Thyroid Flashcards by Ashley Chirchirillo

what types of thyroiditis are included in autoimmune thyroiditis?

hashimoto
postpartum
painless (silent) sporadic

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MC thyroid disorder in US

“chronic lymphocytic thyroiditis” - autoimmune thyroid cell distruction

Asymptomatic or hyperthyroidism (initial phase w destruction) or hypothyroidism

hashimoto thyroiditis

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w/in first 12 mo postpartum

autoimmune destruction of thyroid

Asymptomatic or hyperthyroidism (initial phase w destruction) or hypothyroidism

more common if had it in previous pregnancy, preexisting T1DM, autoimmunity, FMHx

postpartum thyroiditis

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“hashitoxicosis”

autoimmune destruction of thyroid

Asymptomatic or hyperthyroidism (initial phase w destruction) or hypothyroidism

caused by chemotherapy, lithium, amiodarone

painless (silent) sporadic thyroiditis

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PE: gland may be diffusely enlarged, firm + finely nodule, painless

LABS: elevated serum antithyroid antibodies, endocrine deficiencies (DM1, hypoparathyroidism, adrenal insufficiency), autoimmune conditions

Primary hypothyroid pattern: increased TSH + decreased free T4

Nodule = FNA

autoimmune thyroiditis

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how do you treat autoimmune thyroiditis?

treat with levothyroxine

selenium supplement can dec TPO Ab

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painful neck discomfort, dysphagia, low grade fever, fatigue, sore throat, URI symptoms

Transient hyper→hypo

Viral illness, summer, early autumn

painful subacute thyroiditis

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de Quervain, granulomatous, giant cell
Result of preceding viral illness or vaccination with recurrence common

painful subacute thyroiditis

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PE: tender, enlarged thyroid gland

LABS: elevated ESR with low antithyroid antibodies, giant cells on histology

painful subacute thyroiditis

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how do you treat painful subacute thyroidits?

aspirin or NSAIDs, prednisone if severe pain
Propranolol, iodinated agents for thyrotoxic symptoms

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febrile, severe pain, tenderness, erythema, fluctuation, pain radiating to ears, jaw, chills common in immunocompomised

suppurative thyroiditis

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Non-viral infection (staph aureus) think

suppurative thyroiditis

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LABS: elevated ESR, leukocytosis

suppurative thyroiditis

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suppurative thyroiditis tx

staph antibiotics
MRSA vancomycin or daptomycin
MSSA cefazolin or nafcillin or oxacillin

surgical drainage if fluctuance

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IgG4: dysphagia, dyspnea, pain, hoarseness

Airway compression
Middle age, older women

IgG4 thyroiditis

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Rare; Riedel, invasive fibrous, woody - chronic inflammation + dense fibrosis invading thyroid and neck structures

IgG4 thyroiditis

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PE: asymmetric thyroid enlargement - rock hard, nontender, rapidly growing, fixed goiter
IgG4 serum levels + TPO antibodies

IgG4 thyroiditis

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how do you treat IgG4 thyroiditis?

long term tamoxifen, steroids

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Hair loss, lethargy, dry skin, constipation, brittle nails, cold intolerance, anorexia, fatigue, menstrual disturbances (amenorrhea), goiter, high cholesterol, arthralgia

Decreased metabolic processes except for menstrual flow which is increased

Sluggishness, fatigue, memory loss, depression, bradycardia

hypothyroidism

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Congenital = cretinism (permanent cognitive impairment), iodine therapy, surgical thyroidectomy, TSH deficiency, iodine-deficient diet, drugs (lithium, amiodarone, interferon, PTU, methimazole, chemo), viral, autoimmune (Hashimoto/Graves)
Later stage of thyroiditis
Hashimoto’s = MCC

hypothyroidism

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what’s the MCC of hypothyroidism

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Hashimoto’s thyroiditis

PE: palpably enlarged, often with nodules, loss out of outer ⅓ eyebrow, non pitting edema

TSH high
Free T4 low
If w/o sx: subclinical

LABS:
Lipid panel - hypercholesterolemia
CBC - anemia, hypoglycemia
CMP - hyponatremia, GFR, liver enzymes
ANA, antibodies

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hypothyroidism

how do you treat hypothyroidism

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Levothyroxine

TSH, FT4, FT3 monitored every 4-6 weeks until normal – in AM with water only

Subclinical – consider treating when TSH >10 to prevent cardiac complications

Severe illness, major surgery
Receiving high dose steroids, dopamine infusions, ICU
Low T4, T3, TSH in patient w/o known thyroid disease

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nonthyroidal illness syndrome

AMS Hypothermia, hypoventilation, hyponatremia, hypoglycemia, hypoxemia, hypercapnia, HOTN, rhabdomyolysis, AKI Elderly women with long-standing hypothyroidism during the winter

myxedema crisis

Severe, life-threatening manifestations of hypothyroidism from failure to take prescription levothyroxine, precipitated prolonged exposure to cold, stroke, HF, pneumonia, trauma

myxedema crisis

myxedema crisis tx

Levothyroxine (T3) bolus → daily treatment, can add liothyronine (T4)

