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Thyroid Flashcards

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1
Q

what is thyroxine and where is it produced?

A

T4 and only produced in the thyroid gland

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2
Q

what is Triiodothyronine and were is is produced?

A

T3 produced in thyroid and peripheral organs from the deiodination of T4

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3
Q

what are the physiological affects of the thyroid hormone?

A

critical function in cell differentiation during development
key role for brain and somatic development in infants***
important to maintain metabolic activity in adults
effects the function of every organ

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4
Q

Labs for thyroid evaluation?

A 
TSH- most common initial test 
serum free T3 and T4
serum total T3 and T4 
ultrasound
radiographic iodine uptake test 
thyroid antibodies 
serum thyroglobuin levels- endogenous vs exonogenous  
thyroid scan-structure and function of thyroid gland 
fine needle aspirations biopsy
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5
Q

Iodine deficiency in pregnancy is a/w?

A

cretinism, increased neonatal and infant mortality

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6
Q

Iodine deficiency in childhood is a/w?

A

learning disabilities and thyroid enlargement

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7
Q

Iodine deficiency is adults is a/w?

A

goider and abnormal thyroid function

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8
Q

what is the most common cause of goiter worldwide?

A

iodine deficiency

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9
Q

what is the most common cause of goiter in the us?

A

graves disease, chronic immune thyroiditis, multinodular goiter

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10
Q

overt hyperthyroid

A

low TSH

High T3 and T4

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11
Q

subclinical hyperthyroid

A

Low TSH

normal T3 and T4

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12
Q

what is the major risk factor for hyperthyroidism?

A

TOB use

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13
Q

Cause of hyperthyroid with high radioactive Iodine uptake?

- where hormone synthesis is increased

A

Graves
hashitoxicosis
toxic adenoma and toxic multinodular goiter
Iodine-induced
trophoblastic disease and germ cell tumors
TSH mediated
Epoprostenol ( a prostaglandin)

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14
Q

Cause of hyperthyroid with low radioactive Iodine uptake?

- where hyperthyroid is due to release of stored hormone form damaged cells

A

thyroiditis
exogenous and ectopic hyperthyroidism
- injured or inflamed gland can not take up iodine

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15
Q

what are the symptoms that always prompt you to eval for hyperthyroid?

A 
unexplained weight changes
new onset of A fib
myopathy
menstrual disorders
gynecomastia
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16
Q

symptoms to consider hyperthyroid?

A 
osteoperosis ( increased fractures)
hypercalcemia
heart failure
premature atrial contractions
dyspnea
deterioration of glycemic control in patient with a previous diagnosis of DM
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17
Q

derm manifestations of hyperthyroid

A 
warm, dry
excessive sweating
oncomycosis and softening of the nail
hyperpigmentation
puritis and hives
vitiligo and alopecia areata
hair thinning
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18
Q

ocular manifestations of hyperthyroid

A

stare and lid lag

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19
Q

cardiovascularmanifestations of hyperthyroid

A

increased CO
A fib
high or normal output CHF can occur

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20
Q

metabolic manifestations of hyperthyroid

A

decreased total serum and HDL cholesterol (reversible)
impaired glucose tolerance
decreased total serum cortisol

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21
Q

respiratory manifestations of hyperthyroid

A

dyspnea and dyspnea on exertion

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22
Q

GI manifestations of hyperthyroid

A 
increased gut motility=hyperdefication and malabsorption
appetite changes
dysphagia d/t goiter
change in liver function test
vomiting
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23
Q

heme manifestations of hyperthyroid

A

normocytic normochromic anemia

prothrombotic state

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24
Q

GU manifestations of hyperthyroid

A

frequent urination
noctouria
amenorrhea or oligomenorrhea infertility in women
gynecomastia, decreased libido, erectile dysfunction in men

