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46 Cards in this Set
- Front
- Back
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What is the typical presentation of excess thyroid hormone
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1. Increased Metabolism
2. Increased heat production 3. Increased catecholamine excess |
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What are the symptoms of excess thyroid hormone
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1. Weight loss
2. Nervous/anxious/insomnia 3. Sweating/hot 4. Palpitations 5. Tremor |
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What would you see on the examination of a pt who has excess thyroid
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1. Weight loss
2. Tachycardia 3. Atrial fibrilation 4. Lig lad and stare |
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How can elderly patients with excess thyroid present
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Depression like symptoms and weight loss
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What is Apathetic Hyperthyroidism
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Don't have a lot of symptoms except for atrial fibrillation (happens a lot in elderly)
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What is your ddx for thyrotoxicosis
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1. GRAVES DISEASE
2. Nodule 3. Thyroiditis 4. Exogenous thyroid hormone 5. hCG mediated |
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1. What is Graves Disease
2. Is it more common in men or women 3. What is the pathogenesis |
1. Autoimmune disease
2. Women 3. Stimulating IgG antibodies against TSH receptor (thyroid stimulating antibodies or thyroid stimulating immunoglobulins) |
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1. What is an effect on the eyes due to Graves Disease
2. What is a risk factor |
1. Autoimmune attack of the orbital tissue causing inflammation (Proptosis)
Can be independent of thyroid disease 2. Smoking |
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How do you diagnose Graves Disease
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1. Low TSH
2. High T4/T3 3. Family history of autoimmune disease 4. Diffuse radioactive iodine uptake 5. TSH receptor antibodies (good incases pregnant/breast feeding) |
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What is the treatment for Graves disease
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Treat symptoms: Beta blocker untel hyperthyroid improves
Treat Hyperthyroidism: Anti-thyroid medication Radioactive iodine ablation |
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What are the 2 types of Nodular thyrotoxicosis
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1. Multinodular goiter (small nodules that are hyper functioning)
2. Toxic adenoma (one big nodule that is hyper functioning) |
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What is a multi nodular goiter
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Nodules become autonomous (don't listen to TSH feedback)
> 50 years old Can be precipitated by an iodine load |
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What is the diagnosis for mulitnodular goiter
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A lot of nodes on palpation or on ultra should
Patchy Radioactive iodine uptake |
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What is the treatment for a multi nodular goiter
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Anti thyroid medication
Radioactive iodine ablation Surgery |
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What is a toxic adenoma
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One nodule that become autonomous
Mutation in TSH receptor (always on) |
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How do you diagnose Toxic adenoma
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Big nodule on exam/ultra sound
Hot nodule on radioactive iodine |
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What is the treatment for Toxic Adenoma
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Radioactive ablation (best one to treat using this)
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What is thyroiditis
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Stored T4 and T3 is released from a damaged gland
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What are the subtypes of thyroiditis
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1. Painless
2. Post Partum 3. Painful |
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What are the symptoms of thyroiditis
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1. Referred ear pain
2. High fever 3. Muscle ache |
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1. What causes painless/post partum thyroiditis
2. How long does hyperthyroid last |
1.thyroid directed autoimmunity
2. Painless = 1-2 months Postpartum = 3-6 months |
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How do you diagnose Thyroiditis
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Low TSH, High T4/T3
Radioactive iodine absent (because its just the stores that are released nothing new is being made) |
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What is the treatment for Thyroiditis
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Treat symptoms: beta blocker, NSAIDS/ steroids to help with pain
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What is Thyroiditis Factitia
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Exogenous thyroid hormone
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How does Thyroiditis Factitia happen
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On purpose or accidental
Low TSH, hight T4/T3 Low iodine uptake |
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How do you differentiate between thyroiditis and exogenous thyroid hormone
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Do a thyroglobulin level (high in thyroiditis and low in exogenous thyroid hormone)
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What is the drug class called for anti -thyroid medications
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Thioamides
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What are the 2 thioamides
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1. Methimazole
2. Propylthiouracil (PTU) |
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What is the MOA of thioamides
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Inhibit enzyme TPO (inhibits the formation of thyroid hormone)
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Which thioamide is preferred
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Methimazole because it fixes the hyperthyroidism more quickly and fewer side effects
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When do you want to use PTU
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Drug choice in pregnancy because methimazole causes birth defect in first trimester
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What are the side effects of methimazole
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Rash
Agranulocytosis ANCA - vasculitis |
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When is radio iodine ablation contraindicated
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Pregnancy and severe graves opthalmopathy
Avoid pregnancy 6 months after treatment |
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What is the main effect of radio iodine ablation
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Hypothyroidism
Monitor thyroid q4-6 weeks after treatment |
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What are the symptoms of decreased thyroid hormone
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1. Cold intolerance
2. Tired 3. Constipated 4. Low mood 5. Weight gain |
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What would you find on examination of hypothyroidism
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1. Bradycardia
2. Hypertension 3. Dry skin, hair and puffy 4. Hoarse voice 5. Delayed relaxation phase of reflexes |
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What are the differential diagnosis
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1. Low TSH, Low T3/T4 = Pituitary problem (Secondary hypothyroidism)
2. High TSH, Low T3/T4 = Thyroid problem (primary hypothyroidism) |
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What are the potential ddx for Primary Hypothyroidism
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1. Hashimoto thyroiditis
2. Congenital 3. Gland destruction (surgery) 4. Drugs - Lithium, Amiodarone 5. Iodine deficiency |
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What is the most common cause of hypothyroidism in North America
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Hashimoto's Thyroiditis
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What is the Pathogenesis of Hashimoto's
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Autoimmune destruction of the thyroid gland
High levels of TPO and anti-thyroglobulin antibodies but they are not pathogenic Firm goitre |
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How do you treat hypothyroidism
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1. T4 replacement
2. Wait 4-6 weeks to adjust dose because it takes 5 half lives to reach steady state 3. Dose should increase 30-50% immediately once pregnancy confirmed |
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What interferes with the absorption of T4
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Iron and Calcium
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What is it important to do an ultra sound on a nodule
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Because 5% of these will be thyroid cancer
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What are some history risk factor for thyroid nodules
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1. Rapid growth
2. Family history of thyroid cancer 3. Previous head and neck radiation |
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What do you do a TSH and Ultrasound for a nodule
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TSH = because hot nodules are almost never cancer
Ultrasound = because we suck at palpating nodules |
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What happens if TSH is low or norma/high
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Low = oder T4 and a radioiodine scan (if nodule is hyper functioning no cytology needed)
Normal/High = Do fine need aspiration if risk factors, > 1-1.5 cm or large lymph nodes |
