Thyroid/ Parathyroid Flashcards
What are the distinguishing features of Grave’s disease?
- Nervousness
- Palpitations
- Weight loss
- Fine resting tremor
- Dyspnea on exertion
- Difficulty concentrating
- Tachycardia
- Hypertension
- Heat insensitivity
- Exophthalmos
- Dry skin
- Amenorrhea
- Atrial fibrillation (irregular heart rate)
What is the most appropriate imaging in suspected Grave’s?
- Nuclear medicine thyroid scan with uptake
What is the definitive nonsurgical treatment of Grave’s?
- Thyroid ablation with radioactive iodine and often times thyroid hormone replacement
Describe the pathophysiology behind Grave’s disease.
- Autoimmune thyroid disorder where autoantibodies agains TSH receptors on the thyroid gland result in hyper functioning of the gland
What is common the demographic for Grave’s disease?
- Reproductive age females
What are the treatments for Grave’s disease?
- Antithyroid drugs => propylthiouracyl and methimazole
- Beta blockers to block the peripheral effects of excessive thyroxine
Who is radioactive iodine contraindicated in the treatment of Graves/hyperthyroidism?
- Pregnant women (these patients undergo thyroidectomy)
- Breastfeeding women
- Children
What are the most dangerous consequences of thyroid storm?
- Altered mental status, coma, seizures
What are the symptoms of thyroid storm?
- Fever
- Confusion
- restlessness
- Psychotic behavior
- Tachycardia
- Elevated BP
- Dyspnea on exertion
- Peripheral vasoconstriction
- Cerebral or cardiac ischemia
- Altered mental status, coma, seizures
What lab results would indicate hyperthyroidism?
- High free thyroxine
- Low TSH
How would Graves differ from thyroiditis on radio nucleotide imaging?
- Grave’s => Diffuse hyperactivity with large amounts of uptake due to presence of new hormone
- Thyroiditis => patchy uptake with overall reduced activity, reflecting the release of existing hormone rather than over production
How do propylthiouracil and methimazole work?
- PTU => inhibit the organification of iodine AND prevents the peripheral conversion of T4=> T3
- Methimazole => inhibit the organification of iodine
What is the most risky potential side effect of PTU and methimazole?
- Agranulocytosis
What is the treatment in thyroid storm?
- PTU
- Beta blockers
- Hydrocortisone to prevent adrenal crisis
What symptoms are observed in patients who are hypothyroid?
- Lethargy
- Weight gain
- Hair loss/thinning
- Dry skin
- Slowed mentation or forgetfulness
- Constipation
- Cold intolerance
- Depressed affect
- Low BP
- Bradycardia
- Myxedema
- Diminished relaxation of reflexes