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42 Cards in this Set
- Front
- Back
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Lecture 22
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thyroid I
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look at slide 8 (lecture 22)
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Thyroid hormone effects:
-Regulates ... -Improves cardiac ... -Increases sensitivity to ... -Increases ... motility -Increases ... of muscle contraction -Decreases ... (a good effect) -Required for proper fetal ... growth |
basal metabolic rate
contractility catecholamines bowel speed cholesterol (LDL) neural |
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*Thyroid Hormone*
Majority of circulating hormone is ... -98.5% ... -1.5% ... Total Hormone load is influenced by serum binding proteins -... 70% -Albumin 15% -Transthyretin 10% The ... component of thyroid hormone is the biologically active form |
T4
T4 T3 Thyroid Binding Globulin (thyroid binding protein) free |
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*Thyroid Antibodies*
-... used as marker for thyroid cancer mets after surgery -High titres ... in Hashimoto's & Reidel’s thyroiditis -... in peripheral resistance to Thyroxine -... in Graves’ Hyperthyroidism |
Anti-TG (thyroglobulin)
TPO Ab (Anti thyroxine peroxidase) Anti thyroxine Ab TSA (thyroid stimulating antibodies) |
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*What initial tests should I order ?*
As per the Guidelines: 1. ... alone if Hypothyroidism is suspected 2. ... and ... only if Hyperthyroidism is suspected or for routine evaluation 3. ... if T3 toxicosis is suspected 4. For follow-up of treatment only ... 5. Don’t order ... or ... |
TSH
TSH and Free T4 Free T3 TSH Total T4 or Total T3 |
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look at slide 28
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*... *
Epidemiology -Most common endocrine disease -Females:Males ~ 8 : 1 -Often unsuspected and grossly under diagnosed -90-95 % of the cases are ... |
Hypothyroidism
Primary Hypothyroidism |
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symptoms of hypothyroidism:
fatigue, dry skin, ... intolerance, hair loss, constipation, weight ..., hoarseness, difficulty concentrating, depressed mood, dyspnea (late effect – enlargement of the gland), menorrhagia, paresthesia, decreased hearing. |
cold
gain |
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Signs of Hypothyroidism:
... skin ... extremities Swelling of face, hands, feet (...) -accumulation of increased amounts of ... and chondroitin sulfate in the dermis Alopecia Bradycardia Peripheral edema Decreased muscle stretch reflexes Carpal tunnel syndrome |
Dry
Cool myxedema hyaluronic acid |
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*Causes of Hypothyroidism*
Primary -Autoimmune -... thyroiditis, Atrophic thyroiditis -Drugs -..., antithyroid drugs, amiodarone -... excess -Radioactive iodine treatment -... thyroiditis -Iodine deficiency (rare in US) -Thyroidectomy (total or subtotal) -Inborn errors of thyroid hormone synthesis -Infiltrative disease - amyloidosis, sarcoidosis, hemochromatosis, ... thyroiditis (scar tissue) |
Hashimoto's
lithium Iodine Subacute Riedel's |
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*Causes of Hypothyroidism*
Secondary - Hypopituitarism -pituitary adenoma -pituitary surgery -pituitary radiation -... syndrome (pituitary necrosis usually due to hypotension caused by blood loss during delivery) -... disorders (amyloid, sarcoid) -genetic pituitary deficiency -Bexarotene treatment Tertiary -... dysfunction (rare) Peripheral resistance to action of thyroid hormone |
Sheehan's
infiltrative Hypothalamic |
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look at slide 40 (lecture 22)
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Many Causes, One Treatment*
-Treatment of choice for hypothyroidism is ... -Goal : Normalize ... level regardless of cause of hypothyroidism -Average dose of daily ... required is 1.6µg/kg/day -Start low and go slow -Monitor ... levels at 6 to 8 weeks, after initiation of therapy or dosage change |
levothyroxine (T4)
TSH levothyroxine TSH |
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*Start low and go slow!* (hypothyroid tx)
-Starting dose for healthy patients < 50 years at ... µg/kg/day -Starting dose for healthy patients > 50 years should be < ... µg/day. Dose increase by 25 µg, if needed, at 6 to 8 weeks intervals. -Starting dose for patients with heart disease should be ... to ... µg/day and increase by 12.5 to 25 µg/day, if needed, at 6 to 8 weeks intervals |
1.0
50 12.5 to 25 |
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lecture 25 – thyroid II
