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Hyperthyroidism

  • Definition: Condition where too much T3 or T4 is produced by the thyroid, leading to increased metabolism.

  • Key characteristics: Increased cardiac output, blood pressure, heart rate. Individuals experience high appetite but may be very thin due to calorie burning.

Signs and Symptoms

  • Palpitations

  • Tachycardia (increased heart rate)

  • Increased systolic blood pressure

  • Frequent diarrhea

  • Heat intolerance

  • Anxiety and restlessness

  • Diaphoresis (excessive sweating)

  • Insomnia

  • Goiter (enlarged thyroid) and exophthalmos (bulging eyes)

  • Myxedema (autoimmune skin condition with thick, scaly plaque)

  • Amenorrhea (absence of menstruation in females)

Causes

  • Graves' Disease: An autoimmune disorder, causing the immune system to attack the thyroid.

  • Toxic Multinodular Goiter: Presence of nodes in the thyroid gland causing hyperthyroidism.

  • Thyroid Storm/Crisis: Sudden, severe hyperthyroid condition requiring emergency care, characterized by tachycardia, fever, and possibly delirium.

Treatments

  • Immediate Care: Monitor vital signs, control heart rate with beta blockers (not a cure for hyperthyroidism).

  • Lab tests: Check T3 and T4 levels; a high reading indicates hyperthyroidism.

  • Thyroid Scan: Use radioactive iodine to assess thyroid iodine uptake.

    • Radiation precautions include limiting contact with others, especially vulnerable individuals.

  • Nonsurgical Management: Daily weight measurement, pulse monitoring, EKG for cardiac risk. Reduce environmental stimulation to prevent thyroid storms.

Medications

  • Methimazole: Preferred first-line treatment to inhibit T3 and T4 production by restricting iodine absorption.

  • Propylthiouracil (PTU): Alternative but more toxic to the liver.

  • Lugol's Iodine: Excess iodine given to decrease blood flow to the thyroid, lowering hormone production; takes weeks to take effect.

Surgical Option

  • Thyroidectomy: Removal of part or all of the thyroid, usually as a last resort. Patients will likely need lifelong hormone replacement therapy (Synthroid).

    • Pre-operative monitoring for hypertension, dysrhythmias, and tachycardia.

    • Post-operative care includes vital sign monitoring and avoiding neck strain. Check for hemorrhage and low calcium levels due to potential parathyroid damage (tingling, muscle twitching).

Hypothyroidism

  • Definition: Condition where not enough thyroid hormone (T3 or T4) is produced, leading to slowed metabolism.

    • Results from autoimmune disorders, such as Hashimoto's disease, thyroid surgery, iodine deficiency, or certain medications (e.g., amiodarone and lithium).

Signs and Symptoms

  • Bradycardia (slow heart rate)

  • Decreased activity tolerance

  • Constipation

  • Weight gain

  • Cold intolerance

  • Poor wound healing

  • Confusion and impaired memory

  • Low T3, T4 levels; high TSH due to pituitary stimulation to produce more hormone.

Treatment

  • Levothyroxine (Synthroid): Hormone replacement therapy.

  • Goiter formation: Thyroid attempts to grow larger to produce more hormone.

  • Myxedema Coma: Severe, untreated hypothyroidism causing decreased mental status, hypothermia, and organ dysfunction; this is a medical emergency. Fluid and hormone therapy (IV) needed immediately.

Parathyroid Disorders

  • Function: Regulates calcium levels in the body. Normal calcium levels range from 8.5 to 11 mg/dL.

Hypoparathyroidism

  • Definition: Decreased secretion of parathyroid hormone leads to low calcium levels, often due to surgical removal or autoimmune disease.

  • Symptoms: Low calcium causes muscle cramps, tingling, and Chvostek's and Trousseau's signs.

  • Treatment: Oral calcium (calcitriol, calcium carbonate) or IV calcium gluconate in severe cases.

Hyperparathyroidism

  • Definition: Excess parathyroid hormone secretion leads to high calcium levels, causing low phosphorus and increased risk of kidney stones.

  • Treatment options include medication (calcimimetic drugs) for mild symptoms or parathyroidectomy for severe cases.

  • Post-surgical monitoring is essential due to risks of low calcium levels post-removal.