Thyroid disorders Flashcards
Hypothyroid- Eti
- Low T4, high TSH
- 1% population
- W>M
- Elderly- 4-10%
- Hep C, chemo, Amiodarone
Hypothyroid- Dx
- High TSH, +/- low T4
Hypothyroid- Sx
- Fatigue
- Wt gain
- Dry skin, hair loss
- Cold sensitivity
- loss of memory, depression
- Delayed DTRs
- Goiter
Myxedema coma- Sx
- Life threatening
- Decompensated hypothyroidism
- Mental status change
- Hypothermia
- Hypoventilation- biggest risk
- opioid sensitivity
Hashimoto thyroiditis- Eti
- Autoimmune disorder- B- lymphocytes
- W 6x > M
- Most common thyroid disorder
- family hx
Hypothyroid- Tx
- Levothyroxine- 1.7 micrograms/kg/day
- Recheck within 6 weeks
Hyperthyroid- Eti
- High T4, suppressed TSH
- W>M
- Younger, 2%
- Excess production from gland, autoimmune, goiter
Hyperthyroid- Sx
- Wt loss, increased appetite
- Sweating
- Palpitations, restlessness, nervousness
- Oligoamenorrhea, gynecomastia
- Tremor
- Hyperdefecation
- palpitations
- Insomnia, irritability, poor concentration
Thyroid crisis/ storm- Eti
- Life threatening, extreme thyrotoxicosis
- Triggered by stress
- Rare disorder, high mortality rate
Hyperthyroid- Tx
Acute: - Beta blockers - Propylthiouricil or methimazole to block T4 synthesis Chronic: Tailored to etiology
Graves disease- Tx
- Symptomatic relief- eye drops, beta blockers
- Antithyroid meds- long term remission after 12 months tx
- Radioactive iodine- destroy tissue
- Surgery- not routinely recommended
Goiter- Eti
Enlarged thyroid gland
- 5% population
- W>M
- Painful v painless
Goiter- Dx
- Thyroid fxn tests
- Radioactive iodine scan (hyperthyroid)
- US
- Flow-volume loop, barium swallow (obstruction)
Goiter- Tx
- Tx cause- hyper or hypo
- Surgery if large, substernal or obstruction
Thyroid nodules- Eti
- 4-7% adults
- Women, older, radiation exposure, iodine deficiency
- Commonly asymptomatic
- Hyper or hypothyroid
- 30-40% have non-palpable nodule
- 5-10% are malignant
Thyroid nodules- Malignant risks
- Male
- Hoarseness or dysphagia
- Rapid growth
- Hx of radiation
- Hashimoto’s thyroiditis (lymphoma)
Thyroid nodules- Dx
- Serum TSH
- Radionuclide scan
- Ultrasound for defining characteristics
- Fine needle aspiration if indicated
Myxedema- Eti
- Elderly women
- Hx of stroke, infection, stop med
Myxedema- Tx
- IV levothroxine- large dose
- Tx hypoventilation & hypothermia
Graves- Eti
- Most common cause of thyrotoxicosis
- W>M
- 20-40 yrs old
- Fam hx
Graves- Sx
- Pretibial myxedema
- exophthalmos
- Lid lag
- periorbital edema
Subacute thyroiditis- Eti
- Viral infections
- W>M
Subacute thyroiditis- Sx
- Tender thyroid
- Enlarges 3-4 x size
- Dysphagia- pain radiates to jaw or ear
Subacute thyroiditis- Tx
- NSAIDs
- Corticosteroids
Thyroid crisis/ storm- Sx
- Severe tachycardia
- Marked delirium
- high output heart failure, wide pulse pressure, elevated SBP, fever
- Vomiting, diarrhea & dehydration
Thyroid crisis/ storm- Tx
- Thiourea drug & iodine
- Hydrocortisone
Thyroid nodule- Sx
- Palpable nodule
- Hoarseness, discomfort & dysphagia
- Dyspnea
- Superior vena cava syndrome- facial erythema, JVD & facial edema
Thyroid nodule- Tx
- Levothyroxine if TSH elevated
- Surgical excision of hx of radiation, positive cytology
- Percutaneous ethanol injection
Hashimoto Thyroiditis- Sx
- Hypothyroid more common
- Diffusely enlarged, firm & finely nodular
- Xerostoma and dry eyes
- Associated with other autoimmune diseases
Hashimoto Thyroiditis- Dx
- Anthithyroglobulin antibodies
- Antithyroid peroxidase
- Fine needle aspiration
- Ultrasound- diffuse heterogeneous
Hashimoto Thyroiditis- Tx
- Hypothyroid- Levothyroxine to shrink goiter size
Thyroid cancer- Eti
- W>M, increases with age
- Most microscopic & indolent
- Papillary thyroid carcinoma most common
Thyroid cancer- Sx
- Firm, palpable nontender nodule
- Asymptomatic
- Neck discomfort, dysphagia & hoarseness
- Flushing & diarrhea
Thyroid cancer- Dx
- Radioactive iodine scan
- US, CT or MRI
- Normal thyroid function test
Thyroid cancer- Tx
- Surgical removal
- Thyroxine suppression or Radioactive iodine
Endemic goiter- Eti
- Iodine deficiency
- Risk of miscarriage & stillbirth
Endemic goiter- Sx
- Large, multinodular goiter
- Compression of anatomical structures nearby
- May be hypothyroid or thyrotoxic
Endemic goiter- Dx
- See/ feel goiter
Endemic goiter- Tx
- Add iodine to diet
Toxic multinodular goiter- Eti
- Toxic adenoma
- Older women
- Nodules progress to toxic & cause hyperthyroid
Toxic multinodular goiter- Sx
- Nodular goiter
- Nervousness, resetlessness, irritibility
- Heat intolerance, sweating, wt loss
- Tachycardia & palpitations
Toxic multinodular goiter- Dx
- Hyperthyroid TSH/ free T4
- US
- FNA
- RAI- increased uptake
Toxic multinodular goiter- Tx
- Methimazole
- RAI
- Surgery
