Flashcards in Clinical Approach Hyperthyroidism and Hypothyroidism Deck (46)
What is the approach to the diagnosis of thyroid disease?
- inspection, palpation, and auscultation of the thyroid.
- delphian lymph node
- thyroglossal cyst'
- pemberton's sign= the presence of facial congestion, cyanosis, and respiratory distress after approximately one minute of having the patient elevate both arms until they touch the sides of the face.
Who are candidates for thyroid disease screening?
- those with autoimmune disease (DM, pernicious anemia).
- first-degree relative with thyroid disease
- history of surgical removal of thyroid tissue or tx with sodium iodide I 131.
- history or radiation to the neck.
- those treated with Amiodarone
- pts over 60 (esp. women)
- psychiatric pts treated with lithium
*** What are the 3 most common thyroid function tests?
- ultrasensitive TSH (best)
- free T4
- free T3
How sensitive is TSH regulation to T3 and T4 levels?
- VERY; when T4/T3 is high, TSH is low, and when T4/T3 is high, TSH will be low
What is subclinical hypothyroidism?
- mildly elevated TSH (5-7) with a NORMAL T4
*may need treatment with Levothyroxine
What is subclinical hyperthyroidism?
- mildly lowered TSH (0.4-5) with a NORMAL T4.
What drugs will decrease TSH secretion?
What drugs will decrease thyroid hormone secretion?
What drugs will increase thyroid hormone secretion?
What is iodide inducing hyperthyroidism?
- Jod basedow phenomenon
What is iodide inducing hypothyroidism?
- wolff chaikoff pheonomenon
What drugs can decrease the absorption of thyroid hormone?
- aluminum hydroxide
- ferrous sulfate
What is thyroiditis?
- inflammation of the thyroid gland.
**** What is the most common cause of inherited hypothyroidism (thyroiditis) in the U.S.?
- Hashimoto's thyroiditis (struma lymphomatosa)= autoimmune destruction of the thyroid gland.
*thyroid peroxidase antibody
**** What is subacute granulomatous (De Quervain) thyroiditis?
- granulomatous thyroiditis (hypothyroidism) that follows a viral infection.
- presents as a tender thyroid with transient hyperthyroidism.
Is hypothyroidism insidious?
What are the symptoms of hypothyroidism?
- tiredness, lethargy, weight gain
Can Hashimoto thyroiditis present with a goiter?
- YES, but it does not have to.
What is the most common acquired form of hypothyroidism?
- postablative hypothyroidism
*aka a pt becomes hypo by treating hyperthyroidism.
What are the cardiovascular effects of hypothyroidism?
- increased peripheral resistance (due to lack of vasodilation via thyroid hormone)= cool distal extremities.
- elevated diastolic BP
- decreased HR
- "Myxedema heart" (pericardial effusion).
What is Myxedema?
- hypothyroidism in older children or adults.
- dough-like feeling and hyperpigmentation of extremities due to lymph-edema (not vascular edema).
What are the respiratory signs of myxedema (hypothyroidism)?
- pleural effusion
- CO2 retention
What are the alimentary tract signs of myxedema (hypothyroidism)?
- achlorhydria= low HCl gastric secretions.
- weight gain (no more than 5 lbs).
- gastric atrophy (pernicious anemia; autoantibodies against intrinsic factor preventing B12 absorption).
What are the neurological signs of myxedema (hypothyroidism)?
What are the muscular signs of myxedema (hypothyroidism)?
- proximal myopathy
- Kocher-Debre Semelaingne syndrome in newborns
- Hoffman's syndrome in adults
What is the most severe form of hypothyroidism?
- myxedema coma with profound hypothermia (usually during winter months)
When treating myxedema coma, how do we prevent adrenal crisis from occurring?
- give steroids (glucocorticoids) first before giving thyroid hormone (IV levothyroxine) so we don't increase the demand of the adrenals to the point that they fail.
May a goiter be euthryoid, hyperthyroid, or hypothyroid?
How do we treat Hashimoto thyroiditis?
- thyroid replacement (Levothyroxine)
*early response is loss of edema; diuresis, improved hoarseness, better well being