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Endocrinology
Thyroid Disorders Part 2
35
Medical
Graduate
05/03/2010

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Term
What are the s/sx of thyroid storm? (5)
Definition
1)High temps (104-106F) 2)Tachycardia 3)Arrythmias 4)CHF 5)Extreme agitation or psychosis
Term
What are the tx for thyroid storm?
Definition
Anti-thyroid meds, inorganic iodine, BB
Term
Differentiate b/t primary and secondary hypothyroidism.
Definition
Primary - thyroid can't produce enough hormone. Secondary - pituitary doesn't stim. thyroid to prod. hormone
Term
The incidence of hypothyroidism becomes increasingly common with _____.
Definition
Advancing age
Term
Which type of hypothyroidism is most common, primary or secondary?
Definition
Primary - 95% of cases
Term
Name 5 causes of primary hypothyroidism.
Definition
1)Idiopathic 2)Hashimoto's 3)Late stage invasive fibrous thyroiditis 4)Iodine def. 5)Tx for Grave's dz (irradiation or thyroidectomy)
Term
Name 2 drugs that can cause primary hypothyroidism.
Definition
Lithium and interferon
Term
Name 4 infiltrative dz that cause hypothyroidism.
Definition
1)Sarcoidosis 2)Amyloidosis 3)Scleroderma 4)Hemochromatosis
Term
Name 3 causes of secondary hypothyroidism.
Definition
1)Pituitary or hypothalmic neoplasm 2)Congenital 3)Pituitary necrosis (Sheehan's syndrome)
Term
What are global s/sx of hypothyroidism?
Definition
Weakness, lethargy, cold intolerance, forgetfullness, decreased sweating
Term
Name skin/hair changes in hypothyroidism.
Definition
Dry/coarse skin, cold skin, pallor, coarse hair
Term
What are facial/speech s/sx of hypothyroidism?
Definition
Eyelid/facial edema, thick tongue, slow speech
Term
What is a GI sx of hypothyroidism?
Definition
Constipation
Term
What lab findings are expected in primary hypothyroidism?
Definition
Elevated TSH and low free thyroid hormone
Term
What lab findings are expected in secondary hypothyroidism?
Definition
Low or undetectable TSH
Term
What is the tx for hypothyroidism?
Definition
Thyroid HRT
Term
What conditions necessitate higher dosages of thyroid HRT?
Definition
Conditions that increase serum binding proteins (high estrogen states, OCP, post-menopausal HT)
Term
What conditions necessitate decreased doasges of thyroid HRT?
Definition
Conditions that decrease serum binding proteins (androgens, elderly, nephrosis, protein losing enteropathies, cirrhosis)
Term
what is subclinical hypothyroidism?
Definition
Mildly elevated TSH w/ normal T3/T4, reflects early failure
Term
Name 2 risk factors for thyroid CA.
Definition
Age and females
Term
What is the MC type of thyroid CA?
Definition
Papillary (75%)
Term
What gender has the worst prognosis for thyroid CA?
Definition
Male
Term
What are red flags for thyroid CA? (5)
Definition
1)Age <20 or >65 2)Rapid growth 3)Dysphagia, hoarseness, neck pain 4)h/o XRT to neck or head 5)Fhx thyroid CA or polyposis
Term
What is the prognosis of papillary thyroid CA?
Definition
Good, esp. for >45yo
Term
What is the tx for most types of thyroid CA to reduce risk of local recurrence?
Definition
Radioactive Iodine-131 therapy
Term
What types of thyroid CA do not respone to radioactive iodine?
Definition
Medullary and anaplastic
Term
what is the most aggresive form of thyroid CA? Describe it.
Definition
Anaplastic thyroid CA, present in elderly w/ rapidly enlarging mass in a multinodular goiter
Term
Which type of thyroid CA causes flushing and diarrhea in 30% of pts? What causes these sx?
Definition
Medullary, serotonic and prostaglandins
Term
What is the clinical finding in thyroid CA?
Definition
Palpable, firm, non-tender nodule
Term
What are lab findings in thyroid CA?
Definition
Thyroid function test normal, high serum thyroglobulin
Term
Increased calcitonic levels in which type of thyroid CA is a good indicator of recurrence?
Definition
Medullary
Term
What is the preferred test to distinguish b/t malignant and benign thyroid nodules?
Definition
FNA bx
Term
What are risks associated with radical neck surgery for thyroid CA?
Definition
Permanent hypothyroidism or hypoparathyroidism, or vocal cord paralysis d/t recurrent laryngeal n. damage
Term
What is the TOC for thyroid CA?
Definition
Thyroidectomy w/ limited removal of cervical lymph nodes
Term
What is the surgical TOC for medullary thyroid CA?
Definition
Radical neck dissection
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