Darrow, Hyperthyroid Flashcards Preview

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Flashcards in Darrow, Hyperthyroid Deck (58):
1

heat intolerance and palpitations

hyperthyroid

2

clubbing of fingers

hyperthyroid

3

What is higher in graves T3 or T4

T3

4

what are clinical signs of graves

goiter, exophthalmos, pretibial myxedema

5

what type of HS reaction is graves

type II
Ab dependent cytotoxicity
IgG

6

What HLA is graves

HLA-DRB1, DR8
HLA DR is MHC II

7

major cell causing pretibial myxedma

TH1

8

what cell drives graves disease

TH2

9

TH1 CD4 cells do what in graves

stimulate effector cells (macrophages, CTLs, NK cells) against TSH R and fibroblast to produce GAGs

10

What do CD4 TH2 cells do in graves

sitmulate TSH R Ab(TSI) that act on follicular cells to stimulate thyroid growth and secretion
cross react with antigens in fibroblasts, adipocytes etc

11

how do type II HS reactions cause disease

C' mediated lysis through MAC
Ab dependent cytotoxic attack (CTL)
alter cell surface R function toward activation or blockade

12

What are other type II HS reaction diseases

autoimmune hemolytic anemia
blood transfusion reaction
graves
myasthenia gravis

13

if patient with graves has diplopia what do you have to keep

coexistant myasthenia gravis

14

what causes the proptosis and diplopia in graves

firbobalst proliferation with GAG deposits and lymphocytes that is caused by TH2

15

what can cause clubbing of fingers or 'hypertrophic osteoarthropathy"

cardiac diseases
pulmonary diseases
GI diseases
Rena failures
thyroid disease (graveS)
malignancies
idiopathic

16

what classifies tyrotoxid cardiomyopathy

tach induced cardiomyopathy, Afib, high output failure, pulm HTN

17

how do you rule out factitial thyrotoxicosis

no thyroglobulin in factitial thyrotoxicosis

18

why does increased T3 lead to hyperCa

more bone turnover

19

what HLA is responsible for euthyroid Graves orbitopathy

HLA B40 DQw3

20

first line of Tx for graves

antithyroid drugs to block oxdation of Iodine, block organification iodine and couling

21

What are the antithyroid drugs used in graves

PTU
methimazole

22

How does PTU work

blocks T4 to T3

23

what is the first drug of choice for graves

methimazole because less hepatic necrosis

24

side effects of antithyroid drugs

agranulocytosis, hepattis, SLE

25

What do you give after starting thiourea drugs in graves

iodine to block T4 to T3
wolff chaikoff effect because blocks synthesis and release

26

besdies antithyroid drugs and iodine what other medicaiton is used in graves

lithium, K perchlorate

27

What is second line Tx graves

radioactive iodine

28

what is the final Tx for graves

surgery

29

what can stimulate primary hyperthyroidism by creating low TSH

acute steroid administration
amphetamines
Ca ch blockers
dopamine
NSAIDs
opiates
elderly euthyroid
pregnancy or hCG secretion
severe non-thyroidal illness (IL , TNF)

30

what heart condition can thyrotoxicosis caUSE

A FIB

31

Apathetic hyperthyroididsm signs

apathy, weight loss, angina, AF, CHF and less adrenergic Sx

32

What cuases apathetic hyperthyroidism

somatic mutations of TSH R and G alpha protein leading to cAMP cascade of inositol phosphate pathway

33

what drug can cause an autonomous thyroid nodule to become a toxic multinodular goiter

amiodarone excess iodine

34

someone on amiodarone will have what result in an radioactive thyroid scan

decreased uptake of iodine from iodine induced TMN goiter
thyroid already saturated of iodine

35

what is Jod basedown phenomenon

when patient has ample iodine so induces TMN goiter

36

What are the type I amiodarone induced thyrotoxicosis

- jod basedown type with TMNG and no thyroid Ab
- graves type with Ab

37

what is type II amiodarone induced thyrotoxicosis

thyroiditis

38

what can cause increased uptake on iodine scan

graves
adenoma(plummers)
inappropriate secretion TSH (pituitary adenoma)
TMN
Trophoblastic (embryonal carcinoma and hydatiform mole)

39

Tx for an autonomous thyroid nodule

RAI or surgery or antithyroid drugs

40

Tx for TMNG

RAI or surgery of ATDs

41

what should you do for RAI Tx in someone with low uptake

prime with PTU or recombinant TSH

42

patient has normal free T4 and low TSH

subclinical hyperthyroidism

43

risks of subclinical hyperthryoidism

AF and diastolic dysfunction
osteoporosis
dementia

44

Tx for subclinical hyperthyroidism

TAI or small dose of antithyroid drug

45

patient with normal T4 and TSH between 0.1- 0.3 (low)
what would you Tx

observation and consider beta blocker

46

what can cause thyrotoxic storm

acute illness, thyroid surgery or RAI therapy in inadequately Tx patient

47

signs thyroid storm

fever, tachycardia, tachypnea, hypotension, vomiting, diarrhea, irritability, delerium, coma and death

48

Tx for thyroid storm

thiourea with iodides
must start iodides after thiourea
start metoprolol and hydrocortisone as well

49

thyroid storm presents similar to what

sepsis, pheo, malignant hyperthermia

50

male on thyroid hormone replacement has muscle pain and weakness
gynecomastia, severe prosimal muscle weakness and dec reflexes
low K
Dx?

thyrotoxic periodic paralysis

51

what is thyrotoxic periodic paralysis

channelopathy with muscle weakness (Na/KATPase increased) hypopolarization

52

levels of K in thyrotoxic periodic paralysis

serum hypokalemia with heavy meal or post exercise in asian men

53

what drugs can increase ATPase activity in thyrotoxic periodic paralysis

thyroid hormone, catecholamines, insuline, testosterone

54

25 y.o F postpartum with shakiness, palpitations and heat intolerance
BP 120/50
enlarged non tender thyroid gland
tremor in hands
increased T4
TSH low
TPOAb low
dec uptake on scan
Dx?

postpartum

55

what are causes of hyperthyroidism with decreased uptake on RAI

Drugs: thyroxine
Iodine: jod basedown
Ectopic: struma ovarii, teratoma
Thyroiditis: painful types and painless types

56

what are the painful types of thyroiditis

subacute granulomatous--> viral, high ESR, HLA B-35
suppurative (staph)
radiation
drug induced

57

Amiodarone induced thyroiditis involves what IL?

IL-6

58

what are the painless types thyroiditis

postpartum- DR3 DR5 (precursor to hashimoto)
subacute or chornic autoimmune lymphocytic (DM, vitiligo, downs or turners)
Riedels fibrosis