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Endorcine System II

Endorcine System II

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Published by: api-26938624 on Oct 19, 2008
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03/18/2014

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- Delayed ankle jerks (the single best clinical indicator for hypothyroidism)
- Maroni sign = hyperthyroid, redness and itchiness of skin over thyroid
- Berry Sign = The absence of carotid pulsation w/ malignant thyroidmegaly

Congenital Abnormalities
-Lingual thyroid
o
Thyroid fails to descend during embryogenesis
-Heterotropic Thyroid Tissue
o
Nests of thyroid tissue found along the pathway of its descent into the
lower neck
-Lateral Aberrant thyroid
o
Ectopic thyroid tissue in the lymph nodes and soft tissue adjacent to the
normal gland
-Thyroglossal duct cyst
o
Failure of the thyroglossal duct to completely involute resulting in a
cystic, fluid-filled remnant
Non-toxic Goiter
-Simple or Diffuse Nontoxic Goiter (Euthyroid)
o
Enlargement of the thyroid gland without evidence of thyroid dysfunction
o
Asymptomatic, if symptomatic there is smooth neck mass
o
Serum T3, T4 and TSH normal, normal or high RAIU
-Multinodular Nontoxic Goiter (Euthyroid)
o
Enlargement of the thyroid gland without evidence of thyroid dysfunction
o
Multiple nodules and/or cysts have developed
o
Serum T3, T4 and TSH normal, normal or high RAIU
o
Asymptomatic, but may progress to thyrotoxicosis = hyperthyroidism
-Euthyroid Sick Syndrome
o
Abnormal thyroid function tests in a normally euthyroid patient, suffering
from severe nonthyroidal systemic illness
o
Decreased T3, decreased or normal T4, variable TSH, increased cortisol
Hypothyroidism
-Congenital Cretinism (congenital myxedema)
o
A

congenital condition caused by a deficiency of thyroid hormone during
prenatal development because mother is deficient in iodine and
characterized in childhood by dwarfed stature, mental retardation,
dystrophy of the bones, and a low basal metabolism. Also called
congenital myxedema.

o
T3 and T4 low, TSH High unless lack of TSH secretion
Primary Hypothroidism, Non-Goitrous
-Hashimoto\u2019s Thyroiditis
o
Chronic thyroid inflammation caused by
autoimmune factors
o
Serum TSH elevated but free T4 is normal
o

Course of illness: get myxedema (puffy face and eyelids, hand and foot
edema) then severe agitation known as myxedema madness, get
constipation, heart problems and reproductive problems

o
Serum cholesterol often high in primary hypothyroidisms
o
Primary hypothyroidisms have a history of menorrhagia (
heavy menstrual
bleeding)
o
Complications are myxedema coma
-Subacute Thyroiditis (aka Granulomatous, Giant Cell or de Quervain\u2019s
Thyroiditis)
o
An acute inflammatory thyroid probably caused by a VIRUS
o
Self-limited hyperthyroid phase, followed by transient hypothyroidism and
eventual recovery to euthyroid sate
o
\u201cSore throat\u201d (progressive neck pain) and low grade fever
o
Early phase increased T3 and T4, decreased TSH, high ESR
o
Late phase decreased T3 and T4, low TSH
-Silent Thyroiditis
o
A subacute disorder occurring most commonly in the postpartum period
o
Self-limited hyperthyroid phase, followed by transient hypothyroidism and
eventual recovery to euthyroid state
o
WBC count and ESR normal
-Goitrogenic Vegetables = cabbage, turnips, sweet potato and kelp
o
Goitrogenic d/t suppression of thyroid hormone synthesis
Primary Hypothryroidism, Goitrous
-Iodine Deficiency
o
Dietary iodine deficiency
o
TSH may be slightly elevated, T4 may be low, normal or high, T3 is
normal or slightly elevated
-Iodide Induced
o
Goiter induced through excessive iodine consumption
Hyperthyroidism
-Grave\u2019s Disease (aka Basedow disease in Europe)
o
Autoimmune disorder, diffure goiter, hypermetabolism and exopthalmus
o
Proptosis (forward displacement of eyeball)
o
Lid lag and lid retraction, Heat intolerance
o
Low TSH, except in those w/ an anterior pituitary tumor
o
Opthalmopathy is specific to Graves: orbital pain, lacrimation,
photophobia, double vision, exopthalmos
o
Pretibial myxedema shows non-pitting tibial edema and rarely occurs in
the absence of Grave\u2019s opthalmopathy
-Toxic Multinodular Goiter (Plummer-Vinson Syndrome)
o
Hyperfunctioning thyroid nodules
o
Same presentation as Graves but without the opthalmopathy and pretibial
edema
o
Focal accumulation of radioiodine in one or more nodules
o
Eexogenous T4 does NOT suppress uptake of iodine
o
T4 and T3 often only minimally \u2191, and RAI uptake normal or slightly\u2191
-Toxic Adenoma
o
Solitary, hyperfunctioning follicular neoplasm in an otherwise normal
thyroid
o
Scan shows a solitary focus of iodine uptake \u201cHOT NODULE\u201d in a
background of minimal inake
o
Not dependent on TSH and not suppressed by hormone administration
-Hypersecretion of TSH
o
Rare cause of hyperthyroidism: pituitary adenomas that secrete TSH, and
or \u2191 hypothalamic secretion of TRH
-Iodine Induced
o
Treatment with iodine can lead to hypersecretion
-Thyroid Storm
o
Abrupt onset of the more florid sx of hyperthyroidism
o
Thyroid storm is a life-threatening emergency requiring specific tx
o
Fever, Weakness and muscle wasting, Extreme restlessness, Wide emotions
swings, Confusion
o
Psychosis, Coma, Hepatomegaly w/ jaundice
Neoplasms \u2013 Benign
-Follicular Adenoma: Solitary Cold Nodules
o
Asymptomatic neck mass
o
Hot nodules are benign in 98% of cases
o
Whereas 5-10% of cold nodules are malignant
o
Order serum calcitonin in pt who have a family hx of medullary thyroid
carcinoma
Neoplasms \u2013 Malignant
-Papillary Carcinoma
o
75% of US thyroid cancers
o
Most common thyroid cancer, can metastasis to lungs
o
Painless palpable nodule in otherwise normal gland or
o
Nodule w/ enlarged cervical LN or
o
Cervical lymphadenopthy in the absence of a palpable thyroid nodule
-Follicular Carcinoma
o
15% of all thyroid cancers
o

Follicular carcinoma differs from papillary in being solitary and rarely
occult, metastasis goes mainly to the bones of the shoulder, pelvis,
sternum and skull

o
Palpable nodule or enlarged thyroid
-Anaplastic Carcinoma

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