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Clin med 1 > Diseases of thyroid > Flashcards

Diseases of thyroid Flashcards

1
Q

What is the function of the thyroid?

A

Helps regulate metabolism, regulate long bone growth and brain development

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2
Q

Physiology of thyroid hormones

A

TRH -> TSH -> Thyroxine -> T4 -> T3

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3
Q

Why is iodine so important?

A

Needed to produce T3 and T4. The T4 structure contains 4 iodine atoms

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4
Q

Deiodination leads to what?

A

Production of the potent hormone Tiiodothyronine (T3)

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5
Q

Thyrotoxicosis is what?

A

Elevated unbound “free” thyroid hormone circulating in the body

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6
Q

Most common cause of thyrotoxicosis?

A

Hyperthyroidism (90%)

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7
Q

What is the most common cause of Hyperthyroidism?

A

Graves Disease, F>M ratio 5:1

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8
Q

Graves disease typically effects who?

A

Women ages 20-40

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9
Q

Toxic Nodular goiter occurs in who?

A

Older population

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10
Q

3 causes of primary hyperthyroidism

A
  1. Graves disease (most common)
  2. Toxic Multinodular Goiter
  3. Toxic Nodular Goiter
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11
Q

Other causes of thyrotoxicosis ro hyperthyroidism

A

Subacute or post partum thyroiditis, Pituitary adenoma, Struma Ovarii, iodine induced hyperthyroidism (Jod-Basedow Dx), med induced, testicular germ cell tumors, palpation thyroiditis

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12
Q

What is elevated in pituitary adenomas?

A

TSH, T4 and T3

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13
Q

Which medications can induce hyperthyroidism?

A

Lithium and Amiodarone

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14
Q

How do germ cell tumors cause hyperthyroidism?

A

Stimulate TSH

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15
Q

Hyperthyroid symptoms

A

Irritability, nervousness, anxiety, restlessness, emotional lability, sweating, poor concentration, fatigue, muscle weakness/cramps, palpitations, increase bowel movements, SOB, heat intolerance, menstrual irregularities

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16
Q

PE findings skin/nails with hyperthyroidism

A

Pruritus, moist skin, thinning hair, hyperpigmentation, onycholysis

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17
Q

PE findings of HEENT with hyperthyroidism

A

Lid lag and stare, exopthalmus, goiter or nodules

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18
Q

PE findings of cardiac with hyperthyroidism

A

Tachy/AFIB, Neuro: fine tremor, hyperreflexia

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19
Q

PE findings of endocrine with hyperthyroidism

A

Weight loss despite increased appetite

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20
Q

Graves disease PE findings

A

Ophthalmopathy/exopthalmos, infiltrative dermopathy, thyroid acropathy, goiter with bruit
a pt with graves may experience all of hyperthyroid symptoms in addition to these

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21
Q

Hyperthyroid labs to draw

A

TSH, free T4, total T3, antibodies, serum cholesterol, calcium

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22
Q

What will a TSH show for hyperthyroidism?

A

Decreased

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23
Q

What will a free T4 show for hyperthyroidism?

A

Elevated

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24
Q

What will a total T3 show for hyperthyroidism?

A

Elevated

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25
Q

What will serum cholesterol be for hyperthyroidism?

A

Decreased

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26
Q

What will happen to calcium in hyperthyroid?

A

Hypercalcemia

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27
Q

Imaging studies for hyperthyroid

A

Nuclear scintigraphy w/RAIU: Thyroid scan with radioactive iodine uptake

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28
Q

Hyperthyroid treatment

A

Symptomatic Antithyroid drugs (Thionamides), Radioactive Iodine treatment (TOC), surgery

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29
Q

What is the symptomatic treatment for hyerpthyroid?

A

Oral or IV rehydration PRN, Beta-blocker: Propranolol, Atenolol, Metoprolol

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30
Q

Hyperthyroid treatment with Thionamides

A

Methimazole: Taper dose down, preferred
PTU: preferred in pregnant 1st trimester, causes agranulocytosis

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31
Q

Radioactive iodine treatment for hyerpthyroid

A

Treatment of choice*

PO single dose, causes fibrosis and destruction of thyroid over weeks, requires Levothyroxine for life

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32
Q

What is the treatment of choice for hyperthyroidism?

