USMLE Step 2 (3) - Thyroid Disease
USMLE Step 2 (3) - Thyroid Disease
USMLE Step 2 (3) - Thyroid Disease
THYROID DISEASE
HYPOTHYROIDISM
Clinical features
HYPOTHYROIDISM
Clinical features
HYPOTHYROIDISM
Myxedema coma
HYPOTHYROIDISM
Diagnosis of hypothyroidism
HYPOTHYROIDISM
Therapy
HYPERTHYROIDISM
Clinical features
"Overactive" metabolism
Sweating
Heat intolerance
Weight loss
Sinus tachycardia
Atrial fibrillation (apathetic hyperthyroidism in the elderly)
HYPERTHYROIDISM
Etiology
Graves' disease
Nodular toxic goiter
Subacute thyroiditis
Factitious
Pituitary tumors
HYPERTHYROIDISM
Clinical features
Diarrhea
HYPERTHYROIDISM
Thyroid storm
HYPERTHYROIDISM
Laboratory studies
HYPERTHYROIDISM
Treatment
Antithyroid drugs
Methimazole and propylthiouracil (PTU)
o Decrease the synthesis of thyroid hormone by inhibiting the
oxidation of iodide
o PTU also inhibits the conversion of T4 to T3
o Skin rash, joint pain, or agranulocytosis may occur
HYPERTHYROIDISM
Treatment
HYPERTHYROIDISM
Treatment
Subtotal thyroidectomy
o Allows for cure of hyperthyroidism
o Patient compliance with long-term medication is necessary
o Less hypothyroidism than with radioactive iodine
o Patient should be euthyroid before surgery
HYPERTHYROIDISM
Treatment
Radioactive iodine
o Most patients require 1 or 2 doses of radioactive iodine to cause
decrease in function and size
o Allows outpatient treatment
o Very high success rate
HYPERTHYROIDISM
Treatment
HYPERTHYROIDISM
Treatment of thyroid storm