Thyroid Disease Flashcards
Presenting symptoms of hyperthyroidism
progressive nervousness, palpitations, weight loss, irritability, fine resting tremor, dyspnea on exertion, concentration difficulties
Physical exam findings of hyperthyroidism
fine resting tremor, rapid pulse, elevated BP (more in systolic so greater pulse pressure), atrial fib
acute hypermetabolic state associated with sudden release of large amounts of thyroid hormone into circulation
thyroid storm
Symptoms of thyroid storm
autonomic instability, confusion, psychosis, restlessness, dysrhythmias,
pathophysiology of Graves dx
autoimmuno disorder caused by immunoglobulins (IgG) antibodies that bind to TSH receptors initiating the production and release of thyroid hormone
common, distinct feature of Graves dx
exophthalmos
second most common cause of hyperthyroidism
autonomous thyroid nodule that secretes thyroxine (ignores TSH)
other causes of hyperthyroidism besides Graves and autonomous thyroid nodule
iatrogenic hyperthyroidism (overuse of thyroxine supplement), thyroditis (acute stages)
Lab values in hyperthyroidism
elevated thyroxine (free T4) and low TSH
Once hyperthyroidism is established with lab values, what test to do next?
radionucleotide imaging (direct scan of gland) with tech99 or iodine123
How to Graves appear on radionucleotide scan
diffuse hyperactivity with large amounts of uptake
How does thyroiditis appear on radionucleotide scan
patchy uptake with overall reduced activity (reflects release of hormone rather than overproduction of it)
How to treat Graves
radioactive iodine
Who shouldn’t get radioactive iodine
pregnant mothers and children
What are alternatives to radioactive iodine?
anti-thyroid meds like PTU, methimazole, carbimazole (inhibit organification of iodine and prevents conversion of T4 into T3; the more active form)
ESP EFFECTIVE IN ADOLESCENTS WITH GRAVES