First Aid for the Medicine Clerkship.pdf

Graves disease d efinition autoimmune disease causing

This preview shows page 79 - 81 out of 376 pages.

GRAVES’ DISEASE D EFINITION Autoimmune disease causing hyperthyroidism due to antibody, which stimu- lates TSH receptor P ATHOPHYSIOLOGY Antibody is produced that interacts with the receptor for TSH resulting in continuous excess secretion. Cause of the exophthalmos (infiltrative opthalmopathy) in Graves’ is unknown, but is thought to be due to immunoglobulins that interact with self-antigens in the extraocular muscles and on orbital fibroblasts. These antibodies are not the same antibodies as those interacting with the TSH receptor. S IGNS AND S YMPTOMS Diffusely enlarged thyroid Exophthalmos Pretibial myxedema Tachycardia, palpitations In elderly patients the presentation is less classic. Apathy can be pres- ent without the common hyperactivity signs (apathetic hyperthy- roidism). Cardiovascular features may be prominent and hyperthy- roidism may not be suspected initially. 80 HIGH-YIELD FACTS Endocrinology Graves’ disease is the most common cause of hyperthyroidism. In initial stabilization of thyroid storm, cooling blankets can be applied to treat hyperpyrexia, if present. Never send any thyroid storm patient for a procedure involving iodine contrast before giving PTU.
Image of page 79

Subscribe to view the full document.

D IAGNOSIS High radioactive iodine uptake on a radionuclide scan. (If uptake is present but low, then diagnosis is thyroiditis or factitious hyperthy- roidism.) Elevated free thyroid hormones (T 3 , T 4 ) Undetectable TSH levels High thyroglobulin level T REATMENT Long-Term Antithyroid Therapy Usually accomplished with propylthiouracil (PTU) Methimazole is as effective as PTU when administered at one tenth of the PTU dosage. PTU has the advantage of inhibiting the peripheral conversion of T 4 to T 3 , thus there is usually a more rapid symptomatic improvement. Twelve- to 24-month course is usually used and one third to one half of patients remain well indefinitely. Complications: Leukopenia (check CBC before initiating therapy). Stop medication if absolute PMN drops below 1,500 cells/ µ L. If patient de- velops fever or sore throat, he or she should be instructed to return. Radioactive Iodine Ablation Therapy (Preferred Treatment) Can produce the same effects as surgery without the surgical complica- tions Tends to produce hypothyroidism over time. Forty to 70% for patients will develop hypothyroidism within 10 years of therapy. Some prefer to reserve radioactive iodine ablation therapy for patients over 30 years of age because of a higher incidence of hypothyroidism in younger patients. Complications: Radiation thyroiditis commonly appears within 7 to 10 days after therapy and is associated with accelerated release of thyroid hormone into the blood. Rarely, this results in thyrotoxic crisis. Adrenergic Antagonists Propranolol is the agent of choice.
Image of page 80
Image of page 81
  • Fall '17
  • Agha

{[ snackBarMessage ]}

What students are saying

  • Left Quote Icon

    As a current student on this bumpy collegiate pathway, I stumbled upon Course Hero, where I can find study resources for nearly all my courses, get online help from tutors 24/7, and even share my old projects, papers, and lecture notes with other students.

    Student Picture

    Kiran Temple University Fox School of Business ‘17, Course Hero Intern

  • Left Quote Icon

    I cannot even describe how much Course Hero helped me this summer. It’s truly become something I can always rely on and help me. In the end, I was not only able to survive summer classes, but I was able to thrive thanks to Course Hero.

    Student Picture

    Dana University of Pennsylvania ‘17, Course Hero Intern

  • Left Quote Icon

    The ability to access any university’s resources through Course Hero proved invaluable in my case. I was behind on Tulane coursework and actually used UCLA’s materials to help me move forward and get everything together on time.

    Student Picture

    Jill Tulane University ‘16, Course Hero Intern