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17 Cards in this Set
- Front
- Back
What are some causes of hypothyroidism?
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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. |
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What are the signs and symptoms of hypothyroidism?
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-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. |
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What tests are used to diagnose hypothyroid?
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T4, TSH, TPO antibodies. For primary hypothyroid, check for high TSH.
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How do you treat hypothyroidism?
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L-thyroxine (T4) replacement,
Goal: achieve euthyroid, rise slowly. T3 and dessicated thyroid have no role in treatment. |
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What are polyglandular Deficiency Syndromes?
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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. |
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What problems are associated with Polyglandular endocrinopathy type 1?
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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. |
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What problems are associated with polyglandular endocrinopathy type 2?
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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. |
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What are some causes of primary hyperthyroidism?
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Graves, nodular goiter, painful/painless thyroiditis, excess iodide in a genetically-predisposed person (seaweed, CT contrast, amiodarone)
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What are causes of secondary hyperthyroidism?
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exogenous thyroid hormone, thyroactive tumor (rare) (producing TSH or mole/choriocarcinoma (hCG)), struma ovarii (T4)
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What causes high uptake hyperthyroidism?
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Graves (diffuse toxic goiter), toxic multinodular goiter, toxic adenoma, TSH-induced hyperthyroid from tumor (rare), trophoblastic disease (Choriocarcinoma/mole, hCG stimulates the thyroid gland).
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What causes low uptake hyperthryoidism?
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painful thyroiditis, painless thyroiditis, iodine induced hyperthyroid (eg amiodarone), exogenous thyroid hormone, metastatic follicular cancer (rare)
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What are the clinical features of hyperthyroidism?
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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. |
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What is the pathogenesis of Graves' disease?
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hyperthyroidism is due to thyroid-stimulating immunoglobulins (IgG type) that stimulate the TSH receptor.
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What are the symptoms of Graves' disease?
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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.) |
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What lab tests would you do for Graves' disease?
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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). |
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What's painful thyroiditis?
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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. |
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What's painless thyroiditis?
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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. |