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6030 Primary Care Test 2 Complete ☑️ > Module 6 (b) > Flashcards

Module 6 (b) Flashcards

1
Q

Hypothyroidism

-Definition

A
  1. Hypothyroidism is a condition resulting from the synthesis of thyroid hormone that is INSUFFICIENT to meet the body’s needs

Supply is less than demand

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2
Q

Hypothyroidism

-Stats

A
  1. Most common disorder of the thyroid gland
  2. Chronic autoimmune thyroiditis is the MOST COMMON cause
    - SLOWING down of many bodily functions and metabolic processes
  3. 5-8x more prevalent in women than men
  4. Compromises almost all body functions
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3
Q

Hypothyroidism

-Undiagnosed complications

A
  1. Infertility
  2. Hashimoto encephalopathy
  3. Myxedema coma
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4
Q

Types & Causes of Hypothyroidism

-Congenital Hypothyroidism

A

Occurs in Infancy or childhood
1. Developmental abnormality of the thyroid gland

Individuals w/ Congenital hypothyroidism can experience

  • Developmental delays
  • Mental retardation (Cretinism)
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5
Q

Types & Causes of Hypothyroidism

-Cretinism

A

A resulting mental retardation that occurs w/ congenital hypothyroidism

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6
Q

Types & Causes of Hypothyroidism

-Central Hypothyroidism

A
  1. Secondary Hypothyroidism
    - Failure of pituitary gland to secrete adequate amounts of TSH
  2. Tertiary Hypothyroidism
    - Inadequate secretion of TRH by the hypothalamus
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7
Q

Types & Causes of Hypothyroidism

-Secondary Hypothyroidism?

A
  1. Failure of pituitary gland to secrete adequate amounts of TSH
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8
Q

Types & Causes of Hypothyroidism

-Tertiary Hypothyroidism

A
  1. Inadequate secretion of TRH by the hypothalamus
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9
Q

Types & Causes of Hypothyroidism

-Iatrogenic Hypothyroidism

A
  1. Occurs after treatment with radioactive iodine or surgery
  2. Accounts for 30-40% of cases
  3. Can be caused by following meds:
    - Amiodarone, lithium, interferon-a, thalidomide
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10
Q

Types & Causes of Hypothyroidism

-Transient Hypothyroidism

A

Occurs after treatment w/ radioactive iodine or after surgery for hyperthyroidism
2nd most common cause

  1. Postpartum thyroiditis
  2. Subacute thyroiditis (Usually viral)
  3. Withdrawal of thyroid hormone therapy

Iodine deficiency is the MOST COMMON cause of thyroid disorders worldwide

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11
Q

Primary Cause of Thyroid Dz?

A
  1. Autoimmune processes are primary cause of thyroid dz
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12
Q

Types & Causes of Hypothyroidism

-Subclinical Hypothyroidism (SCH)

A
  1. Presence of NORMAL serum free T4, with ELEVATED TSH
  2. Untreated SCH can lead to
    - CVD, Dyslipidemia, liver dz, neuropsychiatric symptoms, infertility
  3. Detected through Lab test**
  4. Most Frequent reported symptoms
    - Muscle cramps, tiredness, feeling colder, slowness of thinking, constipation
  5. Repeat testing in 2-3 months prior to treatment **

Treat after Dx is made

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13
Q

Types & Causes of Hypothyroidism

-Subclinical Hypothyroidism Common Reported Symptoms

A
  1. Memory impairment (Slowness of thinking)
  2. Tiredness
  3. Feeling colder
  4. Hoarseness
  5. Constipation
  6. Dry skin
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14
Q

Types & Causes of Hypothyroidism

-Management of Subclinical Hypothyroidism

A

Once SCH dx is made, sort pt by age, TSH level, and presence of symptoms

  1. Treat if patients
    - TSH levels >/= 10 mU/L
    - TSH levels >/=7 to <9, <70 yrs old, symptomatic
  2. Treatment is Levothyroxine 25-50 mcg daily
    - Evaluate serum TSH 6 wks after initiation of therapy
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15
Q

Types & Causes of Hypothyroidism

-Causes of SCH

A
  1. Autoimmune disease
  2. Smoking
  3. Thyroid injury (radiation therapy)
  4. Inadequate replacement therapy
  5. Drugs imparting thyroid function
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16
Q

Types & Causes of Hypothyroidism

-Hashimoto’s Thyroiditis (Chronic Autoimmune Thyroiditis)

A
  1. MOST COMMON cause of hypothyroidism in the US
  2. Autoimmune disorder
  3. Patho = Genetic susceptibility & Environmental factors
  4. Middle age women (30-60 yrs) but can occur in all populations
17
Q

Types & Causes of Hypothyroidism

-Diagnosis of Hashimoto’s Thyroiditis

A
  1. Symptoms of hypothyroidism
  2. Presence of a goiter on PE
  3. Lab testing
    - Elevated TSH
    - Low levels of Free T4

Family Hx usually present

18
Q

Types & Causes of Hypothyroidism

-Symptoms of Hashimoto’s Thyroiditis

A

No s/s that are unique to Hashimoto’s thyroiditis
-Fatigue, weight gain, sensitivity to cold, dry skin
-Irregular and heavy menses
-Enlarged Thyroid (GOITER) may cause
—Neck discomfort and difficulty swallowing

