thyroid Flashcards
causes of hypothyroidism
- congenital
- post operative
- radiation
- thyroidectomy (due to reistant graves or a toxic multi nodular goitre)
- de quervenains
- iodine deficiency - endemic goitre
- iodine excess - amiodrone, factitita (great intake of thyroid hormones)
- radioactive iodine therapy used for graves disease
- riedal (rare)
sub acute thyroiditis is a.ka
DE quervains
what is dequerveins
begin with hyperthyroidism and then hYPO
thyrotoxicosis facttitiica
too much intake of thyroid horses (overdoes)
ECG findins in hypo
low voltage
AV black
other symptoms of hypo
effusions diastolic hypertension alpaca droopy eyelids lateral 1/3rd eyebrow- hertoghe sign menstraul cycle disturbances hyperprolactinemia
diastolic hypertension is associated with
hypothyroidism
what is myxoedema
Myxedema is a term generally used to denote severe hypothyroidism. Myxedema is also used to describe the dermatologic changes that occur in hypothyroidism and occasionally hyperthyroidism.
most serious complication of hypo
myxoedema crisis
subclinical hypothyroidism
high levels of TSH and normal levels of t3 , t4
antibodies for hashimotos
anti TPO
antithyroglobulin
labs for hypothyroidism
look for antibodies and in CBC anaemia is common
tx for hypothyroidism
levothyroxine 1.6 micro grams given TAKE 1 H B4 BREAKFAST VERY IMPORTANT FOR THE ABSORPTION ( start with lower doses and then you gradually increase unlike in graves )
what imaging studies for hypothyroidism
- US 2. radioactive uptake - allows you to differentiate autoimmune
classiccation of hyperthyroidism
with hyperthyroidism
w/o hyperthyroidism
hyperthyroidism causes
- de queervien (initial stage)
- iodine excess
- graves
- toxic multi nodular/adenoma
- hashimotos
- silent thyrodiits
- post partum thyroidits
neurological findings of hyperthyroidism
hyperfrelxia
tremor
muscle weakness
psychiatric : anxious, anxiety
triangle of graves
- TAO
2, MYXOEDEMA ( even though most common in graves) - ACROPATHY
subclinal hyperthyroidism
TSH will be low
thyroid levels are normL
OVERT hypothyroidism
TSH will be low and Thyroid hormones high
antibodies in graves
TSH receptors
tx medication for graves
metamizaole + propuylthiouracil - start at 300 /400 and then decrease - try for 18 months and then if not successful then we do surgery
what kind of myxedma is associated with hyper
pretibial
thyroid storm management
IV propranolol
IV digoxin
Propylthiouracil through NG tube followed by Lugol’s iodine 6 hours later
Prednisolone/hydrocortisone- 100mg/24 lecture says methyprednisolne
lithium is second line tx
lecture says endoyodin?
whats lithium more associated with
hypothyroidism but causes both , random (should be avoided in pregnancy anomalies to fetus)
what is the cause of exophthalmus in graves
the immune system attacks the muscles and fatty tissues around and behind the eye, making them swollen.
tx of subacute thyroiditis
usually not antithyroid medications as its preformed !
nsaids, CS
what would you advise a patient with TAO on life advice
stop smoking its a big risk factor
when is thyrotocisosis without hyperthryoridsm seen
exogenous intake of
thyroid hormones or inflammatory and neoplastic disease with destruction of
thyroid cells
what happens if proptosis is unilateral
rule out malignancy as usually exophthalmus is bilateral
device for measuring prothesis
Hertel exophthalmometer
tx for the TAO
Sunglasses, apply artificial tears, eye protectors during sleep and keep your head
elevated when in bed to decrease oedema of eyes
Glucocorticoids (in severe cases)
External X-RAY therapy on retrobulbar area
surgery can help too- decompression of optic nerve
remember TAO can also cause very wet eyes too
antibodies for Graves
TPO
microsomal
TSH
on a thyroid scan what is the uptake like for subacute
low uptake is charactaeirsitc
side effect of carbimazole
agranulocytosis so look out for mouth ulcers, sore throat
CI of radioactive iodine
CI - Children, age <30, pregnancy, (destroy fetal gland) lactation and leukopenia AND TA0 as makes it worse
hyperthyroidism in pregnancy
Anti-thyroid medications - these drugs cross placenta hypoplasia of fetal thyroid
gland (fetal hypothyroidism) so its CI during 1st trimester as risk of congenital hypothryodisa - we manage symptomatically with small doses of propel
Anti-thyroid drugs given in 2nd/3rd trimester but the lowest possible doses
Propylthiouracil - preferred as it crosses placenta to a lesser extent
Small doses of propranolol given to control symptoms for mother
Sub-total thyroidectomy can be done in mid-trimester, but you want to delay as much ss possible to improve fetal survival (premature
Hyperthyroidism in breast-feeding period
Anti-thyroid drugs can pass into breast milk - If possible stop taking medications
after birth/during breast feeding period
Propylthiouracil is not concentrated in milk
rf far thyroid cancer
deficiency in iodine, head and neck radiation , having hashimotos/grvaes
most common thyroid
papillary - remember more local spread so LN’S
where do thyroid cancers typically metasitse too
lungs and bone
which cancer freuqnely spread to ln
paiallry
signs of cancer
dyspahgia
trouble breathing
hoarseness of voice if spread
which cancer associated with iodine deficiency
follicular
which cancers are graves and hashimotos more likely to get
papally
whats associated with medullary carcinoma
raised calcintotn , which is associated with diarrhoea too .
Secretes bioactive substances: ACTH, CTRH, VIP (like neuroblastoma so diarrhoea)
bushings syndrome and + diarrhoea syndrome
which cancer is sensitive to iodine
follicular
tx of lymphoma radiation
RADIATION
thyroid scan for thyroid cancer is most likely o shw
‘Cold nodules’ but some follicular Ca
take up the radioiodine and appear hyperactive
LYMOHAMA
Almost always Non-Hodgkins lymphoma
Highly associated with Hashimoto’s thyroiditis
responds to radiotherapy
tumoru markers
Elevated Thyroglobulin- papillary or follicular
Elevated calcitonin- medullary carcinoma
citokeratin - anaplastic carcinoma
whats descriptive of a thyroid mass
lump that moves on swallowing but not on tongue protrusion
ANTITHYROID DRUGS
nhibit synthesis of thyroid hormones.
Main monotherapy or an adjunctive therapy before surgery or radioactive iodine therapy.
WHAT DO We typicallly use radioactive iodine for what is the proecedure
certain types of thyroid cancer (P+F)( higher does)
hyperthyroidosim (
RAI is taken in an oral capsule form. You don’t need to be hospitalized unless the dose is very high, which is rarely needed. You will be prompted to drink lots of water after taking the pill to flush the remaining radioactive iodine out of your system.
Most patients need only one dose before their hyperthyroidism is resolved, which may take a few weeks to several months.
what’s the procedure for RAI tx in thyroid cancer
usually after surgery to catch any stray cancer cells
gold standard diagnosis of graves
US
relationship between hyperthyroid gland and diabetes
increased risk as metabolism in increased clearance of insulin and thyroid hormones are contrainsular
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