Endocrinology: Diseases Of The Thyroid

Front 1

The Endocrine System?

Back 1

-The endocrine system is a complex network of glands, hormones, and receptors

Front 2

What else about the endocrine system?

Back 2

-Provides key communication and control link between the NS and Bodily FXNS such as reproduction, immunity, metablolism, and behavior
-The NS works in TANDEM with the endococrine system to control all bodily fxns and processess

Front 3

6 Essential Hormone FXNS?

Back 3

-DIFFERENTAION of reproductive and CBS in the developing fetus
-STIMULATION of sequential growth and development during childhood and adolescence
-COORDINATION of male and female reproductive systems, which makes sexual reproduction possible
-MAINTENANCE of an optimal internal enviornment t/o the life span
-INITIATION of collective adaptive responses when emergency demands occur
-REGULATION of responses(in conj with CNS) to the internal and external enviornment

Front 4

Throid anatomy?

Back 4

-15-20 gms
-The Thryorid secretes moslty T4 and very little T3
-Iodine is essential to maintain euthroid fxn

Front 5

FXN of Thyroid hormone?

Back 5

-Diurnal pattern
-Increases metabolic rate and protein synthesis
-Inc bone, protein, and fat turnover
-Increases response to catecholamines
-Nec for fetal and infand G and D

Front 6

FXNS of Thyroid Gland cont:

Back 6

-Metabolic rate
-CV/respiratory fxn
-GI FXN
-NM effects
notes pg 2

Front 7

Goiter?

Back 7

-increase in size of thyroid
-usu palpable
-can occur in hypothyroid, euthyroid, hyperthyroid states
-diffused or nodular
-hypertrophy of tissue from thyroid hormone out malfunction

Front 8

What can Goiters do?

Back 8

* Large goiters can compress the esophagus, trachea, superior vena cave in extreme cases!

Front 9

Hypothyroidism?

Back 9

-Congenital
-prev cause of mental retard
-1:5000 births
Due to lack of thyroid gland or insufficient prod of hormone (TH or TSH)
-Infants may appear normal at first due to maternal hormones
-Results in CRETINISM

Front 10

Causes of Hypothyroidism?

Back 10

-Pituitary
-Hypothalamic dysfn
-Post-menopausal women (Commonly seen)

Front 11

Signs and sxms of Cong. hypothyroidism?

Back 11

-Mental retard
-Growth impair
-Poor psycomotor development

Front 12

Labs of Hypothyroidism?

Back 12

-Thyroxine (T4) is low to normal
-TSH is high
-Increased serum chol, liver enzymes, creatine kinase, hypoglycemia, and anemia

Front 13

Tx for hypothyroidism?

Back 13

Levothyroxine(T4)
-take in am with water and no food or Fe+++
-initial dose 50-100 MCG daily
-SUPP contiues for life!

Front 14

Thryoiditis?

Back 14

-Inflammation of the thyroid gland
-May occur post pregnancy
-Hashimotos Thyroiditis

Front 15

Hashimoto's Thyroiditis?

Back 15

-**Most common form of Thyroiditis
-Most common thyroid disorder in US
-Familial
-Greater in Women
-Freq increased by dietary iodine supplements and some medications

Front 16

Hashimoto's Thyroiditis signs and sxms:?

Back 16

-Diffuse PAINLESS ENLARGEMENT of thyroid gland
-Depression, chronic fatigue
-Neck tightness, dry mouth
-Lost of natural skin lub with sebum

Front 17

What does Hashimotos progress to?
Lab findings too?

Back 17

-Transient hyperthyroidism

follow with serial labs
Labs:
Increased circulation levels of anti thyroid peroxidase
-Increased levels of anti-thyroglobulin

Front 18

Tx of Hashimoto's?

Back 18

-if hyperthyroid is present tx with Propanalol then once conv to hypothyroid state = Levothyroxine

Front 19

Myxedema Coma?

Back 19

-Hypothyroidism with edema due to infiltration of a glycosaminoglycan that traps H20 into connective tissue and dermis.
Signs and symptoms:
-Hypothermic, stuperous state with dull expressionless face, sparce hair, periorbital puffiness, large tongue, and pale, doughy, cool skin
-Brought on by illness or cold exposure
*Severe form of hypothyroidism

Front 20

Hyperthyroidism?

Back 20

-Tactile temp
-Elevated heart rate
-Anxious/Nervous
-Diarrhea
-WT loss
-Palpatations
-Menstrual irregularities
Physical:
-warm,moist skin
-Tachycardia
-A fib**
-Exophthalmia
-Eyelid lag or staring
-Fine tremor
-+/- Goiter
-Chronic, long term can reslut with Osteoporosis

Front 21

DX Hyperthyroidism?

