Thyroid Function Screening Tests
- If TSH High
- Free T4 (FT4)
- If TSH Low
- Free T4 (FT4) and T3 (Triiodothyronine)
- Consider Serum Total T4 (Thyroxine)
- Only Total T4 Increases in Pregnancy
- T4 is Converted to T3
- Avoid for Inpatient Screening
Hyperthyroidism Assessment
- Heat Intolerance
- Exophthalmos
- Warm, Moist Skin and Silky Hair
- Tremors
- Goiter
- Diarrhea
- Weight Loss
- Tachycardia
- Hypertension
- Amenorrhea
- Decreased TSH with Elevated Free T4
- Radioactive Iodine Uptake (RAIU)
Hyperthyroidism Interventions
- Propylthiouracil (PTU)
- Methimazole (Tapazole)
- Iodine
- Beta Blockers
- Radioiodine Ablation
- Thyroidectomy
- Thyrotoxicosis
- Post-Surgery Hypocalcemia
Levothyroxine
- Hypothyroidism
- Myxedema Coma
- Isomer of Thyroid Hormone (T4)
- T3 has Higher Potency
- Hyperthyroid Symptoms
Graves' Disease Characteristics
- Women 20-40 years old
- Anti-TSH Receptor Antibodies
- Ophthalmopathy
- Exophthalmos
- Hyperthyroidism
- Goiter
- Pretibial Myxedema
Graves' Disease Labs and Treatment
- Decreased TSH
- Increased T3
- Increased T4
- Radioactive Iodine Uptake (RAIU)
- Beta blocker
- Methimazole
- Radioiodine Ablation
Thyroid Storm
- Diarrhea
- Liver Failure
- Insulin Resistance
- Tachycardia
- Lid lag
- Change in LOC (Altered Mental Status)
- High fever
- Propranolol (Or Esmolol)
- PTU (Thionamides) Initially
- Iodine Solution (Lugol Iodine)
- Glucocorticoids
- Cooling Blanket
Hashimoto's Thyroiditis
- Hypothyroidism with Bouts of Hyperthyroidism
- Enlarged, Nontender Thyroid
- Autoimmune
- Anti-Thyroid Peroxidase (TPO)
- Anti-Thyroglobulin
- Hurthle Cells
- Lymphoid Follicles
- HLA-DR5 and HLA-DR3
- Increased Risk Of Non-Hodgkin Lymphoma
Subacute Thyroiditis Pathophysiology
- Self-Limiting
- Triphasic Response
- Thyrotoxic Phase
- Damaged Follicular Cells Release Pre-formed Colloid
- 2-8 Weeks
- Hypothyroid Phase
- Decreased Thyroid Hormone Synthesis
- 2-8 Weeks
- Euthyroid Phase
- Thyroid Gland Recovery
Subacute Lymphocytic Thyroiditis
- Drugs
- Autoimmune Disorders
- Postpartum Thyroiditis
- Hyperthyroidism and Hypothyroidism
- Painless Thyroid
- Thyroid Function Tests
- Elevated ESR
- Decreased Radioactive Iodine Uptake (RAIU)
- Lymphocytic Infiltrate
- Beta Blockers
- Levothyroxine
- Avoid Antithyroid Drugs
Subacute Granulomatous Thyroiditis (de Quervain)
- Viral Upper Respiratory Infection
- Tender Thyroid
- Hyperthyroidism and Hypothyroidism
- Thyroid Function Tests
- Elevated ESR
- Decreased Radioactive Iodine Uptake (RAIU)
- Multinucleated Giant Cells
- Beta Blockers
- NSAIDs
- Avoid Antithyroid Drugs
Hypothyroidism Assessment
- Weight Gain - Edema
- Lethargy
- Cold Intolerance
- Bradycardia
- Hypertension
- Brittle Nails and Dry Skin
- Constipation
- Goiter
- Prolonged Menses
- Slowed Thinking
- Decreased Free T4
- Increased TSH
Hypothyroidism Intervention
- Levothyroxine (Synthroid)
- Liothyronine (Cytomel)
- Myxedema Coma
- Lifelong Replacement Hormone
- Monitor Vital Signs
- Fluids and Fiber
- Low Calorie, Low Fat Diet
- Medication Education
- No Switching Brands
Thyroid Gland
- TSH Stimulates T3 and T4 Release
- Metabolism Regulation
- Blood Calcium Sensor
- Calcitonin Release
- Blood Calcium Decreases
- Bone Building
Papillary Thyroid Carcinoma
- Most Common Thyroid Cancer
- Excellent Prognosis
- Lymphatic Spread
- Orphan Annie Nuclei
- Empty Nuclei with Central Clearing
- Psammoma Bodies
- Head and Neck Radiation
- RET and BRAF Mutations
- Gardner Syndrome
- Cowden Syndrome
Follicular Thyroid Carcinoma
- Most Common to Present as Solitary Cold Nodule
- Hematogenous Spread
- Good Prognosis
- Uniform Follicles
- May Invade Capsule
- Head and Neck Radiation
Medullary Thyroid Carcinoma
- Sporadic and Familial Types
- Arises from Parafollicular C cells
- Produces Calcitonin
- Hypocalcemia
- May Produce ACTH
- Sheets of Cells With Amyloid Deposition
- Increased Calcitonin with Pentagastrin Infusion
- MEN 2A and 2B
Anaplastic Thyroid Cancer
- Rapidly Progressive
- Poor Prognosis
- Hoarseness
- Invades Local Structures
- Mixed Morphology
- Multinodular Goiter
- Older Age
- History of Thyroid Disease
Thyroid Storm Causes
- Sepsis
- Thyroid Trauma
- Surgery
- Childbirth
- Grave's Disease
- Excessive Thyroid Hormone Ingestion
- TSH-secreting Tumors
- Hyperfunctioning Goiter or Nodule
- McCune Albright Syndrome
Thyroid Nodule Assessment
- Thyroid-Stimulating Hormone (TSH)
- Ultrasound
- Fine Needle Aspiration
- Most Accurate Test
- Radioactive Iodine Uptake (RAIU)
- Hot Nodules Rarely Malignant
- Free T3 and T4
- Repeat Ultrasound 6 -18 Months