Thyroid Disorders Flashcards
(28 cards)
What are some complications that can be associated with a large goiter?
Esophageal, tracheal, jugular, and SVC compression
What is the pathophysiological cause of a goiter? Under what conditions can a goiter occur?
Thyroid tissue hypertrophy
Hyperthyroid, euthyroid, or hypothyroid
Your pt just had a baby, and when the doctors screened the baby they found signs of hypothyroidism. Your pt asks you what disease her baby has and what could have caused it. What do you tell her?
Congenital hypothyroidism
Most likely caused by thyroid gland dysgenesis or agenesis (80-85%) or by thyroid hormone synthesis errors (10-15%)
What is the greatest risk of congenital hypothyroidism?
Cretinism (severely stunted physical and mental growth)
How would you treat a child with congenital hypothyroidism?
Hormone supplement
Levothyroxine
A few weeks ago your 1 month old pt was fine, but recently she doesn’t appear to be growing and she has poor psychomotor development. What disease do you suspect this pt has?
Congenital hypothyroidism
A 60 yo woman presents with weight gain, fatigue, constipation, brittle nails, thin hair, a puffy face, and cold intolerance. What complications could this pt develop if she is not treated?
Myxedema crisis
Infertility (not this pt)
CV complications
A 52 pt comes in because she has gained 5 lbs despite a decreased appetite. She has also noticed that her face and eyelids are puffy, and that her hair has become coarse but that it is thinner. On exam you note bradycardia and diastolic HTN. What labs should you perform on this pt?
Serum TSH
Free T4
Lipid panel
Last week a 55 yo pt came in to your office complaining of fatigue, depression, constipation, dry skin, and always feeling cold even when she wears multiple layers. You ordered some blood work for the pt with the results below. What is your treatment plan for this pt?
Elevated serum TSH
Low free T4
Hypothyroidism
Levothyroxine daily
Start her on 50-100mg levothyroxine daily. Test her TSH and T4 levels every 6-8 weeks and adjust her dose in 12.5-25mg increments until she is stable
Your 28 yo pt is currently on levothyroxine for her hypothyroidism. She tells you that she and her husband are trying to get pregnant, and she wants to know if her hypothyroidism might affect her pregnancy. What do you tell her?
You’ll need to monitor her more closely during her pregnancy. She’ll need to be check at each trimester, and you might have to increase her dose by up to 50% during her pregnancy to keep her euthyroid.
What are the three types of hypothyroidism?
Primary
Transient
Secondary/Central
What is the pathophysiology behind primary hypothyroidism?
Autoimmune disease (Hashimoto's) Drugs/Iodine excess Congenital Iodine deficiency Infiltrative disorders Thyroidectomy
What is the pathophysiology behind transient hypothyroidism?
Subacute thyroiditis (hyperthyroidism –> hypothyroidism –> euthyroid)
What is the pathophysiology behind secondary/central hypothyroidism?
Hypopituitarism (tumor, surgery, radiation, trauma, genetic, infiltrative disorder) Hypothalamic disease (tumor, trauma, infiltrative disorder, idiopathic)
When is an ultrasound indicated for hypothyroidism?
If the pt has an asymmetric goiter
A 45 yo female presents because she is worried about how swollen-looking her neck appears. Last week she felt hot, anxious, and like she couldn’t sit still, but the past couple days have been the opposite. She has felt cold, tired, and constipated. What disease does this pt likely have? What diagnostic tests would you perform to confirm your diagnosis, and what results would you expect to see?
Hashimoto’s thyroiditis
Serum TSH would be elevated
Free T4 would be low or low-normal
Thyroperoxidase/thyroglubulin antibodies should be present
What are the underlying pathological causes Hashimoto’s thyroiditis?
Autoimmune
Genetic and environmental factors
Cause thyroid gland destruction
A 39 yo female presents with fatigue, lethargy, weight gain, a puffy face, bradycardia, and weight gain despite a decreased appetite. Her lab results are below. How will you treat this pt? Serum TSH - elevated Free T4 - low Thyroperoxidase antibodies - positive Thyroglobulin antibodies - positive
Hashimoto’s thyroiditis
Treat with daily levothyroxine
Start her on 50-100mg levothyroxine daily. Check her TSH and Free T4 levels every 6-8 months and adjust her dose in 12.5-25mg/d increments until she is euthyroid
What is the most common cause of hypothyroidism in the US?
Hashimoto’s thyroiditis
Which type of hypothyroidism is Hashimoto’s thyroiditis?
Primary hypothyroidism
An elderly woman is brought into the ER because she has impaired cognition, hypothermia, hypoventilation, and hypotension. Her daughter tells you that a few years ago she had a stroke, but other than that she has been healthy, except for a cold that she just got over. What condition does this pt most likely have? How will you treat her?
Myxedema crisis
Treat with rapid hormone replacement and supportive therapy
20-50% mortality with treatment (100% mortality without Tx)
A pt is brought to the ER with impaired cognition, convulsions, hypothermia, hypoventilation, and hypotension. He also appears to have signs of kidney damage. What could have caused this pt’s condition?
Myxedema crisis
Infection
Cold exposure
Drug use
A pt comes in because recently he has felt “hyperactive”. He has been irritable, sweaty, and noticed impaired concentration. He mentions weight loss despite eating much more than he usually does, and he has had diarrhea a lot recently. What disease does this pt most likely have? What are the three sub-categories of this disease?
Hyperthyroidism
Primary
Transient
Secondary
What causes primary hyperthyroidism?
Grave's disease MNG (toxic multinodular goiter) Toxic adenoma Struma ovarii Drugs/Iodine excess
