27. Hyperthyroidism Flashcards Preview

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Flashcards in 27. Hyperthyroidism Deck (29):
1

MCC of hyperthyroidism

graves disease

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graves disease - pathophysiology

autoantibodies ( IgG( stimulate TSH receptor on thyroid , retrorbital fibroblasts and dermal fibroblasts ( pretibial edema)

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graves disease - type of antibodies

IgG autoantibodies

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graves disease - stimulate TSH receptor on ( where)

1. thyroid
2. retro-orbital fibroblasts
3. dermal fibroblast

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graves disease often present during

stress ( eg. childbirth)

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graves disease TSH receptror stimulation on thyroid causes

1. hyperthyroidism
2. diffuse goiter

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graves disease - goiter appearance

diffuse goiter

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graves disease - TSH receptor stimulation on dermal fibroblasts causes

pretibial myxedema

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graves disease - TSH receptor stimulation on retro -orbital fibroblasts causes

exophtalmos: proptosis, extraocular muscle swelling

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Proptosis is

proptosis is protrusion of the eyeball

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toxic multinodular goiter - pathophysiology

focal patches of hyperfunctioning follicular cells working independently of TSH due to mutation in TSH receptor

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toxic multinodular goiter - due to

mutation in TSH receptor ( in 60%)

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toxic multinodular goiter - results in

increased release of T3 and T4

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toxic multinodular goiter - malignancy

hot nodules are RARELY malignant

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toxic multinodular goiter - histology

follicles of various sizes distended with colloid and line by flatterned epithelium with areas of fibrosis and hemorrhage

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toxic multinodular goiter - apperance

enlarged thyroid gland with multiple nodules

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thyroid storm - treatment

- β blockers ( proprapnolol)
-propylthiuracil
-corticosteroids ( prednisolone)
-potassium iodide ( Lugol iodine)

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thyroid storm - presents with ( symptoms )

1. agitation
2. delirium
3. fever
4. diarrhea
5. coma
6. tachyarrthmia
7. may increases LFTs

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cause of death in thyroid storm

tachyarrythmia

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thyroid storm - mechanism

uncommon but serious complication that occurs when hyperthyroidism is incompletely treated/ untreated and then signigicantly worsen in the setting of acute stress such as infection, trauma, surgery

21

tJob - Basedow phenomeno - definition

thyroitoxicosis if a patient with iodine deficiency and partially autonomous thyroid tissues ( eg. autonomous nodule ) is made iodine replete

22

thyroid storm - may see increased ( lab)

1. ALP 2. LFTs

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thyroid storm - increased ALP due to

increased bone turnover

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• A woman with Graves disease has syncope and palpitations. What lab finding might you see in this serious complication of hyperthyroidism?

Thyroid storm (stress-induced catecholamine surge may cause death by arrhythmia)—can increase alkaline phosphatase via high bone turnover

25

• A woman has low TSH, goiter, high T3/T4, and nodules in her thyroid. What is the likelihood that one or more of these nodules are malignant?

Very low, because hot nodules associated with toxic multinodular goiter are rarely malignant

26

What is the Jod-Basedow phenomenon?

Thyrotoxicosis caused by repletion of iodine in a patient with an iodine-deficiency goiter

27

A patient with known Graves disease is agitated, feverish, and delirious. Her ALP is elevated. How do you manage her condition?

The 3 P's: β-blockers (e.g., Propranolol), Propylthiouracil, corticosteroids (e.g., Prednisolone)Ôshe has thyroid storm

28

A man has hyperthyroidism resulting from IgG autoantibodies' stimulating his TSH receptors. List three locations of affected TSH receptors.

Thyroid (hyperthyroidism), retro-orbital fibroblasts (proptosis, exophthalmos), dermal fibroblasts (pretibial myxedema)

29

• A patient has orange peel–textured skin on his lower legs and protrusion and limited mobility of his eyes. Which autoantibody causes this?

IgGs against TSH (the hallmarks of Graves disease are exophthalmos, proptosis, and pretibial myxedema)