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Hypothyroidism Flashcards

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1
Q

What are the muscles that overlie the Thyroid gland?

A

SCM
Omohyoid
Sternohyoid

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2
Q

How do you palpate the thyroid gland?

A

Superior to inferior, from the hyoid cartilage, have them swallow, and compare

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3
Q

Why use your stethoscope with hypothyroidism?

A

May hear a bruit

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4
Q

sign***

A
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5
Q

What is the first step of thyroid hormone synthesis?

A

Trapping of Iodide by the Na/I symporter

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6
Q

What is the second step of thyroid hormone synthesis?

A

Trapping–TPO catalyzes iodine oxidation to thyroglobulin

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7
Q

What is the third strep of thyroid hormone synthesis?

A

COupling–MITs and DITs

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8
Q

What is the Jod Basedow effect?

A

Initial increase in organification with iodide synthesis

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9
Q

What is the Wolff-Chaikoff effect?

A

Very high concentrations of iodide actually inhibit organification of T4

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10
Q

What is the Escape phenomenon with thyroid function?

A

AT extremely high iodide concentrations, organification will resume

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11
Q

How is T4 converted to T3?

A

5’ Deiodination in the periphery by deiodinase

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12
Q

What are the two subunits of TSH? What is the function of each

A

Alpha subunit

Beta subunit = active part

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13
Q

What happens to prolactin levels with TRH levels?

A

May increase. Thus hypothyroidism may cause prolactin

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14
Q

Why is it that a woman who is hypothyroid may have high levels of prolactin?

A

TRH causes increase in prolactin

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15
Q

What is the major output of the thyroid gland?

A

T4 (95% of secretion)

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16
Q

What is the process that converts T4 to T3 in the periphery?

A

5’ Deiodination

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17
Q

What is the half life of T4? T3?

A 
T4 = 7 days
T3 = 1 day
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18
Q

True or false: thyroid hormone bound to proteins have no biological effect?

A

True

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19
Q

What is the purpose of transporting thyroid hormone bound to protein?

A

Allows for a reserve and a buffer

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20
Q

What percent of T4 and T3 are “free” in the serum?

A 
T4 = 0.04%
T3 = 0.4%
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21
Q

What is the main protein that binds thyroid hormone?

A

Thyroid binding globulin

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22
Q

What are the labs that are evaluated for thyroid issues?

A

Free T4 and FT3 vs T4

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23
Q

What are the factors that may increase TBG levels? (2)

A

Estrogen (pregnancy, BCP)

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24
Q

What are the factors that decrease TBG? (3)