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look at slide 5 (lecture 25)
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*Hyperthyroidism*
Epidemiology -Affects 2% of ... and 0.2% of ... in US -60-80% of cases are due to ... disease *... dz: Peak age of 20-40 yo |
women
men Graves Graves |
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*Symptoms of Thyrotoxicosis*
Nervousness Irritability Weight ... Fatigue Palpitations ... intolerance Amenorrhea/Menometrorrhagia Burning eyes Muscle ... Diarrhea |
loss
Heat weakness |
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*Signs of Thyrotoxicosis*
-Tachycardia or ... arrhythmia -... hypertension -..., moist, and smooth skin -Lid lag -Tremor -Muscle weakness -... (Graves disease only) -... tissue inflammation (Graves disease only) -... myxedema (Graves disease only) |
atrial
Systolic Warm Proptosis Extraocular Pretibial |
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*Graves Disease*
-Graves disease is the most common cause of ... (~60%) -Organ-specific ... disorder characterized by a variety of circulating antibodies, including common autoimmune antibodies, antithyroid peroxidase (anti-TPO), and antithyroglobulin (anti-TG) antibodies -The most important autoantibody is ... -... is directed toward epitopes of the thyroid-stimulating hormone (TSH) receptor and acts as a TSH-receptor agonist |
thyrotoxicosis
autoimmune thyroid-stimulating immunoglobulin (TSI) TSI |
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*Graves Disease*
Similar to TSH, TSI binds to the TSH receptor on the ... cells to activate thyroid hormone synthesis and release and thyroid growth (hypertrophy) Results in the characteristic picture of Graves thyrotoxicosis, with a ... enlarged thyroid, very ... radioactive iodine uptake, and ... thyroid hormone levels |
thyroid follicular
diffusely high excessive |
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look at slide 16 (lecture 25)
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*Graves Disease*
Clinical findings specific to Graves disease -thyroid ... (periorbital edema, chemosis, injection, and proptosis) -... over the lower extremities- rare Associations -May be seen with other autoimmune diseases such as pernicious anemia, myasthenia gravis, vitiligo, adrenal insufficiency, and type 1 diabetes mellitus |
ophthalmopathy
dermopathy |
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*... *
-Causes approximately 15-20% of cases of thyrotoxicosis -Occurs more commonly in elderly individuals, especially in patients with a long-standing goiter -Thyroid hormone excess develops very slowly over time and often is only mildly elevated at the time of diagnosis -Very high thyroid hormone levels may occur in this condition after high iodine intake -Symptoms of thyrotoxicosis are often mild and the signs and symptoms of thyrotoxicosis often are blunted (... hyperthyroidism) in older patients -Nuclear scintigraphy scan typically demonstrates an enlarged thyroid gland with areas of increased and decreased activity |
Toxic Multinodular Goiter
apathetic |
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*...*
-Causes approximately 15-20% of cases of thyrotoxicosis -A destructive RELEASE of preformed thyroid hormone -Abrupt onset of thyrotoxic symptoms as hormone leaks from an inflamed gland -A typical nuclear scintigraphy scan shows ... radioactive iodine uptake in the thyrotoxic phase of the disease -Thyroid hormone levels can be extremely elevated in this condition. -Often follows a ... illness -Symptoms usually resolve within eight months -This condition can be recurrent in some patients |
Subacute Thyroiditis
no viral |
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*... *
-Causes approximately 3-5% of cases of thyrotoxicosis -Age 35-50 yo -Result of a single hyperfunctioning follicular thyroid adenoma -Excess secretion of thyroid hormone occurs from a benign monoclonal tumor that usually is larger than 2.5 cm in diameter -Excess thyroid hormone suppresses ... levels -Radioactive iodine uptake usually is ..., and the radioactive iodine scan shows only the ... nodule, with the remainder of the normal thyroid gland suppressed because the TSH level is ... |
Toxic Adenoma
TSH normal hot low |
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*Treatment Options* (hyperthyroid)
Symptom relief medications Anti Thyroid Drugs – ATD -Methimazole, Carbimazole -... Radioactive Iodine treatment ... – Subtotal or Total NSAIDs and Corticosteroids –> ... Thyroiditis |
Propylthiouracil (PTU)
Thyroidectomy Subacute |
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*Symptom Relief* (hyperthyroid)
