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Thyroid 1

Endocrine

QuestionAnswer
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
Created by: Abarnard