Thyroid Disorders Powerpoint PDF

Alterations of Thyroid Function 1 Thyroid Functioning Condition Examples of Diseases Hyperfunction Hyperthyroidism Thyrotoxicosis Graves disease Hyperthyroidism resulting from...

Alterations of Thyroid Function 1 Thyroid Functioning Condition Examples of Diseases Hyperfunction Hyperthyroidism Thyrotoxicosis Graves disease Hyperthyroidism resulting from nodular thyroid disease Thyrotoxic crisis (thyroid storm) Hypofunction Hypothyroidism Primary hypothyroidism Hashimoto disease Secondary hypothyroidism Subclinical hypothyroidism Congenital hypothyroidism Thyroid carcinoma Alterations of Thyroid Function (Cont.) 2 Copyright © 2019, Elsevier Inc. All rights reserved. Alterations of Thyroid Function (cont2) 3 Primary Secondary Conditions that cause Dysfunction or disease alterations in pituitary of the thyroid gland or hypothalamic functioning Alters TSH or Alters thyroid hormone thyrotropin-releasing (TH) production hormone (TRH) production Copyright © 2019, Elsevier Inc. All rights reserved.  Hyperthyroidism  Hyperthyroid condition: Graves disease  Most common cause of hyperactive thyroid  Autoimmune disease; develops autoantibodies  Clinical manifestations  Always some degree of Ophthalmopathy  Exophthalmos: increased secretion of hyaluronic acid, orbital fat accumulation, inflammation, and edema of the orbital contents  Diplopia: double vision Pretibial myxedema (Graves dermopathy): leg swelling  Treatment  Antithyroid drugs (methimazole and propylthiouracil), beta blockers, radioactive iodine, or surgery (thyroidectomy)  Does not reverse infiltrative ophthalmopathy or pretibial myxedema Copyright © 2019, Elsevier Inc. All rights reserved. Hyperthyroidism – S & S  Hypermetabolism  Resting tachycardia, palpitations. Atrial fib  Heat intolerance  Exertional dyspnea  Fatigue  Increased appetite  Anxiety  Weight loss  Nervousness  Frequent BMs  Insomnia  Smooth warm most velvety skin  Manic behavior  Fine /thin hair  Restlessness  Exophthalmos  Emotional liability  Eyelid lag  Fine tremors  Infrequent blinking  Hyperreflexia deep tendon reflexes  Graves Ophthalmopathy – 20-40% of cases Hyperthyroidism - exophthalmos 6  Graves disease with exophthalmos Copyright © 2019, Elsevier Inc. All rights reserved. Hyperthyroidism – Diagnostics / Labs  TSH low (< 3 ulU/L)  Serum T3, T4, free Thyroxine elevated  Elevated ESR  Serum antinuclear antibody (ANA) elevated  Hypercalcemia & anemia  If unclear etiology – radioactive iodine uptake  High iodine uptake = Graves  Low iodine uptake = subacute thyroiditis (thyroid inflammation with low grade fever, dysphagia, elevated ESR) Hyperthyroidism – Management  Symptomatic (beta blockers)- tachycardia, tremors  Propranolol (Inderal) 10 mg po  Metoprolol (Lopressor) 25 mg po  Antithyroid meds  Methimazole (Tapazole)  Initial 30-60 mg daily divided in 3 doses  Maintenance – 5-15mg PO  Propylthiouracil  Initial 300-600 mg/day in four doses  Maintenance = 100-150 mg/day  Radioactive iodine - to destroy goiters; may take 3-4 to become euthyroid (goal). May become hypothyroid  Thyroid surgery – not common; used w/pregnancy & suspected cancer Hyperthyroidism - cont. 9  Hyperthyroidism, resulting from nodular thyroid disease  Toxic multinodular goiter: several hyperfunctioning nodules secrete thyroid hormone  Solitary toxic adenoma: only one nodule becomes hyperfunctioning  Clinical manifestations  Are the same as hyperthyroidism but occur slowly  Exophthalmos and pretibial myxedema do not occur  Treatment  Examination is performed for cancer.  