Thyroid Flashcards
Hyperthyroidism causes
Primary
Secondary
TSH and T4 levels
Primary
-decrease tsh, increase t4
Graves
-autoimmune thyroid-stimulating-antibodies
Multi-nodular goitre/Toxic adenoma
-hyperactive thyroid nodules
Thyroiditis
- inflammation of the thyroid gland w release of T4/T3
- can get hypothyorodism ,then hyperthyrodiism
Other - amiodarone
Secondary - rare, TSH producing pituitary adenoma
- increase or normal tsh
- high t4
Hypothyroidism
Primary
-increase tsh, decrease T4
Hashimotos thyroiditis
- autoimmune
- antithyroglobuilin and antihyorid peroxidase antibodies
Iodine deficicency
Thyroidisitis
-postpartum, postviral, subacute
iatrogenic - radioactive ablation, excision, drugs (lithium, amiodarone)
Secondary
- pituitary macroadenomas
- infiltrative disease
- post pituitary disease
Subclinical hypothyrodism
increase tsh, normal hormone level + asymptomatic
Euthyroid sick syndrome
- Normal Tsh decrease t4,t3 (mainly t3 because t4 is converted to t3)
- caused by serios illness, caloric deprivation and increased cytokines
Radioactive iodine uptake findings for different causes
Graves - increase uptake, diffuse uptake
Multinodular goiter - increase or normal uptake, multiple nodules
Toxic adenoma - normal or increase upake, one are of increased uptake
Thyroditis, iodine exposure extraglandular production - low iodine uptake –> increased thyroglobulin
Exogenous thyroid hormone - low uptake - decrease thyroglobulin
Hyperthyroidism
History
Exam
- Weight loss
- heat intolerance
- anxiety
- palpitations
- increased bowel frequency
- myopathy/proximal muscle weakness
- insomnia
- menstrual abnormalities
Examination
- goiter
- sinus tachy or AF
- fine tremor
- lid lag
- hyperactive reflexes
- exopthalmous, pretibila myxedema, thryoid bruits –> specific to graves
Diagnosis
- TSH, T4
- radioactive iodine scan and thyroglobulin (if need more info)
Treatment
- Symptom treatment - propranolol, metoprolol (adrenergic symptoms)
- Pharmacologic - antithryoid drugs (carbamazole) –> not for thyroditis (these patients should heal spontaneously)
- Definitive treatment - radioactive ablation or total thryoidectomy then give levothyroxine
goiter cause
- low iodine
- overactive thyroid gland
Thyroid storm
Acute and life-threatening
may present with af, fever, delreium
- Treat urgently with anti-thyroid drugs (carbimazole) then iodine
- IV emolol
- Corticosteroids
- admit to ICU
Hypothyroidism
History
-weakness, fatigue, cold intolerance, constipation, weight gain, depression, hair loss, mestrual iregualrieis, myopathy, hoaresness
Exam
- dry, cold, puff skin
- odemea
- brady cardia
- slow tendon reflex
Diagnosis
- tsh, t4
- can have high ldl, triglycerides, ck, hypothermia
treatment
-levothyroxine
(in subclinical - treat if tsh >10, if t4 normal)
complications
- increased risk of thyroid lymphoma
- Myedema coma - severe hypothyrodism with decrease mental status, hypotermai, hypotension, bradycardia, hypoventilation
- high mortality
- Give IV levothyroxine, IV hydrocortisone
Thyroiditis
- cause
- history and exam
- diagnosis
- treatment
-inflammation of the thyroid gland (radiation induced, autoimmune, postpartum, drug induce (amiodarone)
Histroy.exam
-tender thyroid, malaise, Upper resp symptoms
Diagnosis
- thyrotoxicosis followed by hypothyrodism
- decrease uptake on RAI and scan during hyperthyroid phase
Treatment
- beta blockers- hyper ,levo - hypo
- self limited - treat nsiads or oral corticosteroids
Thyroid neoplasms
-thyroid nodules are common
History / exam
- normally asymptomatic or found insidentally
- hyperfunctioning nodules - hyperthryodism
- large nodules - can present with - dysphagia, dyspnea, cough, chocking senstaion
- check lymphadenopathy
-Increase risk of malignancy - cold nodules on RAI scan, female sex, age less than 20 or over 70, firm and fixed, and family history and rapdily growing nodules with hoarseness.
Treat - fine needle aspiriation
- US
- malignant FNA - surgical resection
Papillary is most common , lymphatic spread,
