CECIL THYROID

Question 1

Which psychiatric drug may block thyroid hormone release?

Answer 1

Lithium

Question 2

Which sort of situations may increase the TBG

Answer 2

Pregnancy
Exposure to estrogens
Hepatitis
Familial TBG escess
5FU Tamoxifen Methadone

but T4 and T3 remain constant

Question 3

Decreased TBG levels may occur with

Answer 3

Systemic illness
Severe hepatic disease
Nephrotic syndrome
Androgens
Glucocorticoids
Slow-release nicotinic acid

but T4 and T3 remain constant

Question 4

Deiodinases (T4 to T3) may be inhibited by

Answer 4

Systemic illness
Iodide-containing compounds (amiodarone, radiocontrast)
Glucocorticoid
Selenium deficiency

Question 5

What does T3 do to LDL levels?

Answer 5

It results in accelerated LDL clearance

Question 6

What effect does aging have on TSH?

Answer 6

Aging is associated with increased serum TSH concentrations with no change in free T4 levels

Question 7

What sort of antibodies may confirm the diagnosis of autoimmune thyroiditis?

Answer 7

Antithyroid peroxidase and

Atithyroglobulin aitbody

Question 8

Causes of primary Hypothyroidism

Answer 8

Hashimoto's
Scleroderma
Amyloidosis
Amiodarone
Lithium

Question 9

Secondary Hypothyroidism

Answer 9

Sheehan
Inflammation (sarcoidosis, vasculitis)
Infiltration (hemochromatosis, tuberculosis, fungal infection)
Tumor (lymphona, germinoma, glioma)

Question 10

Hypothyroidism Epidemio

Answer 10

Women

Whites and Latin Americans

Question 11

Polyglandular autoimmune syndrome type 2

Answer 11

Hypothyroidism
DM1
Adrenal insuficciency

Question 12

Polyglandular autoimmune syndrome type 1

Answer 12

Hypothyroidism
Adrenal insufficiency
Hypoparathyroidism
Chronic mucocutaneous candidiasis

Question 13

Which sort of drug may cause autoimmune thyroiditis?

Answer 13

Infereron-alpha

Question 14

Riedel’s thyroidism

Answer 14

Fibrous Thyroiditis

Infiltrative disorder

Question 15

Infiltrative disorders affecting the hypothalamus

Answer 15

Sarcoidosis
Hemochromatosis
Hitiocytosis

Question 16

Clinical manifestations of Hypothyroi..

Answer 16

Hoarseness
Constipation
Myalgias
Arthralgias
Paresthesias
Dry Skin
Hair Loss

Question 17

Females with hypothyroidism may develop

Answer 17

Precocious puberty
Menorrhagia
Amenorrhea
Galactorrhea

Question 18

Physical findings of hypothyroidism in children

Answer 18

Delayed linear growth despite weigh gain
Precocious or delayed puberty
Pseudohypertrophy of muscle

Question 19

PFindings of hypothyroidism in adults

Answer 19

Bradycardia
Diastolic hypertension
Mild hypothermia

Question 20

Routine blood tests in Hypothyroidism

Answer 20

Anemia (which is typically macrocytic)
Hyponatremia
Hypoglycemia
Elevated creatine phosphokinase 
Elevated Prolactin
Elevated Homocysteine
Elevated Triglyceride
Elevated total and LDL cholesterol

Question 21

Increased metabolism of thyroxine, including drug interaction

Answer 21

Pregnancy
Phenytoin
Phenobarbital
Carbamazepine
Rifampin

Question 22

In how many weeks should one assess if the treatment was successful? How should one assess?

Answer 22

4-6 weeks

TSH measurement

Question 23

Once an adequate dose has been established, the TSH level should be checked how often?

Answer 23

Annually

Question 24

How should be evaluate the success of the treatmente in secondary hypothyroidism?

Answer 24

serum free T4 levels in theupper half of the reference range. 2 to 4 weeks after the thyroxine dose is started

Question 25

Thyrotoxicosis hyperthyroidism

Answer 25

``` Graves Toxic adenoma Toxic multinodular goiter Struma ovarii Mtx differentiated thyroid cancer TSH-secreting pituitary adenoma ```

Question 26

NOnhyperthyroid thyrotoxicosis

Answer 26

Subacute thyroiditis | Autoimmune thyroiditis

Question 27

Symptoms of thyrotoxicosis

Answer 27

``` Weight loss despite a hearty appetite Heat intolerance Palpitations Tremor Hyperdefecation Fatigue Insomnia Anxiety Irritability Weakness Atypical chest pain Dyspnea on exertion ``` Atypical Headache Periodic paralysis Nausea and vomiting

Question 28

Apathetic thyrotoxicosis

Answer 28

In the elderly | Weight loss and the absence of sympathomimetic symptoms and signs

Question 29

Signs of thyrotoxicosis

Answer 29

``` Resting tachycardia Systolic hypertension with a widened pulse pressure Warm moist skin with a velvety texture Onycholysis Staring gaze with lid lag Deep tendon reflexes (brisk) Proximal muscle weakness ```

Question 30

Graves disease Epidemio

Answer 30

Women | 30-60a

Question 31

Clinical manifestations of ocular Graves disease

Answer 31

``` Ocular irritation Foreign body sensation Dryness Excessive tearing Exophtalmia ```

Question 32

Treatment of thyroid eye disease

Answer 32

Moisturizing drops and ointment Taping the eyelids in bedtime Selenium supplementation High-dose systemic GC

Question 33

Pretibial myxedema, how does it appear and in what disease?

Answer 33

Graves | Mildly pruritic, orange peel-like thickening of the sking along the anterior aspect of the shin

Question 34

Antibody found in Graves disease

Answer 34

Antithyrotropin

Question 35

Concerning the T4 and T3 levels, which one is elevated in Graves disease toxicosis?

Answer 35

T3

Question 36

Antithyroid drug pharmaco class

Answer 36

Thionamide

Question 37

Which thionamide may be taken as a single daily dose?

Answer 37

Methimazole

Question 38

In severe complicated thyrotoxicosis, which thionamide is prefered?

Answer 38

PTU

Question 39

Toxicity of PTU

Answer 39

Hepatotoxicity

Question 40

How often to check for hypothyroidism in patients treating for hyperthyroidism?

Answer 40

3-12 weeks

Question 41

Alert QC in patients treating for hyperparathyroidism

Answer 41

Jaundice High fever Pharyngitis Abdominal pain