-Hyperparathyroidism-
-should be suspected when high serum calcium levels are detected
-Primary hyperthyroidism occurs due to PTH activation of osteoclasts leading to more bone reabsorption causing elevated calcium levels
-This also causes increased intestinal absorption of calcium
-Most common cause of primary hyperthyroidism is due to parathyroid adenoma
-Diagnosis of primary hyperparathyroidism is made with a high PTH or one that is in the normal range but elevated inappropriately given the elevated given the patients hypercalcemia
-Patients with primary hyperparathyroidism are usually asymptomatic
-Elevated isolated serum calcium level should be repeated.
-Malignancy is another cause for hypercalcemia. Malignancy and Primary Hyperparathyroidism account 90 percent of cases of hypercalcemia
-If malignancy is present, the PTH level is usually normal or low, where as in primary hyperparathyroidism the levels are usually high
-Familial hypocalciuric hypercalcemia (FHH) is due to an inactivating mutation of the calcium sensing receptor in the kidneys. See a hypercalcemia with a mildly elevated PTH concentration
-Family history of hypercalcemia that is symptomatic is helpful for coming up with the diagnosis
-Thiazide diuretics reduce calcium urine excretion and can cause mild hypercalcemia
-Lithium decreases parathyroid gland sensitivity to calcium, and decreases urinary excretion.
-Some patients on lithium develop hypercalcemia and hypocalciuria
-Secondary Hyperparathyroidism is when the parathyroid appropriately responds to a reduced level of calcium. This causes elevated PTH, the calcium absorption from the intestines to increase and increase bone reabsorption.
-Secondary Hyperparathyroidism has an elevated PTH and a low or normal calcium
-Secondary hyperparathyroid may come from renal failure and impaired calcitrol production and inadequate calcium uptake. Vitamin D Deficiency can cause.
-Normocalcemic Primary Hyperparathyroidism-secondary hyperparathyroid causes need to be ruled out. Normal calcium and elevated PTH. Vitamin D deficiency can cause
-Clinically most the time hyperparathyroidism can be asymptomatic
-Classic symptoms if present "bones, stones, abdominal moans, and psychic groans." Anorexia, nausea, constipation, polydipsia, bone pain, kidney stone, muscle weakness, polyuria, and psychiatric psychosis.
-Hypoparathyroidism-
-most common cause is neck surgery on the thyroid or parathyroid
-after surgery hypoparathyroidism may be transient or may be permanent
-clinically will see a low PTH and low serum calcium
-calcium and vitamin D supplementation are the mainstays of hypoparathyroidism treatment
-symptoms of hypoparathyroidism include: tingling in hands and feet, involuntary muscle movements, muscle cramps, fatigue, irritability, anxiety, and depression
-long term hypoparathyroidism can cause cataracts, dry skin, coarse hair, and brittle fingernails
-Hyperthyroidism-
-many disorders can cause hyperthyroidism: Graves Disease, Hashiomotos Thyrotoxicosis, Toxic Adenoma, Toxic Multiple Nodular Goiter, Iodine Induced Hyperthyroidism, Trophoblastic Disease from Germ Cell Tumors, TSH mediated hyperthyroidism, Thyroiditis, and exogenous and ectopic hyperthyroidism
-Graves Disease is the most common cause of hyperthyroidism.
-Graves Disease is an autoimmune disorder that causes thyrotropin (TSH) receptor antibodies, which stimulate thyroid gland growth and thyroid hormone synthesis and release.
-Hashimoto's Thyroiditis is an autoimmune disease that causes patients initially to present with hyperparathyroidism and high radio iodine uptake similar to Graves disease but eventually go hypothyroid
-hypothyroid develops because of the infiltration of the thyroid gland with lymphocytes
-Toxic adenoma and multinodular goiter result from focal or diffuse hyperplasia of the thyroid follicular cells whose functional capacity is independent regulation of TSH.
-Toxic multinodular goiter tends to be more common in areas where iodine uptake is low
-Thyroid adenomas are not related to iodine uptake
-Iodine Induced Hyperthyroidism can occur after an iodine load such as IV contrast for CT scan, or amiodarone administration.
