Download I. Thyroid gland

I.
Thyroid gland:
A. Endocrine gland
1. Secretes, stores & liberates T3 & T4
2. Major endocrine role - regulating metabolic rate
B. General principles of regulation
1. Hypothalamic-Pituitary-Thyroid axis
2. Thyroid-binding proteins & free hormones
a. Unbound
b. Bound
(1) Thyroid-binding proteins
3. Peripheral metabolism of thyroid hormone
II.
Thyroid function tests
A. Serum TSH
1. Good screening test
2. Used to DDX hyperthyroidism vs. hypothyroidism
B. Total T4, Free T4, FT4 index
C. Total T3, Free T3, T3 uptake
1. Free T4 & T3 – assess true metabolic status
2. Total T4 - altered by TBG, illness, drugs
D. Radioactive Iodine uptake
1. Needed in Graves’ DX & management
E. Other tests:
1. Autoimmunity – Thyroid peroxidase AB
2. Thyroid Cancer - Thyroglobulin
III.
Dysthyroid
A. Hypothyroidism
1. TFT crucial in making DX
2. Primary hypothyroidism
a. low free T4 & high TSH
3. Secondary hypothyroidism
a. low or inappropriately normal TSH & low free T4
B. Hyperthyroidism
1. Primary hyperthyroidism
a. high free T4 & suppressed TSH
2. Secondary hyperthyroidism
a. high free T4 & high or inappropriately normal TSH
IV.
Common orbital disorders of adults
A. TED – most common cause of unilateral & bilateral proptosis
V.
Graves’ Syndrome
A. Hyperthyroidism – most common feature
B. Goiter
C. Ophthalmopathy/orbitopathy – 10 -25% incidence
D. Dermopathy
VI.
Patient Assessment of suspected Thyroid Orbitopathy
A. Systemic review
1. Signs & symptoms
B. Physical exam
1. Goiter
C. Eye Signs
1. Proptosis
2. Lid retraction
3. Lid lag
4. Conjunctival edema
5. Periorbital edema
6. Superior Limbic Keratoconjunctivitis
7. Myopathy
D. Laboratory studies
E. Imaging
VII.
Classification & Grading of Thyroid Orbitopathy
A. NO SPECS
VIII.
Graves Orbitopathy Risk Factors
A. Genetic predisposition
B. More common in women
C. Smoking
D. Age > 60
E. Stress
F. Treatment of Graves with I 131
IX.
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Table of Therapeutic Options in Thyroid Orbitopathy
A. Symptomatic
B. Topical Meds
C. Systemic drugs/procedures
D. Plasmapheresis
E. Orbital radiation surgery
F. Surgical Management