Hyperthyroidism Flashcards by tcarlso 3

What are the cardiac ssx of hyperthyroidism?

HTN
Tachycardia
Increased contractility

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What are the sequelae of the cardiac effects of hyperthyroidism?

A0fib

high output failure

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What is Grave’s dermopathy

Thickening of the skin, especially in the dependent areas

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What are the eye findings of hyperthyroidism?

Lid lag

Lid retraction

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What are the eye ssx that are specific to Grave’s disease?

Proptosis
Ophthalmoplegia
Periorbital edema

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What is the pathophysiology of primary and secondary hyperthyroidism?

Primary = inherent thyroid issue
Secondary= increased TSH levels

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What primary pathology may cause hyperthyroidism, but is not causing increased synthesis?

Inappropriate leakage of premade T4

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What happens to the TSH levels and FT$ or FT# levels?

Decreased TSH, increased FT4/FT3

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What is subclinical hyperthyroidism?

Normal ft4, but increased TSH

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What is the basis for the radionuclide scan?

Thyroid uptake and scan after pt given radioactive iodine I-123

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Who is usually affected with Grave’s?

Young females

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What is the cause of Grave’s disease?

Antibodies to TSH receptors stimulate growth and hormone productions

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What are the antibodies that are found with Grave’s disease?

TRAb

TSIg

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True or false: there usually is no familial predisposition of Grave’s disease

False

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What are the ssx of Grave’s disease?

Hyperthyroidism + Graves ophthalmopathy + dermopathy

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What is Graves ophthalmopathy?

abs stimulate inflammation of the eyes in the orbit, as well as deposition of GAGs, lipogenesis, and orbital muscle hypertrophy.

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What are the risk factors for developing Grave’s ophthalmopathy?

Smokers

High TSI

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True or false: Grave’s ophthalmopathy correlates with the thyroid status

False–independent

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What causes the goiter formation with Grave’s disease?

TSH stimulation

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What is the sensitivity/specificity of a bruit in Grave’s disease?

Insensitive, but specific

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What are the uptake and scan findings with Grave’s disease?

Uptake is NOT low

Scan is homogenous

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What is the treatment for Grave’s disease?

Beta blockers
Steroids
Antithyroids

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What is the MOA of antithyroids?

Inhibits the organification of iodine to iodotyrosine and coupling

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What is the MOA of Propylthiouracil? Use? Side effects?

Inhibits the organification of iodine to iodotyrosine and coupling

Treats hyperthyroidism

Hepatitis, agranulocytosis

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What are the labs that should be monitored with Grave's disease?

Thyroid function CBC Transaminases

How long is PTU used for Grave's disease?

Less than two years, since a bit less than 50% have a long term remission

What is the permanent treatment for Grave's disease?

Radioactive ablation of thyroid gland, with I-131, causing destruction in 4 weeks to 6 months

What is the goal of radioactive ablation of the thyroid? Why is this used instead of chronic PTU?

Destroy it to give them Levothyroxine PTU has more side effects than levothyroxine

What are the radiation precautions that must be taken for radioactive ablation of the thyroid?

no prego No sexy time Sleep alone

What may happen with the eye disease of Grave disease with radioactive ablation of the thyroid?

May worsen

What are the prep procedures for a thyroidectomy?

- Antithyroids to render euthyroid | - Beta blockers

Why give SSKI preop of a thyroidectomy?

To decrease T4 and vascularity

Who should get a thyroidectomy as opposed to radioactive ablation?

Pts on amiodarone | Prego

What are "hot" nodules?

autonomously functioning nodule

What is Plummer's disease? IN whom is this common?

Toxic multinodular goiter Older patients greater than 50 yo

What is the pathophysiology of autonomously functioning nodules?

Hyperplasia of follicular cells, overproduction of T4 independent of T4

What are the PE finding with autonomously functioning nodules?

Nodular thyroid

What are the chances that plummer's disease will resolve on its own

will not

What are the uptake and scan findings of autonomously functioning nodules?

Patchy hyperactivity, with other areas suppressed

What is the treatment for autonomously functioning nodules? Why is the outcome for this different than in other thyroid diseases?