-Iodine Induced Hyperthyroidism is rare
-Trophoblastic or germ cell tumors can be rare causes of hyperthyroidism
-Can occur as a hydatidiform mole in women
-Can occur in Choriocarcinoma in men with testicular germ cell tumors via direct stimulation of the TSH receptors
-TSH mediated hyperthyroidism is when there is a pituitary adenoma producing TSH. Therapy is directed at removing the tumor
-Thyroiditis is a group of heterogenous disorders that result from inflammation of thyroid tissue with transient hyperthyroidism
-Thyroiditis has hyperthyroid phase, then hypothyroid phase and then a recovery of thyroid function
-Exogenous and ectopic hyperthyroidism occurs from taking too much thyroid hormone or it being produced by other parts of the body.
-exogenous thyroid hormone can be produced by struma ovarii, which is from a functioning ovarian neoplasm.
-Thyroid hormone effects almost every organ system in the body.
-Skin-hyperthyroidism causes increased sweating due to increased caloric burning
-Hyperthyroidism causing softening of nails, thinning of hair, and can cause hyperpigmentation
-Stare and lid lag occur in patients with hyperthyroidism because of sympathetic overactivity
-Patients with graves disease can get exophthalmus because of inflammation of the extraocular muscles and orbital fat and connective tissue.
-Hyperthyroidism patients have increased cardiac output and increased peripheral oxygen needs and increased cardiac contractility. Can cause systolic hypertension
-Atrial fib occurs in 10-20 percent of the patients with hyperthyroidism
-Hyperthyroid patients have lower serum total and HDL cholesterol
-Hyperthyroid patient can have impaired glucose tolerance if untreated
-Hyperthyroidism can result in lower serum cortisol concentrations
-Dyspnea can occur with hyperthyroidism because oxygen consumption and CO2 production increase
-can be tracheal obstruction due to large goiter
-respiratory muscle weakness can cause dyspnea with hyperthyroidism
-Weight loss with hyperthyroidism is due to increased metabolic rate and increased gut motility.
-Dysphagia may occur because of goiter
-RBC mass index is increase with hyperthyroidism
-may have a noromchromic normocytic anemia
-hyperthyroidism can be associated with ITP
-Urinary frequency and nocturia are common with hyperthyroidism
-Woman with hyperthyroid may see high serum estradiol, high LH, and may get oligomenorrhea and anovulatory infertility
-Thyroid hormone stimulaters bone reabsorption, bone loss
-May see increased urinary calcium excretion
-Hyperthyroidism can cause psychosis, agitation and depression
-Treatment of hyperthyroidism includes beta blockers, PTU or methimazole, or radioactive iodine
-Beta Blockers are for symptomatic treatment of hyperthyroidism
-PTU or methimazole are thyroid hormone antagonists
-Radioactive iodine is indicated for graves disease
-surgical removal of thyroid gland is an option if necessary
-Hypothyroidism-
-Several different causes of hypothyroidism
-Primary hypothyroidism is when there is decreased secretion of T3 and T4 which results in a increase int TSH secretion
-Chronic autoimmune (Hashimotos) Thyroiditis- most common cause of hypothyroidism. When there is cell and antibody mediated destruction of thyroid tissue
-Iatrogenic Hypothyroidism-caused by thyroidectomy radio iodine treatment, or external radiation and there is less secretion of T3 and T4 as a result of it
-Iodine related hypothyroidism-excess or iodine deficiency can cause hypothyroidism. Iodine excess causes the inhibition of iodide organification from T4 to T3 synthesis. Iodine deficiency causes the inability to synthesize thyroid hormone.
-Drugs such as PTU and methimazole can cause hypothyroidism. Lithium, Amiodarone and Ethionamide have been known to cause hypothyroidism.
