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
