Thyroid

Question 1

hCG concentrations greater than what are required to cause sufficient thyroid stimulation of thyroid hormone production to result in suppressed TSH?

Answer 1

400,000 to 500,000 mIU/mL

Question 2

What is thyroglobulin “washout”?

Answer 2

Measuring thyroglobulin in the fluid obtained from FNAB aspirates of lymph nodes. FNA biopsy alone, without thyroglobulin washout, may fail to diagnose thyroid cancer in up to 20% of cases. (Q19)

Question 3

1. Tall cell variant of papillary thyroid cancer is associated with?
2. For non iodine avid PTC, what is the treatment?

Answer 3

1. An aggressive presentation. May often not be iodine avid. 2. External beam radiation therapy (tumoricidal) vs tyrosine kinase inhibitor therapy (benefits are transient)

Question 4

1. Cytopathology showing uniform-appearing lymphocytes may be consistent with either?
2. What is typically needed to confirm a diagnosis of lymphoma?
3. Treatment of thyroid lymphoma?

Answer 4

1. Hashimoto thyroiditis or thyroid lymphoma 2. FNAB with flow cytometry 3. Chemotherapy with or without radiation

Question 5

When evaluating patients with recurrent miscarriage, with or without infertility, what should be measured?

Answer 5

TPO antibody

Question 6

1. What is Riedel thyroiditis?
2. First line treatment?
3. Second line treatment?

Answer 6

1. a rare fibrotic condition that results in destruction of the thyroid and overgrowth of progressively fibrosing connective tissue. Histologically defined by the presence of inflammation. Primary hypothyroidism and positive antithyroid antibodies are present in most patients.
2. High dose glucocorticoids
3. Tamoxifen Debulking surgery is effective but usually limited to isthmusectomy due to complications such as hypoparathyroidism and recurrent laryngeal nerve damage.

Question 7

What is the treatment for myxedema coma?

Answer 7

IV levothyroxine with a LOADING DOSE of 200-400 mcg (lower doses for smaller/older pts or with h/o CAD or arrhythmia). Then daily MAINTENANCE LT4 dose of 1.6 mcg/kg body weight reduced by 25% while on IV. A LOADING DOSE of liothyronine 5-20 mcg can be given, followed by a MAINTENANCE dose of 2.5-10 mcg q8h.

Question 8

What monoclonal antibody has recently been shown to effectively improve symptoms of active moderate-to-severe Graves ophthalmopathy?

Answer 8

TEPROTUMUMAB

Question 9

1. What medication is currently approved for use in advanced medullary thyroid cancer?
2. What about for differentiated thyroid cancer?

Answer 9

1. vandetanib and cabozantinib (MEN in a van and cab)
2. sorafanib and lenvatinib (sorab and len are different)