Lec 5 Thyroid 1 Flashcards
What are clinical signs of hyperthyroidism?
- hypermetabolism
- appearance of hyperadrenergic state
What should you think if patient presents with new onset AFib?
think hyperthyroidism
What is effect of hyperthyroid on GI?
increased frequency of bowel movements but not diarrhea
What is etiology of graves disease?
anti-TSH receptor antibodies –> cause diffuse goiter and hyperthyroidism
What are 3 extra-thyroid signs of graves?
- graves eye disease
- pretibial myxedema: peau d’orange
- thyroid acropachy: clubbing and periosteal thickening
What do you see histologically in grave’s disease?
thyroid hyperplasia
white scalloping of colloid
What is graves opthalmopathy?
- orbitopathy
- bulging eyes
- red/inflamed
- asymmetrical
- diplopia
- lid swelling = periorbital edema
- can have visual loss from optic nerve compression
What is thyroid onycholysis? Underlying diagnosis?
plummers nails = in 3rd and 4th digit separation of nail from nail bed
sign of graves disease [not just hyperthyroid]
What is mech of action thioureas [propylthiouracil + methimazole]?
block thyroid hormone synthesis
What are signs of thyroid storm?
- fever
- confusion or coma
- hypotension
- CHF
What are 3 types of autoimmune thyroid disease?
- graves
- hashimotos
- silent [postpartum] thyroiditis
What is toxic multinodular goiter?
have multiple autonomous hyperplastic nodules secreting thyroid hormone
What is etiology of toxic adenoma?
single autonomously functioning benign neoplasm
What is mech of postpartum thyroiditis?
occurs in months after pregnancy –> painless lymphocytic thyroiditis causing release of thyroid hormone stores followed by hypothyroid phase
have longterm future risk of other autoimmune thyroid disease [graves, hashimoto]
What is mech of DeQuervain’s subacute thyroiditis?
painful inflammation of thyroid after viral URI – > swelling and pain lasts months; transient thyrotoxicosis then transient hypothyroidism
What is etiology of thyrotoxicosis factitia?
ingestion of thyroid hormone
What is mech of trophoblastic tumor?
high levels of HCG cross react with TSH receptor
What is struma ovarii?
ectopic thyroid tissue in ovarian teratoma
What is presentation of toxic multinodular goiter?
- seen in older patients
- gradual onset of thyroid autonomy + insidious onset of hyperthyroidism
What is presentation of solitary autonomously functioning hot nodule?
- longstanding solitary thyroid nodule with insidious onset of hyperthyroidism
What is transiet thyrotoxicosis due to thyroiditis? X types?
not true hyperthyroidism –> no true increased synthesis just have release of thyroid hormone stores
present w/ transient mild thyrotoxicosis for 1-2 months then hypothyroidism for a few months
- postpartum thyroiditis
- subacute [DeQuervain’s thyroiditis]
- drug induced
What is a drug that is known to cause drug-induced thyroiditis?
amiodarone
What should you suspect if hyperthyroid early in pregnancy?
trophoblastic tumor = molar pregnancy; high levels of HCG cross react with TSH receptor
What type of antibodies seen in autoimmune thyroid disease?
- stimulating TSH receptor antibodies [graves]
- blocking TSH receptor antibodies [hypothyroid]
- anti-thyroglobulin; anti-thyroid peroxidase [most pts]
What is hashimotos thyroiditis?
- autoimmune thyroiditis causing gradual progression to hypothyroidism over many years
- have antithyroid antibodies
What do you see histologically in hashimotos?
lymphocytic infiltrate with germinal centers + destruction of thyroid follicels
What labs do you see in hypothyroid?
- low T3/T4
- high TSH
- anemia
- high cholesterol
What is myxedema coma?
severe hypothyroid plus some kind of stress causes:
- hypoventilation
- hypoxia
- hypercarbia
- hypothermia
- coma
What are 3 causes of congenital hypothyroidism?
- endemic iodide deficiency
- thyroid dysgenesis
- inherited defect in hormone synthesis
What are effects of congenital hypothyroid?
cretinism
- mental retardation
- growth retardation
- characteristic facies
What is treatment for hypothyroid?
pure T4; dose adjusted to normalize serum TSH
What is clinical presentation of silent thyroiditis?
small goiter, non-tender
post-partum woman
thyrotoxic for 4-8 wks then hypothyroid for months
What do you see histologically with subacute DeQuervain’s thyroiditis?
granuloma/giant cell formation
