Flashcards in Clinical Approach Hyperthyroidism and Hypothyroidism Deck (46)
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1
What is the approach to the diagnosis of thyroid disease?
- H&P
- 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.
2
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
3
*** What are the 3 most common thyroid function tests?
- ultrasensitive TSH (best)
- free T4
- free T3
4
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
5
What is subclinical hypothyroidism?
- mildly elevated TSH (5-7) with a NORMAL T4
*may need treatment with Levothyroxine
6
What is subclinical hyperthyroidism?
- mildly lowered TSH (0.4-5) with a NORMAL T4.
7
What drugs will decrease TSH secretion?
- dopamine
- glucocorticoids
- octreotide
8
What drugs will decrease thyroid hormone secretion?
- lithium
- iodide
- amiodarone
- aminoglutethimide
9
What drugs will increase thyroid hormone secretion?
- iodide
- amiodarone
10
What is iodide inducing hyperthyroidism?
- Jod basedow phenomenon
11
What is iodide inducing hypothyroidism?
- wolff chaikoff pheonomenon
12
What drugs can decrease the absorption of thyroid hormone?
- colestipol
- cholestyramine
- aluminum hydroxide
- ferrous sulfate
- sucralfate
13
What is thyroiditis?
- inflammation of the thyroid gland.
14
**** 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
15
**** What is subacute granulomatous (De Quervain) thyroiditis?
- granulomatous thyroiditis (hypothyroidism) that follows a viral infection.
- presents as a tender thyroid with transient hyperthyroidism.
- self-limited
16
Is hypothyroidism insidious?
- YES
17
What are the symptoms of hypothyroidism?
- tiredness, lethargy, weight gain
18
Can Hashimoto thyroiditis present with a goiter?
- YES, but it does not have to.
19
What is the most common acquired form of hypothyroidism?
- postablative hypothyroidism
*aka a pt becomes hypo by treating hyperthyroidism.
20
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).
21
What is Myxedema?
- hypothyroidism in older children or adults.
- dough-like feeling and hyperpigmentation of extremities due to lymph-edema (not vascular edema).
22
What are the respiratory signs of myxedema (hypothyroidism)?
- pleural effusion
- CO2 retention
23
What are the alimentary tract signs of myxedema (hypothyroidism)?
- achlorhydria= low HCl gastric secretions.
- constipation
- weight gain (no more than 5 lbs).
- gastric atrophy (pernicious anemia; autoantibodies against intrinsic factor preventing B12 absorption).
24
What are the neurological signs of myxedema (hypothyroidism)?
- headache
- somnelescence
- lethargy
25
What are the muscular signs of myxedema (hypothyroidism)?
- proximal myopathy
- Kocher-Debre Semelaingne syndrome in newborns
- Hoffman's syndrome in adults
26
What is the most severe form of hypothyroidism?
- myxedema coma with profound hypothermia (usually during winter months)
27
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.
28
May a goiter be euthryoid, hyperthyroid, or hypothyroid?
YES
29
How do we treat Hashimoto thyroiditis?
- thyroid replacement (Levothyroxine)
*early response is loss of edema; diuresis, improved hoarseness, better well being
30
