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Hyperthyroidism causes/Etiology
- 1. More common in women
- 2. Onset most commonly between 20 and 40 year of age
- 3. Grave's disease is the most common presentation
- 4. Other causes of hyperthyroidism include toxic adenoma, subacute thyroiditis, TSH secreting tumor of the pituitary, high dose of amiodarone
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Hyperthyroidism s/s
- 1. Nervousness
- 2. Anxiety
- 3. Increased sweating
- 4. Fatigue
- 5. emotional lability
- 6. Fine tremors
- 7. Hyperreflexia of DTRs
- 8. Increased appetite
- 9. Weight loss
- 10. Smooth, warm, moist vevety skin
- 11. Fine/thin hair
- 12. Exophamlosis
- 13. Lid lag
- 14. Tachycardia
- 15. Heat intolerance
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Hyperhytoridism laboratory/diagnostics
- - TSH assay is the most sensitive test and is low in most cases
- - Serum T3, T4, thyroid resin uptake,and free thyroxine index increased
- Sometimes T4 is normal, but T3 elevated
- - Serum ANA usually elevated without evidence of lupus or other collagen disease
- -Thyroid radioactive iodine uptake and scan usually performaed to establish etiology of hyperhytoidism
- - a high iodine uptake is consistent with Grave's disease
- - A low uptake is consistent with subacute thyroiditis
- - MRI of the orbits is the preferred choice for visualizing Grave's ophtalmopathy
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Hypothyroidism causes/ etiology
- - Primary disease of the thyroid gland
- - Pituitary deficiency of TSH
- - Hypothalamic deficiency of TRH
- - Iodine deficiency
- - Hashimoto's thyroiditis
- _Idiopathic causes
- - Damage to the gland
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Hypothyroidism s/s
- - Extreme weakness
- - Muscle fatigue
- - Arthralgias
- - Cramps
- - Cold intolerance
- - constipation
- - Weight gain
- - Dry skin
- - Hair loss
- - Brittle nails
- - Puffy eyes
- - Edema of the hands and face
- - Bradycardia
- - Slowed DTRs
- - Hypoactive bowel sounds
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Hypothyroidism laboratory/diagnostics
- - TSH elevated
- - T4 low or normal
- - resin T3 uptake - decreased (T3 is not a reliable test)
- - Hyponatremia
- - Hypoglycemia
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Hyperhyroidism management
- - referral
- propranolol (inderall) for symptomatic relief- begin dosing with 10 mg po, may goto 80 mg four times daily
- Thiourea drugs for patients with mild cases, small goiters of fear of isotopes
- - methimazole (tapazole )
- - Propylthiouracl
- - Radioactive iodine
- 131 -1 used to destroy goiters
- - thyroid surgery must b e euthyroid preop
- - Lugol's solution 2-3 gtts po every day for 10 days to reduce vascularity of the gland
- patients with subacute thyroiditis are best treated symptomatically with propranolol
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Treatment of Thyroid crisis
- - Prophylthiouracil 150-250 mg every 6 hours
- -Methimazole (Tapazole) with the following:
- - Lugol's solution
- - Sodium iodide IV
- -Propranolol IV
- - Hydrocortisone with rapid reduction as situation improves
- Avoid ASA
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Hypothyroidism treatment
Levothyroxine
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Hyxedema coma
- - Protect airway - mechanical ventilation as needed
- - fluid replacement as needed
- - Levothyroxine IV
- - Support hypotension
- - Rewarming with blankets
- - symptomatic care
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