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Adult/Ped Medicine 5 > Thyroid Disorders - Scholting > Flashcards

Thyroid Disorders - Scholting Flashcards

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1
Q

What thyroid hormone is the major product of the thyroid gland?

A

T4

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2
Q

What thyroid hormone is active at the cellular level?

A

T3

biologically more active; shorter half life

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3
Q

Primary hypothyroidism affects what level?

A

Gland

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4
Q

Secondary hypothyroidism affects what level?

A

Pituitary

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5
Q

Tertiary hypothryoidism affects what level?

A

Hypothalamus

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6
Q

Describe the hypothalamic-pituitary-thyroid axis:

A

Hypothalamus releases TRH which stimulates pituitary. Pituitary releases TSH which acts on the thyroid. Thyroid hormones then exhibit NEGATIVE feedback on the pituitary and hypothalamus.

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7
Q

Describe the spectrum of presentation of hypothyroidism (3).

A
  1. Subclinical hypothyroidism (elevated TSH, normal T4)
  2. Symptomatic disease
  3. Severe myxedema coma
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8
Q

Etiologies of Primary Hypothyroidism (9)

A
  1. Autoimmune (Hashimotos)
  2. Idiopathic
  3. Post ablation
  4. Post external radiation
  5. Thyroiditis (subacute, silent, postpartum)
  6. Infiltrative Disease (lymphoma, sacroid, amyloidosis, Tuberculosis)
  7. Congenital
  8. Iodine Deficiency
  9. Drug-induced hypothyroidism (Amiodarone, lithium)
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9
Q

Etiologies of Secondary Hypothyroidism (3)

A

caused by insults to the pituitary gland

  1. Neoplasm
  2. Infiltrative
  3. Hemorrhage into the gland
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10
Q

Etiologies of Tertiary Hypothyroidism (4)

A
  1. Neoplasm
  2. Infiltrative Disease
  3. Anorexia Nervosa
  4. Cerebrovascular or surgical insult
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11
Q

What causes systemic symptoms of hypothyroidism?

A

lack of T3

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12
Q

Frequent Signs and Symptoms of Hypothyroidism

all of the signs and symptoms are listed

A 
Weakness
Edema of face
Lethargy
Course Skin
Slow Movements
Edema of Eyelids
Sensation of Cold
Hoarseness
Peripheral Edema
Dry Skin
Decreased Sweating
Pallor of Lips
Slow speech
Cold Skin
Constipation
Thick Tongue
Paresthesias
Gain in weight
Muscle Weakness
Slow cerebration
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13
Q

Typical Symptoms of Hypothyroidism (6)

A 
fatigue
weakness
cold intolerance
constipation
weight gain
deepening of voice
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14
Q

Cutaneous Symptoms of Hypothyroidism (4)

A

dry, scaly, yellow skin
non-pitting waxy edema of the face
myxedema
thinning of eyebrows

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15
Q

Cardiac Symptoms (3)

A

bradycardia
enlarged heart
low voltage electrocardiogram

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16
Q

Hypothyroidism Symptoms in the Neck (5)

A 
Pain
Swelling
Tenderness
Nodules
Cysts
or could be asymptomatic
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17
Q

Neurological Symptoms of Hypothyroidism (3)

A

Paresthesia
Ataxia
Prolongation of DTR

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18
Q

Describe the hormone levels in HYPOthyroidism - TSH and T4

A

TSH: increased (normal 0.5-5.0 ug/mL)
Free T4: low or low-normal (normal 0.7-1.86 ng/dL)

thyroid is unable to produce sufficient quantities of hormone (low T4), so pituitary compensates further stimulating the thyroid (high TSH)

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19
Q

What is Hashimoto’s Disease?

What markers will be present?

A

Autoimmune thyroiditis
Positive test for antibodies - Anti-Tg and Anti-TPO
10 x more common in women

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20
Q

What is subclinical hypothyroidism? How is it treated?

A

Elevated TSH with normal free T4
TSH > 10: treat
TSH 5-10: monitor or possible trial of hormone replacement

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21
Q

What is Acquired Transient Central Hypothyroidism also known as Euthyroid Sick Syndrome?

A

Extremely ill patients with non thyroidal illness
Euthyroid with elevated TSH but normal free T4
It generally resolves without treatment, only treat if TSH > 10

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22
Q

What is Goiter?

A

Enlargement of Gland

can be uniform or diffuse; irregular or multi nodular

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23
Q

How is goiter managed?

A
  • Suppression Therapy: thyroid hormone replacement, decreases TSH stimulation
  • Rapidly enlarging - biopsy
  • If hypo or hyper treat for the condition
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24
Q

