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Thyroid disorders 2 :balloon: (:thought_balloon: Non-thyroidal illness…
Thyroid disorders 2 :balloon:
:thought_balloon:
Thyroiditis
:stars:
Acute suppurative thyroiditis
:monkey:Introduction
Rare
in children
usu. associated with
Left pyriform sinus tract
Commonly asso. with
sepsis, acute infection of upper respiratory tract
or
head& neck infection
Common pathogens include
S. aureus
Streptococcus pyogenes
Pneumococcus
:leaves:
S&S
High graded fever, chill
Tenderness & swelling of thyroid gland
Sore throat
Severe dysphagia
Cervical lymphadenopathy
:male-scientist::skin-tone-3:
Investigations
CBC, ESR
TFT
Thyroid aspiration & culture
Thyroid scan: :arrow_down: upatke
Absence of thyroid antibodies
U/S
to rule out abscess
Fistulography/barium swallowing study (usu. use to workup after Rx whether got pyriform left?)
:green_heart:
Mx
Parenteral ATBs
Supportive care
Surgical excision for abscess
Complete extripation of fistula
:stars:
Subacute thyroiditis
Def: Self-limited inflammation of thyroid that
usually follow URI
Common pathogens: Infleunza, Adenovirus, Coxsakie, EBV
:evergreen_tree:
Symptoms
Local pain
Swelling
Tenderness
low graded fever,
malaise
Hyperthyroid symptoms
:green_heart:
Mx
Only symptomatic Rx is necessary
Radiation thyroiditis
Autoimmune thyroiditis
:thought_balloon:
Thyroid nodule
:crossed_swords:
Important info. to obtain
Previous irradiation to Head & Neck region
Rate of growth of nodule
Pressure symptoms (eg. hoarseness, difficult to swallow or breathing)
FxHx of
MEN2A (Med Pa Phe)
Medullary thyroid cancer
Parathyroid hyperplasia
Pheochromocytoma
Presence of mucosal neuromas
MEN2B (Mu Mar Med Phe)
Mucosal neuromas
Marfanoid body habitus
Medullary thyroid carcinoma
Pheochromocytoma
:male-scientist::skin-tone-4:
Lab
TFT
Thyroid Abs
I123 scan
Ultrasound (mass? cystic?)
Fine needle aspiration (FNA)
Thyroglobulin
Calcitonin
:green_heart:
Management
No. of nodules?
Solitary nodule ➯ Surgical excision
Multinodular goiter ➯ Thyroxine suppressive therapy
:thought_balloon:
Non-thyroidal illness
Aka Sick euthyroid syndrome or low T3 syndrome
usu. presented in
Premature neonates
Malnutrition or Fasting subjects
Severe acute/chronic illness pt
Pt who receive PTU, propanolol, amiodarone, dexamethasone, contrast agents
:pig2:
causes
Impairment of Iodothyroine B-ring monodeiodenase activity ➯ :arrow_down: T3 production
:lollipop:
Thyroid func
Mild to moderate
non-thyroidal illness
Inh. of tissue conversion of T4 to T3
Low serum T3
:arrow_up: or normal serum rT3
Inh. of T4 binding to TBG
:arrow_down: serum T4
Normal serum FT4
Normal func of HPT axis
Normal serum TSH
Severe
non-thyroidal illness
Inh. of tissue conversion of T4 to T3
Low serum T3
:arrow_up: or normal serum rT3
Inh. of T4 binding to TBG
:arrow_down: serum T4
Hypothalamic-Pituitary dysfunc
:arrow_down:serum FT4
:arrow_down: glycosylation of TSH
Recovery phase
Low ➯ Normal T3, FT3
Elevated ➯ Normal rT3
Low ➯ Normal T4, FTT4
Mild elevation ➯ Normal TSH
:purple_heart:
must ddx
with Central hypothyroidism
:green_heart:
Treatment is not needed