Thyroid DX Flashcards
What gland regulates the thyroid and where is it made
anterior pituitary gland where TSH madeand the hypothalmus regulates it
What does the parathyroid regulate
calcium blood levels
what is primary hyerparathyroidism
asympotomatic, increased serum CA + levels then follow up by testing the PTH
what is hypothyroidism? What is the most common cause? What is the screening test?
Elevated TSH
Auto-immune dx called Hashtmoto’s
TSH
What are the risk factors for hypothyroidism?
Fam hx, post-partum, females > 50 , other autoimmune dx
Hypothyroidism Presentation ? Mnuemonic
MOM's SO TIRED Memory loss Obesity Menorhhage Slowness ( mental and physcial ) Skin and hair dryness (hair loss) Onset Gradual Tiredness Intolerance to cold Raised BP Energy level falls Depression/delayed reflexes Achilles rupture and alopecia
What would you see on hypo-T labs
increased TSH
Low t4 and low t3
when would you order a anti-tpo test
when r/o hashimotos dx ( would be elevated if it was autoimmune related)
what labs would you see in sub-clinical hypothyroidism?
elevated TSH normal T4 … check every 6-12 months
What is the tx for hypothyriodism? when should you check it?
levothyroxine (can take while preg) should be 1.6 mcg/kg body weight per day
should recheck levels 6-8 weeks
what is armour thyroid?
dessicated porine thyroid ( it can not be given to jews or muslums due to the fact that it has pork in it)
When should you re-evalute dosing?
symptomatic, losing more than 10% body weight, or pregnancy ( will need higher dose)
What drugs can cause hypo-T
Lithium and Amiodarone (both), interferon
What labs would you see on HYPER-T
Low TSH
increased T4 and T3
What is the most common cause of HYper-T
graves (autoimmune) #2 toxic multi-nodular goiter
What test should you order with HyperT
Screening: TSH
TSH - antibody test = (anti-TPO) will be elevated if they have Graves or Hashimoto’s
If they have a goiter or nodules what should you order ?
thyroid US with a thyroid function panel
What is the classic presentation for HYPER-T
SWEATING Sweating Weight loss Emotional mind racing Appetitie increased Tremor/ tachy Intolerance of heat, irritability, irregular menstration Nervousness Goiter, Gi problems
eye lid lag
What is a common feature in Graves’ dx
Exopthalmus and goiter , eye lid lag
What medication can cause HYPER-T
amiodarone
What are the complications with HYPER-T
arrythmias (afibb, PVC’s) angina, CHF, thyroid storm , osteoporosis
refer asap
What is radioiodine ablation? what does it result in
People with HYPER -T get this ablation which results in destroying the thyroid and HYPO-T will need synthroid for rest of life
What medications can you take for HYper-T
Methimazole once a day
PTU- preffered for preg woman
INderal ( propanolol ) to control tremors
What are the clinical findings concerning for a maligant thyroid nodule?
history of neck radiation larger than 4 cm Firmness, nontender on palpation Nonmobile Dysphonia Lymphadenopathy hemotysis
What is the process for once you find a mass
- TSH level
- Low - thyroid scan - HOT ( good news) Not Hot - get a fine needle aspiration biopsy
- HIGH - good news
