Thyroxtoxicosis (And other thyroid issues)

Question 1

Thyroid masses can spread to be intrathoracic?

Answer 1

True

Question 2

NO Iodide before PTU? Why?

Answer 2

Because given alone it can increase thyroid hormone production.

Question 3

Symptoms of thyrotoxicosis

Answer 3

Hyperthermia, Tachycardia, CHF, agitation and confusion

Question 4

Treatment of Thyrotoxicosis:

Answer 4

Large doses of PTU, supportive measures to control fever (cooling blankets/acetaminophen), Fluids to restore intravascular volume, propranolol or esmolol, digoxin for HF if pt develops a fib with RVR

Question 5

Etiology of Thyrotoxicosis:

Answer 5

Graves (most common)
Thyroid adenoma
pituitary tumors secreting TSH

Question 6

Symptoms of thyrotoxicosis:

Answer 6

diarrhea, weight loss despite high caloric consumption , hypertension

Question 7

DDX of thyrotoxicosis:

Answer 7

Pheochromocytoma, MH, NMS

Question 8

MH vs thyroid storm

Answer 8

Unlike MH, thyroid storm is typically not associated with rigidity, elevated CK, or lactic acidosis.

In contrast to MH, hypokalemia is very common in thyroid storm. Also unlike the typical intraoperative presentation of MH, thyroid storm generally develops postoperatively.

Question 9

NMS vs MH:

Answer 9

Clinically, a patient with NMS displays motor impairment, rigidity, akinesia, or extrapyramidal signs. Mental status deteriorates, and coma or delirium may develop. Hyperpyrexia is noted, with dehydration and hypotension. The duration is 7-10 days. Treatment consists of stopping the drug, controlling the symptoms, and administering dopamine agonists (eg, bromocriptine). Dantrolene will lower the temperature

Question 10

PTU vs Methimazole in pregnancy:

Answer 10

Use PTU over methimazole in pregnancy

Question 11

Glucocorticoids and mgmt of thyrotoxicosis:

Answer 11

Reduces hormone secretion, and reduces peripheral conversion of T4 to T3.

Question 12

Propranolol and thyrotoxicosis:

Answer 12

Propranolol: used to treat symptoms but can not prevent thyroid storm

Question 13

Avoid which types of meds in hyperthyroid patients? Is MAC affected with thyroid issues?

Answer 13

Avoidd ketamine, pancuronium (assoc tachy), avoid anxiety as that may cause tachycardia
MAC not affected with thyroid even though increase in cardiac output may make it seem that way?

Question 14

Special attention to eyes in which hyperthyroid patients/

Answer 14

Special attention to patients with exopthalamos