A

Radioactie iodine treatment

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33
Q

Surgical treatment for hyperthyroid

A

Indicated for non compliant patients, patients with large goiters, also need lifelong Levo

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34
Q

What occurs in people with untreated hyperthyroidism?

A

Thyroid storme

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35
Q

Thyroid storm can be brought on by what?

A

Major stress such as trauma, heart attack, or infection

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36
Q

Clinical presentation of thyroid storm

A

Fever, tachycardia, HTN, neurological and GI abnormalities

HTN can be followed by CHF with hypotension and shock

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37
Q

Is thyroid storm fatal?

A

If left untreated, yes

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38
Q

Treatment of thyroid storm

A

Antipyretics PRN, IV rehydration, IV Thiourea, administration of iodine compound PO (Lugol’s solution) one hour AFTER Thiourea, Glucocorticoids

39
Q

What does the Lugol’s solution block?

A

Blocks release and conversion of T4/T3

40
Q

Why are glucocorticoids given in thyroid storm treatment?

A

For adrenal insufficiency, will decrease the conversion of peripheral T4/T3

41
Q

Thyrotoxicosis refers to what?

A

Clinical manifestations associated with serum levels of T4 or T3 that are excessive for the individual

42
Q

Subacute thyroiditis is also known as what?

A

“De Quervain” or “granulomatous” thyroiditis. Its typically caused by various viral infections

43
Q

What is the most common cause of hypothyroidism in developing countries?

A

Iodine deficiency

44
Q

What is the most common cause of hypothyroidism in US?

A

Hashimotos

45
Q

Who is more likely to be hypothyroid?

A

Elderly, F>M, caucasian>AA

46
Q

Myexedema coma has what?

A

High mortality rate

47
Q

Hypothyroid etiology

A
  1. Hashimotos (Autoimmune thyroiditis)
  2. Thyroidectomy
  3. Central hypothyroidism
48
Q

Hypothyroidism symptoms

A

Fatigue, lethargy, depression , weakness, dyspnea on exertion, arthralgias/myalgias, muscle cramps, menorrhagia, constipation, HA, paresthesias, cold intolerance, infertility

49
Q

PE findings of hypothyroidism

A

Dry skin, weight gain, thinning of hair, puffy face/eyelid, goiter, bradycardia, delayed reflex

50
Q

Labs/diagnostics for hypothyroidism

A

TSH (best screening tool), FT4, T4/T3, thyroid antibodies, LDL triglycerides, sodium, glucose, anemia, BMP

51
Q

TSH is hypothyroidism?

A

Elevated

52
Q

FT4, T4 and T3 in hypothryoid

A

All low

53
Q

LDL triglycerides in hypothyroidism?

A

Elevated

54
Q

Sodium, glucose in hypothyroidism

A

Hyponatremia, hypoglycemia, decreased BMP

55
Q

Treatment for hypothyroidism

A

Levothyroxine (synthroid): take with water in morning after overnight fasting, start low and titrate up with elderly

56
Q

Which antibodies are elevated for hypothyroidism?

A

Elevated antithyroid peroxidase TPO Ab and antithyroglobulin antibodies TgAb

57
Q

What invades the thyroid gland in Hashimotos?

A

B-lymphocytes invade it, also known as chronic lymphocytic thyroiditis

58
Q

What is severe, life threatening hypothyroidism?

A

Myxedema comas

59
Q

Si/sx of myxedema coma

A

Impaired cognition, confusion, severe hypothermia, hypoventilation, hyponatremia, hypoglycemia, hypotension, rhabdo and AKI can occur

60
Q

Myxedema treatment

A

Large doses of Levo IV, hypothermic: warm with blankets, hypercapnia: intubate and assist mechanical ventilation, infections: treat aggressively, adrenal insufficiency: hydrocortisone

61
Q

Abnormal findings on thyroid fxn tests that occur in setting of nonthyroidal illness, without thyroid gland dysfunction

A

Euthyroid sick syndrome

62
Q

Lab results for euthyroid sick syndrome

A

TSH normal, NORMAL or low T4, T3, serum cortisol elevated, antibodies negative
Treat: underlying cause

63
Q

Inflammation of the thyroid gland

A

Thyroiditis

64
Q

Includes a group of individual disorders causing thyroidal inflammation but presenting in different ways

A

Thyroiditis

65
Q

Treatment of thyroiditis

A

Symptomatic relief of thyroid pain and tenderness

66
Q

What can occur in the recovery phase from thyroiditis?

