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Terms in this set (16)
What are causes of myxedema coma?
Any cause of hypothyroidism; infection, exacerbation of heart disease, opiates, or cold temp
What are signs of myxedema coma?
progressive hypo sx; decreased mentation, bradycardia, hypothermia, hypoglycemia, hypotension
What lab studies are done in myxedema coma?
TSH and FT4 if stable; baseline cortisol and ACTH to r/o adrenal insufficiency
What is the treatment of myxedema coma?
1st give dose of cosyntropin
if unstable, give glucocorticoids first
Treat: T3, T4, T3 and T4
Antibiotics until infection r/o
What is the treatment for Graves disease?
MMI (methimazole) preferred in nonpregnant patients
PTU for thyroid storm and 1st trimester pregnancy
Beta blockers for sx
Radioactive iodine ablation
What are the side effects of treatments for Graves?
hepatic toxicity and agranulocytosis
What precipitates thyroid storm?
Patient with undiagnosed or undertreated hyperthyroid.
Events: surgery, infection, iodine load, amiodarone
What are symptoms of thyroid storm?
Fever, tachycardia, altered mental status
May die from cardiac collapse
What are treatments for thyroid storm?
glucocorticoids (high dose), IV propanolol, PTU, antibiotics, ICU supportive care
What causes subacute thyroiditis?
Virus; very tender neck +/- fever
RAIU is decreased
When is it appropriate to check TFTs in a sick person?
If acute illness may be due to thyroid storm or myxedema coma
When is FNA indicated?
any suspicious characteristics by U/S or clinical concern
What is the evaluation of a thyroid nodule with normal-high TSH?
U/S; FNA if suspicious (solid, hypoechoic, irreg margins, microcalcifications, >= 1 cm
What is the evaluation of a thyroid nodule with low TSH?
scan; hot nodules should not be biopsied (false-pos rate is high); cold nodules need U/S then FNA if suspicious
What are the four types of thyroid cancer?
Papillary (most common), Follicular (vascular invasion differentiates from a benign adenoma), Medullary (hyperplasia of C cells, elevated serum calcitonin, MEN syndromes, RET+ screen for pheo), Anaplastic (rare, highly undiff, highly malignant; no tx)
What autoimmune disease is thyroid lymphoma associated with?
chronic autoimmune thyroiditis
diffuse B cell lymphoma
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