Thyroid Disease Flashcards
Who to screen for thyroid disorder
– Personal history of autoimmune disease (T1DM or other) – Family history of thyroid disease – History of neck radiation – History of thyroid surgery – Consideration for age ≥60 years
Medications that cause hypothyroid
lithium, potassium iodide,
Lugol’s solution
How to start synthyroid
young/healthy- 100 mcg daily
low and slow on elderly
TSH monitoring
repeat every 4-6 weeks after dose change otherwise yearly or with estrogen status change (effects TBG) 10% change in weight Symptoms Goal- .5-3.5
When treat subclinical hypothyroid
Treat if TSH >10
Etiology of Hyperthyroid
Graves’ disease is more often in younger
women (TRAb)
• Toxic multinodular goiter is more common
in older women
Work-up of Hyperthyroid
• Thyrotropin receptor antibody (TRAb or
TSI)
• Radioactive iodine uptake and scan
• Thyroid blood flow on US
Monitoring of Anti thyroid medications
-Check labs every 4-6 weeks: TSH, free T4, and total T3 • CBC and liver panel at baseline and periodically (agranulocytosis) • Typically treat with anti-thyroid medication for 12-18 months
Etiology of subclinical hyperthyroid
-Most common cause is exogenous thyroid hormone • Next most common cause is autonomously functioning thyroid adenoma or multinodular goiter
When to treat subclinical hyperthyroid
• If TSH <0.1 uIU/mL, treat underlying cause
• If TSH 0.1-0.5 uIU/mL, consider treatment
if low bone density, postmenopausal, age
>65, known heart disease or risk for
arrhythmia
Postpartum Thyroiditis
Hyperthyroidism, hypothyroidism, and/or hyperthyroidism followed by hypothyroidism in the first year postpartum in women without overt thyroid disease before pregnancy • Almost exclusively antibody positive • Prevalence varies geographically • Usually transient ~1 year postpartum normal TFTs return
• Check thyroid function tests every 4-8 weeks
• Treat hypothyroid phase in women:
– Who are actively trying to conceive
– Who are breastfeeding
– With symptoms
• If T4 is not started, check TFTs every 4-8
weeks until euthyroidism achieved and use
contraception
- repeat TSH annually
Hyperthyroid symptoms
nervousness, palpitations, frequent stools, diaphoresis, heat intolerance, weight loss, and insomnia.
Physical exam findings may include goiter, tachycardia, hypertension, tremors, ophthalmopathy (lid lag and retraction), and pretibial edema.
Pregnancy complications of hyperthyroid
uncontrolled- preeclampsia, miscarriage, heart failure
preterm birth, growth restriction, goiter, tachycardia, hydrops, and stillbirth
Transient hypothyroidism occurs in 10 to 20% of newborns of treated mothers and < 5% of neonates will be hyperthyroid due to transplacental antibody passage.
methimazole embryopathy
esophageal or choanal atresia and aplasia cutis
Thyroid Storm treatment
PTU, Iodine, Steroids (t4 to t3 conversion), Propanolol