A

Systemic illness
Glucocorticoids
Cirrhosis

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25
What is the main lab test to assess for thyroid function? Why?
TSH levels are the most sensitive and are less prone to fluctuations
26
What is the relationship to TSH with hypo/hyperthyroidism?
Inverse
27
Why is T3 not a good lab test to order?
Prone to fluctuations
28
Which is better: T4 levels or total thyroid hormone?
T4
29
What is the relationship between TSH and FT4?
Inverse
30
What happens to TSH levels as you progress from hypo to hyperthyroidism?
Decreases
31
What are the tests that assess for autoimmune thyroid dzs? What is the problem with this?
Thyroperoxidase Ab Super sensitive to any sort of autoimmune disease
32
What are the three ab that can be obtained for suspected autoimmune thyroid dz?
Thyroperoxidase Thyroglobulin Thyrotropin ab
33
What is the ab that is detected with Grave's disease?
Thyrotropin receptor ab
34
What is subclinical hyperthyroidism/hypothyroidism?
T3/T4 levels are normal, but TSH levels are low/high respectively
35
What happens to TSH levels and T3/T4 levels with secondary/central hypothyroidism?
Low TSH | Low T4/T3
36
What happens to TSH levels and T3/T4 levels with primary hyperthyroidism?
low TSH | High T3/T4
37
What happens to TSH levels and T3/T4 levels with central hyperthyroidism?
High TSH | High T4/T3
38
What happens to TSH levels and T3/T4 levels with Primary hypothyroidism?
High TSH, low T3/T4
39
Who is thyroiditis usually seen in?
Postpartum women
40
What are the drugs that can cause hypothyroidism?
- Iodine - Sunitinib - ANtithyroids
41
What are the ssx for hypothyroidism?
Non pitting edema Pericardial effusion Bradycardia
42
What are the GI ssx of hypothyroidism?
Decreased motility | Ascites
43
What are the reproductive abnormalities with hypothyroidism?
Menstrual abnormalities Decreased fertility Prolactin levels high
44
What are the odd neuro ssx of hypothyroidism?
- Carpal tunnel syndrome | - Decreased reflexes, slowed relation phase
45
What are the metabolic ssx of hypothyroidism? (3)
- Hypercholesterolemia - Hypertriglyceridemia - Weight gain
46
What is the most common cause of hypothyroidism?
Hashimoto's thyroidits
47
What is Hashimoto's thyroiditis?
Autoimmune-mediated destruction of the thyroid causes lymphocytic infiltration of the thyroid
48
What is the Fhx like with Hashimoto's?
Family h/o autoimmunity
49
In whom does Hashimoto's usually occur in? What are the PE findings?
Women (7:1) Goiter Bosselated feel of the thyroid
50
What are the TSH levels in hashimoto's?
High
51
What are the TPO ab levels with Hashimoto's?
Elevated, but this is not a requirement
52
How specific is TPO elevation for Hashimoto's?
Not super
53
What is the classic echo findings of Hashimoto's?
Heterogenous appearance
54
What is iodine-relater hypothyroidism?
Iodine deficiency may cause a lack of fuel for hormone sythesis
55
What are the lab and PE findings with iodine-related hypothyroidism?
Increased TSH levels | Goiter formation
56
Excess Iodine can cause what?
Hyper or hypothyroidism
57
True or false: most patient demonstrate the escape phenomenon
True
58
What are the sources of Iodine induce hypothyroidism?
Amiodarone Supplements Radiocontrast for CTs
59
What is the treatment for hypothyroidism?
Replacement with Levothyroxine
60
What is the dosage for Levo thyroxine?
1.5 mcg/kg/day
61
In whom should levo-thyroxin be started at low levels with?
Cardiac pts
62
What are the factors that influence L-Thyroxine levels?
Foods | TBG levels
63
When is treatment for hypothyroidism indicated?
TSH more than 10, or maybe if they're symptomatic
64
What is the timeframe for f/u with starting thyroid replacement? Why?
6 weeks | Half Life of TSH is ~7 days, so not reached steady state
65
When should patients taking TSH recheck their levels?
If patients switch brands, or starts BCP, prego
66
What is the MOA of liothyronine? When is this recommended?
Synthetic T3 Not recommended, but may be used for cancer pts
67
What is Armour thyroid?
Dessicated porcine or bovine thyroid (T3 and T4)
68
What happens to thyroid needs with pregnancy?
Increases throughout pregnancy--may need up to 150% of dose
69
What are the contributing factors for the increase in thyroid hormones in prego? (3)
Weight gain Increasing TBG levels Increased 5' deiodination
70
What is myxedema coma?
Mental status change Hypothermia Hypoglycemia Hypotension
71
In whom is myxedema coma occur in?
Older women, usually precipitated by CVA
72
What is the treatment for myxedema coma?
Supportive | IV thyroxine replacement
73
What is the treatment for thyroid cancer?
Pts are usually surgically hypothyroid---T4 is used to replace them, and to suppress TSH levels
74
What is the treatment for secondary hypothyroidism?
Pituitary or hypothalamic insult
75
Why is TSH not reliable for secondary hypothyroidism? What should be followed?
Pituitary may be the issue, and thus may be normal--need to use T4 levels
76
Should T4 be used to shrink nodules?
No
77
Should T4 be used to lose weight?
No
78
Should T4 be used to treat depression?
No
79
Should T4 be used to lower cholesterol?
No
80
What should be done with pregnant women with hypothyroidism?
Check TSH levels when pregnancy begins, every 4-6 weeks, and after delivery

Endocrine (32 decks)

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