Snapshot A 34-year-old woman presents to the physician's office with complaints of weight loss and sweatiness. She states that despite a ravenous appetite, she has lost 4 pounds this past month. In addition she states that she has been more sweaty lately, and unable to cool down in rooms that others find comfortable. On physical exam you see an anxious and fidgety woman who has a very prominent gaze with protuberant eyes. Introduction An autoimmune disease with stimulating anti-TSH receptor antibodies a type II hypersensitivity anti-microsomal and anti-thyroglobulin antibodies also present (more commonly associated with Hashimoto's thyroiditis and hypothyroidism) anti-TSH antibodies also stimulate retroorbital fibroblasts → exopthalmos Epidemiology most common cause of hyperthyroidism female dominant HLA-B8, -DR3 association often incited during stress e.g., childbirth, infection, and steroid withdrawal Presentation Symptoms hyperthyroidism Physical exam symmetrical, non-tender thyroid enlargement ophthalmopathy (proptosis and exopthalmos) due to glycosaminoglycan deposition pretibial myxedema digital swelling Evaluation Serology ↑ total serum T4 ↑ free T4 ↑ 123I uptake diffusely on radioactive iodine uptake scan ↓ serum TSH Histology not a routine part of evaluation, but on histology may see scalloping of the colloid increased activity of the epithelium to produce increased thyroid hormone Treatment Pharmacologic β-blockers symptomatic relief via blockade of beta-1 adrenergic receptors propranolol inhibits peripheral T4 to T3 conversion by deiodinase thiocyanate inhibits the Na-I symporter located on the basolateral membrane of thyroid epithelial cells decreased iodide uptake leads to decreased hormone synthesis thionamides inhibits thyroid peroxidase result in reduced hormone synthesis 131I ablation glucocorticoids treatment of exophthalmos Prognosis, Prevention, and Complications Complications stress-induced catecholamine surge may be fatal by arrhythmia pregnancy complications anti-TSH receptor antibodies may cross placenta and produce hyperthryoidism in the fetus may present with tachycardia, goiters, growth delays, microcephaly, or craniosynostosis High Yield Presentation a female patient with weight loss, tachycardia, irritability, pretibial myxedema and exopthalmos Pathophysiology TSH stimulating antibodies stimulate TSH receptors (-->hyperthyroidism) associated with other autoimmune disorders and HLA B8 and DR3 stimulation of thyroid gland leads to increased T4 and T3 decreased TSH diffuse increase in radioactive iodine uptake exophthalmos caused by lymphocytic infiltration TSH stimulating antibodies can stimulate retro-orbital fibroblasts antithyroid medications will not improve/reverse glucocorticoids may help decrease inflammation Management best initial step: propranolol and propylthiouracil be aware of agranulocytosis with thionamides definitive management: radioactive iodine ablation (in general) or surgical removal of the thyroid in extreme cases (pregnancy)
QUESTIONS 1 of 10 1 2 3 4 5 6 7 8 9 10 Previous Next Sorry, this question is for PEAK Premium Subscribers only Upgrade to PEAK Sorry, this question is for PEAK Premium Subscribers only Upgrade to PEAK Sorry, this question is for PEAK Premium Subscribers only Upgrade to PEAK Sorry, this question is for PEAK Premium Subscribers only Upgrade to PEAK Sorry, this question is for PEAK Premium Subscribers only Upgrade to PEAK Sorry, this question is for PEAK Premium Subscribers only Upgrade to PEAK (M1.EC.13.62) A 25-year-old Hispanic male presents with heat intolerance and recent weight loss. Serum analysis shows increased levels of T4 and T3, as well as the presence of thyroglobulin-stimulating immunoglobulins. The patient is found to be tachycardic and has marked edema and waxy discoloration in his legs. Which of the following would be consistent with this patient's disease? QID: 100363 Type & Select Correct Answer 1 Sympathetic underactivity 3% (3/94) 2 Anti-thyroglobulin antibodies 5% (5/94) 3 Exophthalmos 71% (67/94) 4 Increased TSH release 15% (14/94) 5 Multinucleate giant cells present in the thyroid 3% (3/94) M 2 Question Complexity E Question Importance Select Answer to see Preferred Response SUBMIT RESPONSE 3 Review Tested Concept Review Full Topic Sorry, this question is for PEAK Premium Subscribers only Upgrade to PEAK (M1.EC.12.26) A patient suffering from Graves' disease is given thiocyanate by his physician. Thiocyanate helps in the treatment of Graves' disease by: QID: 100327 Type & Select Correct Answer 1 Inhibiting thyroid peroxidase 15% (10/65) 2 Inhibiting 5'-deiodinase 12% (8/65) 3 Inhibiting thyroid deiodinase 8% (5/65) 4 Inhibiting beta-adrenergic receptors 8% (5/65) 5 Inhibiting iodide follicular uptake 43% (28/65) M 3 Question Complexity E Question Importance Select Answer to see Preferred Response SUBMIT RESPONSE 5 Review Tested Concept Review Full Topic (M1.EC.12.109) A 25-year old Caucasian female presents with symptoms of Graves' disease. Her doctor prescribes medications and sends the patient home. After two months of therapy, the patient returns upset that her exophthalmos has not gone away. Which of the following drugs should the physician have prescribed to treat the exophthalmos? QID: 100410 Type & Select Correct Answer 1 Propanolol 7% (15/216) 2 Metropolol 0% (0/216) 3 PTU 9% (20/216) 4 Corticosteroids 64% (138/216) 5 No treatment as this will resolve naturally 17% (37/216) M 4 Question Complexity C Question Importance Select Answer to see Preferred Response SUBMIT RESPONSE 4 Review Tested Concept Review Full Topic
All Videos (0) Endocrine | Graves Disease Endocrine - Graves Disease Listen Now 17:6 min 5/27/2021 26 plays 3.0 (1)