-Infiltrative disease such as fibrous thyroiditis, hemochromatosis, scleroderma, leukemia, and cystinosis are rare causes of hypothyroidism
-Hypothyroidism in infants and children are caused by agenesis and dysgenesis of the thyroid
-Transient hypothyroidism can be caused by post partum thyroiditis, subtotal thyroidectomy, or patients post radioactive iodine therapy with Graves disease
-Secondary Hypothyroidism is caused by lack of TSH secretion from the anterior pituitary gland
-Tertiary (Central) is caused by lack of TRH secretion form the hypothalamus
-Hypothyroidism affects essentially every organ system
-Hypothyroidism causes decreased sweating, skin discoloration, hair to be coarse, non pitting edema (myxedema), vitiligo, and alopecia
-Hypothyroidism cans cause periorbital edema
-Hypothyroidism can cause normochromic normocytic anemia
-Hypothyroidism causes decrease cardiac output and reduction of heart rate and cardiac contractility. Hypertension can be caused from an increased in peripheral vascular resistance. Increased cholesterol can be seen from decreased cholesterol metabolism
-Fatigue, shortness of breath on exertion and rhinitis can be caused by respiratory muscle weakness with hypothyroidism
-Hypothyroidism causes decreased gut motility, constipation, and decreased taste sensation, and gastric atrophy
-Hypothyroidism can cause oligomenorrhea, amenorrhea, or hypermenorrhea. This can lead to infertility. Decreased libido, erectile dysfunction, and delayed ejaculation are possible in hypothyroidism
-Hypothyroidism left untreated can cause hashimotos encephalopathy, myxedema coma, and carpal tunnel syndrome
-Hypothyroidism can also cause joint pain, aches, and stiffness. There is an increased incidence of gout with hypothyroid patients.
-Hypothyroidism can cause hyponatremia
-Standard treatment of hypothyroidism is replacement therapy. Synthetic thyroxine (T4) or combination T3 and T4 therapy. There is also T3 alone therapy
-Neoplastic Disease-
-Thyroid Cancer is divided into 4 categories: papillary follicular, medullary, and anaplastic
-Papillary and follicular cancers are differentiated tumors and are basically treated the sam
-Anaplastic cancer appear to arise from other cancers
-Other cancers include primary thyroid lymphoma, multiple endocrine neoplasia type 2, familial medullary cancer, or mets from breast, colon, renal cancer, or melanoma
-Initial staging is done with TMN (Tumor Node Metastasis)
-Surgery is the initial treatment for differentiated thyroid cancer. It is recommended if the primary tumor is at least 1-2 cm in diameter or if mets are present
-Radioiodine therapy is used post thyroidectomy for adjuvant ablation on residual thyroid tissue and possible microscopic residual cancer, treatment of residual or metastatic thyroid cancer, and distant metastasis
-After thyroidectomy levothyroxine is need in all patients to prevent hypothyroidism.
-Radiation therapy may be needed for patients with differentiated thyroid cancer who have metastatic disease that is not responsive to radioiodine or patients with tumors that do not concentrate radioiodine
-Diagnosis is made by biopsy usually on fine need aspirate.
-This is done after Iodine 129 scan nuclear scan
-serum thyroglobulin is used to monitor patients with differentiated thyroid cancer
-Parathyroid Cancer-
-It is rare cause of hyperparathyroidism
-most patients have hypercalcemia or normal calcium and present with a neck mass
-Multiple glands being affected are extremely rare
-Surgery is the mainstay in treatment of parathyroid carcinoma
-Radiation and Chemotherapy have poor results and should only be considered when patient not a candidate for surgery
-Thyroiditis-
-Thyroiditis refers to a group of disorders that cause thyroid inflammation
-Subacute thyroiditis is characterized by neck pain, tender goiter, and elevated T3 and T4. Usually has hyperthyroidism followed by hypothyroidism
-Infectious Thyroiditis can be acute or chronic. Acute infections may cause abscess formation. Staph or strep may cause.
-Radiation Thyroiditis happens when a patient with Graves Disease develops thyroid pain and tenderness 5-10 days after radiation therapy
-Palpation or trauma induced thyroiditis can happen from a vigorous exam or manipulation of the thyroid during biopsy or neck surgery. Can also be from seat belt during auto accident
-Post Partum Thyroiditis occurs within a year after childbirth. It is usually painless
-Drug Induced Thyroiditis can occur with patients taking interferon alpha, amiodarone, lithium, or intraleukin 2.
