ENDOC- THYROTOXICOSIS

Question 1

_____________ is defined as the state of thyroid hormone excess and is not synonymous with hyperthyroidism , which is the result of excessive thyroid function.

Answer 1

Thyrotoxicosis

Question 2

However, the major etiologies of thyrotoxicosis are _______________

Answer 2

hyperthyroidism caused by:

1. Graves’ disease,
2. toxic MNG,
3. and toxic adenomas.

Question 3

•state of thyroid hormone excess

Answer 3

•Thyrotoxicosis

Question 4

•excessive thyroid function

Answer 4

•Hyperthyroidism

Question 5

Causes of Thyrotoxicosis

Answer 5

1. Primary Hyperthyroidism
2. thyrotoxicosis without hyperthyroidism
3. Secondary Hyperthyroidism
   4.

Question 6

Primary Hyperthyroidism

Answer 6

1. Graves’ disease
2. Toxic Multinodular goiter
3. Toxic Adenoma
4. Functioning thyroid carcinoma metastases
5. ACtivating mutation of the TSH receptor
6. Activating mutation of Galpha ( McCune-Albright syndrome)
7. Struma ovarii
8. Drugs: Iodine excess ( Jod- Basedow phenomenon)

Question 7

Thyrotoxicosis without Hyperthyroidism

Answer 7

1. Subacute thyroiditis
2. Silent Thyroiditis
3. Other causes of thyroid destruction; amiodarone, radiation, infarction of adenoma
4. Ingestiopm pf excess thyroid hormone ( thyrotoxicosis factitia) or thyroid tissue

Question 8

SEcondary Hyperthyroidism

Answer 8

1. TSH-secreting pituitary adenoma
2. Thyroid homrone resitance syndrome; occasional patient may have features of thyrotoxicosis
3. Chorionic Gonadotropin-secrreting tumors
4. Gestational thyrotoxicosis

Question 9

What are the symptoms of Thyrotoxicosis in Descending Order of Frequency

Answer 9

1. Hyperactivity, irritability, dysphoria
2. Heat intolerance and sweating
3. Palpitations
4. fatigue and weakness
5. Weightloss with increased appetite
6. Diarrhea
7. polyuria
8. oligomenorrhea
9. loss of libido

Question 10

What are Thyrotoxicosis in Descending order of Frequency

Answer 10

1. Tachycardia: atrial fibrillation in the elderly
2. tremor
3. Goiter
4. Warm, moist skin
5. Muscle weakness, proximal myopathy
6. Lid retraction or lag
7. Gynecomastia

Question 11

Thyrotoxicosis

Answer 11

1. Gravess Disease
2. Thyroiditis
   
   • acute
   • subacute
   • silent
3. Toxic Multinodular Goiter
4. Hyperfunctioning Solitary Nodule

Question 12

_____________- accounts for 60–80% of thyrotoxicosis.

Answer 12

Graves’ disease

Question 13

The prevalence of Graves’ disease varies among populations, reflecting _____________________.

Answer 13

genetic factors and iodine intake (high iodine intake is associated with an increased prevalence of Graves’ disease).

Question 14

Graves’ disease occurs in up to 2% of women but is one-tenth as frequent in men.

Answer 14

Mas madami sa boys

Question 15

Graves’ dse rarely begins before adolescence and typically occurs between ____________of age; it also occurs in the elderly.

Answer 15

20 and 50 years

Question 16

What is the pathophysio of Graves’ Dse?

Answer 16

• a combination of environmental and genetic factors,
• including polymorphisms in HLA-DR, CTLA-4 , CD25 , PTPN22 (a T cell regulatory gene) and TSH-R , contribute to Graves’ disease susceptibility
• Smoking is a minor risk factor for Graves’disease and a major risk factor for the development of ophthalmopathy

Question 17

GRAVES’ DISEASE

•TSI (thyroid stimulating immunoglobulins) that are synthesized in the thyroid gland as well as in bone marrow and lymph nodes•high levels of TSI can cross the placenta and cause____________-
•
•TPO antibodies occur in up to 80% of cases
•
•there is no direct correlation between the level of TSI and thyroid hormone levels in Graves’ disease

Answer 17

neonatal thyrotoxicosis

Question 18

The hyperthyroidism of Graves’ disease is caused by_________that are synthesized in the thyroid gland as well as in bone marrow and lymph nodes.