A

43% hypothyroidism
32% hyperthyroidism
25% hyperthyroidism follow by hypothyroidism

67
Q

What is the etiology of subacute lymphocytic thyroiditis/ silent thyroiditis/ painless thyroiditis

A

Often autoimmune related can occur after exposure to certain drugs, like interferon-alpha, interleukin-2, lithium and tyrosine kinase inhibitors

68
Q

How do you decipher subacute lymphocytic thyroiditis/ silent thyroiditis/ painless thyroiditis from Graves disease?

A

There it little to no thyroid enlargement, no graves opthalmology

69
Q

Post partum thyroiditis etiologies

A

2-13 mos postpartum, painless, usually transient. >80% will have antibodies. The hyperthyroid lasts a few weeks and most progress to hypothyroid which can last months. Recurrence rate high 70%

70
Q

What percentage of people with subacute lymphocytic thyroiditis/ silent thyroiditis/ painless thyroiditis with have antibodies?

A

50%

71
Q

What is another name of subacute granulomatous thyroiditis

A

De Quervains

72
Q

Etiologies of De Quervains

A

Low grade fever, viral etiology: URI with extreme neck pain. Painful nodule, throat, dysphagia

73
Q

Why is De Quervains often overlooked?

A

Symptoms mimic pharyngitis, must rule out infectious bacterial suppurative thyroiditis

74
Q

Chronic lymphocytic thyroiditis is also called what?

A

Hashimotos Thyroiditis

75
Q

What drugs can cause thyroiditis?

A

Amiodarone, Lithium, Phenytoin, Radioactive iodine

76
Q

Amiodarone Thyroiditis

A

Type 1: active production of excessive hormones due to too much free iodine
Type 2: destructive thyroiditis which releases stored hormones

77
Q

Thyroiditis treatment

A

Treat symptoms, treat with levo if in hypothyroid state, DO NOT treat with Thionamides

78
Q

Epidemiology of thyroid cancers

A

1% of all endocrine cancers, death rate low, peak incidence 3rd and4th decade of life, papillary follicular, medullary, and anaplastic carcinomas

79
Q

What are some risk factors for thyroid cancers?

A

Radiation exposure, MEN (medullary carcinoma), family hx, hashimotos? iodine deficiency? (follicular carcinoma), nodular dx <30year and >60 years age

80
Q

Thyroid cancer si/sx

A

Painless, palpablenodule. Firm non mobile nodules suspicious for malignancy
Rapid growth: bad sign
Vocal cord paralysis, hoarse voice

81
Q

What is a Firm cervical mass highly suggestive of ?

A

Regional lymph node and metastasis

82
Q

What is the most common type of thyroid cancer?

A

Papillary: Psammoma bodies: cleaved nuclei

83
Q

Papillary thyroid cancer

A

Multifocal, invades locally. Spread via lymphs and through the blood, SLOW growth

84
Q

What type of thyroid cancer is more common in iodine deficient regions?

A

Follicular, spreads through the blood

Has the Hurthle cell

85
Q

What does the Hurthle cell require?

A

Rare, considered a variant of follicular carcinoma that required aggressive surgery

86
Q

Which type of thyroid cancer is involved with MEN 2A and 2B?

A

Medullary

87
Q

Medullary thyroid cancer

A

Calcitonin is elevated, management is primarily surgical, high rate of recurrence

88
Q

Poorly differentiated, aggressive, early metastasis to nodes and distant sites. Poor prognosis

A

Anaplastic thyroid cancer

89
Q

Anaplastic thyroid cancer

A

Uncommon, inactivation of p53 gene, older patients with a rapidly enlarging mass

90
Q

Thyroid cancer diagnostics

A

Ultrasound: can provide info for possible FNA

Diagnostic of choice: Fine needle aspiration

91
Q

What labs can be used to diagnose thyroid cancer?

A

TSH, serum calcitonin and CEA, PCR germline mutation (medullary)
Thyroid radioiodine imaging: can provide hint whether malignant or not
CT or MRI without contrast: evaluates soft tissue extension of large or suspicious thyroid mass

92
Q

Hot vs Cold thyroid

A

Used to describe findings on a radioactive iodine uptake scan
The hotter the nodule, the less likely its cancerous

93
Q

Thyroid cancer treatment

A

Gold standard: Thyroidectomy

Clin med 1 (9 decks)

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