BMS ENDO 2 DISEASES

GOITER

GOITER

-mot common thyroid disease

-enlargement of gland

-most often iodine deficiency

-epidemic vs sporadic

T3/T4: normal

TSH: usually normal but MAY be elevated

TX:

-sx removal

-radioactive iodine therapy

-levothyroxine therapy

GRAVES DISEASE

production of IgG autoAB to the TSH receptors

(anti TSH receptors!!)

-exophthalmos (40%)

-pretibial myxedema

-periorbital swelling

-TSI

-TGI

-TBII’s

T3/T4: increased

TSH: decreased

TSI/TGI: increased

tx

-b blockers

-anti thyroid meds

-radioactive ione

most common

-sx

stages

1. inflammatory

2. fibrotic

   -lid retraction

therapeutic measure

-artificial tears/ointment

-sunglasses

-eye patches/nocturnal taping of eyes

-prisms

-elevating the head at night

HYPOTHYROIDISM

PRIMARY

>most common: Hashimoto’s

-sx ablation

-radiation ablation

-1ry idiopathic hypothyroidism

T3/T4: decreased

TSH: increased

SECONDARY

after ppit of hypothalmic damage (tumor, ischemia)

T3/T4: decreased

TSH:decreased

SUBCLINICAL HYPOTHYROIDISM

T3/T4: normal

TSH:elevated

IATROGENIC HYPO

most common cause of hypothyroidism in the US

-2ry to thyroidectomy or radioactive iodine tx

tx

levothyroxine (synthroid) 25-300mcg (0.25-3.00mg)

CONGETINAL HYPOTHYROIDISM (CRETINISM)

infancy or early childhood

-impaired dev of skeletal system (dev delay)

-severe mental retardation

tx

levothyroxine (10-15 mcg/kg/d)

HASHIMOTO’S

-chronic autoimmune inflammation

body attacks the thyroid gland and causes tissue destruction

>CD8 cells and auto-AB

-increased risk for b cell leukemia

>painless enlargement of gland

-transient thyrotoxicois

• followed by hypofunction

SUBACUTE THYROIDITIS (de Quervain’s)

30-50 yr

>after viral infection

CLINICAL FINDINGS

-neck pain

-fever

-transient hyperthyroidism

-usually self limited to 6-8 weeks

ADENOMAS

follicular most common

solitary painless mass

cold nodule: hypofunctional thyroid issue

warm nodule: normal thyroid function

hot nodule: hyperfunctional thyroid issue

MALIGNANT TUMORS

1. papillary carcinoma (75-85%)

2. follicular carcinoma

3. medullary carcinoma

4. anaplastic carcinoma

PAPILLARY CARCINOMA

most common malignant tumor

>associated with ionizing radiation

-orphan annie eye (big ass nuclei)

tx

-resection

-levothyroxine

FOLLICULAR CARCINOMA

2nd most common

>solitary cold nodule

hematogenous metastasis

-lungs

-bones

-liver

rx

sx resection

MEDULLARY CARCINOMA

secretes calcitonin

-sporadic in 80%

-associated with MEN

5 year survival rate 50%

ANAPLASTIC CARCINOMA

very aggressive lesion (high mortality rate)

rapid growth and metastasis

death within 1 year

PRIMARY HYPERPARATHYROIDISM

>parathyroid adenoma (80%)

pathogenesis

hypercalcemia

labs

Ca & PTH: elevated

CLINICAL FEAUTURES

-asymptomaic

-kidney stones. osteoporosis

-neurologic changes

SECONDARY HYPERPARATHYROIDISM

etiology

-chronic renal failure

-vit d def

-malabsorption

tx

parathyroidectomy

HYPOPARATHYROIDISM

labs

Ca & PTH: decreased

neuromuscular excitability and tetany

>hypomg, hypoalkalemia, alkalosis (hyperventilation)

rx:

vit d and ca