Back 21

-Increased T3 and T4
-Decreased TSH
-RAIU
-CT scan and US

Front 22

Unusual causes of Hyperthyroidism?

Back 22

-TSH secreting tumors
-Normal pregnancy
-Amiodarone, radiographic contrast media, iodine preps

Front 23

Grave's DZ?

Back 23

-Occurs at any age, freq middle age
-AUTOIMMUNE DZ with anti-microsomal and anti-thyroglobulin antibodies
-*Most common casue of hyperthyroidisn-80% of all cases

Front 24

What is the most common cause of
Hyperthyroidism?

Back 24

Grave's DZ

Front 25

Myxedema coma is what type of thryoidism?

Back 25

Hypothyroidsim

Front 26

What else can you find with Grave's DZ?

Back 26

-Thyroid bruit
-Visual disturbances, dry eyes
-Pretibial edema(swollen shins)
-Diffuse overactivity of thyroid(Radioiodine scan)

Front 27

2 important clinical manifestations with Grave's dz?

Back 27

-Exophthalmoses
-Pre-tibial Myxedema

Front 28

TX for Grave's?

Back 28

-Propanolol for symptomatic relief
-Tapizol
-PTU *DOC for Hyperthyroid!
-Iodated contrast agents work by blocking conversion of T4 and T3 (Telepaque, Bilvist)
-Radiation (Radiated Iodine)
-Surgery

Front 29

Complications of Thyrotoxicosis?

Back 29

-Cardiac (Tachy, A-fib)
-Decreased libido, impotence, decreased sperm count and gynecomastia
-Osteoporisis

Front 30

Complications of Grave's:
Thyroid Storm?

Back 30

-Life threatining complication
-Occurs post physiologic stress
(DKA, emotional stress, trauma, surgery, infxn, labor)
-High mortality

Front 31

SXMS of Thyroid Storm?

Back 31

-Tachycardia, AFIB
-Fever
-Confusion
-agitation
-Psychosis
-NV, diarrhea

Front 32

TX for Thryoid storm?

Back 32

PTU, Methimazole, Ipodate, Iodine

Front 33

Subacute Thyroiditis?

Back 33

AKA de Quervains Thyroiditis
-acute fever with rapid thyroid enlargement
-VERY PAINFUL thyroid**
-Young and middle age women
-Dysphagia, pain may radiate to pts ears
-usu follows viral infxn

Front 34

Subacute Thyroiditis labs?

Back 34

-ESR very elevated
-Low anti-tyroid antibodies
-Radioactive iodine uptake low
-asp biopsy reveals granulomatous infiltratio and inflammation
-Low T4/T3
-Euthroid then hypothyroid

Front 35

Subacute Throiditis tx?

Back 35

Empirical
-Aspirin 325 mg Q6
-Propanalol 10-40mg Q6
-Sodium Ipodate or Iopanoic acid daily until T4 levels normalize
Levothroxine if symptomatic

Front 36

Solitary nodules?

Back 36

-most often ja benign adenoma, nodule or cyst
-Occ a primary thyroid malignancy
-Need to work up for malignancy

Front 37

#1 cause of Thyroid CA?

Back 37

Radiation!

Front 38

A cancerous nodule is?

Back 38

-non-tender

Front 39

Low level of suspicion for Thyroid nodules?

Back 39

-HX family, hyper, hypo
-older women, elderly
-soft nodules-multi nodular
-TSH low or high would help rule out CA
-Thyroid antibodies
-Fine needle aspiration biopsy: Nodule or adenoma
-Thyroxine TX
-Hot nodule is a good sign**

Front 40

High level of suspicion for Tyroid nodules?

Back 40

-Rad tx
-Family hx thyroid ca/dz
--Dysphonia with nodule
-young adults
-male
-hard, painless, immobile tyroind nodule
-Thyrotoxicosis

Front 41

Thyroglobulin is a marker for?

Back 41

Thyroid CA

Front 42

Ultrasound?

Back 42

-determine palpable nodule is solitary or one of many underlying nodules
-directs fine needle aspiration bx
-determine solid vers cystic mass

Front 43

Papillary carcinoma 75% least aggresive =

Back 43

Indolent(slow growing)

Front 44

Anaplastic carcinoma 5%

Back 44

worst one

Front 45

Cold nodule?

Back 45

Malignancy

Front 46

TX for thyroid Ca?

Back 46

-Thyroidectomy
-Radioactive iodine (I 131)
-Rad tx
-Brain metastasis-Gamma knife

Front 47

Multi-nodular goiters?

Back 47

Usually benign
-Caused by
iod def
preg
graves
Hasimoto
sub acut thyroiditis
infns
-Usu not symptomatic
if it is:
-Propanalol
-Thyroidctomy
-Radioactive Iodine 131