Flashcards in EXAM #1: HYPERTHYROID Deck (41):
What are the cardiac sequelae of hyperthyroidism?
2) High-output failure
What is Graves' dermopathy?
Thickening of the skin in the setting of hyperthyroidism
What changes in the eyes are specific to Graves' disease?
3) Periorbital edema
*Can't look in certain directions, can lead to diplopia
What are the three major pathophysiologic mechanisms of hyperthyroidism?
1) Increased thyroid hormone synthesis
- Primary (thyroid)
- Secondary (TSH)
2) Inappropriate LEAK of T4
What are the major etiologies of hyperthyroidism?
1) Graves' Disease
2) Autonomous nodules
3) Subacute thyroiditis
5) TSH-producing adenoma
6) HCG-mediated (pregnancy)
What are the TSH and FT4 levels in hyperthyroidism?
- Low TSH
- High FT4 (normal is subclinical)
What antibody test is used in the diagnosis of hyperthyroidism?
What is the most common cause of hyperthyroidism?
What causes Graves' Disease?
Autoimmune antibodies to TSH receptors
What are the "extra" manifestations of Graves' disease compared to hyperthyroidism?
1) Graves' Ophthalmopathy
- Extraocular muscle hypertrophy
What is the direct cause of Graves' Ophthalmopathy?
What is the main test used to diagnose Graves' Disease? What is the expected outcome?
Radionuclear uptake and scan
- Uptake will be normal/high
- Homogenous scan
What is the treatment for Graves' Disease?
1) Symptomatic: beta-blockers, steroids
What is the MOA of the antithyroid drugs?
Inhibits organification and coupling
What drugs are "antithyroid?"
What adverse is associated with the antithyroids, especially PTU?
How long are the antithyroid medications typically given?
What is used for a radioactive ablation in Graves' Disease?
I131 (different from what is used for the diagnostic test)
*Permanent but can take 4 weeks to 6 months
What do you do when a patient becomes hypothyroid s/p radioactive thyroid ablation?
Why would you treat a patient with iodine for a week prior to surgery?
Decreased T4 and vascularity
*Utilizes the Wolff Chiakoff Phenomenon
What is an autonomously functioning thyroid nodule?
Hot nodule with hyperplasia of follicular cells
*There is overproduction of T4 INDEPENDENT of TSH
How will the uptake and scan appear in autonomously functioning thyroid nodule?
- Normal to high uptake
- Focal hyperactivity i.e. NOT homogenous
What is the preferred treatment for autonomously functioning thyroid nodule?
*Only the focal hot-spots will uptake the radioactive material
How does the outcome of radioablation for autonomously functioning thyroid nodule differ from Graves' Disease?
Much less likely to cause hypothyroid
What is the underlying pathology in thyroiditis?
Inflammation of thyroid tissue leading to leakage of preformed hormone
What will a radionuclear scan appear in thyroiditis?
What is the treatment for thyroiditis?
What should you be sure to check after a patient with thyroiditis transitions to euthyroid?
TSH/T4 to ensure they don't develop hypothyroid
When is iodine-induced hyperthyroidism commonly seen?
*Utilizes the Jod Basedow effect
What are the types of amiodarone induced hyperthyroid?
Type 1 AIH= increased synthesis
Type 2 AIH= thyroiditis
How can you diagnose Type 1 vs 2 AIH?
Ultrasound will show increased muscularity in Type 1
How can AIH be treated?
1) Glucocorticoids i.e. prednisone
What labs are seen in a TSH-producing pituitary adenoma? What name is given to this condition?
- Increased T4
- Increased TSH
This is SECONDARY hyperthyroidism
What clinical features are associated with TSH-producing pituitary adenomas?
3) Visual field defects
What is the treatment for a TSH-producing pituitary adenoma?
2) Transphenodial resection
Why is hyperthyroid seen in pregnancy?
HCG stimulates thyroid
What is the treatment for HCG-mediated hyperthyroidism in pregnancy, IF T4 is high?
First trimester= PTU
*Note if T4 is normal, no treatment necessary
What typically triggers Thyroid Storm?
1) Omission of anti-thyroid drug
2) Surgery, MI, CVA
*In patient with underlying hyperthyroidism
What is the specific treatment algorithm for Thyroid Storm?
What is euthyroid sick syndrome?
Low serum levels of thyroid hormones in clinically euthyroid patients with nonthyroidal systemic illness
*TSH is also low