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Flashcards in Darrow, hypothyroid Deck (39):
1

What is myxedma in hypothyroid

lymphadema with accumulation of GAGs in skin with doughy feeling on palpation

2

myxedema with diastolic HTN

hypothyroid

3

10 hypos hypothyroid

hyporeflexia
hypomentia
hypothermia
hypoventilaion
hypotension or diastolic HTN
hypoHbinemia
hypoglycemia
hyponatremia
hypometabolism of drugs and lipids (HLD)
hypocortisolism
hypoadrenalism

4

causes of hypothyroidism

iodine deficiency and congenital defects in children
chronic lymphocytic thyroiditis (hashimotos in adults)

5

what is HLA of hashimoto

HLA DR5

6

patient with large thyroid gland
+FMH celiac and pernicious anemia
dry eyes and dry mouth
hgih TSH normal T4
additional test to confirm Dx?

TPO Ab

7

normal T4
hgih TSH
Dx?

subclinical hypothyroidism

8

risk of subclinical hypothyroidism

eleated lipids
CHF and ASHD
early dementia
poor iron absorption (anemia)

9

Tx criteria subclinical hypothyroidism

if no TPO Ab but TSH >10 Tx
if TPO Ab and TSH>5 Tx

10

Tx criteria for pregnant patients with TPO Ab

TSH> 2.5

11

causes of hypothyroidism

chronic lymphocytic (hashimoto)!!
RAI induced!!
subacute lymphcytic thyroiditis!!
drugs: PTU, iodine, lithium!!, interferon!!, amiodarone!!, thalidomide etc
irradiation and thyroidectomy
infiltrative diseases
Hep C!!
central hypothyroidism
congenital
iodine deficient

12

other autoimmune diseases assoc with hashimoto

addisons, hypoPTH, DM , PA, sjogrens, vitiligo, PBC and IBD
HLA B8- DR, DQ

13

65 F nubness in thumbs and index fingers
weak and dizzy with chest pain
constipation, pedal edema
diastolic HTN
ywllowing skin
speech hoarse
bradycardia with II/VI systolic ejection murmur at base with high pitched systolic murmur at apex
hair thin and + Tinels sign
DTRs 1+ b/l

hypothyroidism

14

Dec Fe levels increased TIBC

Fe deficiency

15

what is gallavardin phenomenon

II/VI systolic ejection murmur at base with high pitched systolic murmur at apex

16

what can cause gallavardin phenomenon

diastolic HTN

17

hypothyroidism can change Na how

hypotonic euvolemic hyponatremia from decreased NA/K ATPase

18

urinary Na from hypothyroidism?
Usom?

>20meq/L
Uosm >150-200 mOsm/L

19

first line for hypothyroid Tx

L thyroxine 25-75/day unless pregnant or history of CAD

20

L thyroxine levels for pregnant women

100-150 mcg

21

what is the euthyroid dose level to stay near in Tx hypothyroidism

1.6 mcg/kg/day

22

if patient is being Tx for hypothyroid and has TSH <2 and is still tired what shoul dyou look for

anemia, B12 deficiency, sleep apnea

23

what are modifications in patients being Tx with L thyroxine

monitor oral intake drugs: imatinib, omeprazole and food:soy milk coffee, fiber and Ca

24

what will precipitate a myxedema crisis

on compliance to meds, surgery, stress, infections

25

mortality of myxedema crisis

20-50%

26

Tx mxyedema crisis

hydrocortisone IV
levothyroxine
LT3

27

what is definition bacterial peritonitis ascites

if there is >250 PMNs in sear from pericentesis

28

what are common pathogens that cause bacterial peritonitits ascites

E coli and serratia

29

what do yo worry about if pericentesis shows ?1 bacteria type

bowel perforation

30

55 y.o M with alcoholic cirrhosis and ascites with encephalopathy
has bacteral peritonitis
severe hypotension
lethargy
low TSH
Dx?

svere non thyroidal illness (TNF-euthyroid sick syndrome)

31

What can cause low TSH

Autonomous functioning thyroid nodule
drugs: steroids, amphetamines, Ca Ch blockers, dopamine, NSAIDs, opiates
elderly euthyroid
pregnancy or hCG secretion

32

causes of euthryoid sick syndrome

non thyroidal illness
major surgery

33

T3 levels in euthyroid sick syndrome

LOW

34

what causes low T3 in euthryoid sick syndrome

decreased 5' deiodinase
increased IL that displaces binding of T4 (increases T3 uptake)

35

What causes low TSH in euthyroid sick syndrome

severe
drugs: acute steroid, amphetamines, Ca Ch blockers, dopamine, NSAIDs, opiates
increased IL-1, IL-6 and TNF alpha

36

how do TNF alpha and IL-1 decrease TSH

increast somatostatin which dec TRH so dec TSH

37

how does IL-6 decrease TSH

increases CRH which inc ACTH which inc cortisol which dec both TRH and tSH

38

50 y.o F with hoarsness, diminished sense tast and smell, menorrhagia, thinking of eyebrowns, thick tongue, cardiac enlargement and galactorrhea
pituitary enlarged on CT
best approach?

thyroid replacement

39

TRH activates release of what

TSH and prolactin