EXAM #1: HYPERTHYROID Flashcards Preview

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Flashcards in EXAM #1: HYPERTHYROID Deck (41):
1

What are the cardiac sequelae of hyperthyroidism?

1) A-fib
2) High-output failure

2

What is Graves' dermopathy?

Thickening of the skin in the setting of hyperthyroidism

3

What changes in the eyes are specific to Graves' disease?

1) Proptosis
2) Ophthalmoplegia*
3) Periorbital edema

*Can't look in certain directions, can lead to diplopia

4

What are the three major pathophysiologic mechanisms of hyperthyroidism?

1) Increased thyroid hormone synthesis
- Primary (thyroid)
- Secondary (TSH)
2) Inappropriate LEAK of T4

5

What are the major etiologies of hyperthyroidism?

1) Graves' Disease
2) Autonomous nodules
3) Subacute thyroiditis
4) Iodine-induced
5) TSH-producing adenoma
6) HCG-mediated (pregnancy)

6

What are the TSH and FT4 levels in hyperthyroidism?

- Low TSH
- High FT4 (normal is subclinical)

7

What antibody test is used in the diagnosis of hyperthyroidism?

TSI

8

What is the most common cause of hyperthyroidism?

Graves' Disease

9

What causes Graves' Disease?

Autoimmune antibodies to TSH receptors
- TRAb
- TSIg

10

What are the "extra" manifestations of Graves' disease compared to hyperthyroidism?

1) Graves' Ophthalmopathy
- Inflammation
- GAG
- Edema
- Adipogenesis
- Extraocular muscle hypertrophy
2) Dermopathy

11

What is the direct cause of Graves' Ophthalmopathy?

Antibodies

12

What is the main test used to diagnose Graves' Disease? What is the expected outcome?

Radionuclear uptake and scan
- Uptake will be normal/high
- Homogenous scan

13

What is the treatment for Graves' Disease?

1) Symptomatic: beta-blockers, steroids
2) Specific

14

What is the MOA of the antithyroid drugs?

Inhibits organification and coupling

15

What drugs are "antithyroid?"

PTU
Methimazole

16

What adverse is associated with the antithyroids, especially PTU?

Hepatitis

17

How long are the antithyroid medications typically given?

2 years

18

What is used for a radioactive ablation in Graves' Disease?

I131 (different from what is used for the diagnostic test)

*Permanent but can take 4 weeks to 6 months

19

What do you do when a patient becomes hypothyroid s/p radioactive thyroid ablation?

Levothyroxine

20

Why would you treat a patient with iodine for a week prior to surgery?

Decreased T4 and vascularity

*Utilizes the Wolff Chiakoff Phenomenon

21

What is an autonomously functioning thyroid nodule?

Hot nodule with hyperplasia of follicular cells

*There is overproduction of T4 INDEPENDENT of TSH

22

How will the uptake and scan appear in autonomously functioning thyroid nodule?

- Normal to high uptake
- Focal hyperactivity i.e. NOT homogenous

23

What is the preferred treatment for autonomously functioning thyroid nodule?

Radioactive ablation

*Only the focal hot-spots will uptake the radioactive material

24

How does the outcome of radioablation for autonomously functioning thyroid nodule differ from Graves' Disease?

Much less likely to cause hypothyroid

25

What is the underlying pathology in thyroiditis?

Inflammation of thyroid tissue leading to leakage of preformed hormone

26

What will a radionuclear scan appear in thyroiditis?

Low uptake

27

What is the treatment for thyroiditis?

Supportive care

28

What should you be sure to check after a patient with thyroiditis transitions to euthyroid?

TSH/T4 to ensure they don't develop hypothyroid

29

When is iodine-induced hyperthyroidism commonly seen?

Amiodarone*

*Utilizes the Jod Basedow effect

30

What are the types of amiodarone induced hyperthyroid?

Type 1 AIH= increased synthesis

Type 2 AIH= thyroiditis

31

How can you diagnose Type 1 vs 2 AIH?

Ultrasound will show increased muscularity in Type 1

32

How can AIH be treated?

1) Glucocorticoids i.e. prednisone
2) Surgery

33

What labs are seen in a TSH-producing pituitary adenoma? What name is given to this condition?

- Increased T4
- Increased TSH

This is SECONDARY hyperthyroidism

34

What clinical features are associated with TSH-producing pituitary adenomas?

1) Hyperthyroidism
2) Goiter
3) Visual field defects

35

What is the treatment for a TSH-producing pituitary adenoma?

1) Octreotide
2) Transphenodial resection

36

Why is hyperthyroid seen in pregnancy?

HCG stimulates thyroid

37

What is the treatment for HCG-mediated hyperthyroidism in pregnancy, IF T4 is high?

First trimester= PTU
2nd-3rd= Methimazole

*Note if T4 is normal, no treatment necessary

38

What typically triggers Thyroid Storm?

1) Omission of anti-thyroid drug
2) Surgery, MI, CVA

*In patient with underlying hyperthyroidism

39

What is the specific treatment algorithm for Thyroid Storm?

1) Beta-blocker
2) Glucocorticoids
3) Antithyroids
4) Iodine

40

What is euthyroid sick syndrome?

Low serum levels of thyroid hormones in clinically euthyroid patients with nonthyroidal systemic illness

*TSH is also low

41

What is the treatment for euthyroid sick syndrome?

None--treatment is not necessary