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Résidence - Urgence > Thyroid > Flashcards

Thyroid Flashcards

1
Q

If the diagnosis of thyroid storm is suspected, what to do?

A
  • 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.
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2
Q

Following treatment of the autonomic disturbances, one can begin what therapy? (2)

A

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.

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3
Q

Methimazole and PTU can cause what? (2)

A

agranulocytosis and liver injury.

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4
Q

What should be given following treat-
ment with anti-thyroid medications? (3)

A
  • 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.
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5
Q
A
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6
Q

What can be given to decrease the conversion of T, into its active form, T? (2)

A

Glucocorticoids (eg, dexamethasone or hydrocortisone)

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7
Q

Describe : T3 and T4

A
  • 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.
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8
Q

Describe : TSH

A
  • 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
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9
Q

How’s extreme hyperthyroidism called?

A

Tempête thyroïdienne

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10
Q

Severe hypothyroidism is known as what?

A

a myxedema crisis

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11
Q

Patients with diabetes mellitus are at risk of developing potentially life-threatening conditions related to hyperglycemia. Name them (2)

A
  • Acidocétose diabétique
  • État hyperglycémique hyperosmolaire (EHH)
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12
Q

Name thyroid emergencies

A
  • Thyroid storm/thyrotoxicosis
  • Myxedema crisis
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13
Q

Name sx : Thyroid storm/
thyrotoxicosis (9)

A
  • Fever
  • Tachycardia
  • Atrial fibrillation
  • Heart failaure
  • Altered mental status
  • Seizure
  • No-vo
  • Diarrhea
  • Abdo pain
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14
Q

Describe early tx : Thyroid storm/
thyrotoxicosis (4)

A

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)

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15
Q

Name sx : Myxedema crisis (8)

A
  • Altered mental status
  • Coma
  • Bradycardia
  • Hypothermia
  • Hypotension
  • Non-pitting edema
  • Fatigue
  • Cool, dry skin
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16
Q

Describe tx : Myxedema crisis (2)

A
  • IV steroids
  • IV thyroid hormone
    replacement
    (eg, levothyroxine)
17
Q

Name sx : DKA and HHS (4)

A
  • Altered mental status
  • Abdominal pain
  • Nausea and vomiting
  • Signs of dehydration (eg, dry mucus membranes, poor skin turgor, sunken eyes)
18
Q

Describe tx : DKA and HHS (3)

A
  • IV isotonic fluids
  • IV insulin infusion
  • IV electrolyte supplementation (especially potassium)
19
Q

Describe sx : Hypoglycemia (7)

A
  • Altered mental status
  • Coma
  • Focal neurologic deficits
  • Dizziness
  • Seizures
  • Anxiety
  • Palpitations
20
Q

Describe tx : Hypoglycemia (3)

A
  • Oral sources of glucose (eg, tabs, food and drink)
  • IV dextrose
  • IV dextrose-containing fluids
21
Q

Describe sx : Crise surrénalienne (5)

A
  • Refractory hypotension
  • Abdominal pain
  • Nausea and vomiting
  • Altered mental status
  • Lethargy
22
Q

Describe early tx : Crise surrénalienne (2)

A
  • IV steroids (eg, methylprednisolone)
  • Supportive care (eg, isotonic fluids, electrolyte supplementation)
23
Q

Name sx : Hyperparathyroidism (10)

A
  • Malaise/weakness
  • Confusion
  • Headache
  • Hyporeflexia
  • Bone pain
  • Hypertension
  • Dysrhythmia
  • Nausea and vomiting
  • Constipation
  • Abdominal pain
24
Q

Describe tx : Hyperparathyroidism (2)

A
  • IV isotonic fluids
  • IV loop diuretics (eg, furosemide)
25
Q

Describe : Adrenal Crisis.

A
  • 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.

Résidence - Urgence (9 decks)

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