Hyperthyroidism
What are Grave's disease AI effects?
exopthalmaos, periorbital edema, swelling and redness of the conjunctiva, corneal involvement, vision loss, diplopia, onycholysis, pretrial dermopathy.
What are adverse effects of propranolol?
hypertension, bradycardia, hypotension, fatigue, worsening of reactive airway disease if present, increase in serum TGs, LDL, and blood glucose and lowering of HDL
What are other lab results of diagnosing Grave's disease?
normocytic anemia, mild leukopenia, elevated transaminases, elevated alk phosphatase, elevated serum calcium, reduced total serum cholesterol
What is opthalmopathy?
periorbital edema, conjunctival redness and swelling, proptosis, corneal involvement (keratitis), optic nerve involvement (loss of vision). extra ocular muscle involvement
What is thyrotoxicosis? What are some signs/symptoms
-clinical syndrome resulting from tissue exposure to high levels of thyroid hormones -palpitations, nervousness, easily fatigued, diarrhea, excessive sweating, heat intolerance - may have catecholamine excess, but circulating levels of E/NE are low
What is a goiter?
-when TSI antibodies bind TSH receptors there is stimulation of both growth and function - have AntiTPO and AntiTG -full hyperthyroidism, then hypothyroidism, or even NO thyroid function (due to receptor down-regulation)
What is the etiology of Grave's Disease?
1. fammilal factor - HLA type 2. Stimulated by stressors (viral or bacterial infection or psychological stress) 3. drug/supplementation (iodine excess, lithium, corticosteroid withdrawal, interferon-alpha 4. pregnancy and post partum (auto-antibodies)
What does the presence of TSI antibody correlate with?
ACTIVE Grave's
What is the most common cause of hyperthyroidism? What is the peak incidence age?
Grave's Disease male: female 1:10 peak incidence age 20-40
What are some nutritional treatments of grave's disease?
L-carnitine multivitamin omega 3 (b/c anti inflammatory) antioxidants (protective with reduced glutathione and increased free radical production with Graves) AVOID- DHEA supplementation (potentiates thyroid hormone
How do you monitor Grave's disease?
Labs: evaluate baseline CBC diff and LFT before administration of medication TSH 4-6 weeks after dosage change and then 3-6 months if symptomatic: WBC counts and LFT's
What are the adverse effects of methamizole?
agranulocytosis (usually it occurs within first 90 days) insulin autoimmune syndrome, hepatitis, rash and loss of hair
What are adverse effects of PTU?
agranulocytosis, hepatic failure, skin rash, hair whitening
What are options of medical management for Grave's disease?
anti-thryoid medication thyroid ablation with sodium iodide thyroidectomy (with enlarged gland and pregnancy) beta blockers for symptoms immunosuppresive agents (for ocular) steroids (for autoimmune and ocular)
Grave's disease serious effects?
atrial fibrillation adrenal crisis (hypotension, sock, fever, dehydration, weakness, hypoglycemia) emergency thyrotoxic periodic paralysis (rare) - sudden flaccid paralysis and hypokalemia (asian males) osteopenia/osteoporosis thyroid storm (fever, weight loss, heart failure, coma) ophthalmopathy
What are some adjunctive treatments of Grave's disease?
botanicals )lycopus, cratageus, leonurus) thyroid modulating teas (melissa, lithospermum) botanical nervines autoimmune treatment selenium - improves reduction of anti-thyroid antibodies manage endocrine imablances: hypoestrogenism and hypoadrenocorticism cardiovascular support melatonin stress management homeopathy
What is the cause of exophthalmos in graves?
increase in glycosaminoglycan deposition in retro-orbital fibrofatty tissue and extra ocular muscles, as well as lymphocytic infiltrate
What extra ocular muscles are involved with opthalmopathy in Graves?
inferior rectus most involved - failure to relax limits upward gaze medial rectus second involved - impairs lateral gaze
What do thyroid function tests reveal in Grave's disease?
low TSH high FT4 high FT3 TSI sometimes anti-thyroid antibodies
What are first line therapy managements of Grave's disease?
methimazole initiation OR propylthiouriacil (PTU) 100 mg TID, benefit of decreasing T4 to T3 beta blocker (propranolol - reduces T4-T3 conversion)
What are some Grave's Disease signs/symptoms?
nervousness excessive sweating fatigue/insomnia heat intoerance cardiac palpitations increased appetite weight loss increased bowel motility pruritus exophthalmos goiter thyroid bruit tachycardia widened pulse pressure A-fib fine skin texture hyperreflexia
What is the benefit of using beta blockers for Grave's Disease management?
reduces T4 and T3 conversion initial dose 10-20 mg every six hours and increased until symptoms are control
Lab diagnosis of Grave's disease?
step 1: thyroid panel, TSH low, fT4 high step 2: thyroid antibodies, TSH, TPO, anti thyroglobulin present step 3: thyroid scintigraphy. 123 I or 99 m TcO4
What is dermopathy of Grave's disease?
thickening of the skin, especially over the lower tibia due to accumulation of glycosaminoglycans. only 2-3% of Graves cases
What is occurring in Grave's disease?
thyroid stimulating immunoglobulins are present (TSI's) which bind to TSH receptor activating excessive thyroid hormone production
What are some life threatening complications of hyperthyroidism?
thyroid storm - hypertension, elevated body temp, palpitations, tachycardia, delirium, may lead to heart failure and shock untreated hyperthyroidism - CHF, osteoporosis
What does Grave's disease consist of?
thyrotoxicosis goiter opthalmopathy (exophthalmos) dermopathy (pretibial myxedema)