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Grave's disease diagnosis:
- Presentation of new onset ophthalmopathy, large non-nodular thyroid, or other signs of hyperthyroidism
- Measure TSH, free T4 - TSH will be suppressed, free T4 will be elevated
- Radioactive iodine uptake scan - will have diffusely high radioiodine uptake
- Measurement of thyroidal blood flow on ultrasound - will see increased blood flow
- Measurement of thyrotropin receptor antibodies
Posted 06/29/16 10:50:36 AM by Anna Krigel
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Hyperthyroidism-unique physical exam signs
- Brisk DTRs
- Tachyarrhythmias
- Means-Lerman Scratch - mid-systolic murmur heard in some hyperthyroid patients
Posted 06/29/16 10:56:36 AM by Anna Krigel
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Management of Grave's disease
Methimazole - primary drug used to treat Grave's disease
- faster acting than PTU, better side effect profile
- dosed once daily - inhibits thyroperoxidase for 24 horus
- need to check baseline WBC count as 1/5000 people can have agranulocytosis (though hyperthyroid patients can have a leukopenic lymphocytosis at baseline)
- first-line therapy EXCEPT during 1st trimester of pregnancy - use PTU instead
Radioiodine ablation
- used as definitive therapy for Grave's disease in non-pregnant patients
- patients with significant symptoms or with underlying cardiovascular disease should be treated first with methimazole
- thyroid storm can occur after ablation
- ablation has the potential to cause or worsen Grave's ophthalmopathy
- can take up to 6 months to be fully effective
Surgery
- preferred definitive therapy for Grave's patients with Grave's ophthalmopathy, those in the second trimester of pregnancy, or those who want immediate improvement (e.g. desire to become pregnant)
Posted 06/29/16 11:13:19 AM by Anna Krigel
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Methimazole toxicity
- teratogenicity in the first trimester of pregnancy
- agranulocytosis - occurs in 0.1 to 0.5% of people, usually within the first 2-3 months of drug initiation
- hepatotoxicity - typically secondary to cholestatic dysfunction, shown in case series to occur within 180 days of methimazole initiation, typically occurs at doses >13mg/day
Posted 06/29/16 05:14:39 PM by Anna Krigel
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Posted 06/29/16 05:15:37 PM by Anna Krigel
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