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Thyroid (Tests (Imaging (not needed in traditional thyroid disease.,…

- - - - Agitated
        Irritable
        Tachycardia/palpitations
        High blood pressure
        Polycythemia (high RBC)-> hot, flushed, restless
        Restless
        Warm, moist skin
      - 1.3%, more common in women than men at 5:1 ratio
        4-5% in older women
        More common in smokers.
      - exopthalmus
    - - More common in women than men 8:1
        Onset 20-40 years
        Associated with ↑ antibodies, exophthalmos, pretibial myxedema, onycholysis (separation of nail from its bed)
        ↑ risk other autoimmune disorders
    - - Subacute thyroiditis
        
        “DeQuervain” thyroiditis
      - viral infection
      - ↑ iodine intake
      - ↑intake of exogenous thyroid hormone
      - Drugs (Amiodarone)
    - - Radioactive Iodine (131I)
        Destroys thyroid tissue
        No ↑ of subsequent thyroid cancer, leukemia, or other malignancies
        Contraindicated: pregnancy, lactation, or to mother without child care since she’s radioactive
        Thyroid surgery. not as guaranteed
        
        TREAT symptoms:
        Eg: tachycardia with a beta blocker
        (atenolol, propranolol) or calcium channel blocker (amlodipine, nifedipine)
      - Treat the hormone condition
        Propylthiouracil (PTU), methimazole
      - Thiourea Meds
        
        Propylthiouracil
        100-150 mg/day divided q8h
        MOA: Inhibits thyroid hormone synthesis
        For patients intolerant to methimazole & radioactive iodine Tx or Sx
        
        Methimazole (Tapazole)
        5-15 mg PO q8h
        MOA: Inhibits thyroid hormone synthesis
      - Propranolol ER 60mg PO QD or BID
        Treating symptoms of tachycardia and anxiety
  - - - BMI overweight 25-29 obese 30-34.9 severe;y obese 35-39.9
      - Goiter
        
        Colliod Gel
        
        Brown Dead Macrophages
      - cold, constipation, weight gain, depression, menorrhagia, headache, carpal tunnel syndrome, Raynaud's syndrome. Dry brittle hair skin nails. May appear edematous Bradycardia; thin, brittle nails, thinning of hair; peripheral edema, puffy face & eyelids, skin pallor or yellowing; delayed deep tendon reflexes, palpably enlarged thyroid (GOITER), hoarseness
      - Myxedema
        
        Life threatening
        Impaired cognition → Confusion → Somnolence → Myxedema coma
        Most common: elderly women who have had a stroke, or stopped taking thyroxine Underlying infection, cold exposure, hypoglycemia, hypotension, hypoventilation.
        Hypersensitive to Opiates
    - - Autoimmune Dx
        
        5% have celiac disease-vague GI complaints
        Addison disease, hypo-parathyroidism, DM,
        pernicious anemia, sjorgen syndrome, vitiligo
      - CHECK anti-thyroid antibodies to verify diagnosis:
        Anti-thyroglobulin (Tg) Ab
        Anti-thyroid peroxidase (TPO) ab
    - - Low TSH #
      - Low TRH #
    - - Synthetic T3
        
        Liothyronin (Cytomel)
        
        25 – 75 PO QD
      - Synthetic T4 Levothyroxine therapy 25 – 75 mcg PO QD
        Goal = normalize serum TSH & FT4
      - Natural mix 1 T3:4 T4
        
        Thyroid (porcine) (Armour Throid)
        60 – 120 mg PO QD
      - Take in the morning on empty stomach with water (food decreased absorption)
        Take 30 minutes before any food or other medications
        Don’t eat grapefruit ( inhibits absorption of thyroid medication, antihistamines, and BBs)
      - Retest TSH and T4 (or FT4) in 6-8 weeks
        Retest 6 months when normal, then annually
  - - - Patients without known thyroid disease, with ↓ serum FT4 & nl TSH
        Pregnancy, Major surgery, Chemotherapeutic agents, Viral thyroiditis
        Usually presents with initial hyperthyroid state then hypothyroid state
        Critical illness
        Liver/renal disease
        Malnutrition
- - - - ↑ CARDIAC OUTPUT by ↑ heart rate, ↑ contractility, ↑ blood pressure.
      - Stimulates BONE maturation & growth = ↑ RBC’s.
      - Basal Metabolic Rate = ↑ ATP production by all cells in the body, ↑ heat generation & O2 consumption.
      - Increases metabolism (↑ gluconeogenesis, ↑ glycolysis, ↑ glucose absorption, ↑ lipolysis, ↑ protein turnover)
    - - T4 stays bound longer
- - - - Rreceives negative feedback loop
  - - - thytroglobulin proteolyis
      - Iodine reuptake