Many of the neurological and cardiovascular symptoms of thyrotoxicosis are relieved by ... therapy Examine the patient for signs and symptoms of ... that often occur with hyperthyroidism After oral rehydration, ... therapy can be started Do not administer ... therapy to a patient with a significant history of asthma |
beta-blocker
dehydration beta-blocker beta-blocker |
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*Symptom Relief* (hyperthyroid)
... can be used for the same purposes when beta-blockers are contraindicated or poorly tolerated. |
Calcium channel blockers
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Antithyroid drugs:
... – very potent, CI in pregnancy, MOA is iodination/coupling, no action in conversion of T4 to T3, rashes, neutropenia, 5 to 20 mg PO tid. ... – potent, can safely be given in pregnancy, MOA is iodination/coupling, inhibits conversion of T4 to T3, rashes, neutropenia, 100 to 150 mg PO qid. slide 27 |
Methimazole
Propylthiouracil |
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*... Treatment*
-Most common treatment of hyperthyroidism in adults in the United States -The effect is ... rapid than antithyroid medication or thyroidectomy, it is effective, safe, and does not require hospitalization -It is administered ... as a single dose, in capsule or liquid form -The ... is quickly absorbed and taken up by the thyroid. |
Radioactive Iodine (RAI)
less orally radioactive iodine |
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*Radioactive Iodine (RAI) Treatment*
No other tissue or organ in the body is capable of retaining the radioactive iodine and, therefore, very few adverse effects are associated with this therapy Indicated in: women who ... pregnant, in cases of toxic ... and toxic ..., in Graves disease not remitting with ... |
are not
multinodular goiter adenoma ATD |
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*Radioactive Iodine (RAI) Treatment*
-I... is used for Diagnostic Nuclear Scintigraphy -I... is given for RAI treatment -Goal is to make the patient ... -Will not cure thyroid cancer or other malignancies -Never given for ... and pregnant/ lactating women -Not recommended with patients of severe ... (may cause temporary worsening of the eyes) |
123
131 hypothyroid children Ophthalmopathy |
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Surgical Treatment (not commonly used):
Subtotal Thyroidectomy, Total Thyroidectomy ATD and RAI Rx are very effective Surgical treatment is reserved for -MNG with severe hyperthyroidism in ... -... women who can’t tolerate ATD -Large goiters with severe ... -Large MNGs with ... symptoms -Pts that require ... normalization of thyroid function |
children
Pregnant ophthalmopathy pressure quick |
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look at slide 35 (lecture 25)
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ok
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If you have a shrunken thyroid, and high T4 levels, think of ...
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thyrotoxicosis factitia
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*Thyrotoxicosis Factitia*
-Excessive intake of ... causing thyrotoxicosis -Patients usually deny – it is willful ingestion -This primarily ... disorder -May lead to wrong diagnosis and wrong treatment -They are clinically thyrotoxic without ... signs of Graves -High doses of Thyroxine lead to TSH suppression -This causes ... of the thyroid -Stop ... and give symptom relief drugs |
Thyroxine
psychiatric eye shrinkage Thyroxine |
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*Palpable Thyroid Nodules*
-Occur in 4 to 7 percent of the population -Thyroid ... occurs in roughly 5 to 10 percent of palpable nodules -Most thyroid nodules are ... -Most patients are euthyroid (will have normal thyroid function tests) |
carcinoma
asymptomatic |
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*Red Flags for Thyroid Cancer*
-... gender -Extremes in age (younger than 20 years and older than 65 years) -... growth of nodule -Symptoms of local invasion (dysphagia, neck pain, hoarseness) -History of ... to the head or neck -Family history of thyroid cancer or polyposis (... syndrome) |
Male
Rapid radiation Gardner's |
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Review questions: thyroid clinical
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A 2-year-old child living in Stockholm is small for his age and exhibits profound mental retardation. On physical examination he has dry, coarse skin. Which of the following pathologic features involving the thyroid gland is this child most likely to have?
1. Papillary adenoma 2. Diffuse hyperplasia 3. Granulomatous inflammation 4. Metastatic carcinoma 5. Marked atrophy |
5. Marked atrophy
Congenital hypothyroidism |
