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CCFP 3 > Thyroid Disease > Flashcards

Thyroid Disease Flashcards

1
Q

Features + rx of Subacute granulomatous thyroiditis

A

(viral infection, painful thyroid)
NSAIDs

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2
Q

Rx + monitoring of hypothyroidism

A

Levothyroxine treatment of choice, start 12.5-50mcg/day
Repeat TSH q3-4 months until stable, then yearly

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3
Q

Myxedema coma sx

A

Altered mental status, hypoventilation, hypothermia, hypotension, bradycardia, hyponatremia, hypoglycemia

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4
Q

Rx of myxedema coma

A

Levothyroxine (T4) loading dose 200-400mcg IV, then 1.6mcg/kg/day IV
Liothyronine (T3) 5-20mcg followed by 2.5-10mcg q8h given with T4
Glucocorticoids (hydrocortisone 100mg IV q8-12h x2d) until coexisting adrenal insufficiency can be excluded
Supportive measures (ventilation, fluids, correction of hyponatremia and hypothermia)

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5
Q

What are the receptor ab for Graves?

A

Graves (TSH receptor antibodies=TRAb)

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6
Q

Causes of thyroid storm?

A

Trauma, surgery, RAI

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7
Q

Sx of thyroid storm

A

Hyperthermia, tachycardia, N/V/D, dehydration, delirium, coma

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8
Q

Treatment of thyroid storm

A

B-Blockers (Propranolol 60-80mg q4-6h)
Propylthiouracil 200mg PO q4h
Iodine solution (delayed 1h after PTU)
Iodinated radiocontrast
High-dose IV hydrocortisone 100mg IV q8h

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9
Q

RF for hyperthyroidism

A

Diffuse/ nodular goitre
T1DM
Autoimmune disorder
Fam hx
Amiodarone, lithium, iodide

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10
Q

When to check TSH

A

After med dose changes
Before initiating treatment
Periodically in stable pts

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11
Q

rx for hyperthyroidism

A

Propranolol 10-40mg QID
Methimazole 5-120mg for 12-18mo then taper + DC
Radioactive iodine - single dose
Subtotal thyroidectomy - treatment of choice in pregnancy + pts <40 y/o

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12
Q

Precipitants of hyperparathyroidism

A

thiazide diuretics, lithium, RT, MEN type 1 + 2a

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13
Q

Lab results for hyperparathyroidism

A

high calcium, high PTH, low phosphate, high ALP

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14
Q

Sx of hyperparathyroidism

A

bone pain, fragility fractures, kidney stones, polyuria, N/V, constipation, lethargy, depression, gout, reduced BMD

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15
Q

Rx of hyperparathyroidism

A

parathyroidectomy, volume repletion + loop diuretics, pamidronate

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16
Q

Causes of hypothyroidism

A

Chronic autoimmune thyroiditis (Hashimoto’s)
Postpartum thyroiditis
Iodine deficiency
Drugs: amiodarone, lithium, iodine
Central hypothyroidism
Pituitary adenoma or damage
Infiltrative: sarcoidosis, TB, granulomas)

17
Q

Who is at risk of hypothyroidism?

A

Women >45
1st trimester pregnancy
Trying to conceive
Post partum (6w-6mo)
Elderly
FHx
Autoimmune disease
Neck RT

18
Q

Ix for hypo

A

High TSH + low free T4 = hypothyroidism
Normal/ low TSH + low free T4 = central hypothyroidism
T3 if undetectable TSH + normal T4
Thyroid scan or MRI thyroid if goitre present

19
Q

RF for hyper

A

Diffuse/ nodular goitre
T1DM
Autoimmune disorder
Fam hx
Amiodarone, lithium, iodide

20
Q

Causes of hyper

A

Graves (antibody against TSH receptor) (High uptake, diffuse)
Toxic multinodular goitre (high uptake, nodular)
Toxic adenoma (high uptake, one ‘hot’ area)
Thyroditis (low uptake)
Treatment induced
Thyroid cancer

