Check TSH on: At birth and 2wks of age

American Thyroid Association:

All women> 35 y/o q 5yrs

AEndocrineA= all women by 50, pre/postpartum

Congenital Hypothyroidism

Physical Exam findings

Feeding problems

Hypotonia

edema of face and hands

mental retardation (can lead to)

short stature, delayed puberty, infertility

Hypothyroidism

Physical Exam

1. Thinning of the lateral 3rd of eyebrows

2. Corse dry skin and hair

3. thick tongue  and lips

4. delayed relaxation on DTRs

5. muscle weakness

Myxedema--> high TSH causing cutaneous and dermal edema

Medical emergency-->Findings:

1. hypothermia

2. hypoventilation

3. hyponatremia, Hypoglycemia

4. Hypoxia

5. hypercapnia

6. HoTN

TX: IV levothyroxine sodium and intubation

Diffuse toxic goiter HYPERTHYROIDISM

1. Thyroid stimulating immunoglogulin

2.Goiter, pretibial myxedema, Exophthalmosis

3. Labs: Elevated ANA

4. Thyroid scan--> shows increased uptake

Thyroidtoxicosis Factitia

Jod-Basedow Disease (Iodine induced Toxicosis)

Struma Ovarii-->Ovarian teratoma with thyroid tissue

Pituitary Tumor

Thyroiditis-->intially hyper

Thyroid Carcinoma

Decreased TSH

Increased T3 and T4

Increased TSH

Increased T3 and T4

Propranalol-->

Thiourea--> Methimazole, PTU (prego DOC)

Thyroid Surge--Complication reccurrent laryngeal nerve palsy

Thyroid Storm S/S

and

TX

Symptoms: Fever, Tachycardia, HTN, Confusion,Dilirium N/V/D, Sweating

TX:

1. PTU to stop synthesis of TH

2. Beta Blockers

3. Steroids to stop conversion of T4 to T3

Initially Hyper but results in  hypothyroidism

Supperative (acute) infx

Postpartum (subacute) 2-6 mo postpartum

Suppurative Thyroiditis

S/S

1. Septicemia

2. Fever, red neck

3. THYROID TENDER

Tx with Abx and I&D

Dequervain's Thyroiditis

ESR elevated

VERY LOW IODINE UPTAKE

TX: NSAIDS, levothyroxine

Chronic Lymphocitic Thyroiditis

(most common cause of goiter US)

Antibodies to thyroid peroxidase and thyroglobulin which causes gradual destruction of follicles

Nontender goiter

FNA shows lymphocytes and Hurthle cells

Hyperthyroid (toxic nodular goiter, Graves)

Hypothyroid( Hashimoto Thyroiditis)

Stimulation of TSH receptor in thyroid gland

this causes hyperplasia

Older age

Male

Anaplatic

Cervical LAD

Bone or Brain mets

Lack of I131 uptake into metz

MOST COMMY THYROID CA

Associated with Gardners Syndrome

TSH sensitive

Distant mets rare

High mets to LAD

Second most common

Spread-->local, Lymph and heme to:

Bone, Brain, lung

TSH Sensitive

Higher rate of Distant Mets

Affects parafollicular C cells-->produces calcitonin

RET proto oncogene  mutations

F/U post thyroidectomy annual calcitonin and carcinoembryonic antigen (CEA)

Most aggressive( median survival 8.1months)

Ssx: Dyspnea,hoarsness, palpable cervical mets early

Labs: TSH, Free T4/T3, antithyrotoxicosis Ab

First US then FNA in any nodule >15mm