Clinical Approach Hyperthyroidism and Hypothyroidism Flashcards Preview

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Flashcards in Clinical Approach Hyperthyroidism and Hypothyroidism Deck (46):
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

When should thyroid studies be done for Hashimoto thyroiditis?

- every 6 weeks after each titration of dose.

31

What is HYPERthyroidism?

- increased level of circulating thyroid hormone.

32

What is the most common cause of HYPERthyroidism?

- Graves disease

33

What is Graves disease?

- autoantibody (IgG) that stimulates the TSH receptor (type II hypersensitivity), leading to increased synthesis and release of thyroid hormone.

34

What are some clinical signs of Graves disease?

- hyperthyroidism
- exophthalmos
- pretibial myxedema (PTM)
- tachycardia
- palpitations
- bounding pulses
- wide pulse pressure
- ATRIAL FIBRILLATION
- high output heart failure
- dyspnea on exertion
- amenorrhea

35

(aside) What 2 other conditions can cause high output heart failure?

1. B1 deficiency (BeriBeri)
2. Paget's disease

36

What dermatologic manifestations will you see with hyperthyroidism?

- warm, smooth, glowing skin
- onycholysis of nails

37

What is Graves dermopathy?

- red, swollen skin, usually on the shins and tops of the feet; otherwise known as pretibial myxedema= deposition of hyaluronic acid.

38

How do you treat Graves disease?

- B-blockers
- thioamide, methimazol, or PTU
- radioiodine ablation

39

What is the triad of Graves disease?

1. hyperthyroidism with goiter
2. exophthalmos
3. dermopathy
*may not see this all the time.

40

What is silent thyroiditis?

- mild to moderate hyperthyroidism with absence of viral syndrome or exophthalmos
- usually no neck pain
- usually occurs postpartum (3 mon`ths).

41

Are thyroid nodules present in 50% of the population beyond the 5th decade of life?

- YES
*if you see micro-calcifications, think malignancy and biopsy via FNA.

42

*** What is the most common type of thyroid cancer?

- PAPILLARY CARCINOMA

43

What will examination of nodule reveal in thyroid cancer?

- hardness, irregular texture
- fixation to adjacent structures
- single nodule
- local lymph node enlargement

44

What is the exam of choice when examining thyroid nodules for thyroid cancer?

- Ultrasound

45

What is a potential marker for recurrent thyroid cancer?

- thyroglobulin

46

In what age group will you see toxic multinodular goiters (hyperthyroidism)?

- elderly
*opposed to Graves in younger individuals.