Thyroid

Question 1

__ and ___ are the biologically active hormones from the thyroid

Answer 1

T3 and T4

Question 2

__ is made in the thyroid only, __ is made in the thyroid and outside the thyroid

Answer 2

T4, T3

Question 3

What is the process of releasing T4 and T3

Answer 3

Hypothalamus-> TRH-> Anterior pituitary-> TSH->thyroid gland-> T4 and T3-> back to hypothalamus

Question 4

parafollicular C cells make

Answer 4

calcitonin

Question 5

follicle cells in thyroid make 90% __ and 10% __

Answer 5

T4, T3

Question 6

The best and cheapest screening test for thyroid diseases is

Answer 6

TSH

Question 7

Measure _____ to test for Hashimoto’s

Answer 7

TPO antibodies

Question 8

Order ____ when you want to follow thyroid cancer

Answer 8

thyroglobulin

Question 9

Measure ____ and ___ to see if Grave’s disease

Answer 9

TRAB and TSI

Question 10

Exogenous causes of thyrotoxicosis

Answer 10

too much TH replacement therapy, or a TH suppressive therapy

Question 11

Endogenous causes of thryotoxicoisis

Answer 11

Grace’s disease, thyroiditis, toxic nodular goiter

Question 12

Symptoms are hyperthryoidism

Answer 12

intolerance to heat, fine hair, bulging eyes, facial flushing, tachycardia, increased BP, breast enlargement, weight loss, muscle wasting, menstrual changes

Question 13

Gold standard for hyperthyroid is ____

Answer 13

nuclear medicine uptake and scan. Iodine tracer given and that helps with diagnosis (TRAB and TSI can be ordered)

Question 14

Once you see that there is hyperthyroidism present, first thing to do is ____

Answer 14

β blocker! This is to prevent afib

Question 15

What is the pathophys of Grave’s disease

Answer 15

Autoantibodies on thyroid hormone receptor on thyroid gland-> over production of TH

Question 16

Labs for Graves disease

Answer 16

TSH low, T4 and T3 elevated. TRAb and TSI elevated

Question 17

When should you not just order TSH and need to also order T3 and T4

Answer 17

first tri of pregnancy, pituitary disease, TSh still equilibrating, nonthryoidal illness, acute psychiatric illness, TSH secreting pituitary tumor, thyroid hormone resistance

Question 18

Antithyroidal Medications are:

Answer 18

Thioamides (methimazole and propthiouracil)

Question 19

MOA of thionamides

Answer 19

inhibit synthesis of thyroid hormones by blocking oxidation of I in thyroid gland-> block T3 production. Does not affect circulating T4 and T3

Question 20

What are AEs with thionamides

Answer 20

rash, pruritus, GI

rare: granular cytosine (CBC if fever/sore throat), hepatotoxicity, pancreatitis, vasculitis

Question 21

What medications should be given for someone who has Graves and is pregnant

Answer 21

PTU first tri, switch to MMI second tri. Monitor TSH and T4, keep TSH normal and T4 1.5x mroe

Question 22

Thyroid storm criteria

Answer 22

High temp, cardiovascular events (tachycardia, afib, CHF), GI-hepatic dysfunction, CNS disturbance, history

Question 23

What are the most common causes of thyroid storm

Answer 23

Grave’s disease, toxic adenoma and MNG, hyper functioning carcinoma, TSH secreting pituitary adenoma, strums ovary, hcg secreting tumor, IFN α and IL2

Question 24

What 5 drugs should be given for thyroid storm management

Answer 24

antithyroidals (PTU, MMI), Iodine, β blocker, supportive (Tylenol, hydrocortisone), alternative (lithium, cholestyramine)
must block new synthesis first before giving iodine

Question 25

Iodine therapy blocks the release of _____ and decreases _______

Answer 25

pre-stored hormone | decreases iodide transport and oxidation in follicular cells

Question 26

Avoid ____ as they can increase free thyroid hormone by decreasing thyroid protein binding

Answer 26

salicylates

Question 27

For thyroid storm, surgery would be _____. To go, hold the ___ and stop _____

Answer 27

Total thyroidectomy | hold the iodine, stop antithyroidals and wean β blockers

Question 28

What is the role of steroids in a thyroid storm

Answer 28

block T4 to T3. potential for adrenal insufficiency with autoimmune hyperthyroidism relative adrenal insufficiency (TH-> ups cortisol metabolism-> adrenal reserve. can have longer survival with glucocorticoids)

Question 29

What is Thyroiditis

Answer 29

inflammation of thyroid gland leading to leaking of thyroid hormone

Question 30

Treatment for thyroiditis

Answer 30

β blockers, time, sometimes steroids

Question 31

What are the two types of amiodorone induced thryroiditis and how to treat

Answer 31

type 1: large iodine load-> excessive TH. treat with antithyroidals Type 2: iodine or drug destroys gland, treat with steroids

Question 32

What are the labs with hypothyroidism

Answer 32

High TSH and low free T4

Question 33

Does ultrasound tell you anything when trying to determine thyroid size

Answer 33

no, get nuclear imaging

Question 34

What level of TSH do you need to treat for hypothyroidism

Answer 34

TSH>10 always (if elevated but T4 normal, can still treat)

Question 35

What are the most common treatment options for hypothyroidism

Answer 35

synthetic T4 or levothyroxine | T4/T3 combos from bovine or porcine

Question 36

Most common cause of hypothyroidism in countries with access to iodine is _____ or _____

Answer 36

Hashimoto's or autoimmune thyroid disease

Question 37

What are the two categories of dosing for replacement thyroid hormone (high dose vs low dose)

Answer 37

high dose: hx of thyroid removal or PROFOUNDLY elevated TSH | Low: hypothyroidism not profound but elevated

Question 38

When to take thyroid hormone

Answer 38

First thing in the morning, 4 hours before vitamins and an hour before meals

Question 39

What is the big risk for hypothyroidism

Answer 39

Myxedema coma

Question 40

What are some myxedema coma precipitating factors

Answer 40

Drugs, Infections, CNS events, CHF, hypothermic insult, trauma, metabolic disurbance, GI bleeding, raw bok choy

Question 41

Treatments for myxedema coma

Answer 41

T4, T3, or Combination | continued ECG monitoring

Question 42

Besides medication, what other treatment needs to be given for a myxedema coma

Answer 42

ventilatory support, warming, manage bradycardia and hypotension, hyponatremia, glucocorticoid therapy

Question 43

What are malignancy risk for thyroid cancers (Nodule)

Answer 43

Hx, PET avid nodule, ionizing or craniocervical radiation, hyper Ca2+, FH of MEN2

Question 44

What are the types of thyroid cancer

Answer 44

papillary, follicular, medullary, anaplastic | worst prog is anapestic