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18 Cards in this Set
- Front
- Back
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Causes of hyperthyroidism
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1. Grave's disease (more common in young & middle aged)
2. toxic multinodular goiter (usually older) 3. Toxic adenoma 4. Thyroiditis - subacute, follows a virus, usually of the head/neck. VERY TENDER - painless thyroiditis (post-partum) 5. Increased TSH secretion (pituatary adenoma, thyroid hormone resistance) TSH and T4 will be high -rare |
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Clinical manifestations of hyperthyroidism
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Heat intolerance
brisk tendon reflexes nervousness fatigue wt loss palpitations/tachycardia frequent stools |
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Best initial test for hyperthyroidism
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TSH - it will be undetectable (< 0.1 or 0.05 uU/mL)
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what lab findings will you see with subclinical hyperthyroidism?
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Low TSH with normal T4 and/or T3
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Therapy for hyperthyroidism
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1. radioactive iodine is treatment of choice for most with Graves, MNG, or toxic adenoma - Contraindicated if PG
2.Propranolol is generally used for symptomatic relief until the hyperthyroidism is resolved 3. Thionamides (propylthiouracil), methimazoleis generally used for young adults or patients with mild thyrotoxicosis, small goiters, or fear of isotopes, Thionamides are ineffective against thyroiditits or nodules |
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What do you use to pretreat before thyroidectomy?
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Beta blocker and thionamide
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Thyroid screening is important in newborns to prevent?
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Cretinism
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TSH levels with subclinical hypothyroidism
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>5 and <20
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What is the best screening test for Cushing's?
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Late night salivary cortisol test. If cortisol is high, then Cushing's
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What would you suspect if a patient is hypertensive and hypokalemic?
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hyperaldosteronism
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Clinical manifestations of hyperaldosteronism
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- moderate to severe HTN
- hypokalemia - hypernatremia - metabolic alkalosis |
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Causes of Primary hyperaldosteronism
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adrenal adenoma
idiopathic (bilateral) hyperplasia |
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Causes of secondary hyperaldosteronism
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volume depletion, overactive renin-aldosterone system. (renal artery stenosis, juxtaglomerular cell tumor)
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Other syndromes that can cause hyperaldosteronism
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Cushing's, meds (florinef),
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What is the best screening test for hyperaldosteronism?
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upright plasma aldosterone/plasma renin activity ratio.
A PA/PRA >20 with PA >15ng/dl is suggestive of hyperaldosteronism |
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What is the definitive test for hyperaldosteronism?
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24 hr urine aldosterone metabolites
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Clinical manifestations of pheochromocytoma
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"Attacks" of headache, perspiration, palpitations, anxiety.
Hypertension, frequently sustained but often paroxysmal, especially during surgery or delivery orthostatic hypotension |
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pheochromocytoma are tumors that arise in?
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the adrenal medulla
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