Thyroid Disorder Flashcards
Graves Patients- Who to refer to?
ALL need ophthalmologist
S and S of Hyperthyroidism
Bruit, nodules, ANS hyperactivity, new A.Fib, dermopathy, skin, hair (velvet), exopthalamos, lid lag, pretrial myxedema, adenopathy, quick DTR, pelvic exam (pregnancy)
Medications that Cause Hyperthryoidism
Lithium, steroids, pregnancy, HCG, estrogens, amiodarone, phenytoin
Plummer’s Disease
Toxic Multinodular Goiter
Labs- Increased TSH, T4, and Uptake on radio iodine test
Pituitary tumor
Labs- Decreased TSH, increased T4, Increased uptake of I
Graves, Plummers, Adenoma
Labs- Normal T4, undetectable TSH
Subclinical Hyperthyroidism
Labs- Decreased TSH, Increased T4, decreased uptake of I
Thryoiditis- pregnancy, postpartum, silent, and viral
Treatment for Ssmptoms of hyperthyroidism
Propranolol- 160 mg/day, CCB for those with Asthma, COPD
What does U/S of thyroid show?
Differentiates cyst from nodule, cancer?
What is Antithyroid Perioxidase Antibodies?
Lab- tests for antibodies that attack thyroid. In Graves and Hashimoto’s
What is antithryoglobulin?
Lab- tests for antibodies that attack thyroid. In Graves and Hashimotos
PTU Treatment
For pregnancy. Risks of agranulocytosis, skin rash, and fever. Check CBC and LFT
Radioactive Iodine
Can worsen opthalmopathy. No pregnancy or children, or breastfeeding
Tx for Opthalmopathy
ALWAYS referral to ophthalmologist. Also steroids, eye lubricant for dry eyes.
Treatment for subclinical Thyroiditis
Watch and wait unless: A.Fib, presence of antibodies, menopausal women with osteoporosis.
Drugs that cause hypothyroidism?
Amiodarone and lithium
What can an elevated anti-TPO antibody suggest?
Hashimoto’s or Graves, depending on the T4 and TSH
S and S of hypothyroidism
Dry skin, weight gain, loss of lateral eyebrows, bradycardia, heart hypertrophy, prolonged DTR relaxation
Normal TSH Value
.35-2.5. Up to 3 in Elderly
Treatment of elevated hypothyroidism based on TSH
> 10 should be treated
15 in presence of illness, check again
5-10, depends on judgement
Therapy for hashimoto’s disease
1.6 mcg/kg/day-50-100
>60 or CAD, start at half the dose
Nodules and Cancer: Red Flags
Only one nodule. Firm, nontender, fixed, irregular. Men. >60, or