-Fibrous Thyroiditis is when there is fibrous from macrophage or eosinophil infiltration and extends to adjacent tissues
-Malignancy is another cause for hypercalcemia. Malignancy and Primary Hyperparathyroidism account 90 percent of cases of hypercalcemia
-If malignancy is present, the PTH level is usually normal or low, where as in primary hyperparathyroidism the levels are usually high
-Familial hypocalciuric hypercalcemia (FHH) is due to an inactivating mutation of the calcium sensing receptor in the kidneys. See a hypercalcemia with a mildly elevated PTH concentration
-Family history of hypercalcemia that is symptomatic is helpful for coming up with the diagnosis
-Thiazide diuretics reduce calcium urine excretion and can cause mild hypercalcemia
-Lithium decreases parathyroid gland sensitivity to calcium, and decreases urinary excretion.
-Some patients on lithium develop hypercalcemia and hypocalciuria
-Secondary Hyperparathyroidism is when the parathyroid appropriately responds to a reduced level of calcium. This causes elevated PTH, the calcium absorption from the intestines to increase and increase bone reabsorption.
-Secondary Hyperparathyroidism has an elevated PTH and a low or normal calcium
-Secondary hyperparathyroid may come from renal failure and impaired calcitrol production and inadequate calcium uptake. Vitamin D Deficiency can cause.
-Normocalcemic Primary Hyperparathyroidism-secondary hyperparathyroid causes need to be ruled out. Normal calcium and elevated PTH. Vitamin D deficiency can cause
-Clinically most the time hyperparathyroidism can be asymptomatic
-Classic symptoms if present "bones, stones, abdominal moans, and psychic groans." Anorexia, nausea, constipation, polydipsia, bone pain, kidney stone, muscle weakness, polyuria, and psychiatric psychosis.
-Hypoparathyroidism-
-most common cause is neck surgery on the thyroid or parathyroid
-after surgery hypoparathyroidism may be transient or may be permanent
-clinically will see a low PTH and low serum calcium
-calcium and vitamin D supplementation are the mainstays of hypoparathyroidism treatment
-symptoms of hypoparathyroidism include: tingling in hands and feet, involuntary muscle movements, muscle cramps, fatigue, irritability, anxiety, and depression
-long term hypoparathyroidism can cause cataracts, dry skin, coarse hair, and brittle fingernails
-Hyperthyroidism-
-many disorders can cause hyperthyroidism: Graves Disease, Hashiomotos Thyrotoxicosis, Toxic Adenoma, Toxic Multiple Nodular Goiter, Iodine Induced Hyperthyroidism, Trophoblastic Disease from Germ Cell Tumors, TSH mediated hyperthyroidism, Thyroiditis, and exogenous and ectopic hyperthyroidism
-Graves Disease is the most common cause of hyperthyroidism.
-Graves Disease is an autoimmune disorder that causes thyrotropin (TSH) receptor antibodies, which stimulate thyroid gland growth and thyroid hormone synthesis and release.
-Hashimoto's Thyroiditis is an autoimmune disease that causes patients initially to present with hyperparathyroidism and high radio iodine uptake similar to Graves disease but eventually go hypothyroid
-hypothyroid develops because of the infiltration of the thyroid gland with lymphocytes
-Toxic adenoma and multinodular goiter result from focal or diffuse hyperplasia of the thyroid follicular cells whose functional capacity is independent regulation of TSH.
-Toxic multinodular goiter tends to be more common in areas where iodine uptake is low
-Thyroid adenomas are not related to iodine uptake
-Iodine Induced Hyperthyroidism can occur after an iodine load such as IV contrast for CT scan, or amiodarone administration.