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25
Psych manifestations of hyperthyroid
personality changes | irritable, anxiety, restlessness, insomnia, emotional lability
26
Neuro manifestations of hyperthyroid
``` affect CNS and PNS cognitive dysfunction seizures tremor chorea stroke myopathy polyneuropathy ```
27
what is apathetic thyrotoxicosis?
elderly patients are asymptomatic except for weakness and asthenia
28
T3 toxicosis?
low TSH | high free T3 and normal T4
29
T4 toxicosis?
low TSH | high fee T4 and normal T3
30
TSH induced hyperthyroid?
high TSH | high free T3 and T4
31
what are the antithyroid drugs? for symptomatic relief of tachycardia and tremor?
methimazole propylthiouracil (PTU) BB
32
most common causes of subclinical hyperthyroidism?
normal in first trimester of pregnancy | functioning thyroid adenoma and multinodular goiter
33
what is the cause of graves disease?
autoantibody affecting TSH rc, constantly stimulating it to produce and release thyroid hormones
34
most common cause of hyperthyroidism?
graves disease (60-80% of cases)
35
at what age does graves occur? who is most affected?
20-50 years of age | F>M
36
what are the manifestations of grave thyroid dermopathy?
lesions that are typically not inflamed: they are an indurated plaque with deep purple/pink color and orange skin appearance almost always occurs with opthalmopathy usu. on the anterior and lateral aspects of the lower leg
37
what is thyroid acropatchy?
rare form of clubbing seen in patients with graves disease | -seen almost exclusivly in patients with opthalmopathy and dermopathy
38
Treatment of graves disease?
symptom control- BBs reduce thyroid tissue- surgery/radioiodione therapy reduce thyroid hormone synthesis-antithyroid medication
39
what is the most common form of hypothyroidism?
primary- a problem with the thyroid gland - chronic autoimmune - iatrogenic (treatment for hyperthyroid) - iodine deficiency or excess
40
what secondary hypothyroidism and what are some things that can cause it?
it is a problem with the pituitary gland - hypopituitarism (pit adenoma) - post partum pit necrosis (sheehan's syndrome) - trauma
41
what is tertiary hypothyroidism? what are some things that cause it?
problem in the hypothalamus | -trauma, tumor, radiation therapy, infiltrative disease, genetic mutations
42
general clinical manifestations of hypothyroidism?
``` fatigue weight gain slow movement and speech cold intolerance constipation weight gain delayed relaxation to DTRs bradycardia ```
43
what are the dermatologic manifestations of hypothyroidism?
``` cool and pale decreased sweating dry skin skin discoloration hair loss/coursening of hair brittle nails myxedema-in severe cases ```
44
ocular, thyroid and hematologic manifestations of hypothyroidism?
periorbital edema goiter maybe anemia and increased risk of bleeding
45
cardiovascular manifestations of hypothyroidism?
``` decreased CO pericardial effusion HTN hypercholesteremia hyperhomhcysteinemia ```
46
respiratory manifestations of hypothyroidism?
``` fatigue dyspnea on exertion decreased exercise capacity hypoventiation OSA ```
47
GI manifestations of hypothyroidism?
``` constipation decreased taste sensation gastric atrophy increased risk for celiac disease modest weight gain ```
48
Repo manifestations of hypothyroidism?
w-menstral changes, decreased fertility, galactorrhea | m- decreased libido, erectile dysfunction, delayed ejaculation
49
neuro manifestations of hypothyroidism?
``` myxedema coma congnitive impairment/dementia peripheral neuropathy myopathy cretinism cerebellar dysfunction ```
50
muscle and endo manifestations of hypothyroidism?
``` joint pain and stiffness hyponatremia hyperlipidemia hyperhomocysteinemia elevated creatinine kinase ```
51
secondary hypthyroidism dx?
low TSH | low T3 and T4
52
what is the dx for subclinical hypothyroid?
high TSH | normal T3 and T4
53
what is the treatment for hypothyroid?
synthetic thyroxine T4 | measure TSH every 6 weeks and then yearly
54
what is myxedema coma?
severe hypothyroidism -medical emergency -decreased mental status and hypothermia Treat- aggressive supportive care, T3 and T4 and glucocorticods
55
what is the most common cause of pediatric hypothyroidism?
thyroid agenesis or dysgenesis | - asymptomatic, decreased growth velocity, short stature, pubertal delay, goiter
56
painful/tender thyroiditis
subacute palpation/trauma infectious radiation
57
non painful or tender thyroiditis
``` chronic autoimmune drug induced fibrous pastpartum painless ```
58
what is hoshimoto's encephalopathy?
a/w hosimoto's thyroiditis onset of confusion altered LOC seizures and myoclonus -treat with corticosteriods
59
what is a toxic adenoma?
when the thyroid has 1 hyperfunctioning nodule
60
what is a toxic multinodular goiter?
when the thyroid has several hyperfunctioning nodules

Endocrine (3 decks)

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