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INTERNAL MEDICINE 5TH > thyroid > Flashcards

thyroid Flashcards

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1
Q

causes of hypothyroidism

A
  1. congenital
  2. post operative
  3. radiation
  4. thyroidectomy (due to reistant graves or a toxic multi nodular goitre)
  5. de quervenains
  6. iodine deficiency - endemic goitre
  7. iodine excess - amiodrone, factitita (great intake of thyroid hormones)
  8. radioactive iodine therapy used for graves disease
  9. riedal (rare)
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2
Q

sub acute thyroiditis is a.ka

A

DE quervains

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3
Q

what is dequerveins

A

begin with hyperthyroidism and then hYPO

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4
Q

thyrotoxicosis facttitiica

A

too much intake of thyroid horses (overdoes)

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5
Q

ECG findins in hypo

A

low voltage

AV black

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6
Q

other symptoms of hypo

A 
effusions 
diastolic hypertension 
alpaca 
droopy eyelids 
lateral 1/3rd eyebrow- hertoghe  sign
menstraul cycle disturbances 
hyperprolactinemia
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7
Q

diastolic hypertension is associated with

A

hypothyroidism

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8
Q

what is myxoedema

A

Myxedema is a term generally used to denote severe hypothyroidism. Myxedema is also used to describe the dermatologic changes that occur in hypothyroidism and occasionally hyperthyroidism.

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9
Q

most serious complication of hypo

A

myxoedema crisis

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10
Q

subclinical hypothyroidism

A

high levels of TSH and normal levels of t3 , t4

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11
Q

antibodies for hashimotos

A

anti TPO

antithyroglobulin

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12
Q

labs for hypothyroidism

A

look for antibodies and in CBC anaemia is common

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13
Q

tx for hypothyroidism

A

levothyroxine 1.6 micro grams given TAKE 1 H B4 BREAKFAST VERY IMPORTANT FOR THE ABSORPTION ( start with lower doses and then you gradually increase unlike in graves )

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14
Q

what imaging studies for hypothyroidism

A
  1. US 2. radioactive uptake - allows you to differentiate autoimmune
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15
Q

classiccation of hyperthyroidism

A

with hyperthyroidism

w/o hyperthyroidism

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16
Q

hyperthyroidism causes

A
  1. de queervien (initial stage)
  2. iodine excess
  3. graves
  4. toxic multi nodular/adenoma
  5. hashimotos
  6. silent thyrodiits
  7. post partum thyroidits
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17
Q

neurological findings of hyperthyroidism

A

hyperfrelxia
tremor
muscle weakness
psychiatric : anxious, anxiety

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18
Q

triangle of graves

A
  1. TAO
    2, MYXOEDEMA ( even though most common in graves)
  2. ACROPATHY
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19
Q

subclinal hyperthyroidism

A

TSH will be low

thyroid levels are normL

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20
Q

OVERT hypothyroidism

A

TSH will be low and Thyroid hormones high

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21
Q

antibodies in graves

A

TSH receptors

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22
Q

tx medication for graves

A

metamizaole + propuylthiouracil - start at 300 /400 and then decrease - try for 18 months and then if not successful then we do surgery

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23
Q

what kind of myxedma is associated with hyper

A

pretibial

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24
Q

thyroid storm management

Study These Flashcards
A

IV propranolol
IV digoxin
Propylthiouracil through NG tube followed by Lugol’s iodine 6 hours later
Prednisolone/hydrocortisone- 100mg/24 lecture says methyprednisolne

lithium is second line tx

lecture says endoyodin?

