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Euthyroid: structural change, but no change in function. Don’t see any symptoms in these patients.
Hypo: structure is same, but change in function
Hyper: change in both structure and function.
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Rare for problem to come from pituitary or hypothalamus (secondary or tertiary). Rare to have thyroid insensitivity to TSH.
Measure free T3/T4: up to 90% of T4 is protein bound. T3 is 75% bound.
Liver and chronic kidney disease affects albumin and changes the binding of T3 and T4.
FYI:
Drugs that increase TSH: lithium, potassium iodide
Drugs that decrease TSH: chronic aspirin use, dopamine, heparin, steroids
Pregnancy and estrogen use will increase binding capacity.
Chronic testosterone use decreases binding capacity of globulins
Drugs that increase free T3: estrogen, methodone, BCP, androgens, anabolic steroids, high dose salicylates.
(Test: big ideas, red flags. Exam questions will ask to DDx based on symptoms. Not tricky!)
Congenital abnormalities:
Whatever affects thyroid will also affect heterotropic thyroid tissue.
Lateral aberrant thyroid: tissue on lateral wings (can be metastasis or ectopic thyroid)
Non-toxic goiter:
Increase in size of follicular cells, usually due to hypothyroidism, then it increases in size and becomes euthyroid.
Note how thyroid will feel: With goiter, it will become nodular, but not cancerous.
Can happen after period of emotional stress.
Malignancies are more common in men than women. Every other thyroid condition has a higher incidence in women.
Patient may present with swollen neck, sore throat, swollen lymph nodes.
Under “lab findings” cross off reference to RAIU
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Euthyroid: multinodular (hyperthyroidism)
Treatment: TSH suppression using thyroid hormone may not work after 50 because nodules, functional exogenous TSH
will increase their function.
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Slide 1 under Nutrition: should say T4T3 conversion.
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Primary hypothyroidism, non-goitrous
Very similar to euthyroid. Due to cirrhosis, MI, surgery.
Sub-acute: no autoimmune: no lymphocytic edema, therefore, no symptoms to do with edema.
Acute inflammatory thyroid caused by a virus: antecedent URTI, sore throat.
Lab findings: high erythrocyte sedimentation rate. Initial transient hyperthyroid.
Self-limited hyperthyroid phase, then transient hypothyroidism and eventual recovery.
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Graves’ disease: No nodules, exophthalmus due to edema.
Proptosis=exophthalmus. Lid retraction, lose definition of the upper lid. Eyelashes can scratch eye.
Palpable, audible bruit over thyroid in Graves’
Can spontaneously remit.
If pretibial myxedema gets really bad, they get paraesthesia, then can look like other diseases.
Plummer-vinson syndrome:
Occurs in elderly because it takes time for toxic multinodular goiter to result.
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Anti-thyroid meds don’t work well in elderly.
Often patient describes “hoarseness” as sore throat. Red flag.
Plummer-Vinson:
See areas of atrophy in thyroid. Surgery indicated when issues of compression: trachea, esophagus, laryngeal nerve
(hoarseness), carotid artery, jugular vein.
Toxic adenoma:
Same symptoms as toxic multinodular goiter. Can’t DDX on physical examination. Need nuclear scan.
Hypersecretion of TSH:
Secondary: see high TSH, high T3/T4.
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Cold nodules, because tissue has de-differentiated.
Hard, fixed, non0tendar, non-palpable edges.
Cervical Lymphadenopathy
Follicular adenoma:
Do every test in the book when history of medullary thyroid carcinoma.
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Follow people with family history of MEN and medullary carcinoma.