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56 Cards in this Set
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The two major thyroid hormones.
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Thyroxine (T4) and triiodothyronine (T3)
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Most sensitive test for primary hypothyroidism and hyperthyroidism
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Serum TSH (sensitive assay)
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High in primary and low in secondary hypothyroidism
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Serum TSH
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Elevated in Hashimoto thyroiditis
which causes hypothyroidism |
Anti-thyroglobulin
& anti-thyro-peroxidase antibodies |
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1) In Graves Dz What will TSH Labs be?
T3 FT3 2) I-123 scan 3) Antithyroglobulin antimicrosomal antibodies 4) Thyroid stimulating immunoglobulin levels be in Hyperthyroidism? |
1) Low
except for adenoma high 2) increased diffuse uptake 3) high in graves 4) high in graves. |
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Best diagnostic method for thyroid cancer
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Fine-needle aspiration (FNA) biopsy
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Vascular versus avascular nuke med study for thyroid nodules
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Tc99
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this imaging is:
Useful to assist FNA biopsy. assessing risk of malignancy. monitor nodules and pts after thyroid surgery for carcinoma. |
Utrasound
US |
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The MOST COMMON CAUSE of hypothyroidism.
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Hashimoto thyroiditis
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Resection of thyroid gland
goiter viral thyroiditis chemotherapy amiodarone and hepatitis all can cause what thyroid problem? |
Hypothyroidism
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Hypothyroidism developing in infancy or early childhood
CAUSES what condition S/S: Impaired development of skeletal system & CNS severe mental retardation short stature coarse facial features a protruding tongue and umbilical hernia. |
Cretinism
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The severity of the mental impairment in cretinism seems to be directly influenced by
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The time at which
thyroid deficiency occurs in utero. If there is maternal thyroid deficiency before the development of the fetal thyroid gland mental retardation is severe. |
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Weight gain
fatigue lethargy depression weakness dyspnea on exertion arthralgias or myalgias muscle cramps paresthesias cold intolerance constipation dry skin HA carpal tunnel syndrome menorrhagia. |
Signs and symptoms of hypothyroidism
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Bradycardia
diastolic HTN thin brittle nails thinning of hair peripheral edema puffy face and eyelids skin pallor or yellowing delayed relaxation of dtrs and often a palpably enlarged thyroid or goiter. |
Hypothyroidism
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Refers to severe
life-threatening hypothyroidism that is often induced by an underlying infection cardiac respiratory or CNS illness cold exposure or drug use. |
Myxedema
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Impaired cognition
ranging from confusion to somnolence to coma. Convulsions and abnormal CNS signs may occur. Severe hypothermia hypoglycemia hypotension. Rhabdomyolysis Acute Renal Injury. This condition is a Sequle of a Dz is ?condition? |
Myxedema
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Sever & Refractory hyponatremia
Unusually sensitive to opioids and may die from average opioid doses |
Myxedema
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Complications are mostly cardiac in nature. Increased susceptibility to infection. Megacolon
Organic psychoses with paranoid delusions coma |
Hypothyroidism complications
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Thyroid replacement therapy for hypothyroidism Drug of choice
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Levothyroxine (T4)
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How long does it take to reach peak levels of thyroid hormone after tx with levothyroxine?
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3-4 wks
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What caution should you follow in thyroid replacement for elderly or cardiac patients?
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Lower doses
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What caution should you follow in thyroid replacement for pregnant patients
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Higher doses
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What caution should you follow in thyroid replacement in regards to consistency?
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Patients should stay with the same brand because there are slightly different bioavailabilities
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An autoimmune Dz/disorder
resulting in increased synthesis and release of thyroid hormone. Associated w pernicious anemia myasthenia gravis DM. Familial with HLA association. |
Graves disease
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Non-Graves hyperthyroidism generally will not have
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Autoantibodies
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Nervousness
restlessness heat intolerance sweating pruritis fatigue weakness muscle cramps frequent bowel movements weight loss palpitations angina pectoris menstrual irregularities. |
Thyrotoxicosis
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Thyrotoxicosis is the hypermetabolic condition associated with elevated levels of free thyroxine
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Stare and lid lag
resting finger tremors moist warm skin hyperreflexia fine hair onycholysis upper eyelid retraction lid lag with downward gaze staring appearance osteoporosis clubbing and swelling of fingers |
Thyrotoxicosis
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In addition to signs of thyrotoxicosis:
THIS Dz ALSO CAUSES THESE: Ophthalmopathy consisting of conjunctival edema (chemosis) conjunctivitis mild exophthalmos (proptosis). Sometimes diplopia. |
Graves Dz
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What are 2 advantages to tx hyperthyroidism with thiourea drugs?
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use during
pregnancy & breastfeeding less chance of hypothyroidism than radiation or surgery |
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What are advantages to tx hyperthyroidism with iodinated contrast agents?
