Thyroid

Question 1

Classic presentations
Graves (anti-TSH antibodies): Age
Toxic Goiter: Age

Answer 1

Classic presentations
Graves (anti-TSH antibodies): young, female
Toxic Goiter: elderly

Question 2

Thyroid Disorder
Hx/exam :

Answer 2

Hx/exam : palpitations/afib, N/V/D, agitated, AMS, cardiovascular collapse, anxious, psychosis/delirium, goiter, proptosis, ↑↑HR, diaphoresis, tremor, CNS depression
(late)
Graves: proptosis, lid lag, pretibial myxedema

Question 3

Thyroid Disorder
Labs:

Answer 3

Labs : Lactate, TSH/T3/FT4, UA, hCG, CXR, Cardiac enzymes, cortisol level, EKG

Question 4

Thyroid Storm

Hyperthyroid disorder Tx:

Answer 4

Tx : supportive IVF (use D5NS), cool, treat dysrhythmias, replace lytes PRN, treat fever w/ APAP (no ASA!/NSAIDs- decrease protein binding of T4/3→ increases free
concentrations)

Question 5

Thyroid Storm

If severe sx or storm …
Block peripheral effects:

Answer 5

If severe sx or storm …
Block peripheral effects:
Propranolol 1 mg IV q 15 m up to 10 mg- blocks conversion T4→ 3
Esmolol 500 mcg/kg, then 20-50 mcg/kg/min - used when concerns over B blockers
Majority of CHF in storm is high output- will respond to B blockers (fluid down)

Question 6

Thyroid Storm

If severe sx or storm …
Inhibit thyroid hormone synthesis:

Answer 6

Inhibit thyroid hormone synthesis:
PTU 600-1000 mg PO (also ↓ peripheral conversion T4 → T3)- hepatotox, polyarthritis, vasculitis
Methimazole 90-120 mg PO- agranulocytosis

Question 7

Thyroid Storm

If severe sx or storm …
Inhibit thyroid hormone release:

Answer 7

Inhibit thyroid hormone release: wait 1 hr after PTU , then
SSKI (Potassium iodide) 5 drops PO
Lugol’s sol (K iodide) 20 drops PO

Question 8

Thyroid Storm

If severe sx or storm …
Inhibit peripheral conversion of T4 → T3:

Answer 8

Inhibit peripheral conversion of T4 → T3:
Hydrocortisone 100 mg IV q8
Dexamethasone 2-4 mg IV q6

Question 9

Thyroid Storm

Treat causes :

Answer 9

Treat causes : Infection, Infarction (PE/MI/CVA), Insulin lack (DKA), IUP, Iodine therapy/dye/amiodarone, Injury/surgery