Hypothyroid Flashcards
thyroid axis
hypo>TRH>pit>TSH>thyroid>T3+4>target
where does T34 feedback to
hypo and pit (-ve)
4 presentations of thyroid issues
- hypo
- hyper
- mass effect
- associated probs.
see table of patterns
do it
pattern of 1ry hypo
TSH up, T3-4 down
what to measure for 1ry hypo
just TSH
what to look for in fatigue to help show hypothyroid
FHx, common, not depressed, sleeping well, can have normal Phx
labs for hypo
- TSH, B-HCG
- CBC, creatinine, AST - renal failure
- fasting glucose - DM
- FSH - menpause
what to see on labs for hypothyroid
high TSH - can comfortably say
3 tests not to order
- T4
- neck US
- anti-thyroid ABs
DDx for hypothyroid
- congntial
- hashimotos
- iatrogenic - amiodarone, iodine, radiation, ectomy
- subacute thyroiditis
- hypothalamic disease (2ry)
- peripheral resitance (3ry)
2 most common casues
- hashimotos
2. subacute thyroiditis
hashimotos presentation
- other autoimmune
- small goitre
- pos. anti-thyroid ABs
presentation of subacute thyoiditis
- inflammation of thyroid
- throitoxicosis
- may be painful or pain less
treatment of subaucte thyroiditis
- supportive during toxic phase (B-blocker, pain meds)
2. L-thyroxin during hypothyroid
important things to look out for in thyroid drugs
- common drug error
- take on empty stomach with water
- no food or drink for hour
- no vits. for 3-4 hours
2 times to involve endocrinologust in hypo
- patient request
2. very young female
3 groups that should be screened
- infants
- preggers
- those at high risk (famhx, Sx, drugs that can cause)
why is newborn screening done
prevent dev. delay
3 times to treat subclincal hypo
- patients with Sx
- pregnant
- TSH>10 - CV risk
effects of preg. on normal thyoid
- maternal thyroid incr. production
- increase TBG binds thyroid
- mother supplies thyroid for bb for T1
how to adjust meds in preggers
T1 increase of 30-50%
effect of low thryoid on BB
low IQ
what to tell women that get pregs
take extra 2 pills/week when conceive and call you
