Topic 2: Management of Acute Endocrine Disorders

• What is euthyroid?

  Normal thyroid function.
• What happens when hyperthyroidism becomes extreme?

  Thyrotoxicosis.
• What happens when hypothyroidism becomes extreme?

  Myxedema coma.
• What is hyperthyroidism?


  Overactive thyroid.
• What demographic does hyperthyroidism happen in more?

  Women.
• What age usually gets affected by hyperthyroidism?

  Ages 20 - 40.
• What is the most common form of hyperthyroidism?

  Graves' disease.
• What is subclinical hyperthyroidism?

  • Serum TSH levels below 0.4 mIU/L.
  • Normal T4 and T3 levels.
• What is overt hyperthyroidism?

  • Low or undetectable TSH
  • Increased T4 and T4 levels
  • Symptoms may or may not be present.
• What is thyrotoxicosis?

  • Physiologic effects of hypermetabolism.
  • Results from increased circulating levels of T3 or T4 or both.
• Hyperthyroidism and thyrotoxicosis usually occur together.
• Who should be monitored closely after iodinated contrast media exposure?

  Patients at risk for hyperthyroidism.
• What is Graves' disease?

  Autoimmune disorder that causes diffuse thyroid enlargement and excess thyroid hormone secretion.
• What are precipitating factors to hyperthyroidism?

  Insufficient iodine supply, cigarette smoking, infection, stressful life events.
• Graves' disease has remissions and exacerbations with or without treatment.
• Graves' disease can progress to the destruction of thyroid tissue causing hypothyroidism later on.
• How much more likely are women to get hyperthyroidism compared to men?

  5 times.
• What can happen to the body systemically in regards to hyperthyroidism?

  Increased metabolism, increased tissue sensitivity.
• What can be found in hyperthyroidism if palpating the thyroid gland?

  Goiter or an excessively large thyroid gland.
• What is normal to auscultate when assessing a goiter?

  Bruits are normal due to an increased blood supply in the area.
• What happens to the eyes with hyperthyroidism?

  Exophthalmos.
• Why does exophthalmos occur with hyperthyroidism?

  Increased fat deposits and fluid lead to eyeballs being forced outward.
• What happens to the cardiovascular system with hyperthyroidism?

  • Systolic hypertension
  • Bounding, rapid pulse
  • Palpitations
  • Increased cardiac output
  • Systolic murmurs
  • Dysrhythmias
  • Angina
• What happens to the respiratory system with hyperthyroidism?

  • Dyspnea on mild exertion
  • Increased respiratory rate
• What can happen to the nervous system with hyperthyroidism?

  • Nervousness, fine tremors
  • Insomnia, exhaustion
  • Lability of mood causing delirium or agitation
  • Hyperreflexia of tendons
  • Inability to concentrate
  • Stupor, coma
• What cardiac problem is the immediate risk with hyperthyroidism?

  Cardiac dysrhythmias.
• What is not an immediate risk but a concern for cardiovascular with hyperthyroidism?

  Heart failure.
• What happens to the GI system with hyperthyroidism?

  • Increased appetite, thirst
  • Weight loss
  • Diarrhea
  • Splenomegaly
  • Hepatomegaly
• What happens to the skin with hyperthyroidism?

  • Warm, smooth, moist skin
  • Thin, brittle nails
  • Hair loss
  • Clubbing of fingers
  • Palmar erythema
  • Fine, silky hair, premature graying hair in men
  • Diaphoresis
  • Vitiligo
• What are musculoskeletal manifestations of hyperthyroidism?

  • Fatigue
  • Weakness
  • Proximal muscle wasting
  • Dependent edema
  • Osteoporosis
• What are reproductive system manifestations of hyperthyroidism?

  • Menstrual irregularities
  • Amenorrhea
  • Decreased libido
  • Decreased fertility
  • Impotence and gynecomastia in men
• What is acute thyrotoxicosis?

  Acute, severe, rare condition when there are excessive amounts of thyroid hormones in circulation.
• What should patients know about acute thyrotoxicosis?

  This is a life threatening emergency, but death is rare if treated early.
• What kinds of patients are at risk for thyrotoxicosis?

  Patients undergoing thyroidectomy.
• What are manifestations for acute thyrotoxicosis?

  • Severe tachycardia
  • Heart failure
  • Shock
  • Hyperthermia (up to 106 degrees)
  • Agitation
  • Seizures
  • Abdominal pain
  • Vomiting
  • Diarrhea
  • Delirium
  • Coma
• What do diagnostics show for hyperthyroidism?

  Low or undetectable TSH levels (<0.4 mIU/L) and elevated free thyroxine (T4) levels.
• What does the radioactive iodine uptake (RAIU) test do?

  Distinguishes Graves' disease from other forms of thyroiditis.
• What result of the RAIU shows Graves' disease?

  Diffuse homogenous uptake of 35% - 95% while a thyroiditis patient will have less than 2%.
• What does the RAIU test of a nodular goiter show?

  Uptake in the high normal range.
• What are the main goals for hyperthyroid patients?

  • Block adverse effects of thyroid hormones
  • Suppress hormone oversecretion
  • Prevent complications