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Exam 9 > Thyroid > Flashcards

Thyroid Flashcards

1
Q

__ and ___ are the biologically active hormones from the thyroid

A

T3 and T4

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2
Q

__ is made in the thyroid only, __ is made in the thyroid and outside the thyroid

A

T4, T3

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3
Q

What is the process of releasing T4 and T3

A

Hypothalamus-> TRH-> Anterior pituitary-> TSH->thyroid gland-> T4 and T3-> back to hypothalamus

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4
Q

parafollicular C cells make

A

calcitonin

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5
Q

follicle cells in thyroid make 90% __ and 10% __

A

T4, T3

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6
Q

The best and cheapest screening test for thyroid diseases is

A

TSH

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7
Q

Measure _____ to test for Hashimoto’s

A

TPO antibodies

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8
Q

Order ____ when you want to follow thyroid cancer

A

thyroglobulin

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9
Q

Measure ____ and ___ to see if Grave’s disease

A

TRAB and TSI

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10
Q

Exogenous causes of thyrotoxicosis

A

too much TH replacement therapy, or a TH suppressive therapy

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11
Q

Endogenous causes of thryotoxicoisis

A

Grace’s disease, thyroiditis, toxic nodular goiter

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12
Q

Symptoms are hyperthryoidism

A

intolerance to heat, fine hair, bulging eyes, facial flushing, tachycardia, increased BP, breast enlargement, weight loss, muscle wasting, menstrual changes

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13
Q

Gold standard for hyperthyroid is ____

A

nuclear medicine uptake and scan. Iodine tracer given and that helps with diagnosis (TRAB and TSI can be ordered)

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14
Q

Once you see that there is hyperthyroidism present, first thing to do is ____

A

β blocker! This is to prevent afib

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15
Q

What is the pathophys of Grave’s disease

A

Autoantibodies on thyroid hormone receptor on thyroid gland-> over production of TH

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16
Q

Labs for Graves disease

A

TSH low, T4 and T3 elevated. TRAb and TSI elevated

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17
Q

When should you not just order TSH and need to also order T3 and T4

A

first tri of pregnancy, pituitary disease, TSh still equilibrating, nonthryoidal illness, acute psychiatric illness, TSH secreting pituitary tumor, thyroid hormone resistance

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18
Q

Antithyroidal Medications are:

A

Thioamides (methimazole and propthiouracil)

19
Q

MOA of thionamides

A

inhibit synthesis of thyroid hormones by blocking oxidation of I in thyroid gland-> block T3 production. Does not affect circulating T4 and T3

20
Q

What are AEs with thionamides

A

rash, pruritus, GI

rare: granular cytosine (CBC if fever/sore throat), hepatotoxicity, pancreatitis, vasculitis

21
Q

What medications should be given for someone who has Graves and is pregnant

A

PTU first tri, switch to MMI second tri. Monitor TSH and T4, keep TSH normal and T4 1.5x mroe

22
Q

Thyroid storm criteria

A

High temp, cardiovascular events (tachycardia, afib, CHF), GI-hepatic dysfunction, CNS disturbance, history

23
Q

What are the most common causes of thyroid storm

A

Grave’s disease, toxic adenoma and MNG, hyper functioning carcinoma, TSH secreting pituitary adenoma, strums ovary, hcg secreting tumor, IFN α and IL2

24
Q

What 5 drugs should be given for thyroid storm management

A

antithyroidals (PTU, MMI), Iodine, β blocker, supportive (Tylenol, hydrocortisone), alternative (lithium, cholestyramine)
must block new synthesis first before giving iodine

25
Q

Iodine therapy blocks the release of _____ and decreases _______

A

pre-stored hormone

decreases iodide transport and oxidation in follicular cells

26
Q

Avoid ____ as they can increase free thyroid hormone by decreasing thyroid protein binding

A

salicylates

27
Q

For thyroid storm, surgery would be _____. To go, hold the ___ and stop _____

A

Total thyroidectomy

hold the iodine, stop antithyroidals and wean β blockers

28
Q

What is the role of steroids in a thyroid storm

A

block T4 to T3.
potential for adrenal insufficiency with autoimmune hyperthyroidism
relative adrenal insufficiency (TH-> ups cortisol metabolism-> adrenal reserve. can have longer survival with glucocorticoids)

29
Q

What is Thyroiditis

A

inflammation of thyroid gland leading to leaking of thyroid hormone

30
Q

Treatment for thyroiditis

A

β blockers, time, sometimes steroids

31
Q

What are the two types of amiodorone induced thryroiditis and how to treat

A

type 1: large iodine load-> excessive TH. treat with antithyroidals
Type 2: iodine or drug destroys gland, treat with steroids

32
Q

What are the labs with hypothyroidism

A

High TSH and low free T4

33
Q

Does ultrasound tell you anything when trying to determine thyroid size

A

no, get nuclear imaging

34
Q

What level of TSH do you need to treat for hypothyroidism

A

TSH>10 always (if elevated but T4 normal, can still treat)

35
Q

What are the most common treatment options for hypothyroidism

A

synthetic T4 or levothyroxine

T4/T3 combos from bovine or porcine

36
Q

Most common cause of hypothyroidism in countries with access to iodine is _____ or _____

A

Hashimoto’s or autoimmune thyroid disease

37
Q

What are the two categories of dosing for replacement thyroid hormone (high dose vs low dose)

A

high dose: hx of thyroid removal or PROFOUNDLY elevated TSH

Low: hypothyroidism not profound but elevated

38
Q

When to take thyroid hormone

A

First thing in the morning, 4 hours before vitamins and an hour before meals

39
Q

What is the big risk for hypothyroidism

A

Myxedema coma

40
Q

What are some myxedema coma precipitating factors

A

Drugs, Infections, CNS events, CHF, hypothermic insult, trauma, metabolic disurbance, GI bleeding, raw bok choy

41
Q

Treatments for myxedema coma

A

T4, T3, or Combination

continued ECG monitoring

42
Q

Besides medication, what other treatment needs to be given for a myxedema coma

A

ventilatory support, warming, manage bradycardia and hypotension, hyponatremia, glucocorticoid therapy

43
Q

What are malignancy risk for thyroid cancers (Nodule)

A

Hx, PET avid nodule, ionizing or craniocervical radiation, hyper Ca2+, FH of MEN2

44
Q

What are the types of thyroid cancer

A

papillary, follicular, medullary, anaplastic

worst prog is anapestic

Exam 9 (8 decks)

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