hyperthyroidism

A

Hair Loss

Bulging Eyes

Enlarged Thyroid(Goiter)

Rapid Heartbeat

Weight loss

Frequent Bowel movements

Warm, moist palms

Tremor of Fingers

Soft Nails

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14
Q

Hyperthyroidism -Treatment

A

Surgical Excision

Drugs:

  • Thioamides
  • Iodide salts
  • Radioactive iodine
  • Anion inhibitors
  • Ipodate
  • Beta-blocker
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15
Q

Thioamides

A

Propylthiouracil, Methimazole and Carbimazole

Thioamides - inhibit the hormone synthesis by inhibiting thyroid-peroxidase

Propylthiouracil also inhibits peripheral deiodination

No effect on iodine uptake and release of thyroid
hormones

Slow in onset

Propylthiouracil - preferred in pregnancy

Methimazole and Carbimazole in comparison with
Propylthiouracil:
-More potent
-Longer acting (once daily dosing)

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16
Q

Iodine and Potassium Iodide-Lugol’s Solution

A 
MOA - Inhibits hormone release
 fast / rapid onset of action, preferred in
emergencies
 used in thyroid storm
 Decreases the size and vascularity
 Easier for surgical excision
 Administered for 7-10 days prior to thyroid
surgery
Adverse effects:
 Acute allergic reactions
 Chronic overdose leads to iodism
 Long term use - hypothyroidism and goiter
17
Q

Radioactive Iodine(131I)

A

131I taken up and concentrated in thyroid follicles.
 Gland undergo pyknosis, necrosis and fibrosis
 Thiomides are used to make the gland euthyroid
state - used prior to radioactive iodine
 Within a few weeks, 131I induce euthyroid OR
hypothyroid (80%, managed with Levothyroxine)
Contraindicated in children, pregnancy and lactation:
risk cretinism Advantages - easy to administer, very effective,
inexpensive, absence of pain
 Disadvantage – hypothyroidism

18
Q

Iodinated Contrast Media

A

Ipodate and Iopanoic acid
 MOA:
 Inhibiting the peripheral conversion of T4 into T3
in the liver, kidney and brain.
 Inhibits hormone release
 Used in thyroid storm as adjunctive therapy

19
Q

Thyroid Storm-Thyrotoxic/Thyroid Crisis

A

An acute, life- threatening, hypermetabolic
state.
 Almost invariably fatal (90% mortality), rapid
diagnosis and aggressive treatment are
critical.
 Previously, more commonly observed during
thyroid surgery.
 To date, thyroid storm occurs more
commonly as a medical crisis rather than a
surgical crisis.

20
Q

Thyroid Storm -Clinical Symptoms

A

Fever

Arrhythmias

Vomiting

Diarrhea

Nausea

Tachycardia

21
Q

Thyroid Storm- Other Clinical Symptoms

A

Fever
Unreasonable anxiety confusion delirium up to coma state
Tachyarrhythmia-atrial fibrillation
Tachypnea and dyspnea
Congestive heart failure to cardiac shock
Lerman-means scratch-Pleuro-pericardiac sound
Increased systolic versus diastolic blood pressure ratio Hyperhidrosis and skin hyperemia
Generalized tremors
Diarrhea
Nausea
Vomiting

22
Q

Thyroid Storm - Precipitating Factors

A

Withdrawal of anti thyroid drug therapy major major surgery thyroidectomy iodide compounds intake or radio I odine therapy in patients with Graves’ disease or autonomously functioning thyroid nodules trauma in neck area systemic infections pregnancy parturition infection diabetic ketoacidosis severe emotional stress cerebral vascular disease pulmonary thromboembolism intense exercise use authorising kindness inhibitors minor surgery extraction of teeth

23
Q

Thyroid Storm - Diagnosis

A

1

24
Q

Thyroid Storm - Treatment

A

2

Endocrine System (5 decks)

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