Thyroid Flashcards
If the diagnosis of thyroid storm is suspected, what to do?
- even prior to the results of the thyroid studies being available
- targeted therapy should be initiated and aimed at
treating vital sign abnormalities.
Beta-blocking medications, such as propranolol or esmolol, are often used.
Following treatment of the autonomic disturbances, one can begin what therapy? (2)
therapy to decrease the amount of circulating thyroid hormone and to work on determining the precipitant.
After administration of beta-blocking agents, anti-thyroid medication should be started, most commonly methimazole and PTU.
Methimazole and PTU can cause what? (2)
agranulocytosis and liver injury.
What should be given following treat-
ment with anti-thyroid medications? (3)
- A dose of an iodine-containing agent, such
- as iodine Lugol solution or potassium iodine, should be given 1 hour following treatment with anti-thyroid medications.
- This decreases the release of preformed thyroid hormone and decreases production of further thyroid hormone. However, if given too early, iodine-containing agents can actually worsen the patient’s condition.
What can be given to decrease the conversion of T, into its active form, T? (2)
Glucocorticoids (eg, dexamethasone or hydrocortisone)
Describe : T3 and T4
- T4, and T3, (in smaller amounts, are produced by the thyroid gland, with T3, being the much more active form.
- The conversion of T4 to T3, most often takes place in the target tissues rather than the thyroid gland itself.
Describe : TSH
- released by pituitary (hypophyse) to stimulate the thyroid gland to produce and release thyroid hormone
- TSH level will be decreased in cases of primary hyperthyroidism
How’s extreme hyperthyroidism called?
Tempête thyroïdienne
Severe hypothyroidism is known as what?
a myxedema crisis
Patients with diabetes mellitus are at risk of developing potentially life-threatening conditions related to hyperglycemia. Name them (2)
- Acidocétose diabétique
- État hyperglycémique hyperosmolaire (EHH)
Name thyroid emergencies
- Thyroid storm/thyrotoxicosis
- Myxedema crisis
Name sx : Thyroid storm/
thyrotoxicosis (9)
- Fever
- Tachycardia
- Atrial fibrillation
- Heart failaure
- Altered mental status
- Seizure
- No-vo
- Diarrhea
- Abdo pain
Describe early tx : Thyroid storm/
thyrotoxicosis (4)
Administer in this order:
* 1. IV beta-blockers (eg, propranolol or esmolol)
* 2. IV anti-thyroid medications (eg, methimazole or PTU)
* 3. IV iodine supplementation (eg, Lugol solution)
* 4. IV steroids (eg, methylprednisolone)
Name sx : Myxedema crisis (8)
- Altered mental status
- Coma
- Bradycardia
- Hypothermia
- Hypotension
- Non-pitting edema
- Fatigue
- Cool, dry skin
Describe tx : Myxedema crisis (2)
- IV steroids
- IV thyroid hormone
replacement
(eg, levothyroxine)
Name sx : DKA and HHS (4)
- Altered mental status
- Abdominal pain
- Nausea and vomiting
- Signs of dehydration (eg, dry mucus membranes, poor skin turgor, sunken eyes)
Describe tx : DKA and HHS (3)
- IV isotonic fluids
- IV insulin infusion
- IV electrolyte supplementation (especially potassium)
Describe sx : Hypoglycemia (7)
- Altered mental status
- Coma
- Focal neurologic deficits
- Dizziness
- Seizures
- Anxiety
- Palpitations
Describe tx : Hypoglycemia (3)
- Oral sources of glucose (eg, tabs, food and drink)
- IV dextrose
- IV dextrose-containing fluids
Describe sx : Crise surrénalienne (5)
- Refractory hypotension
- Abdominal pain
- Nausea and vomiting
- Altered mental status
- Lethargy
Describe early tx : Crise surrénalienne (2)
- IV steroids (eg, methylprednisolone)
- Supportive care (eg, isotonic fluids, electrolyte supplementation)
Name sx : Hyperparathyroidism (10)
- Malaise/weakness
- Confusion
- Headache
- Hyporeflexia
- Bone pain
- Hypertension
- Dysrhythmia
- Nausea and vomiting
- Constipation
- Abdominal pain
Describe tx : Hyperparathyroidism (2)
- IV isotonic fluids
- IV loop diuretics (eg, furosemide)
Describe : Adrenal Crisis.
- Crisis. An adrenal crisis is a state characterized by a life-threatening deficiency of the adrenal hormone cortisol.
- This is typically precipitated by a physiologic stressor (eg, surgery, infection, trauma, burn that results in a state where the supply of cortisol (often already diminished by pre-existing adrenal insufficiency) is exceeded by demand.
- This often manifests as severe hypotension that is refractory to vasopressor medications.
