Lec 7 - Endo - Thyroid Diseases 2

Front 1

MCC of thyrotoxicosis/hyperthyroidism

Back 1

grave's disease

Front 2

symptoms of hyperthyroidism related to weight

Back 2

weight LOSS with increased appetite

Front 3

hyperthyroidism will cause a patient to complain of feeling warm or cold?

Back 3

WARM

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pathogenesis of graves' disease

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autoimmune (HLA-DR3) with dysfunction of suppressor T cell to helper T cell ratio allows production of Ig that interacts with the TSH receptor mimicking TSH to cause synthesis of thyroid hormone

Front 5

treat graves' disease by

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beta blockers and thionamide medications (to prevent synthesis of thyroid hormone), radioiodine ablation (most preferred treatment but takes a long time), surgical resection (immediate cure)

Front 6

side effects of thionamide meds

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agranulocytosis, fulminant hepatitis

Front 7

toxic adenoma

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hyperfunctioning nodule that makes a lot of thyroxine --> thyrotoxicosis

Front 8

ethanol injection is used to treat

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toxic adenoma by causing local destruction of the nodule; rarely done in the US, cures 80% of patients

Front 9

thyroid storm

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extreme form of hyperthyroidism

Front 10

how to treat thyroid storm

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beta blockers (to prevent prolif of hormones in blood), anti thyroid drugs (methimazole, steroids to prevent immune crisis), iodine (must always give AFTER thionamides) via paradoxical wholf chaikoff effect

Front 11

apathetic hyperthyroidism

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asymptomatic hyperthyroidism in elderly; most common presentation is tachycardia with afib and muscle weakness and fatigue

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symptoms of thyroid storm

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tachycardia with cardiac arrhythmia, hyperpyrexia, prostration, GI disturbances

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subclinical hyperthyroidism lab findings

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decreased TSH, normal FT4 and FT3

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amiodarone

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iodine containing drug that increases iodine pool and decreases peripheral conversion t4 to t3; falsely decreases RAIU and causes either hypo or hyperthyroidism

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dif between primary vs secondary/tertiary hypothyroidism

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primary will have low FT4 and high TSH, whereas secondary or tertiary will have low FT4 and low TSH

Front 16

myxedema is referred to patients with what?

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severe HYPOthyroidism

Front 17

MCC of hypothyroidism in adults

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hashimoto's thyroiditis

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levothyroxine

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synthetically made T4; most commonly prescribed for HYPOthyroidism

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myxedema coma

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extreme form of hypothyroidism; causes depression of respiratory center, hypothermia, hypoglycemia and hyponatremia

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lab findings for primary hypothyroidism

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low FT4 and high TSH; total T3 will remain normal until condition becomes very severe

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most common thyroid cancer

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papillary carcinoma

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when does papillary thyroid cancer occur and in whom?

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30-50 yo women

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prognosis of pt with papillary thyroid cancer

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high long term survival rates

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where does follicular thyroid cancer like to metastasize?

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lungs and bone

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medullary thyroid cancer

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neoplasia of the parafollicular cell that can be sporadic or familial (MEN types 2A/2B associated with RET oncogene)

Front 26

how to diagnose for medullary thyroid cancer

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calcitonin estimations, genetics for RET mutation

Front 27

ANAPLASTIC THYROID cancer

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undifferentiated tumor of thyroid follicular epithelium that is very aggressive and metastasizes to lungs, liver, and bone, more common in women (~65 yo)