Pales Thyroid CIS Flashcards
differential for weight gain
endocrine disorders
- hypothyroidism
- Cushings
Meds:
- anti-depressants
- corticosteroids
genetic predisposition
living in America (diet and exercise)
differential for dizziness
cardiogenic
neurogenic
psychogenic
vertigo vs light-headedness- figure that part out
high TSH normal T4 is what?
subclinical hypothyroidism
subclinical hypothyroidism
may or may not be symptomatic.
Treat when:
- TSH is above 10
- positive thyroid antibodies
- when symptomatic and symptoms improve
suspecting hyperthyroidism. What’s the next step?
test TSH. If it’s low… check free T4 and T3 to eliminate 2ndary hypothyroidism or euthyroid sick syndrome
Euthyroid sick syndrome
acute, sever illness can cause abnormalities of TSH or thyroid hormone levels in the absence of underlying thyroid disease
major cause of these hormonal changes: release of cytokines, such as IL-6
Several patterns exist:
- low T3 syndrome: derease in T3 levels with normal levels of T4 and TSH peripheral conversion of T4 to Ts is replaced by conversion of T4 to rT3. It is thought to be adaptive as it may limit catabolism in starved or ill patients
- low T4 syndrome: fall in total T4 and T3 levels, normal FT4 level, and TSH being either low or high, which spontaneously reverses after recovery
dx is often presumptive. Only resolution of the test results with clinical recovery can clearly establish this disorder
no treatment required
thyrotoxicosis. (free t4 and t3 elevated, TSH low). Next step?
thyroid uptake and scan
if the scan shows low-uptake, then we know it’s the first stage of thyroiditis (hypothyroid, in fact)
dx of hypothyroidism
hashimoto’s
subacute de quervain’s
riedel’s
acute bacterial thyroiditis
dx of hyperthyroidism
graves toxic nodules iodine exposure (Jod-basedow phenomenon) ectopic thyroid tissue/ strum aovarii TSH-secreting pituitary adenoma factitious/ iatrogenic thyroiditis
hyponatremia. What do we do first?
determine osmolality
hyperosmolar- sugars
hypotonic
iso-osmotic- hyperproteinemia or -lipidemia
if urine sodium is over 20, we’re euvolemic
elevated CPK with hypothyroidism?
myopathy
myxedema crisis
hypothyroidism that becomes life threatening– confusion, hyponatremia, etc.
drug induced hypothyroidism
amiodarone
iodinated contrast
lithium
infiltrative disorders leading to hypothyroidism
amyloidosis
hemochromatosis
lady with proptosis, thyroid bruits, tachycardia, anxiety, LE edema, respiratory distress
what do we do?
TSH
EKG
CXR
