Thyriod Flashcards
Normal TSH T3 and T4 levels
TSH = .4-5.5 T3 = 80-220 T4 = .7-2.0
Thyroid nodules
If visibile - hyperthyroid
Can be uncomfortable
Obstructive sx - sob, hoarness, dyspaghia, sob
Concern if pressing on the laryngeal nerve
Thyroid nodule concerning features
Rapid growth, solid nodule, hard and fixed , esophageal or tracheal obstruction , swelling under jaw
Thyroid nodules - what to do with them
Assess for thyroid function - TSH and T4
Low TSH - nodule is producing thyroid hormone
High TSH - autoimmune inflammation of the thyroid ( hashimotos)
Thyroid US
Can assess # of nodules, location and size
Can tell if it is cystic solid
But not diagnostic
Thyroid scan
Uses a radioactive substance to determine the nodule function
Cold = non function and needs biopsy Hot = not concern for CA
FNA
Biopsy
In office, 5-6 samples, may miss the area
Takes 2-3 weeks to come back
Thyroid Cancer
Risks : childhood ca, ages 30-60 M>W, radiation exposure, fam hx
ROS: hoarness and dysphagia
DX; elevated TSH , cold nodules
Management : scans every 3-6 months x 5 years after diagnosis
Scans 6-12 months once cancer free
Goiter
Pronounced swelling of neck
Common in hashimotos
Hyperthyroidism
decrease in TSH increase in T3 - excess thyroid hormone May be due to graves Inflammation of thyroid gland Excessive intake of thyroxine mediation Excess TSH from pituitary glan
Hyper s/s
Increased metabolic rate
Intolerance to heat
Fine, straight hair, bulging eyes, tachy increased BP, tachy, tremors, weight loss, amenorrhea
Agitation, racing HR
Hyper labs
Low TSH and increased T3 , t4 , free t5
Hyper TX
Radiation , medication , or surgery
- methimazole - 3 divided doses 8 hour internals
- PTU - TID good for pregnant women
- treament may be life long
- beta blocker to decrease HR
- metabolism return to normal 1 -2 months
Hypothyroidism
Caused by hashimotos
Increased TSH decreased T4
Hypo s/s
Early = hair loss, dry skin, contsptiaion , intolerance to cold, thick tongue
Late- Brady, weight gain, decreased loc, thickend skin, cardiac complications
PE: facial puffiness, goiter, enlarged tongue, depression, dementia , diminished reflexes, coarse hair, brittle nail, yellow hue, dryness, weight gain
Hypo labs
Increased TSH and Low t 4
Will see low t4 and low TSH which is a = pituatary failure
Check cholesterol - fix and reassess
Hypo TX
Synthroid - 6 mcg/kg/day : increase by 12.5 - 25 mcg every 6-8 weeks
Young healthy - 100-125 mcg / day
Older w/ cardiac - 75-150 up to 200 mcg/day
Once dose achieve follow up 6-12 months
Look for drug reactions
Should take same time every day on empty stomach 1 hour before meals
Hyperparathyroidism
High calcium caused by a benign tumor in one of the glands
S/s: loss of energy, feels bad, lack of interest, high BP, palpitations,
May have irregular rate and rhythm
> 10.5 ( 8.5-10.5) PT > 65 (10-65)
Refer to endocrine will need surgery and then calcium replacement
Hypoparathyroidism
Low calcium - rare - refer to endocrine
S/s - restlessness, agitation, numbness tingling around nose, lips and extremities,
PE: hyperreflexia of deep tendons, tremors, hyotension
< 8.5 PTH < 10
Treat bases on acuity and severeity
Calcium and Vit D
Cushing syndrome
Adrenal problem
Excessive production of cortisol
S/s: obesity, moon face, water retention, heavy truck, depression
PE: fatty hump on back of neck, HTN, hirtsitism, red/purple striae > 1 cm wide
DX; 24 hour excretion cortisol in urine
Refer to endocrine
Addisons
Adrenal insufficiency
S/s : weight loss, dehydration, increased skin pigmentation, darkened creased of palms, knees and lip, low BP
PE; look at skin and VS
refer to endocrine
PCOS
In women of reproduction age causing infertility due to failure to ovulate
- at risk for DM II , CVD, uterine ca , premature menses, 1st degree relative, antileptic drugs
PCOS s/s
Appears during teenage years Irregular or absent menses Hirstutism Oily skin and acne Skin tag Scalp hair loss or balding Depression, anxiety Overweight
Fewer than 9 men’s trail periods in a year = oligomenorrhea
Amenorrhea = no menstrual periods for three or more months
Our role is to identify and refer
PCOS Treatment
Weight loss / healthy diet exercise
Oral conception to restore menses and protect again uterine cancer - helps with acne
Aldactone - 50-100- a diuretic which acts by blocking the action of testerone at the hair cell level. NOT in PREG
Metformin
Progestin
Tanner stage II boys
Enlargement of testes and scrotum - scrotal skin reddened and change in texture
Tanner II boy
Enlargement of penis in length
Tanner IV boy
Increase size of penis with growth in breadth and development of gains - Scotland skin darker
Tanner II girl
Breast bud stage with elevation fo breast and papilla - enlargement of areola
Tanner stage III
Further enlargement fo breast and areaola - no separation of the countour
Tanner IV girl
Areola and papilla separate form a secondary mound above the level of breast
tanner V. Girl
Projection of papilla only, ,related to recession of areola
Tanner pubic hair 2
Sparse grown of long , slightly pigmented hair , at base of penis or along labia
tanner pubic III
Darker, coarser and more curled hair, speaking sparsely over junction of pubes
Tanner pubic IV
Hair adult type but covering smaller area an adult , no spread to the medial surface of thighs
Tanner pubic stage 5
Adult type and quantity with horizontal upper border
