Thyroid Flashcards
(35 cards)
3 specific signs to Grave’s disease:
- Peritibial myxedema
- Exophthalmos
- Goiter with thyroid bruit
What autoimmune antibodies are likely positive in Grave’s disease?
Thyroid stimulating Immunoglobulin (TSI)
“TSH receptor AB”
What autoimmune antibodies are likely positive in Hashimoto’s thyroiditis?
Anti-peroxidase
Anti-thyroglobulin
Painful tender thyroid
Jaw pain
High ESR
What is the most likely diagnosis
Subacute thyroiditis
Medications may cause hyperthyroidism […]
Amiodarone
Lithium
Focal patches of hyperfunctioning follicular cells with colloid working independently of TSH
Toxic Multinodular goiter
“Plummer disease”
In case of hyperthyroidism with low RAIU what is the likely diagnosis ?
🔹Transient thyroiditis
🔹Extrathyroidal T4
Primary hyperthyroidism
[…] TSH […] T4 […] T3
Primary hyperthyroidism
🔻 TSH 🔺 T4 🔺 T3
Secondary hyperthyroidism
[…] TSH […] T4 […] T3
Secondary hyperthyroidism
🔺 TSH 🔺 T4 🔺 T3
Subclinical hyperthyroidism
[…] TSH […] T4 […] T3
Subclinical hyperthyroidism
🔻 TSH 🟢 T4 🟢 T3
What is the First line treatment of Grave’s disease?
Methimazole
Hyperthyroidism in pregnancy treatment
1st trimester: PTU
2nd & 3rd: Methimazole
What are the side effects of thionamides?
- Agranulocytosis
- skin rash
- hepatotoxicity
- arthralgia
- Methimazole (Teratogenic)
What is the approach of starting Methimazole treatment
Start with 10 mg
If not improved increase to 20
If not improved increase to 40
If not improved RAI
Follow up thyroid function at week […] after starting methimazole
6
Management of Subacute thyroiditis:
NSAIDs
Steroids
Management of Multinodular toxic goiter & toxic adenoma:
RAI (1st line)
Surgical thyroidectomy
Primary hyporthyroidism
[…] TSH […] T4 […] T3
Primary hyporthyroidism
🔺 TSH 🔻 T4 🔻 T3
Secondary hyporthyroidism
[…] TSH […] T4 […] T3
Secondary hyporthyroidism
🔻 TSH 🔻 T4 🔻 T3
Subclinical hyporthyroidism
[…] TSH […] T4 […] T3
Subclinical hyporthyroidism
🔺 TSH 🟢 T4 🟢 T3
Hypothyroidism treatment of choice:
Levothyroxine
At lease […] weeks should pass before repeating Thyroid function test and adjusting levothyroxine dose
6
When should you treat subclinical hypothyroidism ?
🔸 Symptomatic
🔸 TSH >10 mU/L
🔸 Pregnancy
Bethesda categories .. management
I “nondiagnostic” : repeat FNA
II “benign” : follow up U/S
III “AUS/FLUS” : repeat FNA
IV “sus follicular neoplasm” : Lobectomy
V “sus malignancy” : Lobectomy vs near total thyroidectomy
VI “malignant” : near total thyroidectomy
