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19 Cards in this Set
- Front
- Back
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graves disease
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-commonest cause of hyperthyroidism
-overproduction of thryoid hormones, causes an enlargement of the thyroid -autoimmune dz, due to circulating autoabs -thyroid stim immunoglobulins bind to and activate thyrotropin receptors, causing the thyroid gland to grow and the thyroid follicles to inc synthesis of thyroid hormone |
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graves pathogenesis
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-B and T lymphocyte-mediated autoimmunity are known to be directed at 4 well-known thyroid antigens:
1. thyroglobulin 2. thyroid peroxidase 3. sodium-iodide symporter 4. thyrotropin receptor* |
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thyroid stimulating ABs...
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cause release of thyroid hormone and thyroglobulin that is mediated by adenosine 3, 5-cyclic phosphate, and they also stim iodine uptake, protein synthesis and thyroid gland growth
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graves dz risk factors
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-enviornmental and genetic factors
-expression of a viral antigen or previously hidden antigen -the specificity crossover b/t diff cell antigens with an infectious agent or a superantigen -infxs- Y.enterocolitica, B. burgdorferi -iodine and drugs -irradiation -stress and smoking -spring and early summer |
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pospartum thyroid syndrome
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-both t and b cell function are diminished during preg, and the rebound from this immunosuppression is though to contribute to the development of postpartum thyroid syndrome
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graves- frequency
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-US: most common cause of hyperthyroidism
-internationally: 60-90% of all causes of thyrotoxicosis |
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graves- race
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-white and asian pop more susceptible
-susceptibility is influenced by genes in the human leukocyte antigen region on chromosome 6 and CTLA4 on band 2q33 |
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graves-sex
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-F>M
-females 30-60 |
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Graves ssx
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1. ophthalmopathy- lid lad, lid retraction, diplopia
2. pretibial myxedema 3. hypermetabolic- heat intol, inc sweating, restlessness, insomnia, wt loss 4. inc HR 5. warm, moist, fine skin 6. brisk reflexes 7. increased bone turnover, osteoporosis 8. tachycardia, palpitations, afib, angina 9. dyspnea |
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graves ssx cont
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10. dec GI transit time
11. polyuria, polydipsia 12. irreg menstrual periods, impotence 13. inc blood vol 14. normocytic anemia 15. dec total cholesterol levels |
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sx of ophthalmopathy
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-proptosis
-lid retraction -lacrimation -gritty sensation in the eye -photophobia -eye pain -diplopia -in elderly pts fewer sx are apparant to the pt |
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graves- non specific lab finding
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1. high serum bili
2. high aminotransferase 3. high ferritin 4. high sex hormone binding 5. hypercalciuria/hypercalcemia 6. glucose intolerance |
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graves- physical
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1. widening of palperbral fissues
2. hand tremor 3. proximal muscle weakness 4. brisk DTRs 5. thyroid gland diffusely enlarged and smooth; well-delineated pyramidal lobe; bruits and rarely thrills |
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graves other findings
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1. conjunctival irritation
2. gynecomastia 3. acropathy- clubbing of fingers 4; pretibial dermopathy 5. onycholysis- separation of nail |
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diagnosis/lab test
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1. TFTs
2. TSI 3. antithyroid ABs 4. baseline CBC and LFTs |
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indications for measuring TSHR ABs
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1. preg
2. orbitopathy 3. predicting remission/relapse in pts on antithyroid drugs |
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graves-tx
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1. antithyroid drugs: propylthiouracil (inc hepatotoxicity; dont use in kids) or methimazole
2. bblockers-to control HR 3. radioactive iodine therapy 4. surgery |
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graves course
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-20% pts can go into remission on antithyroid drugs alone
-30% may remain euthyroid for longer periods after stopping antithyroid drugs, 15% of these may develop autoimmune hypothyroidism -graves ophthalmopathy has an unpredictable course |
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thyrotoxicosis-other causes
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1. toxic nodular goiter
2. solitary hot nodule 3. thyroditis 4. exogenous source of thyroid hormone 5. TSH hypersecretion 6. trophoblast tumor 7. hyperemesis gravidarum 8. thyroid carcinoma 9. drug induced 10. radiation thyroiditis |
