Thyroid and Parathyroid Flashcards Preview

X Clin Med II Exam 4 > Thyroid and Parathyroid > Flashcards

Flashcards in Thyroid and Parathyroid Deck (80)
Loading flashcards...
1

General sxs of hypothyroidism

Generalized metabolic slowing--fatigue, cold intolerance, weight gain, cognitive dysfunction, constipation, hoarseness, decreased hearing, myalgia, arthralgia, paresthesia, depression, menstrual changes, pubertal delay

2

What might be seen on a PE for hypothyroidism?

Bradycardia, HTN
Dry, coarse skin, thin hair
Puffy face
Ascites
Edema
Delayed DTRs

3

Labs in primary hypothyroidism

High TSH and low FT4 and low T3

4

Labs in subclinical hypothyroidism

High TSH and normal FT4 and T3

5

Labs in central hypothyroidism

Normal/low TSH, FT4 and T3

6

What antibodies tend to be seen in Hashimotos thyroiditis?

Anti thyroid peroxidase antibody (TPO ab)
Anti thyroglobulin antibody (TgAb)

7

Most common cause of hypothyroidism

Hashimotos thyroiditis

8

What is Hashimotos thyroiditis?

Chronic autoimmune thyroiditis
Functional abnormality with associated inflammatory component with a gradual loss of thyroid function

9

When do you see an increased risk for Hashimotos?

Down syndrome and Turners

10

What is hashitoxicosis?

Transient hyperthyroidism related to early inflammation (at first due to dumping of hormones)

11

Precipitating factors of Hashimotos

Stress, infection, pregnancy, iodine intake and radiation exposure

12

What is the goal for T4 replacement in hypothyroidism?

Maintain euthyroid state (.5-5 mU/L), relieve sxs and decrease goiter size if needed

13

What med is used in hypothyroidism?

Levothyroxine (levothyroid, levoxyl, synthroid)

14

Dosing and considerations for Levothyroxine

1.6 mcg/kg/day at starting point (start lower for elderly and people with cardiac probs)
Empty stomach and hr before breakfast (so absorb it all at the same amount every day)

15

F/u for levothyroxine?

6 wks after start to evaluate the dosage

16

What is subclinical hypothyroidism?

Elevate TSH (4.5-7) with normal T4
Present with mild or vague non specific sxs (fatigue, constipation)

17

Risks associated with subclinical hypothyroidism when it is not treated

Increased risk for CV disease
Nonalcoholic fatty liver disease
Neuropsychiatric sxs
Miscarriage and low birth weight babies

18

What must you do to confirm the diagnosis of subclinical hypothyroidism?

Repeat TSH and T4 after 1-3 mos (if dont have overt sxs)
*if pregnant or during a fertility tx, repeat immediately

19

Management of subclinical hypothyroidism

Most will progress to overt hypothyroidism
If TSH>10: treatment recommended
If TSH 4.5-9.9: tx controversial based on age and sxs

20

Common complications of hypothyroidism

Elevated cholesterol and liver enzymes
HF
Infertility
Myxedema coma

21

Who do you see myxedema coma in?

Older pts with long standing profound hypothyroidism

22

Sxs of myxedema coma

Hypothermia, bradycardia, severe hypotension, seizures, coma (may be due to acute illness or cold weather)

23

Tx for myxedema coma

IV bolus T4
IV hydrocortisone
Supportive
Hypertonic saline
**medical emergency

24

Etiologies of hyperthyroidism

Graves: younger women
Toxic nodular goiter: older women

25

Presentation of hypethyroidism

Weight loss, sweating, exophthalmos, goiter, tachycardia, a fib, diarrhea, urine frequency, osteoporosis, pretibial myxedema, insomnia, tremor etc

26

Labs in hyperthyroidism

Low TSH and high free T4 and T3 (overproduction of T4 will turn off the pituitary to decrease TSH)

27

Labs in subclinical hyperthyroidism

Low TSH and normal free T4 and T3

28

What else might be seen on the labs in hyperthyroidism?

CBC: normochromic, normocytic anemia
Cholesterol: low total and HDL
Glucose: impaired glucose tolerance
Others: antibodies

29

What antibody is specific to Graves?

TSH receptor antibody (TRAb) which stimulates the thyroid gland---TSI or TBII

30

Reasons for a high radioiodine uptake (due to de novo synthesis of the hormone)

Graves (most common)
Hashitoxicosis (probs normal tho)
Toxic adenoma or toxic nodular goiter
Iodine deficiency
Autonomous nodule (HOT)