Mental Status Examination: by HC111210064729

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									                                                                          ENDOCRINOLOGY—1
                                                                long duration. If the hypothyroid phase lasts longer
                                                                than six months, permanent hypothyroidism is
              THYROIDITIS                                       likely.
Hashimoto's Thyroiditis                                     Subacute Thyroiditis
Most common form of autoimmune thyroiditis. Usually         Also known as granulomatous or DeQuervain's
    occurs in middle aged adult women. The condition            Thyroiditis.
    can last for years.                                     Usually occurs in middle aged ♀. Associated w/prior
Autoimmune do w/lymphocytic infiltration of thyroid             viral infection
    gland                                                   Clinical Manifestations:
Antibodies vs. specific thyroid cell antigens                  Acute or subactue presentation
  Thyroid peroxidase (TPO) a biosynthetic enzyme.             Thyroid pain swelling or tenderness in one or both
    Anti-TPO Ab (antimicrosomal Ab): present in >               lobes. Often radiation of pain to ear.
    98% of pts w/hypothyroidism, but relationship is            ESR
    uncertain; cell-mediated immunity is a more likely
                                                               Fever
    culprit.
  Thyroglobulin: thyroid hormone precursor                 Usually 4 phases over 4-6 months.
  TSH receptor or iodide symporter (iodine transport          Acute phase: Thyroid pain and Thyrotoxicosis. 3-6
    protein).                                                   weeks.
                                                               Transient asymptomatic euthyroidism
Clinical:
                                                               Hypothyroidism: Lasts weeks to months. May be
Hypothyroidism
                                                                permanent
Thyroid gland enlargement  firm, irregular, non-
     tender goiter                                             Recovery: Thyroid tests begin to normalize.
Antimicrosomal Ab: Over 95% (+)                             Pathology: gland is enlarged 2-3 times normal. Cut
Other Ab may be present. Some of the Ab are the same            surface shows patchy areas of fibrosis.
     as those in Grave's disease but in general, Ab in      Histology: there is rupture of the follicles with
     Hashimoto's  thyroid growth, while Ab in Graves           subsequent formation of granulomas with giant
      thyroid function.                                        cells. The condition resolves by fibrosis
Diagnosis:                                                  Treatment:
                                                            Antithyroid drugs not indicated
Presence of a diffuse goiter and  TSH.
                                                            Beta blockers for thyrotoxicosis.
If diffuse goiter is present w/Nl serum TSH  test
     antithyroid Ab                                         NSAIDS to  thyroid pain.
Pathology: normal sized or moderately, asymmetrically       Steroid taper for more severe pain.
     enlarged. Cut section shows a grey-white surface.
Histology: Plasma cells.
Treatment: Usually asymptomatic and do not require
     treatment.
If hypothyroid then treat with T-4
Annual assessment of thyroid function.
High Antimicrosomal levels > 1:1,600 place pt at high
     risk of becoming hypothyroid in the future.
Patients are at risk for B cell lymphomas.
Subacute Lymphocytic Thyroiditis
Variant of HT.
In US develops in 5 to 9% of all ♀ after parturition
     (postpartum thyroiditis). Occurs in 35% of pts
     w/HT and 25% of those w/DM type 1. Recurrent
     episodes are common and need not be related to
     pregnancy.
Initial phase: 1 to 3 mo. Transient hyperthyroidism with
     zero radioiodine uptake because of leakage of
     thyroid hormone.
Hypothyroidism follows but may occur w/out prior
     hyperthyroidism
Most pts recover, but persistent hypothyroidism or
     goiter is found in 25 to 50% of patients after 2
     years.
Chronic/Silent Thyroiditis:
Occurs in young women.
Clinical Manifestations: Painless thyroiditis with
    thyrotoxicosis.
Hyperthyroidism results from release of thyroid
    hormone rather than increased synthesis of hormone
    and thus the hyperthyroid state usually resolves in
    4-8 weeks.
Pathology: Gland is normal sized to minimally
    enlarged. Cut surface can look normal to focally
    pale.
Histology: lymphocytic infiltration and destruction of
    follicles but no plasma cells (as in Hashimoto's) and
    no granulomas.
Treatment:
Beta blockers for acute symptoms of hyperthyroidism.
Antithyroid drugs not indicated
Thyroid replacement in the hypothyroid phase is
    indicated if the patient's symptoms are severe or of

								
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