Thyroid disease (main)

Background

Thyroid physiology

• Spectrum of Disease
  • Myxedema coma << hypothyroid < euthyroid > hyperthyroid >> thyroid storm

Other

1. Cretinism - no congenital T3 or T4
2. Parafollicular C cells make calcitonin to keep the bone in
3. Endemic goiter- if patient from area of low iodine intake
4. Free t3 & t4 determines thyroid state - not total plasma conc
5. T4→ T3 active & rt3 inactive
6. TRH → TSH → T4 → T3

Thyroid Studies and Etiologies

• Hyperthyroidism
• Subclinical hyperthyroidism
• T3 toxicosis
• Thyroiditis, T4 ingestion, hyperthyroidism of elderly or cormorbid illness
• Euthyroid sick syndrome, central hypothyroidism
• Subclinical hypothyroidism, recovery from euthyroid sick syndrome
• Primary hypothyroidism
• TSH producing pituitary adenoma

See Also

• Thyroid Storm
• Hyperthyroidism
• Myxedema Coma
• Hypothyroidism

References

• Sharma AN, Levy DL; Thyroid and Adrenal Disorders; in Marx JA, Hockberger RS, Walls RM, et al (eds): Rosen’s Emergency Medicine: Concepts and Clinical Practice, ed 8. St. Louis, Mosby, Inc., 2014, (Ch) 128: p 1676-1693.
• Agus, MSD: Chapter 86 – Endocrine Emergencies, in Fleisher & Ludwig’s Textbook of Pediatric EM, 6th Ed., Lippincott Williams & Williams, 2010, p. 779-780