SG 1.1: Thyroid Disorder Cases Flashcards
(45 cards)
what are the 3 congenital thyroid disorders?
- thyroglossal duct cyst
- lingual thyroid
- congenital hypothyroidism
what is the most common cause of preventable intellectual disability?
congenital hypothyroidism
check TSH on a newborn in the first week of life! if TSH is elevated, immediately give TG
how does the thyroid develop?
it starts at the base of the tongue, travels down the thyrroglossal duct to the anterior neck and if the duct persists then the patient gets a cystic dilation
what is athyroglossal duct cyst? how does it present?
cystic dilation of thyrglossal duct remnant
presents as anterior neck mass in the middle
how does congenital hypothyroidism present?
- floppy baby
- difficult to arouse
- hypotonic
- large anterior fontanelle
- umbilical hernia
- slowing mental activity
- myxedema –> puffy, non pitting edema
what developmental issues does hypothyroidism cause? what are its 5 signs?
creationism
- mental retardation
- short stature, abnormal skeleton
- coarse facial features
- big tongue
- umbilical hernia
how does hypothyroidism cause cretinism?
- hypothyroidism in early pregnancy
- thyroid agenesis
- dyshormogenetic goiter; patient unable to make thyroid hormone
- iodine deficiency
what is the most common enzyme deficiency causing dyshormonogenetic goiter?
thyroid perodidase deficiency
this is the enzyme that is hormone that iodinates TG to form T4 and T3
what are the 4 thyroid disorders to remember?
- hyperthyroidism: Graves, thyroid storm, multi nodular/toxic goiter
- hypothyroidism: hypothyroid myxedema, Hashimoto thyroiditis
- subacute deQuervain granulomatous thyroiditis
- Reidel fibrosing thyroiditis
why do you get increased BMR and SNS activation in hyperthyroidism?
BMR increased Na/K ATPase with the generation of heat
sympathetic drive increases due to increased B1 adrenergic receptor activity
why do you get increased BMR and SNS activation in hyperthyroidism?
BMR increased because metabolism of thyroid hormones involves Na/K ATPase with the generation of heat
sympathetic drive increases due to increased B1 adrenergic receptor activity
why do you have heat intolerance and sweating in hyperthyroidism?
increased Na/K ATPase uses lots of ATP
how does hyperthyroidism effect calcium levels?
hypercalcemia from bone resorption which can lead to osteoporosis
how does hyperthyroidism affect cholesterol level and sugar levels?
hypocholesterolemia
hyperglycemia due to thyroid causing gluconeogeneis sand glycogenolysis
what is a multinodular goiter?
enlarged thyroid with multiple nodules
due to relative iodine deficiency like food that stops iodine absoprtion
what is a toxic goiter?
multinodular goiter that has a region that becomes overactive
it secretes excess thyroid hormone
what is a thyroid storm and how does it present?
exacerbation of hyperthyroidism resulting in elevated catecholamines and massive hormone elevation
presents as:
- arrhythmias
- hyperthermia
- vomiting
- hypovolemic shock
how do you treat a thyroid storm?
- B blockers
- PTU
- steroids
what does PTU do in addition to blocking peroxidase?
inhibits peripheral conversion from T4 to T3
T3 is the active form
how does Graves disease lead to hyperthyroidism?
autoantibody IgG that stimulates the TSH receptor and increases thyroid release
who gets graves disease?
women of childbearing age
what are the 3 signs of Graves disease?
- goiter
- exophthalmos
- pretibial myxedema
in Graves disease why do you get a goiter?
antibodies stimulate TSH receptor which increases thyroid hormone production resulting in thyroid hyperplasia
what is the histology seen in Grave’s disease?
hyperplasia
large follicular areas with lots of colloid
