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Thyroid 2


Graves dz: etiology Auto-antibody reacting with the TSH receptor. Thyroid-stimulating immunoglobulin (TSI) 80-95% positive
Graves dz: exam Symmetric non-tender goiter (80%) - bruit pathognomonic. Ocular findings (30%). Pretibial myxedema. Fine hair. Fine tremor of tongue. Hyper DTRs.
Female, weight loss, palpitations, atrial fibrillation Hyperthyroid (work it up with TSH, T4)
Exopthalmos, palpitations, wt. loss. Elevated radioactive iodine uptake (RAIU) Hyperthyroid, Graves Dx
Post thyroidectomy: monitor for this electrolyte abnormality Hypocalcemia
Graves dz: predictors of remission small goiter (decreases w/thioamides, eg, PTU); FT3 predominance; neg TSI titer (IgG Ab vs thyroid cell TSH rec)
toxic multinodular goiter etiology multicell autonomic fn
toxic multinodular goiter exam >50 yo. Large irregular asymmetric nodular thyroid. TSH, FT4, FT3, uptake & scan
Toxic thyroid nodule: etiology activation of TSH receptors via receptor gene mutation
Multinodular goiters 2-4% prev in iodine-sufficient areas; F 5-15 x M; multifactorial; genetic cause?
HLA-B8 & HLA-DR3: associated with: Graves dz
thyroid neoplasm s/s painless neck swelling; single firm nontender nodule: stony, hard gland; medullary: flushing, Cushing; anaplastic: hoarse (recurrent laryng n.)
toxic multinodular goiter Tx Rx RAI
Toxic nodule: etiology activation of TSH receptors via rec gene mutation
Toxic nodule: exam 30-40 yo; large irreg nodular thyroid; onycholysis; TSH, FT4, uptake & scan; Rx RAI
Multinodular goiters 2-4% prev in iodine-sufficient areas; F 5-15 x M; multifactorial; genetic cause?
Multinodular goiters: tx thyroxine suppression of TSH; surg if obstruction
Thyroid nodule/neoplasia: exam benign hx; s/s hypo or hyper; tender nod; FH hypo, nod, or goiter
Thyroid nodule: eval for neoplasm TSH; US (80%); FNA is TOC; indicated esp if >1cm. CT may help in large nodule (assess for tracheal compression)
Most likely post-thyroidectomy injury Recurrent laryngeal nerve = hoarseness
Non-Graves causes of hyperthyroidism Toxic multinodular goiter, solitary hyperfunctioning nodule, early deQuervain, exogenous thyroid hormone, secondary hyper 2/2 pituitary tumor
Hyperthyroid sx/sx Anxiety, poor concentration, insomnia, emotional, tremor. Wt loss, diarrhea. Dyspnea, palps, ?HF. Sweating, hot, fatigue, diplopia.
Hyperthyroid tx RAI is TOC in non-PG pt. PTU. Methimazole (preferred but CI in PG). Beta blockers for sxs. Surgery for recalcitrant dz
Thyroid storm sx/sx high fever, delirium, N/V, tremor, dehydration. +/-A-fib, hypotension.
Thyroid storm mgmt IV Na iodide. PTU/methimazole. glucocorticoids (prevent peripheral T3->T4 conversion)
thyroid nodule: suspect neoplasm if: rapid growth, fixed (do movement w/swallow). Early h/o head/neck XRT. Young male. Hoarse/vocal cord paralysis. Punctate calcification. Increase in size w/thyroxine tx
4 types of thyroid nodule Papillary (50-80%), follicular (20%), medullary (<10%), anaplastic (5-10%, most aggressive). F>M, <20 yo and >70 yo
On histology, fronds and psammoma bodies (laminated microcalcifications) are noted: Papillary thyroid cancer
Type of thyroid cancer associate with pheochromocytoma, parathyroid adenoma, and neuroma: Medullary
Type of thyroid cancer: patients are in 5th decade; slow-growing, may be associated with bone mets: Follicular
Signs of hyperthyroidism with cervical LAD suggest: malignancy
Thyroid cancer mgmt Radioactive iodine ablation +/- chemo (doxorubicin)
Papillary thyroid cancer: surgical tx Thyroid lobectomy and isthmectomy
Medullary thyroid cancer: surgical tx Total thyroidectomy required (bc of multicentricity)
Follicular thyroid cancer: surgical tx Near-total thyroidectomy is favored
Anaplastic thyroid cancer: surgical tx Total thyroidectomy and radical neck dissection for resectable tumors. Surgery in most cases is palliative
Created by: Abarnard