Diagnostic Testing: Serum TSH

A 
Primary Hypothyroidism
Primary Hyperthyroidism (over-replacement of hypothyroid state)
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25
Diagnostic Testing: Serum Free Thyroixine (FT4)
``` Estimates unbound (free) T4 HIGH = HYPER LOW = HYPO ```
26
Diagnostic Testing: Total Thyroxine
thyroxine is protein bound - drugs and conditions can alter the level HIGH = HYPER LOW = HYPO
27
Diagnostic Testing: Total and Free T3
useful for diagnosing HYPERthyroidism
28
Diagnostic Testing: Thyroglobulin
papillary or follicular thyroid cancer | may indicate: recurrent tumor
29
Diagnostic Testing: Thyroid Antibodies
autoimmune conditions HYPO: Hashimotos HYPER: Graves
30
What thyroid diagnostic test should you order first in an asymptomatic patient?
TSH initially if HIGH - T4 to confirm HYPO if LOW - T4 and total T3 HYPER
31
What is thyroid diagnostic test should you order first in a symptomatic patient or patient with risk factors?
Both TSH and free T4
32
Lab Abnormalities in Hypothyroid Conditions: LIPIDS
increased triglycerides and cholesterol | normalizes with treatment
33
Lab Abnormalities in Hypothyroid Conditions: Cellular Enzyme Elevation
CK - suggests myopathy AST and LDH normalizes with treatment
34
Lab Abnormalities in Hypothyroid Conditions: Hyponatremia
associated with SIADH | normalizes with treatment
35
Which patients should be screened for thyroid disorders?
Patients with: Atrial fibrillation, Osteoporosis, Hyperlipidemia, Diabetes Mellitus, Down or Turner's Syndrome Patients Taking: Amiodarone or Lithium
36
Radioactive Iodine Uptake Imaging
I131 Used for the evaluation of Nodules "Hot" less likely to be malignant
37
RAIU - Increased Uptake
Grave's Disease
38
RAIU - Decreased Uptake
Silent thyroiditis Subacute thyroiditis Postpartum thyroiditis Exogenous hyperthyroidism
39
RAIU - What does hot nodule and cold nodule mean?
Hot - take up iodine - overactive; can overproduce thyroid hormone Cold - under active thyroid
40
Thyroid Ultrasound Uses
following nodules determine character of nodule guidance of fine-needle aspiration
41
drugs that decrease TSH secretion (low serum TSH)
Dopamine | Glucocorticoids
42
drugs that INCREASE thyroid hormone secretion
Iodine | Amiodarone
43
drugs that DECREASE thyroid hormone secretion
Lithium Iodine Amiodarone
44
drugs that DECREASE T4 absorption
Ferrous Sulfate
45
drugs that INCREASE TBG concentration
Estrogens
46
Management of Hypothyroidism
Lifelong replacement therapy | Autoimmune causes - removal or ablation
47
Drug for Thyroid Replacement Therapy and Goal of Treatment
Levothyroxine - stay with same brand (bioequivalency issues) goal: normalize TSH (0.4-2.0 mIU/L) over-replacement if <0.3 risk osteoporosis and atrial fibrillation 6-8 weeks to stabilize; once stable check every 6 months to yearly
48
Thyroid Replacement for Healthy Patients
full dose 1.6 ug/kg/day reassess TSH in 6-8 weeks
49
Thyroid Replacement in Elderly Patients or those with Cardiac Disease
start low and go slow
50
Signs and Symptoms of Hyperthyroidism
``` Goiter Sweating of hands Weight loss Tiredness Palpitations Regular Pulse > 90 Lid Lag Dyspnea on Exertion Finger Tremor Nervousness Excessive Sweating Hot Hands Preference for Cold Exopthalmos Hyperkinesis Diarrhea Scant Menses Atrial Fibrillation ```
51
What is Apathetic Hyperthyroidism?
elderly patients present with minimal symptomology of hyperthyroidism
52
Signs and Symptoms of Graves Disease
Diffuse Nontoxic Goiter Ophthalmopathy: stare, lid lag, exopthalamos Dermopathy - pretibial myxedema Thyroid Acropachy - digital clubbing, periosteal reaction
53
Causes of Hyperthyroidism
``` Graves Toxic Multinodular Goiter Thyroid Nodule Thyroiditis Exogenous intake Medications: Amiodarone; iodine RARE: adenoma, trophoblastic disease, stuma ovarii ```
54
Complications of Hyperthyroidism
Very distressing Atrial Fibrillation CHF, Angina, MI, Sudden Death Osteoporosis
55
Hyperthyroidism Treatments
Radioiodine ablative therapy Sub-total thyroidectomy Antithyroid drugs Symptom treatments
56
Radioiodine Ablative Therapy
most common treatment for Graves | goal of treatment: Hypothyroidism
57
Sub-total Thyroidectomy
goal: leave enough gland to produce endogenous hormone spare: parathyroid glands, recurrent laryngeal nerves
58
Antithyroid Drugs
Propythiomuracil (PTU) and Methimazole decrease the production of thyroid hormones - important to monitor hormone levels preferred in pregnant patients side effects: agranulocytosis seek immediate care for fever or sore throat
59
Symptomatic Treatment of Hyperthyroidism
B-Blockers: tremor and heart rate Diltiazem & Verapamil Clonidine ** used until definitive treatment completed
60
What is Thyroid Storm?
Sudden severe exacerbation of thyrotoxicosis | often precipitated by trauma, infection, surgery
61
Symptoms of Thyroid Storm
fever severe tachycardia delirium
62
Treatment of Thyroid Storm
antithyroid drugs: PTU or methimazole high dose glucocorticoids potassium iodide to suppress further hormone release
63
Thyroid Nodule Risks for Malignancy
prior radiation < 30 years of age; > 60 family history
64
Evaluation of Thyroid Nodule
TSH, Free T4 and T3 Normal TSH: fine needle aspiration Benign: follow clinically Malignant: surgical referral
65
Multinodular Goiter
diffuse process identified on physical exam low risk of malignancy
66
Subacute Thyroiditis
cause: postviral s&s: anterior neck pain; elevated ESR tx: symptomatic - analgesics typically recover euthyroid
67
Painless Thyroiditis
``` autoimmune - leads to long term hypothyroidism no neck discomfort decreased uptake of radio iodine postpartum: w/in 1 year of delivery silent: not associated w/ childbirth ```
68
FOUR Phases of Thyroiditis
Hyperthyroid Euthyroid Hypothyroid Some recover to a euthyroid state

Adult/Ped Medicine 5 (17 decks)

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