Such antibodies can be detected by bioassays or by using the more widely available TBII assays.

Other thyroid autoimmune responses TPO antibodies occur

in up to 80% of cases and serve as a readily measurable marker of

autoimmunity

Answer 18

TSI

Question 19

What are the clinical manifestation of Graves’ disease?

Answer 19

CLINICAL MANIFESTATIONS:

•clinical presentation depends on the severity of thyrotoxicosis

• ••features that are common to any cause of thyrotoxicosis
  
  • –unexplained weight loss, despite an enhanced appetite, due to the increased metabolic rate
  • –hyperactivity, nervousness, irritability
  • –Fine tremor is a frequent finding
• •

Question 20

In the elderly, features of thyrotoxicosis may be subtle or masked, and patients may present mainly with fatigue and weight loss, a condition known as_______________

Answer 20

apathetic thyrotoxicosis

Question 21

CLINICAL MANIFESTATIONS:

•features that are common to any cause of thyrotoxicosis

Answer 21

• –Common neurologic manifestations include hyperreflexia, muscle wasting, and proximal myopathy without fasciculation

Question 22

_________: most common CV manifestation

Answer 22

–Sinus tachycardia

Question 23

–___________ ismore common in patients >50 years of age
–sweating and heat intolerance
–Women frequently experience oligomenorrhea or amenorrhea; in men, there may be impaired sexual function and, rarely, gynecomastia

Answer 23

Atrial fibrillation

Question 24

The most common cardiovascular manifestation is _________________ often associated with palpitations, occasionally caused by** supraventricular tachycardia.**

Answer 24

sinus tachycardia,

Question 25

Graves’ disease CLINICAL MANIFESTATIONS: **•ELDERLY – “apathetic thyrotoxicosis”**

Question 26

\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_appear to **play a major role in thyroid-associated ophthalmopathy.** **There is infiltration of the extraocular muscles** by **activated T cells**; the release of cytokines such as **IFN-γ, TNF, and IL-1** results in **fibroblast activation** and **increased synthesis** of **glycosaminoglycans** that trap water, thereby leading to **characteristic muscle swelling**. Late in the disease, **there is irreversible fibrosis** of the muscles.

Answer 26

Cytokines

Question 27

Onset of Graves’ ophthalmopathy occurs**\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_**

Answer 27

within the year before or after the diagnosis of thyrotoxicosis in 75% of patients

Question 28

\_\_\_\_\_\_\_\_\_\_\_\_\_ occurs in **\<5% of patients** with **Graves’ disease** (Fig. 341-7 B ) , **almost always in the presence of moderate or severe ophthalmopathy.**

Answer 28

Thyroid dermopathy

Question 29

Where is Thyroid dermopathy most frequent \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

Answer 29

over the anterior and lateraL aspects of the lower leg (hence the term pretibial myxedema )

Question 30

In thyroid dermopathy, skin changes can occur at other sites, particularly after trauma. The typical lesion is a _____________________ appearance. Nodular involvement can occur, and the condition can rarely extend over the whole lower leg and foot**, mimicking elephantiasis.**

Answer 30

* noninflamed, * indurated plaque with a deep pink or purple color * and an “orange skin”

Question 31

Thyroid acropachy refers to a form of clubbing found in \<1% of patients with Graves’ disease (Fig. 341-7 C ) . It is so strongly associated with \_\_\_\_\_\_\_\_\_\_\_\_\_- that an alternative cause of clubbing should be sought in a Graves’ patient **without coincident skin and orbital involvement.**

Answer 31

thyroid dermopathy

Question 32

Graves Disease •COURSE –Clinical features **generally worsen without treatment** –**mild Graves’ disease e**xperience s**pontaneous relapses and remissions** –**Ophthalmopathy:** worsens @ \_\_\_\_\_\_\_\_\_\_\_ •

Answer 32

1st 3-6 mos, plateau @ 12-18 mos