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Good for thyroid storm
few side effects |
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What are advantages to tx hyperthyroidism with radioactive iodine?
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Permanent
no increased risk of CA |
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What is the major advantage to tx hyperthyroidism with surgery?
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Permanent
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What are disadvantages to tx hyperthyroidism with methods other than surgery?
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Temporary
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What are 2 disadvantages to tx hyperthyroidism with surgery?
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Hypoparathyroidism
hypothyroidism |
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Triggered by
stressful illness thyroid surgery radiation therapy. Signs of delirium severe tachycardia vomiting diarrhea dehydration very high fever. Treated with a Thiourea Iodine propanolol hydrocortisone. |
Thyroid crisis or “storm.”
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Ocular
cardiac and psychological complications Increased long term risks of death from thyroid disease CVD stroke and femur fracture. |
Common sequelae of
Hyperthyroidism |
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Thyroiditis caused by autoimmune. Thyroid diffusely enlarged
firm & finely nodular. May lead to hypothyroidism or transient thyrotoxicosis. Tx goiter or hypothyroid w/T4 |
Hashimoto
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Acute painful enlarged thyroid gland
w dysphagia. Antithyroid antibody titers low. Dyspnea. Thyroiditis caused by viral infection is called __ __ Thyroiditis. Tx pain w/ ? thyrotoxicosis w ? hypothyroidism w ? |
Subacute de Quervain
thyroiditis Tx on H+ |
Tx:
Pain = ASA Thyrotoxicosis = propranolol Hypothyroidism = t4 |
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Caused by infection other than viral
Fever severe pain tenderness redness fluctuation around thyroid gland. Leukocyte count ESR elevated. Txs: Rx Tx = ? What kind of physical Tx when fluctuation is marked. |
Suppurative thyroiditis
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Tx
Antibiotics. Surgical drainage when fluctuation is marked. |
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Previous therapeutic radiation of head
neck or chest hoarseness Young adults men solitary firm nodule vocal cord paralysis enlarged lymph nodes distant metastatic lesions Elevated serum calcitonin |
Risk factors that would increase the likelihood that a thyroid nodule is malignant.
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"cold" nodule
increase in size w thyroxine therapy. Solid on US. |
Risk factors that would increase the likelihood that a thyroid nodule is malignant.
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Biopsy results of Papillary carcinoma
follicular lesion medullary or anaplastic carcinoma |
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Thyroid nodules are an indication for what next step by the PA.
Which labs? |
Thyroid tests
TSH Hashimotos test FNA biopsy Thyroid function testing - Serum determinations for TSH (sensitive assay) FT4 are preferred. May do antibody test for Hashimoto's thyroiditis but suspicious nodules should always be biopsied. Biopsy is the best method to assess a thyroid nodule |
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Hypofunctioning Nodules aka:
Cold Nodules have a somewhat increased risk of |
Being malignant
most are benign. Hyperfunctioning (hot) nodules are ordinarily benign but may sometimes be malignant. |
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Exogenous
Risk fctr & threat for Children who then have an increased lifetime risk of developing thyroid pathology. |
Radiation therapy to the head and neck
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The most common thyroid malignancy.
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Papillary thyroid carcinoma
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My Papi got the #1 thyroid carcinoma.
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Generally more aggressive than papillary carcinoma and it accounts for about 14% of thyroid malignancies.
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Follicular thyroid carcinoma
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Palpable
firm nontender nodule in the thyroid. |
Possible thyroid cancer
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More apt to be advanced at the time of diagnosis
presenting with dysphagia hoarseness dyspnea and metastases to the lungs. |
Anaplastic thyroid carcinoma
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Ana cant sing nor talk!
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Thyroid function tests are generally what?
{elevated or lowered or normal?} when there is thyroid malignancy |
Normal
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Should be performed routinely on all patients with thyroid cancer for the initial diagnosis and for follow-up. Useful in determining the size and location of the malignancy as well as the location of any neck metastases.
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US
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Is less sensitive than ultrasound for detecting metastases within the neck.
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CT
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Particularly useful for imaging bone metastases.
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MRI
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Complications of what?
Metastases secretion of prostaglandins pheochromocytoma hyperparathyroidism. |
Complications of thyroid carcinoma
vary with type |
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Endemic goiter is associated with
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A low-iodine diet.
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Two chemical families that cause a
hypermetabolism similar to a hyperthyroid state |
Nitrophenol
(herbicides like dinoseb) pentachlorophenols (wood preservatives). |
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Stimulation of oxidative metabolism in cell mitochondria
by the uncoupling of Oxidative Phosphorylation mimics hyperthyroidism |
Nitrophenol
(Herbicides like Dinoseb) Pentachlorophenols (wood preservatives). |
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