Fatigue, decreased exercise tolerance, hair intolerance, loss of nails/skin, hair, non pitting edenma of eyelids, face legs

Bradycardia, Diastolic hypertension, proximal muslce weakness, goitre or small/rubbery

Caused by anti-TPO antibodies, and thyroid is initially enlarged but becomes atrophied and rubbery

Not enoguh substrate to produce thjyroid hormone -> Increased TSH -> Increased growth of thyroid -> large goitre

Will typically improve with iodine supplementation

With excess iodine intake -> thyroid gland will downregulate thyroid hormone biosyntehsis as a protective mechanism

Amiodarone: High Iodine content, Lithium: Concentrated in gladn adn prevents iodine uptake, inteferon: induces thyroid autoimmunity, Cancer immunotherapy: Causes thyroiditis, Graves Disease treatment

Do TSH First: if high Suspect primary hypothyroidism, if Low free T4, overt hypothyroidism, and if normal free T4, subclinical hypothyroidism

Insult to the pituitary gland that injures TSH producing cells, resulting in less stimualtion to thyroid

Rare condition resulting from pituitary adenoma or tumors that damage pituitary destruction

Due to severe prolonged hypothyroidism and trigger, presents with signs/symtposm of hypothyroidism, hypoglycemia, bradycardia

Glucocorticoids, Levothyroxine, Supportive measures, Treat underlying cause

Syntehtic T3 is availabel but needs to be dosed BID

Excess thyroid hormone in circulation leading to suppresion of TSH

Normal Free T4/t3 means subclinical hyperhtyroidism, and if they are high, overt hyperthyroidism

Thyroid scan and iodine uptake, and TSH receptor Antibodies (TRAb)

Anxiety, palpitations, Sweating, heat intolerence, weight loss, increased appetitie, Lid Lg, lid retraction, murmur, muscle weakness, brisk reflexes

TSH receptor antibody stimulates TSH receptor -> TSH continuously grows

Orbitopahty, Acropachy, Pretibial myxedema, Thyroid bruit, Diffusely enlarged thyroid gland

ANti-thyroid drugs to reduce Free T4 over weeks/months

Surgery: Mostly for patents who cannot do either or compression from goiter

Small part of thyroiod tissue gained autonomous production of thyroid hormone

Symptomatic therapy (beta blockers), anti-thyroid drugs (methimazole, PTU), radioactive iodine ablation, surgery

Autonomous thyroid tissue sees excess iodine -> more subtrate -> more T4

In presence of hyperthyroid disorder, iodine can exacerbate or trigger hyperthyroidism

Rare life-treatening state of severe decompensated thyrotoxicosis

Symtposm: Hyperpyrexia, large fluid loss, conusion, seiure, coma, tachycarida, nausea, vomiting, dirrhea, hepatic dysfunction

ABCs, Stabolize vitals, block T4-> T3 conversion (high dose PTU/Glucocorticoids), Decrease T3 action on tissyues , Decrease T4/T3 production (PTU and iodine)

TSH and hCG are similar as they have similar compositions, and hCG levels peak in pregnancy leading to suppresssed TSH, but hCG can activate TSH receptor

Infilammation of thyroid: Leads to spilling of pre-formed hormone

Transient hyperthyroidism -> Transient hypothyothyroidism

Similar to subactue but no neck pain or symptoms

Autoimmune insult to thyroid can cause a spilling of hormones

Similar to painless but occurs within 1 year post-partum

Exogenous: Patients may be taking thyroid hormone intentionally, or uninstentionally, which results in thyroid scan is completly suppressed

Subclinical: Low TSH normla Free T4 and free T3, same causes and same investigations