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Thyroid (Hyperthyroid (Dx: look for low TSH confirm w/ free T4 (:check…

- - - - :pencil2::warning: Central Hyperthyroidism (rare) is not the same:
        
        high TSH
        
        high T4
      - RAIU scan
        
        Grave's Disease
        
        Path: TS-Ab's activate T4 production/release.
        
        really BIG thyroid
        
        Active uptake by RAIU :fireworks:
        
        S/S:
        
        exophthalmos :eyes:
        
        pretibial myxedema
        
        Dx: Thyroid Stimulating Ab's (TSI)
        
        Tx: very good therapy
        Thionomides
        
        PTU
        
        Methimazole
        (can go into remission)
        
        2 more items...
        
        Thyroiditis
        
        Path: "-itis" injury to kidney releases preformed T4.
        
        Transient Hyperthyroid
        
        Thyroid either heals, or dies (Hashimoto)
        
        RAIU: cold :snowflake:
        No new T4 being made
        
        Healed:
        
        Painless Thyroiditis
        
        de Quervain (acute granulomatous)
        
        Dead:
        
        Hashimoto
        
        Multinodular Goiter
        
        Similar
        
        Path: Multiple nodules make T4
        
        RAIU: many hot nodes :fireworks:
        
        Toxic Adenoma
        
        Path: nodule makes T4
        
        RAIU: hot node :fireworks:
        
        Factitious Disorder
        
        Path: Exogenous T4
        
        RAIU: cold :snowflake:
        
        Tsestamibi Scan: :green_cross:
        
        Struma Ovarii
        
        Path: Ovarian lesion producing T4
        :warning: beware of HC worker :female_sign: that might be clues to factitious. Must r/o Struma Ovarii, because women have uteruses...uteri...
        
        RAIU: cold :snowflake:
        
        Tsestamibi Scan: :check:
        hot ovaries :fireworks:
  - - - Pt: Tachycardic w/ florid Afib :<3::<3::<3:
        
        Severe hyperthermia :hotsprings::hotsprings::hotsprings:
        
        hypertensive :fire_engine::male-firefighter::skin-tone-3:
        
        AMS
        
        Tx; Storm Cloud :thunder_cloud_and_rain:
        
        cool IV fluids :ocean: :snowflake: & cooling blankets
        
        BBlocker :trumpet:propranolol
        
        Thionomides (PTU/methimazole)
        
        reduce peripheral conversion: Steroids
- - - - :warning:Subclinical
        
        TSH elevated but Asx
        
        Dx: TPO AB's to confirm, won't change treatment
        
        :pencil2:Treat if TSH ≥ 10, or Sx of hypothyroidism appear
    - - :warning:Central hypothyroidism (rare)
        
        low T4 and low TSH
      - Tx: Levothyroxine
  - - - Tx: warm IV fluids & real blankets :hotsprings::hotsprings:
        
        Give IV T4
        
        2nd line: T3
- - - - Thyroid
        
        T4
        
        T4 neg feedback
        
        Hypothalamus
        
        TRH
        
        Move
        
        Mentation
        
        Metabolic activation