Question | Answer |
Subacute thyroiditis (early) AKA: | deQuervain’s |
Silent or painless thyroiditis (early) AKA: | Hashitoxicosis |
thyroiditis (early): course: | hyperthy (1-3 mo); then hypothy (1-3 mo); then euthyroid |
hypothyroid prevalence | 2% of US F (0.2% US M); 1 in 4000 newborns |
Hypothyroid etiology | Primary (Hashimoto/autoimmune); atrophy; meds, lithium; Post thyroid surg; secondary or tertiary/central. World: iodine deficiency |
Hashimoto etiology | cytotoxic anti-thy Ab's (80-90% antithyroglobulin); >50 yo |
subacute thyroiditis etio | TH leak due to viral infxn -> thy gland destruction |
subacute thyroiditis: exam | Fever; large irreg very tender thyroid; TSH, FT4, FT3, thyroglobulin, ESR, uptake & scan(result: zero) |
subacute thyroiditis: Tx | ASA/ NSAIDs; prednisone |
silent thyroiditis: etio | transient autoimmune dysfn (often post-partum); sudden onset of hyperthyroid |
silent thyroiditis: exam & Tx | large nodular thyroid; TSH, FT4, FT3, anti-thy Ab (30%), uptake & scan; Rx beta blocker |
levothyroxine adverse effects | Osteoporosis; Inc cardiac contractility; Inc risk of A-fib; Allergic rxn dye in tablets |
Hypothyroid management | Thyroid replacment. Monitor at 6 weeks after starting & changing dose. May need to decrease AC, insulin, oral DM meds. Cholestyramine may increase T4 requirements. |
Decreased radioactive iodine uptake, decreased free T4, increased TSH | Hashimoto thyroiditis |
Infant w/ round face, large protruding tongue, dry skin, umbilical hernia, constipation, enlarged abdomen, poor feeding, delayed devt milestones = | Congenital Hypothyroidism |
Wt gain, edema, coarse dry skin, hair, menorrhagia, cold intolerance, h/o transphenoidal surgery & radiation | Hypothyroidism |
Primary hypothyroidism | Thyroid gland fails to make T4; TSH is HIGH; FREE T4 is LOW |
Secondary hypothyroidism: | Pituitary gland fails to make TSH; poss sequela of panhypopituitarism; TSH is inappropriately LOW; FREE T4 is LOW |
Hypothyroid S/S | Cold intolerance; fatigue; slowed cognition; depression; menorrhagia; weight gain; constipation; myxedema coma |
Secondary hypothyroidism: you cannot: | Follow TSH to adjust thyroid hormone replacement (must also follow Free T4) |
hypothyroidism & low normal TSH, low normal T4: consider: | Secondary hypothyroidism |
Subacute thyroiditis (early) AKA: | deQuervain; middle age F |
Silent or painless thyroiditis (early) AKA: | Hashitoxicosis |
thyroiditis (early): course: | hyperthy (1-3 mo); then hypothy (1-3 mo); then euthyroid |
Hypothyroid etiology (3) | Primary; goiterous; central |
Hashimoto etiology | cytotoxic anti-thy Ab's (80-90% antithyroglobulin); >50 yo |
subacute thyroiditis etio | TH leak d/t viral infxn => thy gland destn; summer peak |
subacute thyroiditis: exam | Fever; lg irreg very tender thy; dysphagia; pain may radiate to ears |
silent thyroiditis: etio | transient autoimmune dysfn (often post-partum); sudden onset of hyperthyroid |
silent thyroiditis: exam & Tx | large nod thy; TSH, FT4, FT3, anti-thy Ab (30%), uptake & scan; Rx beta blocker |
Myxedema Coma: findings | Emergency: elderly in winter; Hypothermia; Resp depression; Unconsciousness |
Hypothyroid exam | Brittle nails; dry skin; thinning lateral eyebrows; puffy face; nonpitting LE edema; decreased mx strength; DTRs delayed; brady, diastolic HTN |
osteoporosis, clubbing, finger swelling may be 2/2: | chronic thyrotoxicosis |
Thyroiditis: subacute vs suppurative: exam | Both: fever, tenderness. Suppurative: fluctuant, erythema |
Thyroiditis: subacute vs suppurative: Tx | Suppurative: Abx, drainage. Subacute: tx with aspirin |