25
whats lithium more associated with
hypothyroidism but causes both , random (should be avoided in pregnancy anomalies to fetus)
26
what is the cause of exophthalmus in graves
the immune system attacks the muscles and fatty tissues around and behind the eye, making them swollen.
27
tx of subacute thyroiditis
usually not antithyroid medications as its preformed ! nsaids, CS
28
what would you advise a patient with TAO on life advice
stop smoking its a big risk factor
29
when is thyrotocisosis without hyperthryoridsm seen
exogenous intake of thyroid hormones or inflammatory and neoplastic disease with destruction of thyroid cells
30
what happens if proptosis is unilateral
rule out malignancy as usually exophthalmus is bilateral
31
device for measuring prothesis
Hertel exophthalmometer
32
tx for the TAO
Sunglasses, apply artificial tears, eye protectors during sleep and keep your head elevated when in bed to decrease oedema of eyes Glucocorticoids (in severe cases) External X-RAY therapy on retrobulbar area surgery can help too- decompression of optic nerve remember TAO can also cause very wet eyes too
33
antibodies for Graves
TPO microsomal TSH
34
on a thyroid scan what is the uptake like for subacute
low uptake is charactaeirsitc
35
side effect of carbimazole
agranulocytosis so look out for mouth ulcers, sore throat
36
CI of radioactive iodine
CI - Children, age <30, pregnancy, (destroy fetal gland) lactation and leukopenia AND TA0 as makes it worse
37
hyperthyroidism in pregnancy
Anti-thyroid medications - these drugs cross placenta hypoplasia of fetal thyroid gland (fetal hypothyroidism) so its CI during 1st trimester as risk of congenital hypothryodisa - we manage symptomatically with small doses of propel Anti-thyroid drugs given in 2nd/3rd trimester but the lowest possible doses Propylthiouracil - preferred as it crosses placenta to a lesser extent Small doses of propranolol given to control symptoms for mother Sub-total thyroidectomy can be done in mid-trimester, but you want to delay as much ss possible to improve fetal survival (premature
38
Hyperthyroidism in breast-feeding period
Anti-thyroid drugs can pass into breast milk - If possible stop taking medications after birth/during breast feeding period Propylthiouracil is not concentrated in milk
39
rf far thyroid cancer
deficiency in iodine, head and neck radiation , having hashimotos/grvaes
40
most common thyroid
papillary - remember more local spread so LN'S
41
where do thyroid cancers typically metasitse too
lungs and bone
42
which cancer freuqnely spread to ln
paiallry
43
signs of cancer
dyspahgia trouble breathing hoarseness of voice if spread
44
which cancer associated with iodine deficiency
follicular
45
which cancers are graves and hashimotos more likely to get
papally
46
whats associated with medullary carcinoma
raised calcintotn , which is associated with diarrhoea too . Secretes bioactive substances: ACTH, CTRH, VIP (like neuroblastoma so diarrhoea) bushings syndrome and + diarrhoea syndrome
47
which cancer is sensitive to iodine
follicular
48
tx of lymphoma radiation
RADIATION
49
thyroid scan for thyroid cancer is most likely o shw
‘Cold nodules’ but some follicular Ca | take up the radioiodine and appear hyperactive
50
LYMOHAMA
Almost always Non-Hodgkins lymphoma Highly associated with Hashimoto's thyroiditis responds to radiotherapy
51
tumoru markers
Elevated Thyroglobulin- papillary or follicular Elevated calcitonin- medullary carcinoma citokeratin - anaplastic carcinoma
52
whats descriptive of a thyroid mass
lump that moves on swallowing but not on tongue protrusion
53
ANTITHYROID DRUGS
nhibit synthesis of thyroid hormones. | Main monotherapy or an adjunctive therapy before surgery or radioactive iodine therapy.
54
WHAT DO We typicallly use radioactive iodine for what is the proecedure
certain types of thyroid cancer (P+F)( higher does) hyperthyroidosim ( RAI is taken in an oral capsule form. You don’t need to be hospitalized unless the dose is very high, which is rarely needed. You will be prompted to drink lots of water after taking the pill to flush the remaining radioactive iodine out of your system. Most patients need only one dose before their hyperthyroidism is resolved, which may take a few weeks to several months.
55
what's the procedure for RAI tx in thyroid cancer
usually after surgery to catch any stray cancer cells
56
gold standard diagnosis of graves
US
57
relationship between hyperthyroid gland and diabetes
increased risk as metabolism in increased clearance of insulin and thyroid hormones are contrainsular
58
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INTERNAL MEDICINE 5TH (12 decks)

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