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Adult/Ped Medicine 5 > Thyroid Disorders - Scholting > Flashcards

Thyroid Disorders - Scholting Flashcards

1
Q

What thyroid hormone is the major product of the thyroid gland?

A

T4

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2
Q

What thyroid hormone is active at the cellular level?

A

T3

biologically more active; shorter half life

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3
Q

Primary hypothyroidism affects what level?

A

Gland

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4
Q

Secondary hypothyroidism affects what level?

A

Pituitary

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5
Q

Tertiary hypothryoidism affects what level?

A

Hypothalamus

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6
Q

Describe the hypothalamic-pituitary-thyroid axis:

A

Hypothalamus releases TRH which stimulates pituitary. Pituitary releases TSH which acts on the thyroid. Thyroid hormones then exhibit NEGATIVE feedback on the pituitary and hypothalamus.

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7
Q

Describe the spectrum of presentation of hypothyroidism (3).

A
  1. Subclinical hypothyroidism (elevated TSH, normal T4)
  2. Symptomatic disease
  3. Severe myxedema coma
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8
Q

Etiologies of Primary Hypothyroidism (9)

A
  1. Autoimmune (Hashimotos)
  2. Idiopathic
  3. Post ablation
  4. Post external radiation
  5. Thyroiditis (subacute, silent, postpartum)
  6. Infiltrative Disease (lymphoma, sacroid, amyloidosis, Tuberculosis)
  7. Congenital
  8. Iodine Deficiency
  9. Drug-induced hypothyroidism (Amiodarone, lithium)
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9
Q

Etiologies of Secondary Hypothyroidism (3)

A

caused by insults to the pituitary gland

  1. Neoplasm
  2. Infiltrative
  3. Hemorrhage into the gland
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10
Q

Etiologies of Tertiary Hypothyroidism (4)

A
  1. Neoplasm
  2. Infiltrative Disease
  3. Anorexia Nervosa
  4. Cerebrovascular or surgical insult
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11
Q

What causes systemic symptoms of hypothyroidism?

A

lack of T3

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12
Q

Frequent Signs and Symptoms of Hypothyroidism

all of the signs and symptoms are listed

A 
Weakness
Edema of face
Lethargy
Course Skin
Slow Movements
Edema of Eyelids
Sensation of Cold
Hoarseness
Peripheral Edema
Dry Skin
Decreased Sweating
Pallor of Lips
Slow speech
Cold Skin
Constipation
Thick Tongue
Paresthesias
Gain in weight
Muscle Weakness
Slow cerebration
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13
Q

Typical Symptoms of Hypothyroidism (6)

A 
fatigue
weakness
cold intolerance
constipation
weight gain
deepening of voice
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14
Q

Cutaneous Symptoms of Hypothyroidism (4)

A

dry, scaly, yellow skin
non-pitting waxy edema of the face
myxedema
thinning of eyebrows

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15
Q

Cardiac Symptoms (3)

A

bradycardia
enlarged heart
low voltage electrocardiogram

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16
Q

Hypothyroidism Symptoms in the Neck (5)

A 
Pain
Swelling
Tenderness
Nodules
Cysts
or could be asymptomatic
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17
Q

Neurological Symptoms of Hypothyroidism (3)

A

Paresthesia
Ataxia
Prolongation of DTR

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18
Q

Describe the hormone levels in HYPOthyroidism - TSH and T4

A

TSH: increased (normal 0.5-5.0 ug/mL)
Free T4: low or low-normal (normal 0.7-1.86 ng/dL)

thyroid is unable to produce sufficient quantities of hormone (low T4), so pituitary compensates further stimulating the thyroid (high TSH)

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19
Q

What is Hashimoto’s Disease?

What markers will be present?

A

Autoimmune thyroiditis
Positive test for antibodies - Anti-Tg and Anti-TPO
10 x more common in women

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20
Q

What is subclinical hypothyroidism? How is it treated?

