thyroid disorders Flashcards
What is thyroid storm?
severe hypterthyroidism induced by infection, surgery, or physiologic strss in pts with preexisting hyperthyroidism
patients have severe diaphoresis, vomiting, diarrhea, tachycardia, fever, and mental status changes
Besides T3 and T4, what else is made by the thyroid?
calcitonin (made by parafollicular cells)
What are medical treatments for grave’s disease? what are the key side effects of these drugs?
methimazole, propylthiouracil (thionamides). remember that methimazole inhibits only production of T3/T4 (decr. iodination), while PTU also inhibits peripheral conversion of T4 to T3
both can cause agranulocytosis; methimazole is teratogenic
Besides Graves disease, what else can cause hypethyroidism?
toxic adenoma, subacute thyroiditis (aka de quervain thyroiditis), silent hyperthyroidism (often occurs post-partum), exogenous intake
What is the treatment of thyroid storm?
-higher doses of meds, beta blockers, thionamides, IV sodium iodide to block thyroid hormone release, hydrocortisone to inhibit conversion of T4 to T3
What are the s/sx of subacute thyroiditis?
-painful goiter, mild hyperthyroidism, fever, incr. ESR, decr. uptake on thyroid scan
Tx of subacute thyroiditis?
self-limited- BBs may help. may have to give thryoid replacement if hypothyroidism occurs during gland recovery
What is silent thyroiditis?
temporary thyroiditis that may follow pregnancy. these pts have painless goiter, low uptake on thyroid scan, and biopsy confirming inflammation. this is transient and self-limited
What are the antibodies seen in Hashimoto’s thyroidits?
anti-thyroidperoxidate and antithyroglobulin antibodies with lymphocytic infiltrates and fibrosis on biopsy
What are common complications of thyroid surgery?
hoarseness and hypocalcemia
what are risk factors/findings that increase the likelihood that a thyroid nodule is malignant?
male, 20-60 yo, hx of neck irradiation, poor iodide uptake on thyroid scan, single nodule on US
How are thyroid nodules treated?
-Benign, small cystic: observe
-Benign solid nodules treated with surgery, radioablation to stop thyroid overproduction and decr. risk of malignant conversion
Malignancy requires surgical resection and radioiodine ablation. if nonanaplastic and
What is the most common form of thyroid cancer?
papillary; follicular variant most common variant, and follicular has slightly worse prognosis
What are key features of medullary thyroid cancer?
occur in parafollicular cells and produce calcitonin. Also seen as part of MENIIa and MEN IIb syndromes.
