Thyroid Disorders

Question 1

What do we do with a Goiter?

Answer 1

Obtain TSH:
If high—measure serum free T4—Diagnosis?
Most common cause is Hashimoto’s thyroiditis
Tx with Levothyroxine

If low—measure free T4, serum total T3—Diagnosis?
Consider US
Need 24-hour raioiodine uptake scan
Multinodular goiter/Grave’s disease most common

Question 2

Signs and Symptoms of Hypothyroidism

Answer 2

Dry, course skin
Hoarse voice
Brittle nails
Periorbital, Peripheral edema (myxedema)
Delayed reflexes 
Slow reaction time
Bradycardia

Question 3

Hashimoto’s Labs and Imaging

Answer 3

TSH, Free T4
TPOAb (anti-thyroid peroxidase antibody)
TGAb (anti-thyroglobin antibodies)

Imaging:

* ultrasound to establish goiter size
* Radioiodine uptake

Question 4

Myxedema

Answer 4

Not fully understood but thought to be related to connective tissue proliferation in reaction to increased to TSH levels
Patient usually has hx of hypothyroidism

Question 5

Hyperthyroidism Signs

Answer 5

Tachycardia
Goiter
Skin changes (pretibial myxedema)
Tremor
Eye signs  (exophthalmos)
Conjunctival inflammation,
Extraocular muscle dysfunction 
Lid lag 
Osteoporosis

Question 6

Hyperthyroidism Symptoms

Answer 6

Nervousness
Diaphoresis
Heat intolerance
Palpitations
Fatigue
Weight loss
Frequent bowel movements

Question 7

Hyperthyroidism Treatment

Answer 7

Anti-Thyroid Drugs (thioamides):
Methimazole (Tapazole) 5-15mg/day (once daily)
Propylthiouracil (PTU) 100-150mg/day

Both act by inhibiting iodine orgnaification

Radioactive Iodine Treatment