Hyperthyroidism And Hypothyroidism

Front 1

What is the pathogenesis of Grave's disease?

Back 1

Grave's disease - thyroid-stimulating immunoglobulin antibody binds to TSH receptors on thyroid cells and triggers the synthesis of thyroid hormone

Front 2

What is the pathogenesis of Plummer's disease?

Back 2

Hyperfunctioning areas that produce high T4 and T3, low TSH, atrophy of areas not producing thyroid hormone

Front 3

What are the signs and symptoms of hyperthyroidism?

Back 3

Symptoms: insomnia, hand tremor, heat intolerance, weight loss, palpitations, muscle weakness
Signs: enlarged thyroid gland, proptosis, arrhythmias, pretibial myxedema, brisk deep tendon reflexes

Front 4

How do you diagnose hyperthyroidism?

Back 4

Serum TSH level is the initial test of choice; should be low

Front 5

What are the treatment types for hyperthyroidism?

Back 5

1) Methimazole or propylthiouracil (PTU) inhibits thyroid hormone synthesis; PTU inhibits conversion of T4 to T3
2) Beta-blockers for acute management of symptoms such as palpitations, tremors, anxiety, tachycardia, sweating and muscle weakness
3) Iopanoic acid lowers T3 and T4 levels
4) Radioiodine 131 causes destruction of thyroid follicular cells; used for Graves' and contraindicated in pregnancy, complication of hypothyroidism
5) Subtotal thyroidectomy is reserved for patients with large goiters

Front 6

How do you treat hyperthyroidism?

Back 6

1) Beta blocker for immediate control of adrenergic symptoms
2) Start methimazole with beta-blocker for non-pregnant patients
3) PTU for pregnant patients
4) Radioactive iodine ablation therapy; causes hypothyroidism

Front 7

What is a thyroid storm?

Back 7

Life-threatening complication of thyrotoxicosis with exacerbation of hyperthyroidism; precipitating factor such as stress or illness
*Fever, tachycardia, psychosis, confusion, GI symptoms

Front 8

How do you treat thyroid storm?

Back 8

IV fluids, cooling blankets, glucose, antithyroid agents, beta blockers

Front 9

What causes hypothyroidism?

Back 9

1) Hashimoto's disease
2) Iatrogenic causes from treatments of hyperthyroidism (radioiodine, thyroidectomy, medications)
3) Pituitary or hypothalamic disease

Front 10

What are the signs and symptoms of hypothyroidism?

Back 10

Fatigue, cold intolerance, constipation, inability to concentrate, depression
Dry skin, coarse hair, nonpitting edema, slow deep tendon reflexes, bradycardia, goiter

Front 11

How can you make a diagnosis of hypothyroidism?

Back 11

TSH test, high TSH level is the most sensitive indicator of hypothyroidism
*Also low T4 level in patients with clinically overt hypothyroidism
*Elevated LDL and low HDL

Front 12

How do you treat hypothyroidism?

Back 12

Levothyroxine (T4) is the treatment is choice, continued indefinitely, effective at achieving a euthyroid state