Labs and Scans
What happens to TSH and T4 in hyper/hypothyroidism
Hyper: TSH is low, T4 is high
Hypo: TSH is high, T4 is low
What is the pathophysiology of Graves Disease?
Autoimmune process in which antibodies stimulate the TSH receptor leading to overproduction of thyroid hormones
What is the most common cause of hypothyroidism?
Pregnancy is associated with INCREASED or DECREASED levothyroxine requirements?
Increased as early as 4th week of gestation
Which musician was known as the “King of Pop”?
Michael Jackson
What pattern is seen on thyroid uptake scan for Graves?
Homogenous uptake
What are the pathognomonic signs for Graves ?
Pathognomonic for Graves disease include orbitopathy, pretibial myxedema (thyroid dermopathy), and thyroid acropachy, which occur in 25%, 1.5%, and 0.3% of patients, respectively
What is the pathophysiology of hypothyroidism and name 3 signs/symptoms of hypothyroidism.
Hypometabolic state that results from a deficiency in T4 and T3. Major clinical manifestations are fatigue, lethargy, cold intolerance, hair loss, dry skin, weight gain, constipation
What happens to the TSH levels in pregnancy?
TSH levels decrease in early pregnancy because of weak stimulation of TSH receptors by human chorionic gonadotropin in the first trimester, then return to normal throughout pregnancy.
Which member of One Direction left the band to become a solo artist?
Zayn Malik
What causes:
Low TSH, elevated free T4, high uptake with nodular distribution in multiple areas?
Toxic Multinodular Adenoma
What are the three different treatment options for Graves?
Medications: Methimazole or Propylthiouracil, radioactive iodine ablation of the thyroid gland or surgical thyroidectomy
What medication is used to treat hypothyroidism and how should the medication be taken?
Levothyroxine should be taken once per day, 30 to 60 minutes before eating, and four hours before or after drugs that may impede absorption
What should pregnant women who have hypothyroidism do with their levothyroxine dose?
Once pregnancy is confirmed, patients with existing hypothyroidism should start taking an extra dose of levothyroxine two days per week for a total of nine doses per week. This significantly decreases the risk of maternal hypothyroidism during the first trimester. Further treatment is guided by measuring TSH levels at the first prenatal visit, then every four weeks with titration of levothyroxine according to the pregnancy-specific TSH reference range. The lower and upper limits of normal TSH drift downward during pregnancy
Which musician is the most nominated woman at the Grammy Awards?
Beyonce
What causes:
Low TSH levels, elevated free T4 levels, low uptake on radioactive scan?
Thyroiditis, ectopic thyroid hormone and/or exogenous thyroid hormone.
Which one of the medications used to treat Graves is safe in pregnancy? What are the side effects of the other medication if used in pregnancy?
PTU is safe for the fetus in the first trimester
Methimazole can cause aplasia cutis if used in the first trimester of pregnancy
Name at least 2 drug to drug interactions with levothyroxine
DM medications-may increase dose of DM medications to achieve glycemic control
Digitalis-May decrease serum digitalis levels
Foods-Walnuts, fiber supplements, soybean flour, grapefruit juice may require higher doses of levothyroxine
Ketamine-If used together monitor for HTN and tachycardia
Oral anticoagulants-May increase effects
SSRI/TCA-May increase therapeutic and toxic effects
When do we treat subclinical hypothyroidism?
In non-pregnant patients with subclinical hypothyroidism, levothyroxine therapy should be considered when the TSH level is greater than 10 mIU per L or the TPO antibody level is elevated.
How many times did Ross Geller get divorced on Friends?
Three times (Carol, Emily, Rachel)
What causes:
Elevated TSH, elevated free T4 and total T3 levels?
TSH-secreting pituitary adenoma
What is the treatment of choice in the United States for Graves disease? This treatment aggravates what sign/symptom of Graves?
Radioactive iodine ablation is the treatment of choice. It can aggravate Graves orbitopathy so avoid this treatment in these patient's.
What are the three subtypes/classification of hypothyroidism and their origin?
Primary-Thyroid origin
Secondary-Pituitary origin
Tertiary-Hypothalamus origin
Severe hypothyroidism can cause BLANK which is a medical emergency. Lab work can show hypoglycemia, hyponatremia, high TSH, very low FT4, and low cortisol if associated adrenal insufficiency. Name the medical emergency and what is the treatment for this medical emergency?
Myxedema Coma: Most commonly found in older patients with primary hypothyroidism, with a 25% to 60% mortality rate.
Treatment: Levothyroxine should be given as a slow intravenous bolus of 200 to 400 mcg initially, followed by 50 to 100 mcg (about 1.6 mcg per kg) orally per day. For combination treatment, T3 is given at the same time as levothyroxine and dosed at 5 to 20 mcg, then 2.5 to 10 mcg every eight hours until clinical improvement. Lower dosages are appropriate in older adults and patients with a history of cardiovascular disease. Stress-dose glucocorticoids should be administered until adrenal insufficiency is ruled out
When is Mean Girls Day?
October 3