Hypo-Hyperthyroidism Flashcards
What is Hypothyroidism
A condition in which the thyroid gland does not produce enough thyroid hormones.
List the clinical symptoms of Hypothyroidism
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
Myxedema Coma- Definition
A rare life-threatening clinical condition which is an end state of, severe, long-standing and untreated hypothyroidism which a mortality of 80%
Myxedema Coma-Associated Symptoms
Severe weakness
Hypothermia
Hypoventilation
Hypoglycemia
Shock
Coma and Death
Myxedema Coma- Causes
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
Myxedema Coma- Clinical Symptoms
Hypothermia
Hypoventilation
Urinary retention
Seizures
Coma
Confusion
Ileus
Bradycardia
Myxedema Coma- Other Clinical Symptoms
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)
Myxedema Coma-Precipitating Factors
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
Myxedema Coma-Diagnosis
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.
Myxedema Coma- Treatment
- Medical emergency in ICU
- Rewarm the pt.’s body with blankets
- Drugs- all to be given intravenously
-Levothyroxine (T4) (IV/ nasogastric)
-Liothyronine (T3)
-Hypertonic saline with glucose
-Hydrocortisone-in patients having adrenal or
pituitary insufficiency
What is Hyperthyroidism
A condition in which there is increased throid hormone synthesis and secretion from the thyroid gland
What is Thyrotoxicosis
Thyrotoxicosis refers to the clinical syndrome of excess circulating thyroid hormones, irrespective of the source.
List the Clinical Symptoms of Hyperthyroidism
Hair Loss
Bulging Eyes
Enlarged Thyroid(Goiter)
Rapid Heartbeat
Weight loss
Frequent Bowel movements
Warm, moist palms
Tremor of Fingers
Soft Nails
Hyperthyroidism -Treatment
Surgical Excision
Drugs:
- Thioamides
- Iodide salts
- Radioactive iodine
- Anion inhibitors
- Ipodate
- Beta-blocker
Thioamides
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)
Iodine and Potassium Iodide-Lugol’s Solution
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
Radioactive Iodine(131I)
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
Iodinated Contrast Media
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
Thyroid Storm-Thyrotoxic/Thyroid Crisis
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.
Thyroid Storm -Clinical Symptoms
Fever
Arrhythmias
Vomiting
Diarrhea
Nausea
Tachycardia
Thyroid Storm- Other Clinical Symptoms
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
Thyroid Storm - Precipitating Factors
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
Thyroid Storm - Diagnosis
1
Thyroid Storm - Treatment
2
