Thyroid Dz Flashcards
Sx of Hypothyroidism
C W \_\_\_\_\_, D\_\_\_\_\_\_ C L/F/W D\_\_\_\_\_\_ B\_\_\_\_\_\_ D\_\_\_\_\_ C\_\_\_\_\_\_\_ M
cold intolerance
weight loss, dec appetite
Constipation
Lethargy, fatigue, weakness
Dec reflexes
Bradycardia
Dry, cool skin
Coarse, brittle hair
myxedema
Sx of hyperthyroidism
H W \_\_\_\_\_, i\_\_\_\_\_ H\_\_\_\_\_ D T I W F O
Heat intolerance
Weight loss, inc appetite
hyperactivity/tremors
diarrhea
tachycardia
inc reflexes
warm, moist skin
fine hair
Osteoporosis
Dz of thyroid usually results from
Hashimoto’s thyroiditis causes
MCC of
Graves dz
MCC of
AI destruction/stimulation
AI destruction and permanent hypothyroid
hypothyroid
AI stimulation of TSH receptor
hyperthyroid
Thyroiditis is a ____ dz of thyorid
features can be
other common sx
Inflammatory
hyper/hypoThyroid
painful thyroid gland
Hashimoto’s Thyroiditis (AI/lympohcytic)
can be ____
lab findings
tx with
further testing is
Initial destruction of gland causes
as preformed thyroid stores deplete
on PE
Histologically
inherited
high TSH and low free T4
levothyroxine (pharm replacement w hormone supplementation)
not necessary
release of thyroid hormones w initial hyperT state
thyroid tissue damaged, not enough hormone is produced, becomes permanent
moderately enlarged, nontender thyroid
Lymphocytic infiltrate, germinal follicles, Hurthle cells, fibrosis
Subacute Thyroiditis (De Quervains)
course, follows
process
PE
Labs
histology shows
Tx
self limiting, viral URI
hyperT, followed by hypoT, resolving in wks/mnths
very tender thyroid gland
High/low thyroid fxn, inc ESR/CRP, dec iodine uptake
granulomatous inflammation
manage pain w NSAID/aspirin (rarely progresses)
Reidel Thyroiditis
Occurs when thyroid tissue is, resulting in
thought to manifest from
PE
replaced by fibrous tissue, hypoT
systemic, fibroinflammatory dz
nontender, fixed, hard goiter
Pregnant women AI thyroiditis presents w
Infectious Thyroiditis (suppurative/septic) cause
sx such as
tx
HyperT followed by hypoT (self resolving)
bacteial
pain, fever, redness, swelling
underlying cx
Generalized infiltrative dz such as, result in
Drugs resulting in thyroiditis
tx
Additional cause
sarcoid/amyloidosis, hypoT
amiodarone/Li
Stop
Radiation (I131 or external beam)
Graves Dz (AI HyperT)
cause
more common in
frequently occurs in
PE
Other findings
autoantibodies stimulate TSH receptor
females
stress- infection, childbirth, steroid withdrawal
symmetrical, nontender enlarged thyroid
opthalmology (proptosis/exophthalmos due to GAG deposition around eye), pretibial myxedema, digital swelling
Lab of Graves Dz
Tx
more severe tx options
problem
dec TSH, inc T4 free/total, difuse uptake iodine
BB- sx management
Antithyroid drugs- methimazole and propylthiouracil
radioactive iodine ablation/surgery
leads to permanent hypothyroidism
Thyroid storm occurs w
produces
course
MC in pt with
Sx
Acute tx
large release of thyroid hormones
systemic effect, severe hyperT
Graves Dz w surgery/stress
HTN, tachycardia, hyperpyrexia, altered mental status
BB, propylthiouracil, hydrocortisone
Myxedema coma occurs when
pt presents w
precipitated by
exacerbated w
Course
tx w
body is severely lacking thyroid hormone
extreme hypoT- hypothermia/bradycardia/lethargy,altered mental status
medication noncompliance
acute stressor
emergency
supprotive care, thyroid hormone replacement
Congenital hypothyroidism
due to
T4 is critical for
Cretinism refers to
SX
Labs
Tx
lack of iodine intake/defect thyroid or T4 formation in utero
brain development in early life
untreated congenital hypoT and defects/abnormalities
cog impairment, inc weight, short stature, coarse facial features, large tongue, umbilical hernia
inc TSH, dec T4
replace T4 2 levothyroxine
Euthyroid sick syndrome
found in, really a
gland is functioning normally, but
If patient is euthyroid and acutely ill
acute/chronic/critically ill, lab abnormality
alteration to circulating thyroid hormone level so TSH/T4 is inaccurate
do not check thyroid fxn
Nontoxic goiter
MCC
nontoxic bc
toxic occurs if
SX include
TX
enlarged thyroid from TH deficiency
iodide defic (developing countries)
goiter depends on TSH stimulation to fxn
hyperplasia is independent of TSH
neck enlargement, hoarseness, SOB
Replace TH w levothyroxine, surgery
Solitary thyroid nodule
Typically
May be ____ or part of
Can cause
First step when finding nodule
Next, evaluate nodule w
if large or suspicious, ____ recommended to rule out cancer
Benign, incidental
solitary, multinodular goiter
discomfort, dysphagia
thyroid function study (TSH and free T4), usually normal
US
FNA
Thyroid nodule
if TSH is low, suggests nodule is
Get a ____ scan
Independent overactive nodule will
Nodules removed ____ or undergo
fxn independently, causing hyperT
radionuclide thyroid scan
take up lots of iodine, look bright on imaging
surgery, iodine ablation
Thyroid Ca
typically
Labs usually
MC type is
Course/Prognosis
Follicular thyroid Ca course
ASx, incidental
normal
Papillary thyroid ca
grows slow, rare metastasis, excellent
favorable, more distant spread
Medullary thyroid ca
pattern
assc w
part of ___ syndrome
Anaplastic thyroid ca
course/prognosis
hereditary
RET proto-oncogene, endocrine tumors
Multiple endocrine neoplasia
agressive, poor
