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Clinical Laboratory Medicine > Thyroid > Flashcards

Thyroid Flashcards

1
Q

Best initial test of thyroid function…

A

TSH

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2
Q

What is tightly regulated by serum levels of T3/T4?

A

TSH (inverse relationship)

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3
Q

FT4 is used to evaluate an abnormal…

A

TSH

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4
Q

is free T4 or total t4 more diagnostically relevant?

A

FT4

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5
Q

T4 is converted to T3 where

A

liver mostly

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6
Q

Which Abs are mostly found in hypothyroidism (hashimoto’s)?

A

TPO Ab
(thyroid peroxidase)

TgAb
(thyroglobulin)

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7
Q

Which Abs are most often found in hyperthyroidism (Graves)?

A

TRAb

thyrotropic receptor

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8
Q

This is a functional study used to evaluate a suppressed TSH/hyperthyroid…

A

radioactive iodine uptake

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9
Q

This is a non-invasive imaging that can assess structure of thyroid gland tissue

A

US

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10
Q

US is helpful in assessing…

A

nodules

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11
Q

This is the most accurate, reliable, cost-effective test to dx thyroid ca

A

fine needle aspiration

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12
Q

Decreased TSH

Elevated FT4/T3…

A

Hyperthyroidism

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13
Q

4 endogenous causes of hyperthyroidism…

A

graves
toxic multinodular goiter
toxic adenoma
thyroiditis

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14
Q

Exogenous hyperthyroid ism is…

A

iatrogenic in nature

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15
Q

What type of hyperthyroidism?

Decreased TSH
Increased FT4
Increased T3

A

Graves (Most Common Cause)

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16
Q

What type of hyperthyroidism?

Decreased TSH
Normal FT4/T3

A

Sublinical hyperthyroidism

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17
Q

What type of hyperthyroidism?

Decreased TSH
Normal FT4
Increased T3

A

T3 toxicosis

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18
Q

What causes the following result of radioactive iodine uptake…

diffuse high

A

de-novo synth of hormone

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19
Q

What causes the following result of radioactive iodine uptake…

diffuse low

A

inflammation/destruction

extrathyroid source of hormone (factitious thyrotoxicosis)

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20
Q

radioactive iodine uptake in Grave’s disease…

A

diffuse

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21
Q

What causes the following result of radioactive iodine uptake…

increased irregular uptake

A

hyperfunctioning “hot” nodules

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22
Q

are hot nodules usually malignant?

A

no

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23
Q

What causes the following result of radioactive iodine uptake…

decreased irregular uptake

A

hypofunctioning “cold” nodules

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24
Q

Are cold nodules malignant?

A

yes, consider FNA

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25
Q

Subacute thyroididits RAI Uptake result…what other tests?

A

decreased uptake, ESR/CRP

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26
Q

Toxic MNG RAI Uptake Result… what other tests?

A

Irregular, US

27
Q

Toxic adenoma RAI Uptake result… what other tests?

A

irregular, US

28
Q

exogenous etiology of hyperthyroidism RAI Uptake result… what other tests?

A

decreased uptake, serum Tg

29
Q

A patient presents w/ hypothyroid sxs and:

+ TPO Ab, TgAb

A

primary hypothyroidism (hashimoto thyroiditis)

30
Q

A patient presents w/ hypothyroid sxs and:

low TSH and low FT4

A

Central hypothyroidism

31
Q

Secondary central hypothyroidism is a disease of the…

A

pituitary

32
Q

tertiary central hypothyroidism is a disease of the…

A

hypothalamus

33
Q

How do you assess central hypothyroidism?

A

pituitary MRI

34
Q

What four medications may cause iatrogenic hypothyroidism?

A

lithium
amiodarone
iodine drugs
contrast agents

35
Q

What would you be suspicious of with the following labs?

increased TSH
decreased FT4
normal/decreased T3

A

Primary hypothyroidism (MC hashimotos thyroiditis)

36
Q

What would you be suspicious of with the following labs?

increased TSH
Normal FT4/T3

A

subclinical hypothyroidism

37
Q

What would you be suspicious of with the following labs?

normal/low TSH
subnormal FT4
normal/low T3

A

central hypothyroidism

38
Q

How do you treat hypothyroidism?

A

levothyroxine replacement

39
Q

What is dosing based on for levothyroxine?

A

weight-based

40
Q

When should levothyroxine be taken?

A

empty stomach 1 hour before breakfast

41
Q

First line test and imaging for thyroid nodule…

A

TSH and US

42
Q

Is thyroid CA common? Are thyroid nodules common?

A

CA: no

Nodules: yes

43
Q

If a patient has a nodule and subnormal TSH, what is the next step?

A

RAI uptake scan

44
Q

What test should be ordered if there is a hot nodule?

A

FT4/T3

45
Q

If hot nodule and sublinical hyperthyroidism, what is the next move?

A

observe

46
Q

If hot nodule and overt hyperthyroidism, what is the next step?

A

tx

47
Q

If you have a cold nodule, what is the next step?

A

FNA

48
Q

If you have a nodule and normal/elevated TSH, what should be done next?

A

check TPO abs, consider FNA

49
Q

Low TSH/High FT4…

A

primary hyperthyroidism

50
Q

High TSH/Low FT4…

A

primary hypothyroidism

51
Q

Low TSH, low FT4, consider…

A

pituitary MRI

52
Q

tetany, chvostek sign, trousseau sign, prlonged QT are signs of…

A

hypoPTH

53
Q

The following labs are concerning for…

Decreased PTH
Decreased Ca
Increased Phosphate

A

hypoPTH

54
Q

Common cause of hypoPTH…

A

post-surg/irradiation

55
Q

Bones, stones, moans, groans…

A

primary hyperPTH

56
Q

MC cause of primary hyperPTH…

A

parathyroid adenoma

57
Q

A patient with the following labs is concerning for…

increased PTH
increased Ca
Decreased PO4

A

primary hyperPTH

58
Q

how do you treat hypoPTH?

A

Ca, vit D

59
Q

How do you tx primary hyperPTH?

A

bisphosphonates, parathyroidectomy

60
Q

A patient with the following labs is concerning for…

Increased PTH
decreased Ca
Incrased PO4

A

secondary hyperPTH

61
Q

What is the MC cause of secondary hyperPTH?

A

CKD

62
Q

How do you tx secondary hyperPTH?

A

renal mgmt

63
Q

nodule protocol…

A

TSH/US

Subnormal TSH = RIU

Cold = FNA, Hot = FT4, T3

Hot w/ overt hyper = tx, hot w/ sublinical hyper = observe

Clinical Laboratory Medicine (9 decks)

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