Hyper and hypothyroid

Question 1

what type of HS rxn is graves

Answer 1

type II- Ab dependent cytotoxicity

Question 2

what HLA is associated with graves

Answer 2

HLA-DRB1 and DR8
MCH class II cell surface R

Question 3

MHC class II

Answer 3

via CD4:
TH2 -> AbS
TH1 -> macros

Question 4

MCH class I

Answer 4

A,B, C

via CD8

Question 5

what drives the thyroid disease in graves?

Answer 5

TH2 -> activate TSH R

Question 6

what drives the pretibial myxedema and exopthalamos in graves?

Answer 6

TH1 -> secrete cytokines -> cytotoxic T cells, NK cells -> glycosaminoglycans -> deposit -> skin changes

Question 7

other HLA-DR disease that graves patients may get

Answer 7

alopecia areata
PA
anti-phospholipid Ab syndrome
DM
RA
RHS
PBC
MG
SLE
IgA nephropahty 
MS
hashimotos

Question 8

causes of clubbing

Answer 8

cardiac
pulmonary (lung CA, CF)
GI (chrons, cirrhosis, celiac)
renal failure
thyroid disease (graves)
malignancies (HL)
idiopathic

Question 9

random symptoms of graves

Answer 9

gynecomastia

increased vaginal bleeding

Question 10

thyrotoxic cadriomyopathy

Answer 10

AF with CHF
pulmonary HTN in 50% of people with hyperthyroidism
WIDE PULSE PRESSURE

Question 11

euthyroid graves orbitopathy

Answer 11

HLA-B40 DQw3

Question 12

wolff-chaikoff effect

Answer 12

transient blockage of TH synthesis after large dose of iodine

Question 13

jod-basedow effect

Answer 13

hyperthyroidism d/t increased iodine

amiodarone can cause this

Question 14

high TBG

Answer 14

drugs- amphetamines, opiates, 5-FU
hereditary
estrogens- prego
AIDs
liver- hepatitis

Question 15

decreased conversion of T4-> t3

Answer 15

Drugs- amiodarone, propanolol, steroids, PTU

stress- acute medical illness

Question 16

low TSH

Answer 16

drugs- sterioid, CaCh blockers, dopamine, opiates, NSAIDs
elderly euthyroid
pregnancy or hCG decretion
severe non-thyroidal illness

Question 17

causes of pansystolic murmur

Answer 17

mitral regurg
tricuspid regurg
VSD

Question 18

causes of AF

Answer 18

MISS CH ATRIEL

MVP
idiopathic
sick sinus syndrome
sick

congestive cardiomyopahty
HTN and hypoxia
arteriosclerosis, ASD, alcohol, aminophylline and drugs
thyrotoxicosis
Rheumatic heart disease
infilitrative diseases
embolus, emphysema
lone a-fib

Question 19

apathetic hyperthyroidism

Answer 19

apathy, weigh loss, angina, AF, CHF
NOT automimmune
somatic mutationi n TSH R G alpha protein
amiodarone can set off
can be due to toxic adenoma or toxic multinodular goiter

Question 20

type I amiodarone

Answer 20

thyrotoxicosis

can be graves or non-autoimmune (TMNG)

Question 21

type II amiodarone

Answer 21

thyroiditis

Question 22

causes of increases RAIU

Answer 22

graves
adenoma
inappropriate secretion of TSH (pit adenoma, rare)
TMNG
trophoblastic- secretes hCG which binds TSHR

Question 23

risks of subclinical hyperthyroidism

Answer 23

AF and diastolic dynsfunction
osteoporosis
dementia
Tx with RAI r small dose antithyroid drug or beta blockers

Question 24

thyroid storms

Answer 24

fever >102
tachy
tachypnea
hypotensive
very sick

Question 25

Tx of thyroid storm

Answer 25

``` methamizole or PTU iodides metopropolol hydrocortisone plasmaphoresis ```

Question 26

neurological malignant syndrome

Answer 26

rare, but potentially life threatening rxn to antipsychotics or tranquilizers high fever, stiffness of mm, altered mental status, autonomic dysfunction

Question 27

thyrotoxic periodic paralysis

Answer 27

channelopathy with mm weakness increased N/K ATPase activity (driven by thyroxine) -> hyperpolarization and hypokalemia occurs with heavy meal or exercise in asian men

Question 28

what causes decreased RAIU

Answer 28

``` DIET Drugs- THYROXINE Iodine- jod-bassedow, amiodarone type I ectopic thyroiditis- painful (dequervains disease), painless- postpartum, lymphocytic ```

Question 29

ten hypos of hypothyroidism

Answer 29

``` hyporeflexia hypopigmentation hypothermia hypoventilation hypotension or diastolic HTN hypohemoglobinemia hypoglycemia hyponatremia hypometabolism hypocortisolism hypoadrenalism ```

Question 30

HLA of hashimotos

Answer 30

HLA-DR5 (MCH II)

Question 31

risks of subclinical hypothyroidism

Answer 31

elevated lipids and decreased cardiac filling | imparied memory, depression

Question 32

when to Tx subclincial hypothryoidism

Answer 32

Abs and TSH >7 no Abs and TSH >10 prego with TPO Abs and TSH >2.5

Question 33

what else can cause hypothyroidism

Answer 33

drugs | hep C

Question 34

other signs of hypothyroidism

Answer 34

``` gallaverdin phenomenon (apex systolic murmur) queen annes sign diastolic HTN alopecia elevated MCV- macrocytosis braducardia elevated CPK-MB ```

Question 35

myxedema crisis

Answer 35

DO NOT GIVE OPIATES | Tx with hydrocortisone first then TH

Question 36

decreased TBG

Answer 36

``` familial TBG deficiency severe illness acute psychiatric problems cirrhosis nephrotic syndrome catabolic states, malnutrition drugs ```

Question 37

decreased binding of TBG

Answer 37

ASAs | phenytoin

Question 38

euthyroid sick syndrome

Answer 38

low TH high T3 uptake high rT3 low TSH

Question 39

low TSH in euthyroid sick syndrome

Answer 39

d/t steroids, amphetamine, CaCH blockers, dopamine, NSAIDs, opiates increases IL1 and IL6 and TFN alpha