Radioactive ablation. This will not render them hypothyroid, since only the overactive areas pick up the I, while the under active areas do not

Why are antithyroids contraindicated for autonomously functioning nodules?

Will not spontaneously resolve like Grave's disease Side effects more likely the longer you're on it

What is the usual thyroid levels with thyroiditis?

Inflammation of the thyroid causes leakage of preformed T3/T4

What are the etiologies of thyroiditis?

Viral Radiation Iodine exposure Postpartum

What are the PE findings with thyroiditis?

Usual hyperthyroid signs | Tender thyroid

What are the thyroid uptake scans with thyroiditis? Why?

Low, since you're not making more hormone, you're just leaking.

What is the treatment for thyroiditis?

- NSAIDs - Prednisone - beta-blockers - Antithyroids

What is the natural h/o thyroiditis?

Triphasic---Hyperthyroid-euthyroid--hypothyroid

What is the role of radioactive Iodine and antithyroids in thyroiditis?

Since it is not an overproduction pathology, antithyroids and radioactive ablation are not very useful

What is the typical cause of Iodine-induce hyperthyroidism?

Pts who take amiodarone, or other high dose iodine treatments

How do you diagnose amiodarone induced hyperthyroidism?

US may show increased vascularity, but not specific

What are the results of thyroid uptake with amiodarone?

Low

What are the therapeutic options for amiodarone induced hyperthyroidism?

Glucocorticoid

Why isn't radioactive ablation or PTU useful for amiodarone induced hyperthyroidism?

Thyroid already supersaturated with iodine Antithyroids only inhibit new uptake of iodine--again, already super saturated

Why is it difficult to treat amiodarone-induced hyperthyroidism?

Very long half-life, and needed for cardiac reasons

What is the most effective means for treating amiodarone hyperthyroidism?

Thyroidectomy

What are the labs like with a TSH-producing pituitary tumor?

Increased T4, with non suppressed or increased TSH

What are the clinical features of a TSH producing pituitary adenoma?

Hyperthyroid features Goiter Bitemporal hemianopsia

What are the diagnostic tests for a TSH producing adenoma?

High alpha subunit | MRI showing pituitary adenoma

What is the treatment for a TSH producing pituitary adenoma?

Transsphenoidal resection | Octreotide

What is hCG-mediated hyperthyroidism?

HCG weakly stimulate the thyroid, but TSH will deccrase

In what conditions is hCG-mediated hyperthyroidism seen in (2)?

- Hyperemesis gravidarum | - Molar pregnancy

If there is no pathological cause of hCG mediated-hyperthyroidism, what is the treatment?

No Rx needed

When should hCG-mediated hyperthyroidism be treated? What should be used?

- If T4 elevated - PTU first trimester - Methimazole

What is thyroid storm?

Severe exacerbation of a preexisting hyperthyroidism, causing: - tachy - hyperthermia - n/v/d - Mental status change

What are the triggers for thyroid storm?

- Omission of anti thyroid drugs - surgery - infx - MI - CVA

What is the treatment for thyroid storm?

- Supportive (cooling, IVFs, oxygen etc) - Beta blockers - Glucocorticoids - antithyroids - Iodine

What is the mortality rate of thyroid storm?

20-30%

What is euthyroid sick syndrome?

Fluctuation of thyroid hormones during some sort of stress, but does not actually reflect any thyroid pathology

What are the classic lab findings of euthyroid sick syndrome?

TSH low FT4, FT3 low rT3 high

What is the purpose of putting patients on SSKI prior to surgery?

Decreases T4 secretion (through Wolff-Chaikoff phenomenon) Decreases vascularity of thyroid gland

What is the phenomenon of increased T4 synthesis with increase iodine concentrations?

Jod Basedow effect

What is the phenomenon of decreased T4 synthesis with very highly increase iodine concentrations?

Wolff-Chaikoff phenomenon

What is Type 1 amiodarone induced hyperthyroidism?

Increases synthesis of T4 d/t Jod Basedow effect

What is Type 2 amiodarone induced hyperthyroidism?

Thyroiditis

How can HCG reduce hyperthyroidism?

HCG's alpha subunit, which TSH has in common, may cause feedback inhibition