A patient presents with heat intolerance, palpitations, tachycardia, tremors, exophthalmos, and hypereflexia.
What GI disturbance is also common in Hyperthyroidism?
What organs are typically involved in a patient with hyperthyroidism? (name the 3 classic signs)
Goiter (thyroid gland)
Pretibial myxedema (dermis of lower extremity)
What type of autoimmunity is involved in graves disease?
Thyroid stimulating Immunoglobulins (TSI)
Which MHC class II cell surface receptors (x2) causes graves disease?
You are going on rounds and observe one patient with pretibial myxedema and Graves orbitopathy. You then observe another with Hashimotos thyroiditis.
You remember learning that the Graves signs and Hashimotos disease you observed are caused in part by _________ cells.
(they are associated with pretibial myxedema and orbitopathy in graves, and are involved in hashimotos)
What is the cell mediated pathway in which TH1 and TH2 cells respectively mediate thyroid damage?
Start with cell surface TSH receptor being processed by an APC, then explain the TH1 and TH2 pathways separately.
(no cytokines need to be mentioned, although it may be good for boards)
1. APC presents TSHreceptor on MHC class II to a TCR on TH0 cell
2. TH0 cell stimulates TH1 cell
3. TH1 cell stimulates Macrophages, Cytotoxic T cells to attack TSH receptors in Thyroid gland
1. APC presents TSHreceptor on MHC class II to a TCR on TH0 cell
2. TH2 stimulates B cell
3. B cell turns into plasma cell
4. Plasma cells secrete Ab for TSH receptor target
TH2 cells are primarily involved in causing which thyroid disease?
When TH1 stimulated effector cells such as macrophages, cytotoxic T cells, and NK cells react with TSH receptors and fibroblasts in the thyroid gland, what is the byproduct?
Glycosaminoglycans (GAG, hyaluronic acid)
What are the types of antibodies (that can cause thyroid conditions) which TH2 cells can stimulate production of ? (x4)
2. Antinuclear antibodies
3. Anti-thyroperoxidase antibodies (TPO)
4. Anti-thyroglobulin antibodies
What is the respective causes of:
- Proptosis and diplopia
- lid lag
in Graves disease?
1. Exophthalmos is caused by fibroblast proliferation with GAG deposits
2. Lymphocytic infiltration into muscles around the eyes produce proptosis and Diplopia
3. Increased sympathetic stimulation of mueller's muscles
What are some of the causes of Hypercalcemia?
Pneumonic "SPERM DIF"
Sarcoid (granulomatous disease)
Primary hyperparathyroidism, Paget's
Endocrine disease (Pheo, addison's, hyper T)
Renal disease (diuretic phase of ARF, dialysis)
Malignancies (hypokalemic alkalosis); Milk alkali
Drugs (vit D, Vit A, lithium, thiazides)
immobilization; Immune deficieny syndrome; inflammatory disorders
familial hypocalcuric hypercalcemia
Treatments for Graves hyperthyroidism would include? (x5)
1a. Antithyroid drugs (thiourea): block oxidation TPO inhibition of I- to I prime
- PTU (can use in pregnancy, blocks T4->T3)
- Methimazole (less hepatic necrosis and drug of first choice)
1b. Iodine (blocks T4->T3)
1c. Lithium (inhibits sodium iodide)
2. Radio ablative iodine blocks T4>T3
Factors that can stimulate primary hyperthyroidism by causing a low TSH include...(x4)
- Drugs: acute steroid admin, Dopamine, NSAIDS, OPIATES, CCBs
- Elderly euthyroid
- Pregnancy or hCG secretion
- Severe non thyroidal illness (interleukins, TNF)
What can cause a pansystolic murmur and an S3 murmur?
CHF with cardiac dilatation and Mitral regurge
Things that can cause Atrial fibrillation
(pneumonic MISS CH ATRIEL)
1. What thyroid condition can cause Afib?
2. What is another condition common in party peoples in college that can cause Afib?
**if you really want to list them all out bonus points for you
Anyone who has Atrial fibrillation, you should check for
2. Alcoholi holiday heart syndrome
sick sinus syndrome
HTN and hypoxia
arteriosclerosis, ASD, Alcohol (holiday heart syndrome)
Rheumatic heart disease
lone atrial fibrillation
2 effects that amiodarone can have in the thyroid gland are?
1. type I amiodarone induced thyrotoxicosis
Jod Basedow type with Toxic Multinodular Goiter and no thyroid antibodies or an actual graves type with antibodies
2. type II amiodarone induced thyrotoxicosis
Jod-basedow phenomenon refers to decreased uptake of iodine related to what disease?
Toxic multinodular goiter
If thyroid antibodies are absent in the presence of hyperthyroid like Sx that include apathy, angina, and less adrenergic sx, what is the most likely diagnosis?
Apathetic hyperthyroidism d/t Autonomous functioning thyroid nodule (AFTN), or Toxic multinodular goiter
somatic mutations of what cellular level molecules can lead to non autoimmune apathetic hyperthyroidism?
somatic mutations of:
- TSH receptors
- G alpha protein (Gq GPCR)--> cAMP cascade of IP3 ptwy
What is a thyroid disease which arises more commonly in oriental males that can cause muscle weakness and occurs with heavy meals or exercise?
Thyrotoxic periodic paralysis
Thyrotoxic periodic paralysis channelopathy leading to muscle weakness is caused by what cellular process?
What happens to serum levels of potassium in this condition?
1. Increased Na/K-ATPase activity--> K+ excess in muscle cells--> Hypopolarization
*can also have a hyperkalemic type
carbohydrates cause K+ to go into cells by promoting what action?
Increasing insulin levels
How does Thyroid hormone (T4,T3) contribute to thyrotoxic periodic paralysis?
INcreases ATPase activity
thyrotoxic peridiodic paralysis presents with what physical exam signs?
What Cellular receptor channels does this disease affect?
1. Severe proximal muslce weakness, GYNECOMASTIA
2. L-calcium channels and K voltage gated channels
Causes of hyperthyriodism with increased I thyroid uptake? (x5)
2. Adenoma (plummers)
3. Inappropriate secretion of TSH (pituitary adenoma) - rare
4. Toxic Multinodular goiter
Treatment for autonomous functioning thyriod adenoma and toxic multinodular goiters involves.
Radio ablative iodine therapy or surgery
*RAI for low uptake
Risk factors for what conditions are increased by subclinical hyperthyroidism (AFNs or MNGs)? (x3)
1. Atrial fibrillation and diastolic dysfunction
Thyrotoxicosis can cause what phenomenon in blood pressure?
Wide pulse pressure
(example BP 120/50)
Tremors of the hand are caused by many things (VINDICATED pneumonic). What are the two endocrine causes?
Hyperthyroidism with decreased radioactive iodine uptake can indicate what? (DIET pneumonic)
1. Drugs: Thyroxine (factitious low serum thyroglobulin)
2. Iodine (jod basedow) d/t amiodarone type I
3. Ectopic (struma ovarii-teratoma, functioing metastatic thyroid cancer
4. Thyroiditis (Painful and painless)
Causes of painful thyroiditis (4x)?
1. Subacute granulomatous de quervain's
2. suppurative: staph
3. Radiation or trauma
4. Drug induced: amiodarone type II (IL6), Lithium
Causes of painless thyroiditis (x3)?
1. postpartum HLA DR3/DR5 (precursor to hashimotos)
2. subacute or chronic autoimmune lymphcytic (downs or turners)
3. Riedel's fibrosis (nml or low uptake and function
Clubbing of fingers is caused by what thyroid disease?