Palpitations Flashcards
Less thought of symptoms of hyperthyroid
Fatigue Exertional dyspnea- Increased oxygen consumption Depression Hyperreflexia Diarrhea Light periods
More common signs of hyperthyroid in patients > 70
Sinus tach Fatigue Atrial fibrillation Weight loss - Only a couple may be present
Exopthalmos
Associated with graves
Can be bilateral or unilateral
TSH inappropriately normal
Increased T4
Pituitary adenoma or Thyroid hormone resistance
Mild TSH elevation
Normal T4
Subclinical hypothyroid
Decreased TSH
Decreased T4
Central or pituitary hypothyroid
Decreased TSH
Normal T4
Increased T3
T3 Toxicosis
Antibody involved in graves
Thyrotropin receptor antibodies
Thyroid stimulating immunoglobulins
Graves: Men or women
Women 5 to 10
Graves: Age
40 to 60
Graves: Triggers
Stress
High iodine
Recent preg
Less well know signs of hypothyroid
Pedal edema
Heavy periods
Fatigue- Common in both hypo- & hyper-
Eliciting lid lag
Move finger from upper to lower field of vision
- The eyelid will drag behind the iris
Tachycardia, tremulousness, irritability, weakness, and fatigue
Anxiety vs Hyperthyroid
Positional dizziness
Arrhythmia vs Anemia
Radioactive Iodine Uptake Study > 30%
Graves Multi-nodular goiter Toxic solitary nodule TSH-secreting pituitary tumor HCG secreting tumore
Radioactive Iodine Uptake Study
Sub-acute thyroiditis Silent thyroiditis Iodine induced Exogenous L-thyroxine Struma ovarii Amiodarone
Diffuse RAIU
Graves
- Nodular uptake pattern = Multi-nodular or single nodule
Are antibodies to thyroid peroxidase specific for Graves?
No, Hashimoto’s can have them as well
Role of US in hyperthyroidism
Evaluation of nodules
FNA guidance
Doppler can be used to evaluate for Graves
What test has not role in the DX of hyperthyroid disease
MRI
Medications used to treat Graves
Methimazole: Most common
- Caution agranulocytosis
How long does it take to suppress thyroid hormone?
Up to 3 months
- Symptoms can improve by 1 month
How long do patient need to be treated for (graves)?
years
Why do patients need frequent blood work (graves)?
Check for agranulocytosis
Dose needs to be adjusted to fit thyroid level
What medication is more commonly used to suppress thyroid hormone in the US?
Radioactive iodine
- Few side effects, but can worsen eye symptoms
- Eventually destroys thyroid tissue
- Patients will eventually need to take thyroid hormones
How often should thyroid hormone levels be checked in patients with hypothyroidism?
Once or twice a year
What test needs to be done prior to starting radioactive iodine?
UPT
- The iodine can impact the thyroid of the fetus
How often should TSH be checked after starting radioactive iodine?
q2 to 3 months until stable
- Can go to 6+ months after that
Typical starting dose for hypothyroid?
- 5 to 1.8 mcg/kg
- Increase dose slowly, especially in elderly
When should TSH be repeated after starting a thyroid medication?
6 weeks
