Flashcards in Thyroid and Parathyroid Deck (80)
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
What might be seen on a PE for hypothyroidism?
Dry, coarse skin, thin hair
Labs in primary hypothyroidism
High TSH and low FT4 and low T3
Labs in subclinical hypothyroidism
High TSH and normal FT4 and T3
Labs in central hypothyroidism
Normal/low TSH, FT4 and T3
What antibodies tend to be seen in Hashimotos thyroiditis?
Anti thyroid peroxidase antibody (TPO ab)
Anti thyroglobulin antibody (TgAb)
Most common cause of hypothyroidism
What is Hashimotos thyroiditis?
Chronic autoimmune thyroiditis
Functional abnormality with associated inflammatory component with a gradual loss of thyroid function
When do you see an increased risk for Hashimotos?
Down syndrome and Turners
What is hashitoxicosis?
Transient hyperthyroidism related to early inflammation (at first due to dumping of hormones)
Precipitating factors of Hashimotos
Stress, infection, pregnancy, iodine intake and radiation exposure
What is the goal for T4 replacement in hypothyroidism?
Maintain euthyroid state (.5-5 mU/L), relieve sxs and decrease goiter size if needed
What med is used in hypothyroidism?
Levothyroxine (levothyroid, levoxyl, synthroid)
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)
F/u for levothyroxine?
6 wks after start to evaluate the dosage
What is subclinical hypothyroidism?
Elevate TSH (4.5-7) with normal T4
Present with mild or vague non specific sxs (fatigue, constipation)
Risks associated with subclinical hypothyroidism when it is not treated
Increased risk for CV disease
Nonalcoholic fatty liver disease
Miscarriage and low birth weight babies
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
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
Common complications of hypothyroidism
Elevated cholesterol and liver enzymes
Who do you see myxedema coma in?
Older pts with long standing profound hypothyroidism
Sxs of myxedema coma
Hypothermia, bradycardia, severe hypotension, seizures, coma (may be due to acute illness or cold weather)
Tx for myxedema coma
IV bolus T4
Etiologies of hyperthyroidism
Graves: younger women
Toxic nodular goiter: older women
Presentation of hypethyroidism
Weight loss, sweating, exophthalmos, goiter, tachycardia, a fib, diarrhea, urine frequency, osteoporosis, pretibial myxedema, insomnia, tremor etc
Labs in hyperthyroidism
Low TSH and high free T4 and T3 (overproduction of T4 will turn off the pituitary to decrease TSH)
Labs in subclinical hyperthyroidism
Low TSH and normal free T4 and T3
What else might be seen on the labs in hyperthyroidism?
CBC: normochromic, normocytic anemia
Cholesterol: low total and HDL
Glucose: impaired glucose tolerance
What antibody is specific to Graves?
TSH receptor antibody (TRAb) which stimulates the thyroid gland---TSI or TBII