Thyroid – hyperthyroidism Flashcards Preview

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Flashcards in Thyroid – hyperthyroidism Deck (15)
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1
Q

Hyperthyroidism

A

Thyroid making too much thyroid hormone

2
Q

Thyrotoxicosis

A

Too much thyroid hormone for any reason

Exogenous hormone
Thyroid inflammation

3
Q

S/s of thyrotoxicosis

A
Tachycardia
Palpitations
Anxiety
Wt loss
Heat intolerance
Hyperactivity
Warm skin

Low TSH

4
Q

Toxic adenoma/multinodular goiter

A

Focal patches of hyper-functioning follicular cells

Mutation in TSH receptor

Hyperthyroidism w/o exophthalamos and pretibial myxedema

Radioactive iodine study – increased uptake – hot nodule

5
Q

Graves Disease

A

MC
Autoimmune
TSI (IgG Ab) binds TSH receptor -> secretion of T3, T4

Assoc w/ HLA-DR3, HLA-B8
4:1 female predominance

radioactive iodine study: increased uptake – diffusely

Features:
Exophthalmos
Pretibial myxedema
Warm, dry skin, thin hair
Tachycardia, palpitations
Muscle atrophy
Wt loss
Bowel hypermotility
Decreased or absent menstrual flow
Tx:
Methimazole (preferred) propulthiouracil (PTU) – inhibit thyroid production
b-blockers – tachycardia and anxiety
Radioactive iodine over months
Surgical removal
6
Q

Methimazole

A

Inhibits peroxidase in thyroid

Se:
AGRANULOCYTOSIS
Cause severe pharyngitis, pharyngeal abscesses

Cross placenta

  • > fetal goiter and hypothyroidism
  • > fetal aplasia cutis in first trimester

safe in pregnancy 2nd and 3rd trimesters – preferred

7
Q

Propylthiouracil (PTU)

A

Inhibits peroxidase in thyroid
Inhibits peripheral conversion of T4 -> T3

SE:
AGRANULOCYTOSIS
Liver dysfunction

8
Q

Struma ovarii teratoma

A

Contains functional thyroid tissue -> hyperthyroidism

9
Q

Thyroid storm (Thyrotoxic crisis)

A

Rare

Increased body temperature
Altered metnal status
Tachycardia, arrhythmias
V/D, dehydration
Coma
Death 20%

Tx:
Beta-blocker
Methimazole or PTU

10
Q

Causes of thyroiditis

A

Hashimoto
Subacute thyroiditis
Pregnancy and post partum – self limited, low uptake on scan

Overdose of thyroid medication – prescribed, factitious, accidental
-low uptake on scan

transient hyperthyroid – release d/t inflammation
-> normal or hypothyroid depending on damage

11
Q

Suspected thyrotoxicosis w/ normal TSH and T3/T4 ddx

A

Consider menopause, panic attack, anxiety, pheochromocytoma

12
Q

Suspected thyrotoxicosis w/ low TSH and high T3/T4 with low iodine uptake thyroid scan

A

Subacute thyroiditis:
Hx of URI
Painful tender thyroid gland

Excess T3/T4 dosing -> exogenous thyrotoxicosis

13
Q

Suspected thyrotoxicosis w/ low TSH and high T3/T4 with single hot nodule on iodine uptake thyroid scan

A

Thyroid adenoma

14
Q

Suspected thyrotoxicosis w/ low TSH and high T3/T4 with multiple hot and cold nodules on iodine uptake thyroid scan

A

Toxic multinodular goiter

15
Q

Suspected thyrotoxicosis w/ low TSH and high T3/T4 with diffuse uptake on iodine uptake thyroid scan

A

Grave’s disease

  • TSI
  • Exophthalmos
  • Thyroid bruit

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