Kirila Thyroid Flashcards
which condition may not improve after treatment in a setting of grave’s?
exopthalmous
in Graves which antibody supports diagnosis
TSI
TSH will demonstrate what?
that the driver for the hyperthyroidism is NOT the pituitary: TSH will be suppressed
the iodine scan in graves pattern. what is used to accomplish this scan?
homogenous, diffusely increased uptake, radioactive iodine and technetium
what kind of β blocker do you want to use in graves?
non-selective: it will reduce the symptoms FAST, so they are the drug of choice to reduce symptoms, especially if thyroid storm is suspected
what condition do you want to consider if administering a β blocker for thyroid storm?
asthma: avoid β blockers in this circumstance
how long will it take for methimazole and PTU to take effect?
2-8 weeks
d
d
TSH and Free T4
TSH to screen; T4 to confirm
thyroid acropachy
clubbing effect due to thyroid disease
“an extreme manifestation of autoimmune thyroid disease. It presents with digital clubbing, swelling of digits and toes, and periosteal reaction of extremity bones. It is almost always associated with ophthalmopathy and thyroid dermopathy.”
a lump in the throat: what is the first lab
TSH
TSH is low- that means what in relation to a nodule? what is the next order?
it is a primary. condition; a thyroid scan with iodine is the next order
If the TSH is…low…for to what? If the TSH is high, do what?
thyroid scan, FNA
physical appearance of a patient with a large goiter
patient may be contorting their body to improve respiration, their circulation may be compromised by compression and causing him to squirm
- FNA: senstitivity, specifict
- main limitations
- what is required of the clinician?
- sensitivity- 80%; specificity- 90%.
- poor technique or a hypocellular sample not adaquate for a diagnosis
- watch and wait
which finding supports diagnosis of a benign nodule?
tenderness
RFs for benign nodule
- family hx of them
- hashimotos
- tenderness
- mobile nodule
- concomitant diagnosis of hypo or hyperthyroidism
RFs for malignant nodule
- very young
- very old
- men
- history of neck irradiation
- firm fixed nodule
- one more thing i missed
hyperthroid patient with a high TSH
rare, but possible for it to be a functional pituitary adenoma secreting TSH and resists negative feedback
TSH high; T4 almost normal; T3 is high
pituitary adenoma
iodine scan for viral thyroiditis
diffuse bilaterally
queen ann sign
hypothyroidism: dry skin, brittle hair, thinning or loss of the outer third of the eyebrows
desiccated thyroid
T3 from pigs and cow thyroids. kirila said it wasn’t a reliable drug.
