Pituitary and Adrenal Gland/Thyroid

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Imaging studies for Addison's Disease

Abdominal xray (calcifications may be noted), Abdomincal CT ( small adrenal glands indicate either idiopathic atrophy or long standing TB)

Treatment of Addison's Disease

IV fluids, Hydrocortisone, fludrocortisone

Treatment for Hypothyroidism

Radioactive iodine is most common, thyroid ablation and treatment of thyroid cancer

Types of Hypothyroidism

Primary is due to thyroid gland disease (incr. TSH, dec. FT4), Secondary lack of pituitary TSH ( dec. TSH, dec. FT4)

Causes of Hypothyroidism w/ goiter

Hashimoto, lithium, amiodorone, Hep C

Causes of Hashimoto Thyroiditis

Most common cause of primary hypothyroidism, autoimmune, thyroid antibodies positive high titer

Symptoms of Hypothyroidism

Weight gain, fatigue, lethargy, dry skin, depression, cold intolerance, weakness

Physical findings of Hypothyroidism

Bradycardia, thin, brittle hair and nails, peripheral edema (puffy face, eyelids), skin pallor or yellowing, delayed relaxation of deep tend

Signs of Myxedema

Dry, pale, thinning of lateral eyebrows, puffiness of the face and eyelids, dull expressionless

Lab tests of Hypothyroidism

Serum TSH incr. in primary, low or normal to secondary, hyponatremia, hypoglycemia,

Treatment of Hypothyroidism

Typically permanent, lifelong replacement, Levothyroxine (T4), take on empty stomach or after 1-4 hrs of eat

Incidences/ symptoms of Myxedema crisis

Pt with severe hypothyroidism, elderly, seizures, hypothermia, hypotension, hypoventilation, hyponatremia, hypoglycemia

Common causes of Hyperthyroidism (Thyrotoxicosis)

Grave's disease, autoimmune disorder, toxic ademona

Signs and symptoms of Thyrotoxicosis

Nervousness, irritability, emot. lability, hyperactivity, palpation, wt loss despite incr. appetite, retracted eyelid, tachy,moist skin,afib

Eye manifestations of Thyrotoxicosis

Grittiness, excessive lacrimation, photophobia, diplopia, protusion, retraction, lid lag

Infiltrative findings seen in Graves disease

Lid puffiness, conjunctival injection/chemosis, proptosis, extra-ocular muscle weakness, decreased visual acuity

Lab tests for Thyrotoxicosis

TSH suppressed, Ft elevated, hypercalcemia, alkaline phos elevated, anemia, hypokalemia,hypophosphate, ESR elevated

Imaging for Thyrotoxicosis

Thyroid radioactive iodine scan, thyroid ultrasound, MRI of the orbits

Definition of Toxic Adenoma

Hyperfunctioning autonomous follicular adenoma, >3cm, firm, radioisotope scan:intense uptake in nodule w/suppressed upake in rest of gland

Treatment of Graves Disease

Propanol, Thioureas, methimazole, PTU