Any visibly or palpably enlarged thyroid. It can be DIFFUSE (Graves dz, Hashimoto's thyroiditis, subacute thyroiditis, endemic goiter), HETEROGENOUS (multinodular goiter), or SOLID NODULE (benign nodule vs. CA)
What is the 1st line screening tests for thyroid disorders?
TSH (looking at pituitary function) and Free T4 (free T4 doesn't change relative to binding proteins, so it's a little more helpful)
What can an ultrasound help you determine?
anatomy of the gland (size of a nodule, etc)
If there is no uptake of iodine into the thyroid gland, this indicates what? Does it have a good or bad prognosis?
Indicates a cold nodule, which is more worrisome than a hot nodule because cold nodules often contain malignancy
What is the most common form of hypothyroidism?
Hashimoto's thyroiditis (autoimmune); it is a primary cause of hypothyroidism
What are the SxS hypothyroidism?
Fatigue **Dry skin Myalgias/cramps **Hair loss **Brittle nails Abnormal menses **Cold intolerance Constipation Depression Decreased appetite **Wt gain Goiter
What is a PE specific finding that is indicative of hypothyroidism?
abnormal DTR --> delayed relaxation phase (normal upstroke, then slow relaxation); felt best in brachial and achilles
Untreated hypothyroidism can lead to what condition?
What are SxS of myxedema?
Large tongue Carotenemic skin color Course thickened edematous skin Slow/slurred speech Mental apathy Cardiomegaly Hypothermia Bradycardia Anemia Hyponatremia Hypoglycemia
Your pt has hypothyroidism. You order labs to look at TSH and Free T4. How can you determine whether they have primary or secondary hypothyroidism?
Both with have decreased Free T4. The difference is that primary will have elevated TSH, whereas secondary has decreased or low normal TSH.
How do you treat hypothyroidism?
Levothyroxine (Synthroid, Levothroid)
Monitor TSH/Free T4 to determine if dose is appropriate For secondary hypothyroidism, only use free T4 since pituitary not functioning
(T/F): Use Levothyroxine (Synthroid) until TSH and Free T4 levels are normal, and then you can discontinue use of the drug.
F. Tx is long-term because thyroid failure is usually permanent
What is the most common cause of hyperthyroidism?
Graves dz (autoimmune); antibodies target TSH receptors and increase production/release of thyroid hormone
ALL palpable nodules and incidentalomas > 10mm or with risk factors for malignancy
When is radionuclide scanning used?
It's generally not necessary due to high quality of U/S
Are hot or cold nodules more common?
only 10% are hot 90% are cold or warm
You have just detected a thyroid nodule on your pt. What is a very important question you want to ask them?
"Do you have a h/o head or neck irradiation?"
What is the most common type of Thyroid CA?
Papillary (76%); also the least aggressive
How do you treat thyroid CA?
(Near-total) thyroidectomy Post Surgical Total Body I-131 Scan (P & F) High Dose I-131 ablation if + Scan or large tumor >2cm(P& F) Scans done Q 1-3 years depending on duration from initial treatment (P&F) Lifetime Treatment w/ levothyroxine Lobectomy may be acceptable treatment for Papillary tumors <1 cm