A

Elevated TSH with normal free T4
TSH > 10: treat
TSH 5-10: monitor or possible trial of hormone replacement

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21
Q

What is Acquired Transient Central Hypothyroidism also known as Euthyroid Sick Syndrome?

A

Extremely ill patients with non thyroidal illness
Euthyroid with elevated TSH but normal free T4
It generally resolves without treatment, only treat if TSH > 10

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22
Q

What is Goiter?

A

Enlargement of Gland

can be uniform or diffuse; irregular or multi nodular

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23
Q

How is goiter managed?

A
  • Suppression Therapy: thyroid hormone replacement, decreases TSH stimulation
  • Rapidly enlarging - biopsy
  • If hypo or hyper treat for the condition
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24
Q

Diagnostic Testing: Serum TSH

A 
Primary Hypothyroidism
Primary Hyperthyroidism (over-replacement of hypothyroid state)
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25
Q

Diagnostic Testing: Serum Free Thyroixine (FT4)

A 
Estimates unbound (free) T4
HIGH = HYPER 
LOW = HYPO
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26
Q

Diagnostic Testing: Total Thyroxine

A

thyroxine is protein bound - drugs and conditions can alter the level
HIGH = HYPER
LOW = HYPO

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27
Q

Diagnostic Testing: Total and Free T3

A

useful for diagnosing HYPERthyroidism

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28
Q

Diagnostic Testing: Thyroglobulin

A

papillary or follicular thyroid cancer

may indicate: recurrent tumor

29
Q

Diagnostic Testing: Thyroid Antibodies

A

autoimmune conditions
HYPO: Hashimotos
HYPER: Graves

30
Q

What thyroid diagnostic test should you order first in an asymptomatic patient?

A

TSH initially
if HIGH - T4 to confirm HYPO
if LOW - T4 and total T3 HYPER

31
Q

What is thyroid diagnostic test should you order first in a symptomatic patient or patient with risk factors?

A

Both TSH and free T4

32
Q

Lab Abnormalities in Hypothyroid Conditions: LIPIDS

A

increased triglycerides and cholesterol

normalizes with treatment

33
Q

Lab Abnormalities in Hypothyroid Conditions: Cellular Enzyme Elevation

A

CK - suggests myopathy
AST and LDH
normalizes with treatment

34
Q

Lab Abnormalities in Hypothyroid Conditions: Hyponatremia

A

associated with SIADH

normalizes with treatment

35
Q

Which patients should be screened for thyroid disorders?

A

Patients with: Atrial fibrillation, Osteoporosis, Hyperlipidemia, Diabetes Mellitus, Down or Turner’s Syndrome
Patients Taking: Amiodarone or Lithium

36
Q

Radioactive Iodine Uptake Imaging

A

I131
Used for the evaluation of Nodules
“Hot” less likely to be malignant

37
Q

RAIU - Increased Uptake

A

Grave’s Disease

38
Q

RAIU - Decreased Uptake

A

Silent thyroiditis
Subacute thyroiditis
Postpartum thyroiditis
Exogenous hyperthyroidism

39
Q

RAIU - What does hot nodule and cold nodule mean?

A

Hot - take up iodine - overactive; can overproduce thyroid hormone
Cold - under active thyroid

40
Q

Thyroid Ultrasound Uses

A

following nodules
determine character of nodule
guidance of fine-needle aspiration

41
Q

drugs that decrease TSH secretion (low serum TSH)

A

Dopamine

Glucocorticoids

42
Q

drugs that INCREASE thyroid hormone secretion

A

Iodine

Amiodarone

43
Q

drugs that DECREASE thyroid hormone secretion

A

Lithium
Iodine
Amiodarone

44
Q

drugs that DECREASE T4 absorption

A

Ferrous Sulfate

45
Q

drugs that INCREASE TBG concentration

A

Estrogens

46
Q

Management of Hypothyroidism

A

Lifelong replacement therapy

Autoimmune causes - removal or ablation

47
Q

Drug for Thyroid Replacement Therapy and Goal of Treatment

A

Levothyroxine - stay with same brand (bioequivalency issues)

goal: normalize TSH (0.4-2.0 mIU/L)
over-replacement if <0.3 risk osteoporosis and atrial fibrillation

