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