Thyroid Dysfunction
Kristopher Maday, MS, PA-CProgram Director/Associate Professor
University of Tennessee Health Science CenterPhysician Assistant Program
Target Tissue Effect Mechanism
HeartChronotropic Increase number and affinity of β-
adrenergic receptors
Inotropic Enhance responses to circulating catacholamines
Adipose Tissue Catabolic Stimulate lipolysis
Muscle Catabolic Increase protein breakdown
BoneDevelopmentalMetabolic
Promote normal skeletal development, accelerates bone turnover
Nervous System
Developmental Promote normal brain development
Gut Metabolic Increase rate of carbohydrate absorption
Lipoprotein Metabolic Stimulates LDL receptor formation
Metabolism CalorigenicIncreases metabolic rate by stimulating O2 consumption of metabolically active tissues
Thyroiditis• Infectious– Staphylococcus, streptococcus– Signs and Symptoms• Rapid onset• Neck pain, fever, chills, dysphagia
– Ultrasound to evaluate for abscess– Treatment• IV antibiotics PO after 2-3d defervescence
Thyroiditis• Subacute– 2 main causes• Post-viral infection (2-8 weeks)• Autoimmune
– Signs and Symptoms• Enlarged, tender thyroid
– Laboratory• Elevated ESR or CRP• (+) thyroglobulin or thyroperoxidase• Variable thyroid panel
Thyroiditis• Treatment
T3, T4
Hyperthyroidism - Causes• Grave’s Disease–Most common cause of hyperthyroidism
is US– Autoimmune disease• High association with other autoimmune
diseases– Female:Male 8:1– Onset in 20s-40s
TSH-Receptor
Anti-thyroperoxidase
Hyperthyroidism - Causes• Toxic adenoma– Single – Plummer’s Disease–Multiple– Non-tender enlargement of thyroid
Hyperthyroidism - Causes
Hyperthyroidism - Causes
Signs and Symptoms of Hyperthyroidism
Signs and Symptoms of Hyperthyroidism
Signs and Symptoms of Hyperthyroidism
TFTs in Hyperthyroidism
TSH
TSH
T3T4
T3T4
Hyperthyroid - Treatment
Hyperthyroid - TreatmentThianamides
Methimazole Propylthiouracil
Onset Faster Slower
Compliance Better Worse
Cost Cheaper More expensive
Initial Dosing 5-20mg TID 100-300mg TID
Maintenance Dosing 5-15mg daily 30-50mg TID
Pregnancy No Yes
Thyroid Storm
T3, T4
Hyperthyroidism - Causes• Hashimoto’s Thyroiditis–Most common cause of hypothyroid in
iodine sufficient countries– Thyroperoxidase and thyroglobulin
antibodies
Hypothyroidism - Causes
Signs and Symptoms of Hypothyroidism
Signs and Symptoms of Hypothyroidism
Signs and Symptoms of Hypothyroidism
TFTs in Hypothyroidism
TSH
TSH
T3T4
T3T4
Hypothyroidism - Treatment
Initial Dosing1.6 mcg/kg/day
Levothyroxine
Recheck TSH in 6 weeksIncrease by 12.5-25 mcg/day
Temp – 93o F (33.8o C)
HR – 50 bpm
RR – 10 bpm
Sodium – 130 mg/dLTSH – 258 mu/L
T4 – 0.01 ng/dL
Myxedema Coma - Treatment
Thyroid HormonesLevothyroxine Triiodothyronine
Load – 200-400 mcg Load - 5-20 mcgMaintenance – 1.6 mcg/kg/day
Maintenance – 2.5-10 mcg TID
Fluid resuscitationStress dose steroids
Rewarming
Thank You!
w w w . p a i n e p o d c a s t . c o m
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