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Flashcards in Parrott DSA CMDT Deck (50)
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1

Thyroid tests- screening

-serum TSH!!!
-free T4

2

Thyroid tests- for hypothyroidism

-serum TSH
-antithyroglobulin and antithyroperoxidase ab's (Hashimoto)

3

Thyroid tests- for hyperthyroidism

-serum TSH!!!
-T3 or free T3 iodine uptake and scan
-antithyroperoxidase and antithyroglobulin ab's
-TSI

4

Thyroid tests- for thyroid nodules

-fine-needle aspiration (FNA) biopsy
-I uptake and scan (cancer is usually cold)
-Tc scan (vascular vs avascular)
-ultrasonography (assist FNA biopsy)

5

hypothyroidism- common manifestations

-nonspecific- weight gain, fatigue, lethargy, depression, weakness, dyspnea on exertion, constipation, dry skin, cold intolerance
-bradycardia, thin brittle nails, thinning of hair, peripheral eema, yellowing of skin, puffy fae
-palpably enlarged goiter

6

hypothyroidism- lab

-screening- TSH
-primary- inc TSH, dec T4

7

subclinical hypothyroidism

-normal serum FT4 with a serum TSH above range
-transient

8

hypothyroidism- tx

-levothyroxine!!!
-myxedema crisis- need larger dose of levothyroxine

9

hypothyroidism- monitoring and optimizing tx

-elevated TSH indicates the need for a higher dose of levothyroxine
-many drugs interfere with levothyroxine!

10

hypothyroidism- elevated serum TSH level- tx

-confirm that the pt is taking the levothyroxine as directed and doesnt have angina
-exclude malabs of levothyroxine
-usually indicates a under replacement of levothyroxine

11

hypothyroidism- normal serum TSH level- tx

-some pts with CAD or recurrent a fib- lower doses of levothyroxine- keep TSH in high-normal range

12

hypothyroidism- low serum TSH level- tx

-low (0.04-0.4)- inc risk of a fib and osteoporosis
-suppressed (< 0.03)- if hyperthyroidism sx's- reduce dose of levothyroxine

13

Hyperthyroidism- causes

-Graves disease
-postpartum and silent thyroiditis

14

postpartum thyroiditis

-in first 12 months afer delivery
-in 5% of postpartum women
-over 80% have antithyroid ab's
-hyperthyroidism followed by hypothyroidism (22%)
-thyrotoxicosis (30%)
-hypothyroidism (48%)
-recurrence with more pregnancies!

15

silent thyroiditis

(subacute lymphocytic thyroiditis)
-spontaneously or triggered by medications

16

hyperthyroidism- sx's, signs

-nervousness, heat intolerance, inc sweating, fatigue, m cramps, weight loss
-menstrual irregularities

17

hyperthyroidism- thyroid examination

-Graves dz- diffusely enlarged thyroid, often with a bruit, asymmetric
-subacute thyroiditis- enlarged, tender
-toxic multinodular goiter- palpable nodules

18

hyperthyroidism- cardio pulm manifestations

-forceful heartbeat, PACs, sinus tachycardia
-exertional dyspnea
-A fib or a tachycardia (8%)
-pulm HTN (49%)

19

hyperthyroidism- lab findings

-FT4, T3, FT3, T4, thyroid resin uptake- inc
-TSH dec
-Graves- TSI
-subacute thyroiditis- inc WBC, ESR, CRP
-hyperthyroidism during pregnancy- elevated T4 and FT4 and dec TSH
-amiodarone- inc T4 and FT4, dec TSH

20

Graves disease- tx

-propranolol
-Thiourea drugs (methimazole, PTU)
-iodinated contrast agents
-radioactive iodine
-thyroid surgery

21

hyperthyroidism from thyroiditis- tx

-propranolol (during hyperthyroid phase)
-ipodate sodium (corrects elevated T3 levels)
-NO thioureas (TH production is low)

22

subacute thyroiditis

(de Quervain thyroiditis, granulomatous)
-after a URI
-summer

23

Hashimoto thyroiditis- sx, signs

-diffusely enlarged, firm, nodular thyroid gland
-sx's related to levels of TH
-depression, fatigue
-dry mouth

24

subacute thyroiditis- sx, signs

-painful enlargement of thyroid gland
-pain may radiate to ears
-fever, fatigue
-hypothyroidism lasts 4-6 months

25

Hashimoto- lab

-antithyroid peroxidase or anti thyroglobulin ab's
-TSH inc
-ab's assoc with celiac dz (15%)
-T4 is usually higher than T3 levels- passive release of stored H (vs Graves dz- T3 more elevated)

26

subacute thyroiditis- lab

-ESR elevated, antithyroid ab's low

27

Hashimoto- tx

-levothyroxine (if hypothyroidism)
-large goiter and normal/elevated TSH- shrink the goiter by admin levothyroxine to dec the serum TSH- suppressive doses of T4!!

28

Subacute thyroiditis- tx

-aspirin!!!
-thyrotoxic sx's- propranolol
-iodinated contrast agents- decreases serum T3- improves thyrotoxic sx's
-sodium ipodate- given until serum FT4 levels return to normal

29

hypoparathyroidism- caused by?

-acquired (after thyroidectomy)
-APECED (Autoimmune polyendocrinopathy candidiasis ectodermal dystrophy)
-heavy metals- copper, iron

30

hypoparathyroidism- sx's, signs

-hypocalcemia- tetany, m cramps, carpopedal spasm, altered mental status, tingling of hands, feet
-chvostek's sign
-trousseau sign