A fib, hyperreflexia, anxiety, thyroid bruit, diffusely enlarged thyroid Forceful heartbeat, PAC, sinus tachycardia, exertional dyspnea, afib, atrial tachycardia Can cause pulmonary HTN Heat intolerance, weight loss, overall increased metabolic rate Skin warm, moist, soft and fine hair, tremors, nervousness Graves specific = ophthalmopathy + pretibial myxedema

hyperthyroidism "thyrotoxicosis"

“Thyrotoxicosis” MCC: Graves disease Or, toxic multinodular goiter (Plummer disease), Hashimoto’s - early stage, pituitary tumor, pregnancy, diet, contrast, amiodarone, iodine (Basedow)

hyperthyroidism

Elevated T4 + T3 levels → suppression of TSH If all are elevated = adenoma If antibodies are present = Graves Low TSH but normal T4 and T3 = subclinical RAIU (radioactive iodine uptake scan) = uptake increased in hyperthyroid states + can differentiate between cause Severe → MRI + CT of orbits Diffusely enlarged firm + palpable non tender goiter with or without a thyroid bruit

hyperthyroidism

Exophthalmos, dermopathy (red/brown lesions on legs, non-pitting edema) Women, 20-40 Symptoms worsen with stress

grave's disease

Autoimmune disorder – antibodies bind to TSH receptors and continue to stimulate growth, dietary iodine supplementation, amiodarone, HLA-B8, HLA-DR3, viral infections, COVID vaccination

grave's disease

Serum ANA elevation w/o evidence of SLE or other rheum issue TSH-receptor autoantibodies/thyroid stimulating immunoglobulins (TSIs): TBI or TBII

grave's disease

how do you treat grave's disease

Beta blockers (Propranolol - decrease risk of cardio comps) Antithyroid thionamides (methimazole or propylthiouracil (PTU; used only in pregnancy typically)) iodinated contrast agents (temporary) radioactive iodine ablation (NO in pregnancy) Thyroid surgery - large goiters, nodules, malignancy risk Opthalmopathy = IV methylprednisolone

Cardiac issues: HF, sinus tachy, v fib, AMS, shock, delirium, high fever with diaphoresis, vomiting, diarrhea, tremors Hyperthyroid manifestations

thyroid storm

Life-threatening condition of extreme hyperthyroidism Caused by amiodarone, stress, illness, pregnancy, surgery, sepsis, trauma, RAI Low TSH, increased T4 and T3 (primary)

thyroid storm

how do you treat a thyroid storm

ICU → methimazole, iodide, propranolol, IV hydrocortisone, SUPPORT!

Mostly asymptomatic – can grow, become visible → discomfort, hoarseness, dysphagia

nodules/goiter

nodules/goiter are seen more often in

women with hypo or hyperthyroidism

when is there concern for malignancy with nodules?

large solitary nodules, hoarseness, cervical LAD, men, history of head-neck radiation, personal history of malignancy, familial history, no regression with levothyroxine, cold, elevated calcitonin

serum calcitonin if suspicious for medullary thyroid carcinoma neck US and TSH to assess malignancy risk If TSH is low → RAIU scan If hot/nonfunctioning, maybe If TSH is high → Fine-needle aspiration to assess for malignancy Cytopathology indeterminate = molecular testing

thyroid nodules RAIU scan to check hot or cold, with cold being ass w/ malignancy aspiration directly due to high TSH ass w/ malignancy already

how do you treat thyroid nodules

Monitored with exam + US every 6 months >2cm + TSH elevated/normal → levothyroxine >3cm and solid = US radiofrequency ablation Surgery if malignancy suspected

name the types of thyroid carcinoma from MC to least common

papillary (MC) follicular medullary anaplastic

least aggressive thyroid carcinoma spreads to cervical LN RF: radiation to head and neck, FH, genetics, females

papillary thyroid carcinoma

more aggressive thyroid carcinoma with metastasis to lung, liver, brain, bone

follicular thyroid carcinoma

thyroid carcinoma type that can be sporadic, familial, MEN 2 secretion of calcitonin, prostaglandins, serotonin, ACTH

medullary thyroid carcinoma

most aggressive thyroid carcinoma elderly with rapidly enlarging mass/goiter

anaplastic thyroid carcinoma

What does diffuse uptake on RAIU scan mean?

graves or TSH-secreting adenoma on pituitary

What does decreased uptake on RAIU scan mean?

thyroiditis

What does a hot nodule indicate on RAIU scan?

toxic adenoma

What do cold nodules indicate on RAIU?

Potential malignancy

How do you treat hyperthyroidism?

1 Antithyroid drugs with no active nodules or cancer– methimazole or propylthiouracil ------Add beta blockers if symptomatic 2 Radioactive iodine ablation of thyroid gland for VERY symptomatic -----Will need permanent hormone replacement 3 Thyroidectomy reserved for nodules, cancer, or pregnancy

Thyroid Flashcards

(52 cards)