6-8 weeks to stabilize; once stable check every 6 months to yearly

48
Q

Thyroid Replacement for Healthy Patients

A

full dose
1.6 ug/kg/day
reassess TSH in 6-8 weeks

49
Q

Thyroid Replacement in Elderly Patients or those with Cardiac Disease

A

start low and go slow

50
Q

Signs and Symptoms of Hyperthyroidism

A 
Goiter
Sweating of hands
Weight loss
Tiredness
Palpitations
Regular Pulse > 90
Lid Lag
Dyspnea on Exertion
Finger Tremor
Nervousness
Excessive Sweating
Hot Hands
Preference for Cold
Exopthalmos
Hyperkinesis
Diarrhea
Scant Menses
Atrial Fibrillation
51
Q

What is Apathetic Hyperthyroidism?

A

elderly patients present with minimal symptomology of hyperthyroidism

52
Q

Signs and Symptoms of Graves Disease

A

Diffuse Nontoxic Goiter
Ophthalmopathy: stare, lid lag, exopthalamos
Dermopathy - pretibial myxedema
Thyroid Acropachy - digital clubbing, periosteal reaction

53
Q

Causes of Hyperthyroidism

A 
Graves
Toxic Multinodular Goiter
Thyroid Nodule
Thyroiditis
Exogenous intake
Medications: Amiodarone; iodine
RARE: adenoma, trophoblastic disease, stuma ovarii
54
Q

Complications of Hyperthyroidism

A

Very distressing
Atrial Fibrillation
CHF, Angina, MI, Sudden Death
Osteoporosis

55
Q

Hyperthyroidism Treatments

A

Radioiodine ablative therapy
Sub-total thyroidectomy
Antithyroid drugs
Symptom treatments

56
Q

Radioiodine Ablative Therapy

A

most common treatment for Graves

goal of treatment: Hypothyroidism

57
Q

Sub-total Thyroidectomy

A

goal: leave enough gland to produce endogenous hormone
spare: parathyroid glands, recurrent laryngeal nerves

58
Q

Antithyroid Drugs

A

Propythiomuracil (PTU) and Methimazole
decrease the production of thyroid hormones - important to monitor hormone levels
preferred in pregnant patients
side effects: agranulocytosis
seek immediate care for fever or sore throat

59
Q

Symptomatic Treatment of Hyperthyroidism

A

B-Blockers: tremor and heart rate
Diltiazem & Verapamil
Clonidine

** used until definitive treatment completed

60
Q

What is Thyroid Storm?

A

Sudden severe exacerbation of thyrotoxicosis

often precipitated by trauma, infection, surgery

61
Q

Symptoms of Thyroid Storm

A

fever
severe tachycardia
delirium

62
Q

Treatment of Thyroid Storm

A

antithyroid drugs: PTU or methimazole
high dose glucocorticoids
potassium iodide to suppress further hormone release

63
Q

Thyroid Nodule Risks for Malignancy

A

prior radiation
< 30 years of age; > 60
family history

64
Q

Evaluation of Thyroid Nodule

A

TSH, Free T4 and T3
Normal TSH: fine needle aspiration
Benign: follow clinically
Malignant: surgical referral

65
Q

Multinodular Goiter

A

diffuse process
identified on physical exam
low risk of malignancy

66
Q

Subacute Thyroiditis

A

cause: postviral
s&s: anterior neck pain; elevated ESR
tx: symptomatic - analgesics
typically recover euthyroid

67
Q

Painless Thyroiditis

A 
autoimmune - leads to long term hypothyroidism
no neck discomfort
decreased uptake of radio iodine
postpartum: w/in 1 year of delivery
silent: not associated w/ childbirth
68
Q

FOUR Phases of Thyroiditis

A

Hyperthyroid
Euthyroid
Hypothyroid
Some recover to a euthyroid state

Adult/Ped Medicine 5 (17 decks)

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