Physiology
typical lab presentation of hyperthyroidism
What is suppressed TSH and elevated free T4
Symptoms of hyperthyroidism (5)
weight loss, heart palpitations, heat tolerance, irregularity of menses, visual changes
Sustained cure for Graves disease in patient undergoing radioactive iodine ablation
What is 75%
hashimoto has these antibodies
what is antithyroid peroxidase (TPO) antibodies
Indications for thyroidectomy in hashimoto
Same as with patients with benign thyroid nodules- indeterminate nodules, large symptomatic goiter, or compressive symptoms
Describe subclinical hyperthyroidism
What is TSH suppressed and thyroid hormone levels are normal
Causes of thyroiditis (4)
what is iodinated contrast, amiodarone, postpartum, lymphocytic thyroiditis (Hashimoto)
This is used for uptake imaging and this is used for ablative therapy
Iodine-125 is used for uptake imaging tests. Iodine-131 is used for ablative therapy.
Presentation of hashimoto (4)
compressive symptoms, nodularity on exam or US, enlarged multinodular goiter, hypothyroidism
treatment of suppurative thyroiditis
abx and I+D of abscess
3 leading causes of hyperthyroidism
What is graves disease, toxic multinodular goiter, solitary toxic nodule
How Graves appears on thyroid scintigraphy
diffuse increased uptake
Contraindications to RAI (3)
What is pregnancy/lactation, children, smokers
reason for painless postpartum thyroiditis
lymphocytic inflammation of thyroid- antibodies against fetal thyroid cells accumulate in mother's thyroid gland
management of painful subacute thyroiditis
NSAIDs, steroids
Describe where TSH released from and what it does
What is released from the anterior pituitary, regulates iodide uptake as well as the production and storage (bound to thyroglobulin) of T4 and T3.
Needed for cold nodules
what is thyroid US and FNA bx
Surgery recommended in graves disease (3)
What is concurrent thyroid disease, large goiters, severe thyrotoxicosis
Riedel thyroiditis
Presents with dysphagia, respiratory distress, progressive fibrosis of the thyroid gland, age 30-60 years, more common in females
3 types of thyroiditis that has swings of thyrotoxicosis and hypothyroidism
painless postpartum, painless sporadic, painful subacute
Mechanism of Graves
elevated TSH receptor antibodies that mimic TSH action
Physical exam findings on Graves (4)
What is thyromegaly, tracheal deviation, tremor, tachycardia, Graves ophthalmopathy
Preferred medication in pregnancy and side effects of this med
What si PTU and agranulocytosis
Describe triphasic hormone pattern
initial hyperthyroidism (elevated free T4 and suppressed TSH) is followed by hypothyroidism, then resolved with euthyroidism over a 9-month period.
management reidel thyroiditis
Do not operate, steroids, tamoxifen