MOD 6 Flashcards
High iodine uptake/ hyperthyroidism diseases
Graves Multinodular Goiter Toxic solitary nodule TRH secr tumor HCG secr tumor
Low iodine uptake/hypOthyroidism diseases
Hashimotos Subacute thyroiditis Silent thyroiditis Iodine induced (eg from amiodarone) Exogenous L thyroxine admin Struma Ovarii (ectopic thryoid tissue)
Graves patients may have ab’s to what?
TSH
Hashimotos pts/ autoimmune thyroiditis pts have ab’s to?
TPO ab’s
TSI level in graves?
HIGH!
Sx of Graves?
PROPTOSIS (protrusion/Exphthalamos bulging) INCREASED BOWEL MOVEMENTS TREMORS THYROID BRUIT (only in graves!) PERIORBITAL PAIN Anxiety/Irratibility Weakness/fatigue Heat intolerance Can also have infiltrative dermopathy
Free T4 and TSH levels in graves? RAI? (radioactive iodine uptake)
T4 will be high, LOWERING tsh!
RAI uptake high
Toxic solitary nodule sx
Nodular goiter
High free T4, low TSH , incr RAI in part of thyroid
NO proptosis/bruit/abs
Thyroiditis (hypothyroidism) sx
Cervical lymphadenopathy
High T4 low TSH, then switches, positive TPO ab’s, RAI low
NO trempor bruit etc
fatigue and weight gain
Thyroiditis (hypo) graph of T4 and TSH?
thyroid inflamed releasing T4 into circ, so PEAKS, reducing TSH via neg feedback
Eventually thyroid atrophies w fibrosis and produces less T4 (so lowers back down to match TSH), but then TSH rises
PATIENTS CAN RECOVER BACK TO EUTHYROID!
Types of thyroiditis:
Hashimotos
Subacute lymphcytic
Granulomatous (de Quervian)
Hashi- autoimm progressive destr of thryoid parenchyma, histo shows lympho infiltrates
Subacute lymphocytic- autoimm also, occurs AFTER PREGNANCY (postpartum), PAINLESS, lymphocytic inflam of thyroid
Granulo/Quervian- SELF LIMITED secondary to viral infxn, gran inflamm and pain
Sx of interferon induced thyroiditis?
sx: facial puffiness, slow heavy voice, weight gain, cold intolerance, normal gland on exam, feeble heart sounds, slow relaxation reflexes (graves has strong), dry skin and large tongue, TPO ab’s, EKG with low volt complexes and echo with pericardial effusion
What can thyroiditis look similar too?
MENOPAUSE!
However, menopause also inv breast tenderness and hot flashes
(Test for both!)
Addison’s disease
sx
CHRONIC ADRENAL INSUFFICIENCY
-sx: hypotension/shock (not enough cortisol) pigmentation (since reduce cortisol feeds back to incr ACTH which is similar to MSH)
Primary adrenal insuff
all adrenal hormones have issues (cortisol, aldosterone, sex hormones), issue with the ADRENAL GLAND ITSELF in kidney
Low morning cortisol but high ACTH
low aldo but high renin
Secondary adrenal insuff
Problem with the PITUITARY, so ACTH will be LOW from pit, thus low cortisol, but ALDO will be normal bc adrenals are fine
Cosyntropin Stimulation Test
Cosyn= ACTH analog
if given, intact adrenal gland should respond by making cortisol and if it doesn theres primary adrenal insuff (we measure cortisol boudn to cortisol binding globulin)
-but there could be false + if it APPEARS like cortisol is low but it isnt, say due to cirrhosius or nephrotic, or false negative where it looks normal or hgih but hisnt (due to high cortisol binding prot from preg or OCPs)
What do normal adrenal son CT look like? Abnormal/ TB?
elongated comma, if abnormal look v large (if they have stippled calcs its TB)
Tx of adrenal insuff
Primary– hydrocortisone in morning and eve oral (if major give 10x normal) and FLUDROCORTISONE (mineralocorticoid replacement) and DHEA replacements
-for secondary just give hydrocort bc only cortisol isnt working (Adrenal sare fine)
what coudl sxe of cortisol replacement be?
weight gain, insomnia, edema
Congenital Adrenal Hyperplasia (CAH)
Deficiency in 21-OH enzyme inv mineralocorticoid and glucocorticoid pathway
-results in def of aldo and cortisol and overprod of DHEA/andrugens thus test/estr
General path of adrenal steroid synth and where does CAH occur?
cholest to preg
then preg either goes to form DHEA via 17-OH (then to androst which becomes test or estr) (17OH overproduced in CAH)
OR
forks into two other paths which eventually each make aldo and cortisol from 21-OH (CAH is def in 21-OH)
CAH genetics and sx at birth and later on
AR
due to aldo def, salt-wasting
due to dhea excess, females have genital amb and males have early puberty/growth (harder to detect)
-17OH rise with CAH
CAH dx
rise in 17-OH, liquid chrom with mass spec, genotyping for AR
Tx for CAH
hydrocortisone (just like adrenal insuff, since this/Addisons involve cortisol insuff too)
and mineralocorticoid replacement FLUDROCORTISONE and salts (salt wasting common cause of death) (if growth slows then slow down tx)
Possibly feminizing surg etc
Complicatiosn or sxe of CAH tx
Overuse of cortisol can cause cushing like sx
CAH pts can have adrenal masses (it IS hyperplasia after all)
and Leftover adrenal tissue in testicle in some boys (testicular adrenal rests)