Radioactive iodine, surgery, or antithyroid drugs are administered. Copyright © 2019, Elsevier Inc. All rights reserved. Hyperthyroidism – Thyroid Storm 10  Thyrotoxic crisis (thyroid storm)  Rare but life threatening within 48 hours if not treated  Results from excessive stress  Increased action of thyroxine (T4) and triiodothyronine (T3)  Predisposing Factors  Trauma, Stress, Infection, Uncontrolled DM, Thyroid supplement overdose, Pregnancy  Is a condition that results from any cause of increased level of thyroid hormone  Excess amounts of thyroid hormone are secreted from the thyroid gland. Copyright © 2019, Elsevier Inc. All rights reserved. Hyperthyroidism – Thyroid Storm (cont.) 11  Clinical manifestations  Hyperthermia (100-105F), Diaphoresis (4L/24H), Marked Tachycardia (supraventricular), Palpitations, Mental Changes (agitation, delirium, psychosis, stupor, coma), GI disturbances (n/v, diarrhea), Hyperglycemia  Treatment  Block thyroid hormone synthesis Propylthiouracil (900-1200mg/d or Methimazole (90-1200mg/d) Inhibit release of thyroid hormones – given 1 hr after thyroid drug admin Lugols solution 10gtts po TID or Sodium Iodine 1 gm slow IV Block effects of thyroid hormone (Beta-blockers) Esmolol 40-80 mg Q6hr with Hydrocortisone 50 mg q6hr & taper dose  Surgery or treat with radioactive iodine – after pt is euthyroid Copyright © 2019, Elsevier Inc. All rights reserved.  Hypothyroidism and Myxedema Coma  Greatly decreased metabolism  Primary: thyroid gland not functioning  Secondary: Pituitary gland not secreting enough TSH, resulting in hypothyroid (T3 + T4)  Tertiary: Hypothalamus doesn’t secrete enough TRH, resulting in hypothyroid (T3 + T4)  Dopamine and corticosteroids decrease TSH production  Most common thyroid disease  Women > Men  Common w/ other immune disorders – RA, SLE  Worldwide due to iodine def (most common cause worldwide)  In US d/t autoimmune thyroiditis (Hashimoto’s, autoimmune dysfunction of thyroid gland). Most common cause in US  Thyroidectomy  Failure to take thyroid medication  Radioactive iodine treatment for hyperthyroidism Hypothyroidism – S & S  Extreme fatigue  Dry cracked skin  Change in LOC  Coarse brittle hair  Puffiness of face/eyes  Brittle nails  Hypoventilation  Cold intolerance  Bradycardia  Myxedema in extremities  Hypothermia  Periorbital edema  Hypoglycemia  Decreased deep tendon reflexes  Anorexia  Paresthesia  Decreased bowel sounds  Enlarged tongue (OSA)  Constipation  Hair loss  Weight gain, but not morbid obesity  Hoarseness  Abnormal menses: Amenorrhea (no  Males: decreased libido, ED, delayed period), hypermenorrhea, ejaculation menorrhagia. Increased abortion risk  Carpal Tunnel b/l Hypothyroidism – Diagnostics / Labs  Elevated TSH (> 4 ulU/L)  Low or low normal T4 (free), not total (bound) T4  Decreased resin T3 uptake: Do NOT order  T3 is not a reliable test for hypothyroidism bc there is increased conversion of T4 to T3 (compensatory mechanism)  Hypoglycemia  Hyponatremia  Anemia (normochromic, normocytic). RBC normal color and size, hypocoagulable state (increased bleeding risk)  Hypertension (increased vascular resistance), Hypercholesterolemia & elevated Triglycerides (decreased metabolism) Hypothyroidism - Management  Levothyroxine (Synthroid): T4  MYXEDEMA COMA  Oxygen  Fluid restriction & 3% NS for severe hyponatremia  D5W for hypoglycemia  IV Thyroid replacement  Levothyroxine (T4) one dose 300-500mcg IV the n 50-100 mcg daily  Alternative: Liothyronine sodium (Cytomel) (T3) 25-50 mcg IV every 4-6 hr  Another Alt: levothyroxine (T$) 200 mcg and Liothyronine Sodium (T3) 25 mg single dose  If Adrenal Insuff: hydrocortisone (Solu-Cortef) 100 mg IV bolus then 25-50 mg q 8hr. Want to avoid rebound hyperadrenalism effects when rapid thyroid replacements are started  Slow rewarming blankets – Hyperthermia blankets are contraindicated -> circulatory collapse  Levothyroxine 100-200 mcg/d for life