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SMUPASPG19-MED 1 > ENDO-HYPER > Flashcards

ENDO-HYPER Flashcards

1
Q

What is the MCC of Hyperthyroidism

A

autoimmune- Graves disease

1] Toxic nodular goiter (single or multinodular),
2] Thyroiditis (subacute, painless, postpartum),
3] TSH producing adenoma (rare)

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2
Q 
Pt c/o Weight loss,
 insomnia, 
anxiety, irritability,
heat intolerance, 
palpitations, tremors, 
frequent bowel movements,
muscle weakness, 
hair loss, oily skin, 
amenorrhea
A

Hyperthyroidism

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3
Q 
PT has the following on PE. What is DX? 
tachycardia, 
diaphoresis-sweating
diffuse palpable goiter, 
thyroid bruit, 
fine tremor, 
opthalmopathy (proptosis, lid retraction, 
chemosis-edema in eye
A

Hyperthyroidism vitals

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4
Q

why the thyroid bruit occurs in Hyperthyroidism?

A

increased blood flow in goiter

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5
Q

What are the cardivacular findings in Hyperthyroidism

A

sinus tachycardia,
systolic flow murmurs,
atrial fibrillation,
prominent API-arterial pulse pressure

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6
Q

Who is more comonly affected by Graves disease

A

Women 20-40, FH, autoimmune/thyroid disease common

autoantibodies to TSH receptor (TRAb, TSHRAb, TSI, TBII), Abs bind and activate TSH receptors
stimulate thyroid hormone production and thyroid growth

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7
Q

Describe the laboratory findings of Graves disease

A

low TSH, HIGH T4/ T3, positive thyroid antibodies

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8
Q

What is the unique clinical presentation of Graves disease

A

Opthalmopathy- not found in other causes of hyperthyroidism.

2% of all cases

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9
Q

Describe Infiltrative Opthalmopathy

A

Inflammation of the extraocular muscles, connective and adipose tissue

Smoking makes worse

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10
Q

What is the management for Graves disease

A

1] Refer to endocrinology,
2] Anti-thyroid meds (thionamides),
3] TSH, FT4, FT3 monitored after 3-4 weeks and then q 2-3 months.

Goal is euthyroidism.

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11
Q

Describe the Anti-thyroid meds

A

1] propylthiouracil (PTU) and methimazole: inhibit thyroid hormone synthesis,
2] Methimazole preferred (once daily dosing, more rapid efficacy, lower incidence of side effects),

3] Treatment can continue 12-24 months with possibility of remission (20-30%)

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12
Q

What are the side effects of methimazole

A

agranulocytosis/neutropenia.

baseline CBC w/diff prior to tx and monitor during tx.

Neutropenia-first couple months and higher dose of therapy increases likelihood of ADE.

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13
Q

What are the side effects of PTU

A

hepatoxicity, agranulocytosis

monitor LFT’s, CBC

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14
Q

Describe definitive treatment for Graves disease

A

euthyroid with medication(3-8 weeks),

proceed with radioactive iodine ablation (RAI)
permanent solution to hyperthyroidism,
permanent hypothyroidism- need lifelong thyroid replacement
Usually two part series- radioactive iodine uptake and scan then nuclear med radiologist uses that information to determine appropriate dose of iodine for radioactive iodine ablation (patient returns 1-2 days later for ablation)

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15
Q

Describe the use of beta blockers for Graves disease

A

symptomatic relief (tachycardia, anxiety, tremulousness, heat intolerance)

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16
Q

How does atrial fib due to hyperthyroidism

A

because too much thyroid hormone irritates the heart

17
Q

How does CHF due to hyperthyroidism

A

increased HR, palpitations,
causing ventricular hypertrophy-to thick to expand, less vol. less out
decreased cardiac output= SVxHR

18
Q

How does Bone loss due to hyperthyroidism

A

thyroid hormone increases bone turnover= more osteoclast activity

19
Q

Describe the thyroid storm

A

Rare, life-threatening condition (Mortality rate- 20-30%) severe hyperthyroidism with cardiac manifestations , untreated hyperthyroidism;
Eitiology- acute event (surgery, trauma, infection, acute iodine load, childbirth). Body overdrive to fix problme

20
Q

PT tachycardia, cardiac arrhythmia, hyperpyrexia, n/v/d; may progress to delerium, psychosis, comaDescribe the clinical features of thyroid storm

A

S/S of THYROID STORM

21
Q

What is 2nd MC after Graves? Who? DX tool? TX

A

Nodular areas hypersensitive to TSH stimulation,
resulting in nodules excessive amounts of thyroxine,

