goiter + thyroiditis + hyperthyroidism

Question 1

What is a goiter?

Answer 1

An enlarged thyroid gland, appearing as a growth on the neck.

Question 2

Is it benign or malignant?

Answer 2

Benign, can occur with hyperthyroidism or hypothyroidism.

Question 3

What is thyroiditis?

Answer 3

Inflammation of the thyroid gland.

Question 4

Types of thyroiditis?

Answer 4

1. Subacute granulomatous thyroiditis – viral infection
2. Acute thyroiditis – bacterial or fungal infection
3. Hashimoto thyroiditis – chronic autoimmune thyroid destruction
4. Silent painless thyroiditis – postpartum autoimmune reaction

Question 5

Who is at risk for thyroiditis?

Answer 5

Female, white, older age, family history of thyroid disease. Silent thyroiditis can occur within 6 months postpartum.

Question 6

symptoms of thyroiditis?

Answer 6

Ear, throat, or jaw pain, fever, chills, sweats, fatigue.

Question 7

labs for thyroiditis?

Answer 7

• T3 & T4 increased in subacute, acute, silent thyroiditis
• T3 & T4 decreased, TSH increased in Hashimoto

Question 8

Management for acute/subacute thyroiditis?

Answer 8

Often resolves in weeks to months without treatment; treat symptoms if needed.

Question 9

Medications for thyroidits?

Answer 9

NSAIDs, corticosteroids for pain; propranolol/atenolol for cardiac symptoms; thyroid meds for hyper/hypothyroidism.

Question 10

Special considerations for thyroiditis?

Answer 10

Hashimoto patients are at risk for other autoimmune diseases like Addison’s, pernicious anemia, Graves disease.

Question 11

What is hyperthyroidism?

Answer 11

Excess thyroid hormone, caused by thyroid disease, excess stimulation, or excess TSH production.

Question 12

What is Graves disease?

Answer 12

Most common cause of hyperthyroidism in the U.S. Autoimmune disorder where IgG binds TSH receptors, stimulating thyroid hormone secretion.

Question 13

Who is most affected in hyperthyroidism?

Answer 13

More common in women.

Question 14

key symptoms of Graves disease

Answer 14

• Goiter
• Weight loss
• Agitation, restlessness, hyperactivity
• Sweating, heat intolerance
• Diarrhea
• Tachycardia, palpitations, tremors
• Fine hair, oily skin
• Irregular menstrual cycle
• Weakness
• Exophthalmos

Question 15

History and physical exam for graves disease?

Answer 15

Family history of thyroid or autoimmune disease; enlarged thyroid; protruding eyes.

Question 16

Lab tests for graves disease?

Answer 16

Low TSH, high T3 & T4; free thyroxine level; increased radioactive iodine uptake confirms diagnosis.

Question 17

Pharmacologic treatment for graves disease?

Answer 17

Methimazole (Tapazole) – blocks thyroid hormone production.

Question 18

Other Tx options for Graves disease?

Answer 18

• Radioactive iodine – destroys all/part of gland (may cause hypothyroidism)
• Surgical removal – partial or total; total removal requires lifelong thyroid hormone replacement therapy.