Thyroid Disease Flashcards by Hannah Gibson

Features + rx of Subacute granulomatous thyroiditis

(viral infection, painful thyroid)
NSAIDs

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Rx + monitoring of hypothyroidism

Levothyroxine treatment of choice, start 12.5-50mcg/day
Repeat TSH q3-4 months until stable, then yearly

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Myxedema coma sx

Altered mental status, hypoventilation, hypothermia, hypotension, bradycardia, hyponatremia, hypoglycemia

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Rx of myxedema coma

Levothyroxine (T4) loading dose 200-400mcg IV, then 1.6mcg/kg/day IV
Liothyronine (T3) 5-20mcg followed by 2.5-10mcg q8h given with T4
Glucocorticoids (hydrocortisone 100mg IV q8-12h x2d) until coexisting adrenal insufficiency can be excluded
Supportive measures (ventilation, fluids, correction of hyponatremia and hypothermia)

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What are the receptor ab for Graves?

Graves (TSH receptor antibodies=TRAb)

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Causes of thyroid storm?

Trauma, surgery, RAI

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Sx of thyroid storm

Hyperthermia, tachycardia, N/V/D, dehydration, delirium, coma

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Treatment of thyroid storm

B-Blockers (Propranolol 60-80mg q4-6h)
Propylthiouracil 200mg PO q4h
Iodine solution (delayed 1h after PTU)
Iodinated radiocontrast
High-dose IV hydrocortisone 100mg IV q8h

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RF for hyperthyroidism

Diffuse/ nodular goitre
T1DM
Autoimmune disorder
Fam hx
Amiodarone, lithium, iodide

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When to check TSH

After med dose changes
Before initiating treatment
Periodically in stable pts

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rx for hyperthyroidism

Propranolol 10-40mg QID
Methimazole 5-120mg for 12-18mo then taper + DC
Radioactive iodine - single dose
Subtotal thyroidectomy - treatment of choice in pregnancy + pts <40 y/o

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Precipitants of hyperparathyroidism

thiazide diuretics, lithium, RT, MEN type 1 + 2a

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Lab results for hyperparathyroidism

high calcium, high PTH, low phosphate, high ALP

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Sx of hyperparathyroidism

bone pain, fragility fractures, kidney stones, polyuria, N/V, constipation, lethargy, depression, gout, reduced BMD

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Rx of hyperparathyroidism

parathyroidectomy, volume repletion + loop diuretics, pamidronate

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Causes of hypothyroidism

Chronic autoimmune thyroiditis (Hashimoto’s)
Postpartum thyroiditis
Iodine deficiency
Drugs: amiodarone, lithium, iodine
Central hypothyroidism
Pituitary adenoma or damage
Infiltrative: sarcoidosis, TB, granulomas)

Who is at risk of hypothyroidism?

Women >45
1st trimester pregnancy
Trying to conceive
Post partum (6w-6mo)
Elderly
FHx
Autoimmune disease
Neck RT

Ix for hypo

High TSH + low free T4 = hypothyroidism
Normal/ low TSH + low free T4 = central hypothyroidism
T3 if undetectable TSH + normal T4
Thyroid scan or MRI thyroid if goitre present

RF for hyper

Diffuse/ nodular goitre
T1DM
Autoimmune disorder
Fam hx
Amiodarone, lithium, iodide

Causes of hyper

Graves (antibody against TSH receptor) (High uptake, diffuse)
Toxic multinodular goitre (high uptake, nodular)
Toxic adenoma (high uptake, one ‘hot’ area)
Thyroditis (low uptake)
Treatment induced
Thyroid cancer

Sx of hyper

Wt loss, heat intolerance
Lid lag, proptosis, periorbital edema, hair loss, goiter, thyroid bruits
Palpitations, tachy, AF, wide pulse pressure, HTN
Tremor, edema, pretibial myxedema, muscle weakness
Amenorrhea

Ix for hyper

Low TSH high T4
MRI if high TSH + T4 (suspect TSH secreting pituitary adenoma)
Thyroid uptake if low TSH + high free T4
CBC and LFT at BL

Lab results for thyroid storm

low TSH, high free T4, low Hb, high WBC, high glucose, high calcium, high LFTs

Causes of hypo

RF for hypo

Women >45 1st trimester pregnancy Trying to conceive Post partum (6w-6mo) Elderly FHx Autoimmune disease Neck RT

Sx of hypo

Fatigue, weakness, cold intolerance, weight gain Depression, memory loss Enlargement of tongue, hoarseness, goitre Bradycardia, pericardial effusion, HTN, CHF Muscle weakness Constipation Paresthesia, muscle cramps Menorrhagie, amenorrhea, impotence Periorbital edema, hair loss, lateral ⅓ eyebrow thin, brittle nails Anemia

Ix for hypo

High TSH + low free T4 = hypothyroidism Normal/ low TSH + low free T4 = central hypothyroidism T3 if undetectable TSH + normal T4 Thyroid scan or MRI thyroid if goitre present

Management of Subclinical hypothyroidism

No treatment if TSH <10, normal T4, asymptomatic, not pregnant Most normalize over next 5 yrs Monitor annually Treat w/ levothyroxine if: Elevated TPO antibodies Goitre Fam hx of autoimmune dz Pregnancy

Rx for hypo

Tx if TSH >10 + symptomatic TSH 5-10 AND: Elevated TPO antibodies Goitre Fam hx of autoimmune dz Pregnancy

What are the features of + when do you Rx: Subacute granulomatous thyroiditis

(preceding viral infection, painful thyroid) = usually self resolves, treat w/ NSAIDs

Advice for pts on levo

Absorption affected by: high fibre, soy, coffee, calcium, iron, antacids, PPI, anticonvulsants Take on empty stomach 30 mins before breakfast

Thyroid storm Rx

thionamides e.g. methimazole (blocking synthesis), propranolol, iodine, bile acid sequestrant (cholestyramine)

Rx for graves

thionamides e.g. methimazole (blocking synthesis), propranolol, iodine, bile acid sequestrant (cholestyramine), radiation, thyroidectomy

When to screen for hypothyroidism

sx, at risk (pregnancy, prev thyroid dz, prev radiation, pituitary disorder), taking replacement

Next steps if hyperthyroid on labs

BB 6-8 wks, radioactive iodine uptake (unless Graves or pregnant or breastfeeding)

thyroid nodule workup

TSH, thyroid US (>1cm, taller than wide), FNA for cytology)

What are features of a suspicious thyroid nodules?

>1cm, irregular surface, taller than wide, calcifications

Hypothyroidism signs

dry skin, bradycardia, wt gain, delayed reflex relaxation, edema

Hyperthyroidism signs

diaphoresis, tachycardia, wt loss, goiter, tremor, thinning of hair, lid lag, exophthalmos