Who? Elderly

DX-Thyroid uptake scan can determine presence of “hot”- iodine uptake

beta blockers, thionamides
permanent solution -adioactive iodine ablation(RAI), surgery

22
Q

Describe the thyroid scintigraphy (uptake and scan)

A

Diff btwn throiditis and hyperthyoidism

an iodine uptake test-
a scan (imaging) with a gamma camera.-returns 24 hours later to have the level of radioiodine, metal bar measures the radioactivity emitting from the thyroid.
23
Q

PT c/o-Fever, fatigue and lethargy with mild, 2-8 weeks post URI
PE- + Thyroid is tender and diffusely enlarged

A

Subacute Thyroiditis-viral infection or postviral inflammatory process
transient hyperthyroidism initially, followed by transient hypothyroidism,

self-limited non suppurative inflammation with abrupt

onset of pain in the thyroid that radiates to the ear, jaw and neck,

24
Q

How do you treat of Subacute Thyroiditis

A

symptomatic: NSAID, prednisone;

Full recovery is common

25
Q

PT c/o-Fever, fatigue and lethargy with mild, 2-8 weeks post URI
PE- + Thyroid gland is not painful or tender
What is next step in TX

A

Painless/Silent thyroiditis
Transient mild hyperthyroidism, sometimes followed by hypothyroidism, then recovery

TX-symptomatic (beta blocker, short course of thyroxine)

26
Q

What are the lab findings of Thyroiditis

A

Labs often indicate low TSH, elevated T4, T3 can be normal or slightly elevated, and
elevated ESR

27
Q

Describe Postpartum thyroiditis

A

A variant form of Hashimoto’s thyroiditis (+ TPOAb), one year of parturition-mistaken for post partum depression; Typically hyperthyroid phase followed by hypothyroidism

NO tx needed
symptomatic relief during hyper/hypo phases (beta blocker, thyroxine);

Most women recover completely, but 30% have permanent hypothyroidism ***

28
Q

Describe incidence rate of thyroid nodules

A

90% are benign adenomas/cysts;
50% of the population between ages 30-60;
10% are lesions low grade malignancy
agressively thyroid cancer-RARE

29
Q

What are solitary thyroid nodules? What are next steps?

A

benign adenomas with hypofunction;

endocrinologist with
1] Thyroid ultrasounds should be performed on all patients with suspected nodule,-size, consistency, characteristics, and number of nodules

2] Thyroid uptake/scan

30
Q

Ultrasound guided fine needle aspiration (FNA) biopsy results management

A

1] If benign adenoma with nml TFT’s , no tx necessary, annual ultrasounds,

2] If cystic aspirate; repeat 6-12 months,

3] If FNA cytology positive for thyroid cancer: begin aggressive treatment

31
Q

MC malignant neoplasms of the endocrine system;

A

Thyroid Carcinoma

32
Q

Describe Thyroid Carcinoma risk factors. What is key to early dx?

A

history of irradiation to the head and neck,
FH

1] Routine screening with ultrasound and FNA thyroid nodules is key

2] Aggressive treatment to prevent early metastasis

33
Q

What findings solid nodules with increase in size from prior study, presence of microcalcifications mean?

A

Thyroid Carcinoma

34
Q

List the Classification of Thyroid Carcinoma

A

1] Papillary-MC,-Most common and most benign, 80% of all thyroid cancers are papillary type

2] Follicular,
3] Medullary,
4] Anaplastic-

35
Q

cause, prognosis, risk tx of Papillary Thyroid Carcinoma

A

ETI-genetic, radiation exposure

Prognosis- Positive lymph nodes of the neck in > 50% cases-Distant spread uncommon. near 100% cure for small lesions in young patients
distant metastasis-inc mortality

36
Q

What is the treatment of Papillary Thyroid Carcinoma

A

total thyroidectomy,
followed by RAI ablation,
TSH suppression therapy

37
Q

Describe the incidence rate of Follicular Thyroid Carcinoma

A

second most common, Peak onset ages 40-60, Occurs in females > males (3:1), Rarely associated with radiation exposure

38
Q

Describe Medullary Thyroid Carcinoma

A

Neuroendocrine tumor that produces calcitonin

3-5% of all thyroid cancers; Females affected more than males; Not associated with radiation exposure

39
Q

<p>Describe the incidence rate of Anaplastic Thyroid Carcinoma</p>

A

1% of all thyroid carcinomas; Males age 60

Prognoisis- high mortality rate 5 year survival rate around 5%

SMUPASPG19-MED 1 (27 decks)

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