19
Q

Types & Causes of Hypothyroidism

-Treatment of Hashimoto’s Thyroiditis

A
  1. MILD (slight elevation of TSH)
    - No medication and repeat testing in 3-4 months
  2. Overt Hypothyroid (elevated TSH & low thyroid hormone)
    - Levothyroxine 50 mcg/daily
    - adjust dose until normal TSH level achieved
  3. Test TSH every 6-8 wks after dose adjustment then annually

LIFELONG TREATMENT

20
Q

Hypothyroidism

-Clinical Presentation

A
  1. Fatigue is the MOST COMMON presenting symptom
  2. Cold Intolerance & weight gain
  3. Decreased deep tendon reflexes
21
Q

Hypothyroidism

-Diagnosis

A
  1. TSH is the most appropriate first diagnostic test

2. In clinical arena, check both TSH and serum free T4

22
Q

Hypothyroidism

-Differential Dx

A
  1. Chronic autoimmune thyroiditis
  2. Postpartum Thyroiditis
  3. Radiation-induced thyroid damage
  4. Post-infectious thyroiditis
  5. Med-induced hypothyroidism; post Thyroidectomy dysfunction
  6. Depression **
  7. Pituitary tumor
23
Q

Hypothyroidism

-Management

A
  1. Normalize TSH not suppress it **

2. Levothyroxine is drug of choice (A synthetic preparation of T4)

24
Q

Hypothyroidism

-Primary hypothyroidism treatment algorithm (Levothyroxine)

A
  1. Initial Levothyroxine dose influenced by ideal or actual body weight & health status
    - May begin status (1.7mcg/kg/d)
    - May begin at 50 mcg/day
    - Increase dose at 4-6 wk intervals to 100 mcg/day
  2. At euthyroid state, monitor TSH once or twice yearly
25
Q

Hypothyroidism

-Levothyroxine & Afib/heart disease?

A
  1. In patients w/ ischemic heart disease or atrial fibrillation
    - Start at 12.5 to 25 mcg/day
    - Increase by 25 mcg/day every 8 wks
26
Q

Hypothyroidism

-Levothyroxine management

A
  1. Begin with 1/2 dose of expected replacement in OLDER ADULTS or those with CAD
  2. Increase Med dose at 6 wk intervals
  3. Stick with the same brand of medication for consistency
27
Q

Hypothyroidism

-Myxedema Coma

A

Severe Hypothyroidism:

  • Decreased mental status
  • Hypothermia
  • Slowing function in multiple organs

Treat based on Clinical suspicion:

  • Thyroidectomy scar
  • Hx of radioiodine therapy or hx of hypothyroidism

EMERGENCY

Refer to ER** or ER

28
Q

Hypothyroidism

-Risk for Myxedema Coma?

A
  1. Undiagnosed or untreated hypothyroidism
  2. External stress
  3. Low temperature
  4. Infection
  5. MI or CVA
  6. Medical intervention (Ex: surgery or hypnotic drugs)
29
Q

Hypothyroidism

-Education

A
  1. Medication use is LIFELONG
  2. Dose in the morning to avoid insomnia
  3. Low fat, high fiber diet
  4. Limit drug substitution
  5. Avoid use w/ medications that interfere w/ GI absorption
  6. Illness, major surgery, or pregnancy can alter dose requirements
30
Q

Hypothyroidism

-Screening Recommendations

A
  1. American College of Physicians
    - Screen all women older than 50 yrs who have 1 or more clinical features of dz
  2. American Academy of Family Physicians
    - Screen asymptomatic patients older than 60 yrs
  3. American Association of Clinical Endocrinologists
    - TSH measurements in all women of childbearing age before pregnancy or during 1st trimester
  4. US preventive Services Task Force
    - Insufficient evidence to recommend for or against routing screening (GRADE 1 Recommendation)
31
Q

Thyroid Cancer

-Stats

A
  1. Most common endocrine-related cancer
  2. More common in women 3x
  3. MAJOR risk factor is exposure to ionizing radiation
32
Q

Thyroid Cancer

-Most common type?

A

Papillary cancers are the most common about 60%

33
Q

Thyroid Cancer

-Clinical Presentation

A
  1. Major Symptom is a LUMP, or painless nodule in the neck
34
Q

Thyroid Cancer

-Dx

A
  1. Definitive diagnosis is a BIOPSY
35
Q

Thyroid Cancer

-Differential Dx

A
  1. Multinodular goiter
  2. Benign thyroid nodule
  3. Cystic nodule
  4. Lymphocytic Thyroiditis
  5. Regional Lymphadenopathy
36
Q

Thyroid Cancer

-Diagnostic Tests

A
  1. Refer to a specialist ASAP
37
Q

Thyroid Cancer

-Management

A
  1. Refer any swelling suggestive of malignancy to an Endocrinologist
38
Q

Thyroid Cancer

-Patient Education

A
  1. Advise monthly neck check

6030 Primary Care Test 2 Complete ☑️ (8 decks)

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