Approach to a Case of Thyroid Disorder

Approach to a Case of Thyroid Disorder

1. Patient Presentation
   • Symptoms of thyroid dysfunction (e.g., fatigue, weight changes, palpitations, temperature intolerance)
2. Initial Evaluation
   • Detailed history (family history, medications, radiation exposure, autoimmune diseases)
   • Physical examination (thyroid enlargement, nodules, signs of hyper/hypothyroidism)
3. Laboratory Tests
   • TSH (Thyroid Stimulating Hormone)
     • High TSH
       • Check Free T4
         • Low Free T4: Primary Hypothyroidism
         • Normal Free T4: Subclinical Hypothyroidism
     • Low TSH
       • Check Free T4 and Free T3
         • High Free T4/T3: Primary Hyperthyroidism
         • Normal Free T4/T3: Subclinical Hyperthyroidism
4. Further Evaluation (if abnormal TSH)
   • Thyroid Antibodies
     • Anti-TPO (Thyroid Peroxidase Antibodies)
       • Positive: Hashimoto’s Thyroiditis (Hypothyroidism)
     • TSI (Thyroid Stimulating Immunoglobulin)
       • Positive: Graves’ Disease (Hyperthyroidism)
   • Thyroid Ultrasound
     • Evaluate for nodules, goiter, cysts
   • Radioactive Iodine Uptake (RAIU) and Scan
     • High uptake: Graves’ disease, toxic multinodular goiter, toxic adenoma
     • Low uptake: Thyroiditis, exogenous thyroid hormone
5. Diagnosis
   • Hypothyroidism  (Mnemonic – THYROID’S)
     • Primary: Hashimoto’s thyroiditis, iodine deficiency, post-radioactive iodine therapy/surgery, medications
     • Secondary: Pituitary/hypothalamic dysfunction
   • Hyperthyroidism (Mnemonic – GRAVE HIM)     
     • Graves’ disease, toxic multinodular goiter, toxic adenoma, thyroiditis, iodine-induced
6. Management
   • Hypothyroidism
     • Levothyroxine replacement
     • Monitor TSH and Free T4 levels regularly
   • Hyperthyroidism
     • Antithyroid medications (Carbimazole, Methimazole, PTU)
     • Radioactive iodine therapy
     • Surgery (thyroidectomy)
     • Symptomatic treatment (beta-blockers for tachycardia)
7. Follow-Up
   • Regular monitoring of thyroid function tests
   • Adjust treatment based on clinical response and lab results