-Iodine Induced Hyperthyroidism is rare
-Trophoblastic or germ cell tumors can be rare causes of hyperthyroidism
-Can occur as a hydatidiform mole in women
-Can occur in Choriocarcinoma in men with testicular germ cell tumors via direct stimulation of the TSH receptors
-TSH mediated hyperthyroidism is when there is a pituitary adenoma producing TSH. Therapy is directed at removing the tumor
-Thyroiditis is a group of heterogenous disorders that result from inflammation of thyroid tissue with transient hyperthyroidism
-Thyroiditis has hyperthyroid phase, then hypothyroid phase and then a recovery of thyroid function
-Exogenous and ectopic hyperthyroidism occurs from taking too much thyroid hormone or it being produced by other parts of the body.
-exogenous thyroid hormone can be produced by struma ovarii, which is from a functioning ovarian neoplasm.
-Thyroid hormone effects almost every organ system in the body.
-Skin-hyperthyroidism causes increased sweating due to increased caloric burning
-Hyperthyroidism causing softening of nails, thinning of hair, and can cause hyperpigmentation
-Stare and lid lag occur in patients with hyperthyroidism because of sympathetic overactivity
-Patients with graves disease can get exophthalmus because of inflammation of the extraocular muscles and orbital fat and connective tissue.
-Hyperthyroidism patients have increased cardiac output and increased peripheral oxygen needs and increased cardiac contractility. Can cause systolic hypertension
-Atrial fib occurs in 10-20 percent of the patients with hyperthyroidism
-Hyperthyroid patients have lower serum total and HDL cholesterol
-Hyperthyroid patient can have impaired glucose tolerance if untreated
-Hyperthyroidism can result in lower serum cortisol concentrations
-Dyspnea can occur with hyperthyroidism because oxygen consumption and CO2 production increase
-can be tracheal obstruction due to large goiter
-respiratory muscle weakness can cause dyspnea with hyperthyroidism
-Weight loss with hyperthyroidism is due to increased metabolic rate and increased gut motility.
-Dysphagia may occur because of goiter
-RBC mass index is increase with hyperthyroidism
-may have a noromchromic normocytic anemia
-hyperthyroidism can be associated with ITP
-Urinary frequency and nocturia are common with hyperthyroidism
-Woman with hyperthyroid may see high serum estradiol, high LH, and may get oligomenorrhea and anovulatory infertility
-Thyroid hormone stimulaters bone reabsorption, bone loss
-May see increased urinary calcium excretion
-Hyperthyroidism can cause psychosis, agitation and depression
-Treatment of hyperthyroidism includes beta blockers, PTU or methimazole, or radioactive iodine
-Beta Blockers are for symptomatic treatment of hyperthyroidism
-PTU or methimazole are thyroid hormone antagonists
-Radioactive iodine is indicated for graves disease
-surgical removal of thyroid gland is an option if necessary
-Hypothyroidism-
-Several different causes of hypothyroidism
-Primary hypothyroidism is when there is decreased secretion of T3 and T4 which results in a increase int TSH secretion
-Chronic autoimmune (Hashimotos) Thyroiditis- most common cause of hypothyroidism. When there is cell and antibody mediated destruction of thyroid tissue
-Iatrogenic Hypothyroidism-caused by thyroidectomy radio iodine treatment, or external radiation and there is less secretion of T3 and T4 as a result of it
-Iodine related hypothyroidism-excess or iodine deficiency can cause hypothyroidism. Iodine excess causes the inhibition of iodide organification from T4 to T3 synthesis. Iodine deficiency causes the inability to synthesize thyroid hormone.
-Drugs such as PTU and methimazole can cause hypothyroidism. Lithium, Amiodarone and Ethionamide have been known to cause hypothyroidism.