21
Q

Sx of hyper

A

Wt loss, heat intolerance
Lid lag, proptosis, periorbital edema, hair loss, goiter, thyroid bruits
Palpitations, tachy, AF, wide pulse pressure, HTN
Tremor, edema, pretibial myxedema, muscle weakness
Amenorrhea

22
Q

Ix for hyper

A

Low TSH high T4
MRI if high TSH + T4 (suspect TSH secreting pituitary adenoma)
Thyroid uptake if low TSH + high free T4
CBC and LFT at BL

23
Q

Lab results for thyroid storm

A

low TSH, high free T4, low Hb, high WBC, high glucose, high calcium, high LFTs

24
Q

Causes of hypo

A

Chronic autoimmune thyroiditis (Hashimoto’s)
Postpartum thyroiditis
Iodine deficiency
Drugs: amiodarone, lithium, iodine
Central hypothyroidism
Pituitary adenoma or damage
Infiltrative: sarcoidosis, TB, granulomas)

25
Q

RF for hypo

A

Women >45
1st trimester pregnancy
Trying to conceive
Post partum (6w-6mo)
Elderly
FHx
Autoimmune disease
Neck RT

26
Q

Sx of hypo

A

Fatigue, weakness, cold intolerance, weight gain
Depression, memory loss
Enlargement of tongue, hoarseness, goitre
Bradycardia, pericardial effusion, HTN, CHF
Muscle weakness
Constipation
Paresthesia, muscle cramps
Menorrhagie, amenorrhea, impotence
Periorbital edema, hair loss, lateral ⅓ eyebrow thin, brittle nails
Anemia

27
Q

Ix for hypo

A

High TSH + low free T4 = hypothyroidism
Normal/ low TSH + low free T4 = central hypothyroidism
T3 if undetectable TSH + normal T4
Thyroid scan or MRI thyroid if goitre present

28
Q

Management of Subclinical hypothyroidism

A

No treatment if TSH <10, normal T4, asymptomatic, not pregnant
Most normalize over next 5 yrs
Monitor annually
Treat w/ levothyroxine if:
Elevated TPO antibodies
Goitre
Fam hx of autoimmune dz
Pregnancy

29
Q

Rx for hypo

A

Tx if
TSH >10 + symptomatic
TSH 5-10 AND:
Elevated TPO antibodies
Goitre
Fam hx of autoimmune dz
Pregnancy

30
Q

What are the features of + when do you Rx: Subacute granulomatous thyroiditis

A

(preceding viral infection, painful thyroid) = usually self resolves, treat w/ NSAIDs

31
Q

Advice for pts on levo

A

Absorption affected by: high fibre, soy, coffee, calcium, iron, antacids, PPI, anticonvulsants
Take on empty stomach 30 mins before breakfast

32
Q

Thyroid storm Rx

A

thionamides e.g. methimazole (blocking synthesis), propranolol, iodine, bile acid sequestrant (cholestyramine)

33
Q

Rx for graves

A

thionamides e.g. methimazole (blocking synthesis), propranolol, iodine, bile acid sequestrant (cholestyramine), radiation, thyroidectomy

34
Q

When to screen for hypothyroidism

A

sx, at risk (pregnancy, prev thyroid dz, prev radiation, pituitary disorder), taking replacement

35
Q

Next steps if hyperthyroid on labs

A

BB 6-8 wks, radioactive iodine uptake (unless Graves or pregnant or breastfeeding)

36
Q

thyroid nodule workup

A

TSH, thyroid US (>1cm, taller than wide), FNA for cytology)

37
Q

What are features of a suspicious thyroid nodules?

A

> 1cm, irregular surface, taller than wide, calcifications

38
Q

Hypothyroidism signs

A

dry skin, bradycardia, wt gain, delayed reflex relaxation, edema

39
Q

Hyperthyroidism signs

A

diaphoresis, tachycardia, wt loss, goiter, tremor, thinning of hair, lid lag, exophthalmos

CCFP 3 (67 decks)

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