Hyperthyroidism - Darrow

Question 1

hyperreflexia

Answer 1

hyperthyroid

Question 2

heat intolerance, palpitations, tachy, irritable, loose stool, tremor, warm skin, hyperreflexia

Answer 2

hypermetabolic state

• anxiety
• pheochromocytoma
• hyperthyroid

Question 3

goiter, exopthalmos, pretibial myxedema

Answer 3

graves disease

Question 4

type of hypersensitivity in graves?

Answer 4

type 2

• Ab dependent cytoxicity
• Abs to cell surface receptors

Question 5

HLA type in graves?

Answer 5

HLA-DRB1

HLA DR8

Question 6

HLA DR

Answer 6

MHC Class II cell surface repceotor

-in graves disease

Question 7

T cell in pretibial myxedema and graves orbitopathy?

Answer 7

CD4 Th1 cells

fibrosis and infiltration

macrophages, cytotoxic T cells, NK cells
-produce GAGs

Question 8

T cell in graves disease on thyroid?

Answer 8

CD4 Th2 cells

-anti-TSH receptor Abs

Question 9

TSI

Answer 9

TSH receptor Abs
-in graves

CD4 Th2 cells**

Question 10

type II hypersensitivity

Answer 10

Abs that attach to cell surface components

in autoimmune hemolytic anemia or blood transfusion rxn

also in graves and myasthenia gravis - abnormal physiologic response

Question 11

strabismus

Answer 11

misaligned eyes
-seen in graves

fibroblast proliferation, GAG deposits, lymphocyte infiltration in muscles around eye

Question 12

clubbing of fingers

Answer 12

hyperthyroid

hypertrophic osteoarthopathy

Question 13

thyrotoxic cardiomyopathy

Answer 13

tachycardia
atrial fib
high output failure
pulmonary HTN

Question 14

calcium elevation with hyperthyroid?

Answer 14

T3 increases bone turnover

Question 15

factitial thyrotoxicosis

Answer 15

would see NO thyroglobulin present

factitial - induced by human action - ie/ patient takes thyroid pills - gets hyperthyroid

Question 16

TSH receptor pathway

Answer 16

GPCR

Gs - cAMP - PKA transduction

Question 17

tx of graves

Answer 17

radioactive iodine - unless pregnant

or antithyroid drugs - PTU and methimazole

or iodine (wolff chaikoff)

or surgery

Question 18

wolf chaikoff effect

Answer 18

reduction in thyroid levels with ingestion of large amount of iodine

Question 19

PTU

Answer 19

tx for graves

ok in pregnancy 1st trimester

Question 20

methimazole

Answer 20

tx for graves

less hepatic necrosis than PTU

Question 21

causes of low TSH

Answer 21

steroid use
dopamine use
severe non-thyroid illness - ILs and TNF

Question 22

pansystolic murmur and S3 in hyperthyroid patient

Answer 22

CHF

Question 23

hyperthyroid sx with no TSI Abs?

Answer 23

apathetic hyperthyroid

-with autonomous functioning thyroid nodule or toxic multinodular goiter

Question 24

apathetic hyperthyroidism

Answer 24

hyperthyroid due to AFTN or TMNG

mutations of TSH receptor

Question 25

iodine induced hypethyroid

Answer 25

with amiodarone excess iodine can cause autonomous thyroid nodules to become toxic MN goiter

Question 26

jod basedow phenomenon

Answer 26

iodine induced thyrotoxicosis

Question 27

type I amiodarone thyrotoxicosis

Answer 27

jod basedown -high iodine induces hyperthyroid with graves or TMNG

Question 28

type II amiodarone thyrotoxicosis

Answer 28

thyroiditis

Question 29

increased I-123 uptake?

Answer 29

GAIT2 ``` graves adenoma - plummer inappropriate TSH (pituitary adenoma) toxic multinodular goiter trophoblastic ```

Question 30

tx for AFTN or TMNG

Answer 30

radioactive iodine or surgery

Question 31

subclinical hyperthyroidism

Answer 31

low TSH but normal T4 risk of osteoporosis and atrial fib tx with RAI or antithyroid drugs

Question 32

thyrotoxicosis crisis

Answer 32

or storm caused by acute illness, thyroid surgery, or RAI therapy in undertreated thyrotoxicosis patient

Question 33

high fever, tachy, tachypnea, hypothension, V/D, irritable, delirium, coma, death

Answer 33

thyroid storm

Question 34

tx for thyroid storm

Answer 34

thiourea - methamizole or PTU iodides started 1 hour after thiourea also - metoprolol and hydrocortisone plasmapharesis

Question 35

muscle pain weakness, ate two pizzas night before, gynecomastia, proximal muscle weakness

Answer 35

thyrotoxic periodic paralysis

Question 36

thyrotoxic periodic paralysis

Answer 36

channelopathy with muscle weakness thyroid hormone - increased Na/K ATPase activity - results in hypopolarization and hypokalemia** after heavy meal or exercise in asian men

Question 37

after heavy meal or exercise in asian men

Answer 37

look for thyrotoxic periodic paralysis thyroid hormone increases Na/K ATPase activity

Question 38

wide pulse pressure

Answer 38

with thyrotoxicosis

Question 39

tremor

Answer 39

hyperthyroid | hypoglycemia

Question 40

hyperthyroid with decreased radioiodine uptake?

Answer 40

amiodarone type 1 - jod basedow ectopic - stuma ovarii (teratoma) thyroiditis -de quervains - post viral infection - painful painless - reidels fibrosis, postpartum, subacute autoimmune

Question 41

most thyroiditis

Answer 41

produce transient hyperthyroid over few months followed by hypothyroid

Question 42

high ESR, following upper resp infection

Answer 42

subacute granulomatous hyroiditis de-quervains painful