Thyroid Gland Disease Flashcards
Pathology of Graves disease
TSH like Ig binds TSH receptors causing excess thyroid hormone production
How is Graves Disease different from Plummer’s Disease?
Graves (diffuse toxic goiter): universal thyroid gland TH production.
Plummers(toxic multi nodular goiter): certain areas are hyperactive, so TSH is low and only patchy uptake on thyroid scan occurs.
Cause of pre-tibial myxedema in Graves
accumulation of mucopolysaccharides in skin. It just shows up the most in the leg.
Why is T3 measured with suspected hyperthyroidism?
T4 has a higher affinity for Thyroid binding globulin (TBG). If hyperthyroidism is present all the T4 will bind up TBG and the T3 will bind “resin”. Radioactive labeled T3 binding resin can be measured and can differentiate a rise in T4 from a rise in TBG. (A rise in TBG decreases free T4 and the thyroid thinks T4 is decreasing so it’ll make more)
Which form of thyroid hormone is more biologically active?
T3
What are the two pharmacologic treatments for hyperthyroidism?
Methimazole (first line)
Propylthiouracil (in pregnant patients)
What medication is used to control adrenergic symptoms of hyperthyroidism for immediate relief?
Propranolol
-active beta blocker
What is thyroid storm?
A severe form of hyperthyroidism usually with a precipitating factor like DKA, trauma, childbirth, surgery. Fever, tachycardia, psychosis. Can cause mortality in 20% so treat with IV fluids, cooling blankets, and glucose.
Most common cause of hypothyroidism.
Hashimoto’s Thyroiditis
-increase in anti-microsomal Abs
How does hypothyroidism affect menstrual flow?
Menorrhagia
Most sensitive indicator of hypothyroidism.
High TSH
Describe a Subacute Viral Thyroiditis
Painful and possibly enlarged thyroid gland.
state of hyperthyroid initially because damaged cells leak TH into blood followed by hypothyroidism.
Tx for subacute viral thyroiditis
NSAIDs and ASA
How is Subacute lymphocytic Thyroiditis different from viral.
It is painless. Still low radio uptake of iodine on studies so it differentiates from Graves in the acute hyperthyroid phase.
What is Riedel’s Thyroiditis
Fibrous thyroid where fibrous tissue replaces thyroid. Non-functioning and only needs surgery if it causes dysphagia or aphasia.