-Infiltrative disease such as fibrous thyroiditis, hemochromatosis, scleroderma, leukemia, and cystinosis are rare causes of hypothyroidism
-Hypothyroidism in infants and children are caused by agenesis and dysgenesis of the thyroid
-Transient hypothyroidism can be caused by post partum thyroiditis, subtotal thyroidectomy, or patients post radioactive iodine therapy with Graves disease
-Secondary Hypothyroidism is caused by lack of TSH secretion from the anterior pituitary gland
-Tertiary (Central) is caused by lack of TRH secretion form the hypothalamus
-Hypothyroidism affects essentially every organ system
-Hypothyroidism causes decreased sweating, skin discoloration, hair to be coarse, non pitting edema (myxedema), vitiligo, and alopecia
-Hypothyroidism cans cause periorbital edema
-Hypothyroidism can cause normochromic normocytic anemia
-Hypothyroidism causes decrease cardiac output and reduction of heart rate and cardiac contractility. Hypertension can be caused from an increased in peripheral vascular resistance. Increased cholesterol can be seen from decreased cholesterol metabolism
-Fatigue, shortness of breath on exertion and rhinitis can be caused by respiratory muscle weakness with hypothyroidism
-Hypothyroidism causes decreased gut motility, constipation, and decreased taste sensation, and gastric atrophy
-Hypothyroidism can cause oligomenorrhea, amenorrhea, or hypermenorrhea. This can lead to infertility. Decreased libido, erectile dysfunction, and delayed ejaculation are possible in hypothyroidism
-Hypothyroidism left untreated can cause hashimotos encephalopathy, myxedema coma, and carpal tunnel syndrome
-Hypothyroidism can also cause joint pain, aches, and stiffness. There is an increased incidence of gout with hypothyroid patients.
-Hypothyroidism can cause hyponatremia
-Standard treatment of hypothyroidism is replacement therapy. Synthetic thyroxine (T4) or combination T3 and T4 therapy. There is also T3 alone therapy
-Neoplastic Disease-
-Thyroid Cancer is divided into 4 categories: papillary follicular, medullary, and anaplastic
-Papillary and follicular cancers are differentiated tumors and are basically treated the sam
-Anaplastic cancer appear to arise from other cancers
-Other cancers include primary thyroid lymphoma, multiple endocrine neoplasia type 2, familial medullary cancer, or mets from breast, colon, renal cancer, or melanoma
-Initial staging is done with TMN (Tumor Node Metastasis)
-Surgery is the initial treatment for differentiated thyroid cancer. It is recommended if the primary tumor is at least 1-2 cm in diameter or if mets are present
-Radioiodine therapy is used post thyroidectomy for adjuvant ablation on residual thyroid tissue and possible microscopic residual cancer, treatment of residual or metastatic thyroid cancer, and distant metastasis
-After thyroidectomy levothyroxine is need in all patients to prevent hypothyroidism.
-Radiation therapy may be needed for patients with differentiated thyroid cancer who have metastatic disease that is not responsive to radioiodine or patients with tumors that do not concentrate radioiodine
-Diagnosis is made by biopsy usually on fine need aspirate.
-This is done after Iodine 129 scan nuclear scan
-serum thyroglobulin is used to monitor patients with differentiated thyroid cancer
-Parathyroid Cancer-
-It is rare cause of hyperparathyroidism
-most patients have hypercalcemia or normal calcium and present with a neck mass
-Multiple glands being affected are extremely rare
-Surgery is the mainstay in treatment of parathyroid carcinoma
-Radiation and Chemotherapy have poor results and should only be considered when patient not a candidate for surgery
-Thyroiditis-
-Thyroiditis refers to a group of disorders that cause thyroid inflammation
-Subacute thyroiditis is characterized by neck pain, tender goiter, and elevated T3 and T4. Usually has hyperthyroidism followed by hypothyroidism
-Infectious Thyroiditis can be acute or chronic. Acute infections may cause abscess formation. Staph or strep may cause.
-Radiation Thyroiditis happens when a patient with Graves Disease develops thyroid pain and tenderness 5-10 days after radiation therapy
-Palpation or trauma induced thyroiditis can happen from a vigorous exam or manipulation of the thyroid during biopsy or neck surgery. Can also be from seat belt during auto accident
-Post Partum Thyroiditis occurs within a year after childbirth. It is usually painless
-Drug Induced Thyroiditis can occur with patients taking interferon alpha, amiodarone, lithium, or intraleukin 2.
-Fibrous Thyroiditis is when there is fibrous from macrophage or eosinophil infiltration and extends to adjacent tissues
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