Thyriod Disease

nursepractitionerb's version from 2017-05-26 15:38

Section 1

Question Answer
Risk Factors for Thyroid Diseasepersonal history of autoimmune disease (i.e. Type I Diabetes)
Risk Factors for Thyroid Diseasefamily history of thyroid disease
Risk Factors for Thyroid Diseasepersonal history of neck irradiation
Risk Factors for Thyroid Diseasedrug therapies (lithium, amiodarone)
Risk Factors for Thyroid Diseasewomen > 50 years of age
Risk Factors for Thyroid Diseasewomen in the period of up to 6 months post-partum

Section 2

Question Answer
Signs & Symptoms Hypothyriodismweight gain,hair loss,bradycardia/diastolic hypertension,lethargy,menstrual irregularities (menorrhagia),
Signs & Symptoms Hypothyriodismcognitive impairment,depression,constipation
Signs & Symptoms Hypothyriodismgoiter,dry skin
Signs & Symptoms Hypothyriodismcold intolerance

Section 3

Question Answer
Signs & Symptoms Hyperthyroidismweight loss,hair loss
Signs & Symptoms Hyperthyroidismpalpitations/tachycardia/atrial fibrillation
Signs & Symptoms Hyperthyroidismmenstrual irregularities (amenorrhea/oligomenorrhea)
Signs & Symptoms Hyperthyroidismwidened pulse pressure,goiter,
Signs & Symptoms Hyperthyroidismnervousness/tremor/anxiety,heat intolerance,
Signs & Symptoms Hyperthyroidismproximal muscle weakness,hypertension
Signs & Symptoms Hyperthyroidismheat intolerance, diaphoresis, clammy hands

Section 4

Question Answer
Investigations/Diagnostic Tests1-4TSH is the principle test for evaluating thyroid function
free T3 (fT3) and free T4 (fT4) are not necessary when screening for hypothyroidism
free T3 (fT3) and free T4 (fT4) are good formay measure in suspected hyperthyroidism to confirm diagnosis of thyrotoxicosis (elevated fT3 and normal fT4)
free T3 (fT3) and free T4 (fT4) are good formay measure to rule out TSH-producing pituitary adenoma (elevated TSH, fT3, fT4)
a thyroid ultrasound should be done if the physical exam suggests nodularity
thyroid uptake scan should be done to differentiate causes of a hyperthyroid state

Section 5

Question Answer
Two different causes of HypothyroidismPrimary and Secondary
Primary causes of Hypothyroidismchronic autoimmune thyroiditis (Hashimoto’s), medications
transient- temporary cause of hypothyriodismpainless thyroiditis, postpartum thyroiditis,subtotal thyroidectomy,following treatment of Graves’ by thyroidectomy,subacute thyroiditis,
infiltrativefibrous thyroiditis,sarcoidosis
iatrogenicthyroidectomy,radioactive iodine treatment
Secondary causes of Hypothyroidismpituitary lesion causing TSH deficiency,
Secondary causes of Hypothyroidismhypothalamic lesion causing TRH deficiency

Section 6

Question Answer
Two different Causes of HyperthyroidismPrimary and Secondary
Primary causes of Hyperthyroidismautoimmune( Graves’ disease, Hashimoto’s (Hashitoxicosis - rare)
Primary causes of Hyperthyroidismtoxic multinodular goiter,toxic adenoma,exogenous thyroid hormone intake,
Primary causes of Hyperthyroidismpostpartum thyroiditis,neoplastic (usually metastatic thyroid cancer - very rare)
Primary causes of Hyperthyroidismdrug-induced (amiodarone)
Secondary causes of HyperthyroidismTSH-producing pituitary adenoma
other causes of Hyperthyroidismgestational hyperthyroidism (seen with hyperemesis gravidarum)
other causes of Hyperthyroidismtrophoblastic disease

Section 7

Question Answer
Treatmentof HypothyroidismLevothyroxine (LT4)
Starting dose of levothyroxine for general populationusually start at 50mcg daily and increase incrementally
Starting dose of levothyroxine for children and elderlystart children and elderly at 25mcg daily
Special instruction for levothroxinetake on empty stomach to improve absorption
When to monitor TSHcheck TSH* 6 weeks after initiation and change in dose or clinical status
When TSH normalisecheck annually
Treatment of Hyperthyroidismmanage symptoms and then urgent refer to Endocrine

Section 8

Question Answer
Subclinical Thyroid Disease treatment is recommended if:TSH > 10mU/L
in subclinical hypothyroid disease with elevated TSH and normal fT4TSH levels should be monitored annually in untreated patients
TSH above reference range but < 10mU/L and any of the following:goitre,strong family history of autoimmune disease|,pregnancy,elevated thyroid peroxidase (TPO) antibodies
in subclinical hyperthyroidism with suppressed TSH levels and normal fT4 (less common)TSH levels should be monitored every 6-12 month,treatment recommended if patients have atrial fibrillation and/or osteoporosis

Section 9

Question Answer
Thyroid Disease in Pregnancy
maternal hypothyroidism is associated with decreased IQ in newborns
TSH screening is indicated in all wome with: women with a goiter or strong family history of thyroid disease who are planning pregnancy or who are in early pregnancy
TSH target in first trimester 0.5-2.5mU/L
TSH target in second and third trimesters0.5-3.0mU/L
levothyroxine requirements may increase by what % during pregnancy50%
post-pregnancy hypothryiodism womenmost women need a reduction in levothyroxine dose
screening for post-partum thyroiditis should be done at 3 and 6 months in women an increased risk (positive anti-TPO antibodies)

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