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Hypothyroidism Hyperthyroidism Symptoms and Signs

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Hypothyroidism Hyperthyroidism Symptoms and Signs Hypothyroidism Symptoms and Signs Hyperthyroidism General Neuro General Neuro From asymptomatic to myxedema coma • Depression “Like running a marathon all the time” • Nervousness “Like everything is slowed down” • Memory loss • Appear to have high energy but are • Restlessness • Low exercise tolerance • Fatigue fatigued • Insomnia • Hyperlipidemia • poor exercise tolerance • Tremour • Cold intolerance • Heat intolerance Face/Neck Face/Neck • ophthalmopathy Ø ocular changes (periorbital • Hair is coarse, brittle and is lost swelling, lid retraction and lid lag, • Thinning of lateral 1/3 of eye brows stare and infrequent blinking) Ø infiltrative (proptosis/ • Puffy Face exophthalmos, increased edema • Enlarged tongue of lids and conjunctiva, chemosis, ophthalmoplegia) • Hoarseness • ± Goitre • ± Diffuse goitre • Bruit (when osculating over thyroid) • Weight gain (modest) • Weight loss (despite appetite) Cardiovascular Cardiovascular • bradycardia • pericardial effusion • Palpitations, Afib • cardiomegaly • hypertension GI Gu: GI Gu: • Constipation • Menorrhagia • Diarrhea • Infertility, amenorrhea Skin Skin •Skin is dry, coarse, thick, cold, • Sweating pale • Warm, moist skin Muscles • Dermatopathy •Weakness, cramps Ø Hands: Acropachy Ø Legs: “pretibial myxedema * Seen in Graves • Tendon Reflex Delay (relaxation phase) • Increased Reflexes Other: Onycholysis, gynecomastia,palmar erythema,spider angiomata, myopathy, MedNotable.com periodic paralysis, vitiligo Approach to Thyroid Masses HPI • History of Significant Radiation Exposure (Chernobyl nuclear TSH accident in 1986, external beam radiation treatment to the head and neck for other cancers like lymphoma, radiation facial acne treatment in 1950s) • Voice change (neck mass compressing the recurrent laryngeal nerve) Low Normal High FH: • Family history (esp. medullary thyroid cancer) T4 US +/- FNA PE: • physical findings associated with an increased risk malignancy: • Size >4 cm • Male Thyroid • Age <20 or >60 Scan (RAIU) • Rapid growth • Lymphadenopathy • Hoarse voice, voice change, or vocal cord paralysis • Mass is fixed or tethered and does not move with swallowing “Hot” “Cold” FNA MedNotable.com Approach to Hypothyroid Approach to Hyperthyroid ↓TSH/ ↑ TSH ↑T4 No other tests needed à Likely Hashimotos Bypass and Clinically ? RAIU + treat Significant Scan Sub Acute Graves Nodule Thyroiditis Uptake ↑ ↑ ↓ Scan Diffuse Hot Nodule N MedNotable.com Problems Exposure of tissues to subnormal amounts of thyroid hormone • Fetus and neonate: defective neuronal development Function Can have overlap Structure • Childhood: decreased growth and development • All ages: decreased metabolic activity, increased mucopolysaccharide depositions Size: Hypothyroidism Hyperthyroidism Enlarged Nodule(s) (Goitre) Under- Other: Destruction Surgery Congenital Functional production Subclinical Causes Benign Malignant Eg. Lack of • cyst • Papillary Pituitary • colloid nodule thyroid Drive cancer (PTC) • Follicular thyroid cancer (FTC) Radioactive Toxic Toxic Exogenous • Medullary Hasimoto’s Hypopituitarism Iodine Graves’ Thyroiditis Other Iodine Deficiency Medications Nodular Nodule Hormone thyroid cancer (MTC) • Anaplastic • autoimmune Inflammation of • choriocarcinoma or cancer • Most common, • Iodine/drug disorder (can • Iodine deficiency •TSI bind to thyroid causing release hydatidiform moles (HCG) • Metastatic 90% women induced 131I also be • Absence of goître hTSH-R of preformed • thyroid carcinoma (toxic from other Autoimmune treatment thyroid hypo) • Food containing thyroid hormone that carcinomatous nodule or primary Plasma cells and stimulating cassava has anti- immunoglobulin is usually self-limiting from widespread metastasis) (breast, GI lymphocytic (TSI) thyroid properties • struma ovarii cancers) infiltration • Improves with Acute infectious (rare) • associated with • Lymphoma Positive thyroid sodium iodide acromegaly arising in the antibodies treatment Subacute • related to polyostotic thyroid Commonly no local Granulomatous fibrous dysplasia symptoms Thyroiditis (common) • induced by iodine • likely viral • TSH-producing pituitary • Small, diffuse, firm • three phases: adenoma goiter 1) hyperthyroid • T3 toxicosis • Hypothyroidism 2) hypothyroid • Family history of 3) recovery phase autoimmune diseases or • treatment: NSAID or other thyroid prednisone for diseases pain, b-blocker for Can be hyperthyroid, symptoms, L-T4 not usually necessary Postpartum thyroiditis: •lymphocytic thyroiditis up to 1 year post-partum, usually 6 weeks afterdelivery •usually mild phases of hyper(initial)/ hypothyroidism • antimicrosomal antibodies elevated •usually resolves but can recur after future pregnancies MedNotable.com .
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