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1. Gynecomastia -Aging
causes -Neonatal period, puberty (tall/overweight teenagers)
-Obesity
2. Hypothyroidism -85% women
-May be due to failure or resection of the thyroid gland itself or deficiency of
pituitary TSH
3. Goiter -May be present with thyroiditis, iodine deficiency, genetic thyroid enzyme defects,
drug goitrogens (lithium, iodine, propylthiouracil or methimazole, sulfonamides,
amiodarone, interferon-alpha, interferon-beta, interluekin-2, food goitrogens in
iodine-deficient areas
* often absent in autoimmune thyroiditis
4. Hypothyroidism Serum TSH - high in primary and low in secondary hypothyroidism
labs
Elevated in Hashimoto thyoiditis
5. Hyperthyroidism Serum TSH= suppressed except in TSH-secreting pituitary tumor or pituitary hy-
labs perplasia (rare)
T3 uptake and scan= elevated, increased uptake
6. Subclinical hy- Normal T4 with increased TSH
pothyroidism may or may not have symptoms
7. Hypothyroid -Synthetic levothyroxine
Treatment -Average does 1.6mcg/kg/day
-Repeat TSH in 4-6 week after initiation
-TSH levels should be between 0.4-2
8. Hyperthyroidism -Clinical manifestations of elevated T4 or T3
(Thyrotoxicosis) -Most common form is Graves Disease
9. Grave's Disease
, NSG 554- exam 4
Study online at https://quizlet.com/_dbsygy
-Most common cause of thyrotoxicosis
-Autoimmune disorder affecting the thyroid gland
-Increase in the synthesis & release of thyroid hormones
-More common in women
-Onset age 20-40
-Dietary iodine supplementation, chemotherapy can trigger
-Increased r/f systemic autoimmune dx including Sjogren, celiac, pernicious ane-
mia, Addison's, alopecia aerate, vitiligo, DM1, hypoparathyriodism, myasthenia
gravis, cardiomyopathy
10. Hyperthyroid ex- -Diffusely enlarged thyroid
amination find- -Frequent asymmetric and often with bruit
ings
-Subacute: moderately enlarged/tender, dysphagia, jaw/ear pain
-toxic multi nodular goiter: palpable nodules
-Silent thyroiditis: small nontender goiter
11. PALM-COEIN -Polyp, adenomyosis, leiomyoma, malignancy and hyperplasia
-Coagulopathy, ovulatory dysfunction, endometrial, iatrogenic, Not yet classified
12. Abnormal pre- -CBC, pregnancy test, thyroid tests.
menstrual bleed- -Vaginal and urine samples for PCR or culture to r/o chlamydia
ing: Laboratory
studies
13. Vaginitis -inflammation and infection of the vagina
-caused by a variety of pathogens, allergic reactions to contraceptives or other
products, vaginal atrophy, friction during coitus
-normal pH is 4.5 or less
14. Vaginitis: Clinical -vaginal irritation, pain, unusual or malodorous discharge
findings -Hx including LMP, recent sexual activity, use of contraceptives, tampons, douches,