Module 10 - Thyroid

Question 1

Hypothyroidism PE Findings *

Question 2

Thyroid Nodules

Answer 2

• Rarely cancerous
• If TSH is suppressed = HYPERthyroidism and order thyroid scan with uptake

Question 3

Thyroid Storm

Answer 3

• high fever
• severe agitation
• confusion
• CV collapse
• malignant exophthalmos
• difficulty breathing

Question 4

Hypothyroidism Findings in the Elderly *

Answer 4

• frequently, s/s not present
• hypo is more common in elderly
• often diagnosed by screenings
• q 3-5 yrs in 65yo+
• watch for CARDIAC STATUS CHANGES
• watch for DEPRESSION as presenting complaint

Question 5

Hypothyroidism Diagnosis *

Answer 5

• clinical pattern consistent with diagnosis
• consider screening those with strong family history or autoimmune disease
  (sensitive TSH assay = high)
• free T4 or free thyroxine index = low or normal low
  Note: TSH or free T4 low with pituitary or hypothalamic failure = secondary
  *TRH stimulation test to confirm secondary hypothyroidism
• antithyroid antibodies = elevated in hashimoto’s thyroiditis

Question 6

Hypothyroidism Treatment Goals *

Answer 6

• levothyroxine should be consistently provided in same compound (generic v brand)
• if changed, serial TSH should be done

Levothyroxine therapy 3 goals
1. resolution of symptoms and hypothyroid signs including biological and physiologic markers of hypothyroidism
2. achieve normalization of serum thyrotropin with improvement in thyroid hormone concentration
* target: 0.5 - 4.0
3. avoid overtreatment (iatrogenic thyrotoxins) especially in elderly

Question 7

Hypothyroid Tertiary Prevention *

Answer 7

• replacement therapy with levothyroxine is a drug of choice
• healthy adults