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20 Cards in this Set

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what's the MCC of hyperthyroidism?
90% of cases are caused by:

Graves disease
Toxic multinodular goiter
Toxic solitary goiter
this disease results from IgG antibodies against the TSH – receptor
Grave's disease
Pt over 60 y/o with A-fib, weight loss, and HF, what do you think?
Hyperthyroidism
what are the cardinal signs of Graves’ disease?
Diffuse goiter
Vascular bruit over goiters
Pretibial myxoedema
Tachycardia with a bounding pulse
Exophthalmos
Lid lag
Lid retraction
Peri-orbital puffiness
Increased lacrimation
Conjunctival edema and ulceration
Name some Anti-thyroid drugs
Carbimazole
Propylthiouracil
Methimazole
How do you treat hyperthyroidism?
Treatment Options

Anti-thyroid drugs:
Carbimazole or methimazole followed by propylthiouracil

Beta-blocking drugs in the initial stages of management

Sub-total thyroidectomy
Radioactive iodine therapy

THE CHOICE OF THERAPY DEPENDS UPON A NUMBER OF FACTORS, ESPECIALLY THE PATIENTS AGE AND PREVIOUS HISTORY
MCC of Hypothyroidism
Hashimoto's (auto-immune) accounts for over 90% of cases

Drug induced (lithium carbonate inhibits the release of thyroid hormone); results in goiter
> TSH
< T3, < T4
Sign & symptoms of hypothyroidism, Which physical finding would you expect to find?
Enlarged thyroid gland due to Hashimoto's
S/Sx of Hypothyroid
Constipation
Bradycardia
Weight gain
Cold intolerance

< in growth velocity(children)

Pericardial & pleural effusions
How do you diagnose hypothyroidism?
Clinical suspicion
< DTRs
Low EKG voltage
T4 & TSH levels
Thyroid antibody assays
How do you treat hypothyroidism?
Thyroxine - start very slow 25 ug and increase every 4-6 weeks

sudden > in T4 will casue MIs in pts that have h/o ischemic heart disease
what is the function of PTH
regulates release of the calcium from bone, absorption of calcium in the intestine, and excretion of calcium in the urine
On a routine blood test, you find a high level of calcium, what do you suspect?
HPT
What are the mild symptoms of HPT?
often mild and nonspecific, such as:
weakness
fatigue

With more severe disease, a person may have:
anorexia
nausea/vomiting
constipation
confusion or impaired thinking and memory,
and increased thirst and urination
depression
aches and pains
how does hypoparathyroidism effect calcium and phosphorus?
Calcium levels in the blood fall, and phosphorus levels rise
what is the MCC of hypoparathyroidism?
injury to the parathyroid glands during head and neck surgery
What is DiGeorge syndrome?
congenital absence of the parathyroid glands
what are the S/Sx of HypoPTH?
Parasthesia
Tetany/larynx spasms (diff.breathing)
Convulsions/seizuers
Dry hair/skin
Catarats
What is the treatments of HypoPTH?
Oral calcium carbonate and Vit D
High calcium/low phosphorus diet
Periodic monitoring of blood calcium levels
what are some complications of HypoPTH?
acute tetany-resp.obstruction
growth/mental retardation
kidney function impairment, from hypercalcemia
increased risk of pernicious anemia, Addison's disease, cataract development, and Parkinson's disease