Thyroid Disease Flashcards

1
Q

What is Estrogen therapy’s effect on the thyroid?

A

Increases the thyroid binding hormone

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

What drug can impact T4, T3, TSH, and TSAb lab test values?

A

BIOTIN

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

19 y/o female 3 month Hx of sweating, tremor, palpitations, and weight loss of 10 lbs. Recent heat intolerance, proximal muscle weakness.

Family Hx HYPO thyroidism

Exam: 156/60, P-92
Tremor, stare, Thryroid normal size, non-tender

What is your differential?

A
Graves Disease (Hyperthyroidism)
Toxic multinodular goiter
Toxic adenoma
Subacute thyroiditis
Iatrogenic
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

Which altered lab value could indicate and clinically help to definitively Dx Graves Dz?

What age group is it most common?

A

TSI and TSH-R –> Drives the thyroid to repeatedly causing the thyroid to create more T3 and T4

Widened pulse pressure

Age MC 20-50 y/o

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

What are some clinical features of a hyperthyroidism case?

A

Hyperactivity
Heat intolerance, sweating, weight loss
Tremor, palpitations
Oligomenorrhea

Tachycardia, arrhythmias
Muscle weakness, lid lag, stare, goiter

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

What is a significant risk factor which increases a hyperthyroid patient’s risk for Graves Ophthalmopathy?

A

SMOKING

Immunologic mediated

Everything turns green is the 1st sign of optic nerve traction

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

What would the lab evaluation of a PT with Hyperthyroidism look?

A
TSH screen (LOW)
Free T4, Free T3 (HIGH)
          ~~remember T3 more metabolically active~~
Thyroid Receptor Antibody (POS (+))
Radioactive Iodine (HIGH)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Which drug is the of choice for 1st Trimester pregnancy PTs who suffer from hyperthyroidism or for thyroid storm.

A

PTU propothiouracil

increased risk of Liver Toxicity

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

What are some additional Anti-Thyroid drugs which you can Rx?

A

Tapazole
PTU
Organification of Iodide

Beta-blockers –> control adrenergic S/Sx

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

What might a PT present as to your clinic if they suffered from Subacute Thyroiditis?

You decide to order labs; what labs would you order and what values would you expect to see?

A

Pxful or Pxless
VIRAL mediated most likely (recent fever)
Hyperthyroidism –> may lead to –> Hypothyroidism
Sweating, tremor, palpitations
Stare, 166/60, P: 88, tender

Elevated ESR
TSH, T4, and T3 varies
Low 131I uptake in beginning

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q
Fatigue
Weight Gain
Cold intolerance
Dry Skin
Swelling of the neck
No prior Hx of HTN
Edema 
Thyromegaly
Decreased DTRs
Bradycardia
A

Autoimmune Hypothyroidism (Hashimoto’s is Low)

MC in women –> lymphocytic infiltration of thyroid

Peroxidase antibody (+)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

What is the clinical presentation of Hashimoto’s?

A
Fatigue, weight gain
Cold intolerance
Dry skin
Thyromegaly
Decreased DTRs
Bradycardia
Edema
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

What can cause Iodine excess?

A

Amiodarone

Kelp (seaweed)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

What lab values will present with a HYPO-thyroid patient?

A

TSH is HIGH

Free T4 and free T3 LOW

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

What is the Tx for hypothyroidism?

A

L-thyroxine
~~Take on empty stomach
~~1/2 life is 7 DAYS

Follow TSH q two months

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

What is the clinical picture for Subclinical Hypothyroidism?

A
Fatigue
Dry skin
Joint stiffness
TSH is slightly elevated
T3 and T4 are normal

(+) peroxidase antibody test

MC in DM1 WOMEN

17
Q

At what laboratory value will you decide to Tx a patient in respect to their TSH?

A

TSH over 10mU/L

Tx in less than 10 when…

  1. Pregnant
  2. Goiter
  3. (+) thyroid antibodies (peroxidase)
18
Q

What is the 1/2 life of Amiodarone?

Why is this important?
What could it cause?

What would you use to counteract the effects of amiodarone?

A

100 days

High iodine can alter thyroid function and cause Thyroiditis (Hashimoto’s MC) or hypothryoidism
~~Inhibit T4 to T3 conversion
~~Block T3 receptor binding
~~Toxic to follicular cells

Tx with T4 (continue amiodarone)

19
Q

What psychiatric drug must you always check for a goiter?

20
Q

Discuss the differences between Type 1 and Type 2 Amiodarone-induced Hyperthyroidism.

What would you Tx amiodarone induced hyperthyroidism with?

A

Type 1: HIGH T4 and T3
Pre-existing Graves, MNG (multi-nodular goiter)

Type 2: Destructive Thyroiditis
No new synthesis of T4 and T3

Methimazole –> TYPE 1
STEROIDS –> TYPE 2

21
Q

Post-partum mothers should always be checked for their thyroid and related PE for what condition?

A

Postpartum thyroiditis
~~Thyroid inflammation and follicular damage (Flood gates opened and T4 and T3 are released unregulated)
~~Transitions to HYPOthyroid phase

22
Q

What is the Tx for Postpartum Thyroiditis?

A

Hyperthyroid phase: beta blockers
Hypothyroid phase: Thyroid replacement
Annual TSH
EDUCATE –> Likely to happen w/ future pregnancies

23
Q

During normal pregnancy what thyroid based changes from baseline can you expect?

A

TBG elevated; increases bound T4 and T3

Hyperthyroidism MC is Graves during preg

hCG can upreg thyroid stimulation
~~Hyperemesis gravidarum –> Hyperthyroid

24
Q

What are 4 reasons T4 therapy for hypothyroid patients may need to be increased during pregnancy?

A

Increased T4 pool
High TBG
Placenta deiodinase (chews it up)
Reduced GI absorption (Fe in vitamins) must educate PTs to take medication at different time than prenatal vitamin

25
If you note a nodule on the thyroid; what Tx / diagnostic protocol should you follow? What PT demographic is most common to have a thyroid nodule?
Age 30-50 --> Women more likely than men ``` Check Thyroid Function Test Cold Scan or FNA U/S (<1cm will determine not clinically sig.) U/S Risks --> Microcalcifications Ratty borders ```
26
What is sick euthyroid syndrome?
``` VERY ILL PATIENTS Decreased T3 (May have decreased T4 if very ill) Can occur with trauma FEVER Acute or chronic (NON-THYROIDAL ILLNESS) No thyromegaly ```