Darrow, hypothyroid

Question 1

What is myxedma in hypothyroid

Answer 1

lymphadema with accumulation of GAGs in skin with doughy feeling on palpation

Question 2

myxedema with diastolic HTN

Answer 2

hypothyroid

Question 3

10 hypos hypothyroid

Answer 3

hyporeflexia
hypomentia
hypothermia
hypoventilaion
hypotension or diastolic HTN
hypoHbinemia
hypoglycemia
hyponatremia
hypometabolism of drugs and lipids (HLD)
hypocortisolism
hypoadrenalism

Question 4

causes of hypothyroidism

Answer 4

iodine deficiency and congenital defects in children

chronic lymphocytic thyroiditis (hashimotos in adults)

Question 5

what is HLA of hashimoto

Answer 5

HLA DR5

Question 6

patient with large thyroid gland
\+FMH celiac and pernicious anemia
dry eyes and dry mouth
hgih TSH normal T4
additional test to confirm Dx?

Answer 6

TPO Ab

Question 7

normal T4
hgih TSH
Dx?

Answer 7

subclinical hypothyroidism

Question 8

risk of subclinical hypothyroidism

Answer 8

eleated lipids
CHF and ASHD
early dementia
poor iron absorption (anemia)

Question 9

Tx criteria subclinical hypothyroidism

Answer 9

if no TPO Ab but TSH >10 Tx

if TPO Ab and TSH>5 Tx

Question 10

Tx criteria for pregnant patients with TPO Ab

Answer 10

TSH> 2.5

Question 11

causes of hypothyroidism

Answer 11

chronic lymphocytic (hashimoto)!!
RAI induced!!
subacute lymphcytic thyroiditis!!
drugs: PTU, iodine, lithium!!, interferon!!, amiodarone!!, thalidomide etc
irradiation and thyroidectomy
infiltrative diseases
Hep C!!
central hypothyroidism
congenital
iodine deficient

Question 12

other autoimmune diseases assoc with hashimoto

Answer 12

addisons, hypoPTH, DM , PA, sjogrens, vitiligo, PBC and IBD

HLA B8- DR, DQ

Question 13

65 F nubness in thumbs and index fingers
weak  and dizzy with chest pain
constipation, pedal edema
diastolic HTN
ywllowing skin
speech hoarse
bradycardia with II/VI systolic ejection murmur at base with high pitched systolic murmur at apex
hair thin and + Tinels sign
DTRs 1+ b/l

Answer 13

hypothyroidism

Question 14

Dec Fe levels increased TIBC

Answer 14

Fe deficiency

Question 15

what is gallavardin phenomenon

Answer 15

II/VI systolic ejection murmur at base with high pitched systolic murmur at apex

Question 16

what can cause gallavardin phenomenon

Answer 16

diastolic HTN

Question 17

hypothyroidism can change Na how

Answer 17

hypotonic euvolemic hyponatremia from decreased NA/K ATPase

Question 18

urinary Na from hypothyroidism?

Usom?

Answer 18

> 20meq/L

Uosm >150-200 mOsm/L

Question 19

first line for hypothyroid Tx

Answer 19

L thyroxine 25-75/day unless pregnant or history of CAD

Question 20

L thyroxine levels for pregnant women

Answer 20

100-150 mcg

Question 21

what is the euthyroid dose level to stay near in Tx hypothyroidism

Answer 21

1.6 mcg/kg/day

Question 22

if patient is being Tx for hypothyroid and has TSH <2 and is still tired what shoul dyou look for

Answer 22

anemia, B12 deficiency, sleep apnea

Question 23

what are modifications in patients being Tx with L thyroxine

Answer 23

monitor oral intake drugs: imatinib, omeprazole and food:soy milk coffee, fiber and Ca

Question 24

what will precipitate a myxedema crisis

Answer 24

on compliance to meds, surgery, stress, infections

Question 25

mortality of myxedema crisis

Answer 25

20-50%

Question 26

Tx mxyedema crisis

Answer 26

hydrocortisone IV levothyroxine LT3

Question 27

what is definition bacterial peritonitis ascites

Answer 27

if there is >250 PMNs in sear from pericentesis

Question 28

what are common pathogens that cause bacterial peritonitits ascites

Answer 28

E coli and serratia

Question 29

what do yo worry about if pericentesis shows ?1 bacteria type

Answer 29

bowel perforation

Question 30

``` 55 y.o M with alcoholic cirrhosis and ascites with encephalopathy has bacteral peritonitis severe hypotension lethargy low TSH Dx? ```

Answer 30

svere non thyroidal illness (TNF-euthyroid sick syndrome)

Question 31

What can cause low TSH

Answer 31

Autonomous functioning thyroid nodule drugs: steroids, amphetamines, Ca Ch blockers, dopamine, NSAIDs, opiates elderly euthyroid pregnancy or hCG secretion

Question 32

causes of euthryoid sick syndrome

Answer 32

non thyroidal illness | major surgery

Question 33

T3 levels in euthyroid sick syndrome

Answer 33

LOW

Question 34

what causes low T3 in euthryoid sick syndrome

Answer 34

decreased 5' deiodinase | increased IL that displaces binding of T4 (increases T3 uptake)

Question 35

What causes low TSH in euthyroid sick syndrome

Answer 35

severe drugs: acute steroid, amphetamines, Ca Ch blockers, dopamine, NSAIDs, opiates increased IL-1, IL-6 and TNF alpha

Question 36

how do TNF alpha and IL-1 decrease TSH

Answer 36

increast somatostatin which dec TRH so dec TSH

Question 37

how does IL-6 decrease TSH

Answer 37

increases CRH which inc ACTH which inc cortisol which dec both TRH and tSH

Question 38

50 y.o F with hoarsness, diminished sense tast and smell, menorrhagia, thinking of eyebrowns, thick tongue, cardiac enlargement and galactorrhea pituitary enlarged on CT best approach?

Answer 38

thyroid replacement

Question 39

TRH activates release of what

Answer 39

TSH and prolactin