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17 Cards in this Set

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What are some causes of hypothyroidism?
primary: low T4, high TSH. Most commonly Hashimoto's thyroiditis. Find a lymphocytic infiltrate, autoimmune, 10 women per man.
Or iatrogenic/post-radioiodine therapy or following radiation.
secondary: low T4, low/normal TSH. secondary to tumors in pituitary or hypothalamus.
What are the signs and symptoms of hypothyroidism?
-Lethargy, fatigue, weight gain, constipation, cold intolerance, dry skin, hair loss, depression, menorrhagia.
-myxedematous face: pale yellow skin, large tongue, loss of outer third of eyebrows.
-hypothermia, slow speech, hoarse voice, bradycardia, milk hypertension, nonpitting edema, delayed DTR relaxation.
-Pericardial and pleural effusions.
-myxedema coma: hypothermia, hypoventilation, hyponatremia, depressed mental status.
What tests are used to diagnose hypothyroid?
T4, TSH, TPO antibodies. For primary hypothyroid, check for high TSH.
How do you treat hypothyroidism?
L-thyroxine (T4) replacement,
Goal: achieve euthyroid, rise slowly.
T3 and dessicated thyroid have no role in treatment.
What are polyglandular Deficiency Syndromes?
disorders in which two or more endocrine glands are either hypo or hyper functioning as a result of automimmune dysfunction.
the common link of primary adrenal insufficiency.
What problems are associated with Polyglandular endocrinopathy type 1?
autoimmune thyroid function (Hashimoto's/Graves'), hypoPTH, hypoadrenalism, hypogonadism, mucocutaneous candidiasis, alopecia.
Rarely type 1 diabetes.
Also prone to develop other autoimmune conditions.
Develops around 12 yo.
Wikipedia: also known as candidiasis-hypoPTH-Addison's syndrome, or Whitaker syndrome.
What problems are associated with polyglandular endocrinopathy type 2?
Autoimmune thyroid diseases (Hashimoto's/Graves'), hypoadrenalism, Type 1 diabetes.
Also prone to develop other autoimmune conditions.
Develops around 30 yo.
Also knows as Schmidt's syndrome (Wikipedia/syllabus)
70 % of poylglandular endocrinopathy.
What are some causes of primary hyperthyroidism?
Graves, nodular goiter, painful/painless thyroiditis, excess iodide in a genetically-predisposed person (seaweed, CT contrast, amiodarone)
What are causes of secondary hyperthyroidism?
exogenous thyroid hormone, thyroactive tumor (rare) (producing TSH or mole/choriocarcinoma (hCG)), struma ovarii (T4)
What causes high uptake hyperthyroidism?
Graves (diffuse toxic goiter), toxic multinodular goiter, toxic adenoma, TSH-induced hyperthyroid from tumor (rare), trophoblastic disease (Choriocarcinoma/mole, hCG stimulates the thyroid gland).
What causes low uptake hyperthryoidism?
painful thyroiditis, painless thyroiditis, iodine induced hyperthyroid (eg amiodarone), exogenous thyroid hormone, metastatic follicular cancer (rare)
What are the clinical features of hyperthyroidism?
heart: palpitations (Vtach, Afib), CHF
nerves: nervousness, agitation, tremor, emotional lability, proximal myopathy
repro: oligomenorrhea, decreased libido
eyes: grittiness, lacrimation, lid lag, lid retraction, proptosis, ophthalmoplegia
GI: N/V, hyperdefecation, wt loss with good appetite.
sweating, heat intolerance, swelling in neck.
What is the pathogenesis of Graves' disease?
hyperthyroidism is due to thyroid-stimulating immunoglobulins (IgG type) that stimulate the TSH receptor.
What are the symptoms of Graves' disease?
Goiter (diffuse enlargement with bruit) (25% of Graves have no goiter)
Ophthalmopathy-- Non infiltrative (grittiness, redness, lidlag, lid retraction) or infiltrative (pathognomonic) (proptosis due to decreased venous drainage -->edema and chemosis, extra-ocular motor palsy, ocular nerve entrapment)
Dermopathy: onycholysis (retracted nail beds), acropachy (clubbing, pathognomonic), pretibial myxedema (usually w/ eye probs, though eye problems can stand alone.)
What lab tests would you do for Graves' disease?
Free thyroxine, free T4 and TSH. Detectable TSH in the presence of elevated T4 points to a secondary cause. All primary hyperthyroid has low TSH.
Radioisotope studies can be used to differentiate high-uptake (eg Graves) from low-uptake (eg thyroditides).
What's painful thyroiditis?
Aka Subacute, granulomatous, or De Quervain's thyroiditis.
10-14 days after a viral URI, extreme pain and tenderness of theyroid gland.
1-2 months of hyperthyroid due to follicular destruction, then hypothyroid, then euthyroid in 3-6 months (self-limiting).
Treat symptoms with antiinflammatory or beta-blockers.
Tests: elevated T4, suppressed TSH, low iodine uptake, *sedimentation rate > 50-100.
What's painless thyroiditis?
a variant of Hashimoto's, lymphocytic thyroiditis.
Post-partum in 5 % of pregnancies.
Small painless goiter.
TPO antibody is present, low radioiodine uptake.
hyperthyroid, followed by hypothyroid, followed by euthyroid. No specific therapy.