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Clin Med II FINAL (Annie & Lauren) (the answer is always lifestyle modifications) > Thyroid And Parathyroid 🦋 > Flashcards

Thyroid And Parathyroid 🦋 Flashcards

(151 cards)

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1
Q

How will someone with hypothyroidism present?

A

Fatigue, weakness

Cold intolerance

Weight gain

Cognitive dysfunction (“fog”)

Constipation

Pubertal delay

Menstrual changes

Myalgia, arthralgia

Decreased hearing

Depression

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2
Q

How will hypothyroidism affect blood pressure?

A

Diastolic BP increases

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3
Q

How does hypothyroidism affect your skin, hair and nails?

A

Dry skin

Thinning hair

Brittle nails

Eyebrows fall out

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4
Q

How will hypothyroidism affect the face and neck?

A

Puffy facies

Periorbital edema

Tongue enlargement

Goiter**

Loss of eyebrows

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5
Q

How will hypothyroidism affect DTRs?

A

Delayed

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6
Q

Primary hypothyroidism (aka the gland itself is messed up):

TSH:

Free T4/T3:

A

TSH: high

Free T4/T3: low

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7
Q

Central hypothyroidism:

TSH:

Free T4/T3:

A

TSH: low or normal

Free T4/T3: low or normal

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8
Q

Subclinical hypothyroidism

TSH:

Free T4/T3:

A

TSH: high

Free T4/T3: normal

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9
Q

What is primary hypothyroidism?

A

There is something wrong with the thyroid gland itself

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10
Q

What is central hypothyroidism?

A

Something is wrong with the pituitary or hypothalamus and they’re not making TSH or TRH

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11
Q

What 2 antibodies would you expect to see high levels of in Hashimoto’s Thyroiditis?

A

Anti Thyroid Peroxidase antibody (TPO Ab)

Antithyroglobulin Antibody (TgAb)

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12
Q

In what two conditions may Anti Thyroid Peroxidase antibody (TPO Ab) be elevated?

A

Hashimotos Thyroiditis***

Grave’s disease

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13
Q

What antibody is used to monitor thyroid cancer?

A

Antithruglobulin Antibody (TgAb)

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14
Q

In what two conditions may Antithyroglobulin Antibody (TgAb) be high?

A

Hashimoto’s thyroiditis ***

Graves’ disease

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15
Q

Is TSH Receptor Antibody (TRAb) seen in Underactive or Overactive thyroid?

A

Overactive

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16
Q

Will TSH Receptor Antibody (TRAb) be positive in Hashimotos?

A

May or may not be

Have nooo idea what this slide meant

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17
Q

Will TSH Receptor Antibody (TRAb) be positive in Graves’ disease

A

Yes

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18
Q

What is the main cause of primary hypothyroidism

A

Hashimotos

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19
Q

What is the most common cause of hypothyroidism?

A

Hashimotos

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20
Q

What causes HAshimotos?

A

Autoimmune attack on thyroid that causes a gradual loss of thyroid function.

Caused by a combo of genetic and environmental factors

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21
Q

What two syndromes are associated with a higher risk for hashimotos?

A

Down syndrome

Turner’s syndrome

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22
Q

What is Hashitoxicosis?

A

It is transient HYPERthyroidism that happens at the beginning inflammation of Hashimoto’s.

(Thyroid dumps out a ton of thyroid hormones before becoming hypo)

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23
Q

What are some precipitating factors that may cause hashimotos to develop?

A

Stress

Pregnancy*

Infection

Iodine intake

Radiation exposure

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24
Q

Do women or men get hashimotos more?

A

Women 7x more

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25
How do you treat hypothyroidism?
Synthetic Thyroxine (T4) =Levothyroxine (Synthroid, Levothroid, Levoxyl)
26
What is the goal of synthetic T4 replacement therapy?
Maintain a euthyroid state (0.5-5.0), relieve sx, and decrease goiter size
27
How do you dose Levothyroxine?
Start at 1.6 mcg/kg/day and then titrate up or down at the 6 week follow up
28
Who needs a lower dose of Levothyroxine ?
Elderly Patients with heart problems
29
What time of day do patients need to take their Levothyroxine?
Empty stomach one hour before breakfast** Need to absorb ALL of it
30
Do we need to monitor TSH and free T4 while a patient is on Levothyroxine ?
Yes of course you do
31
What is subclinical hypothyroidism?
Elevated TSH with normal T4
32
How will a patient with subclinical hypothyroidism present?
Non-specific symptoms like “Fatigue”
33
WHat can happen if you don’t treat subclinical hypothyroidism?
CV disease Fatty liver Miscarriage and Low birth weight babies**
34
WHat should you do if your patient looks like they have subclinical hypothyroidism (i.e., high TSH, normal T4)?
Repeat TSH and T4 in 1-3 months to confirm the diagnosis BUT if they are pregnant or on fertility treatment, you need to repeat it IMMEDIATELY
35
When do you need to give treatment for subclinical hypothyroidism?
If TSH is 10 or more, definitely treat If TSH is 4.5-9.9, treatment is controversial based on age and symptoms And of course, if they are pregnant or doing fertility treatment
36
What is the biggest complication of hypothyroidism?
Myxedma Coma
37
What is Myxedema coma?
Hypothermia, bradycardia, severe hypotension, seizures, coma. Brought on by cold weather or illness.
38
Who usually gets myxedema coma?
Old patients who have had long-standing profound hypothyroidism
39
How do you treat myedema coma?
IV bolus T4 IV Hydrocortisone Hypertonic saline Supportive
40
Is hyperthyroidism more comon in women or men
Women 5x more | Especially older women and smokers
41
What usually causes hyperthyroidism in younger women?
Graves’ disease
42
What usually causes hyperthyroidism in older women?
Toxic nodular goiter
43
How will someone with hyperthyroidism present?
They will look like they’re on speed: Fast HR AFib**** Weight loss Sweating Stare and lid lag** Exopthalmos** Diarrhea* Insomnia, restlessness Tremor Peeing a lot
44
Hyperthyroidism TSH: Free T4/T3:
TSH: low Free T4/T3: high
45
Subclinical hyperthyroidism: TSH: Free T4/T3:
TSH: low Free T4/T3: normal
46
When you suspect something might be wrong with your patient’s thyroid, what lab test do you order?
“TSH with Reflux Free T4” Which means: check TSH first, and if that is abnormal, then check free T4
47
Why do we check “Free” T4
Because T4 is 99% protein bound
48
When would you order a “total” T4
Never, there is no use
49
What immunoglobulins will be positive in Grave’s disease?
Thyroid-Stimulating Immunoglobulins (TSI)********** Thyroid-binding Inhibitory Immunoglobulin (TBII)
50
Will TSH Receptor Antibody (TRAb) be positive in Graves’ disease?
Yes
51
Will Anti Thyroid Peroxidase antibody (TPO Ab) be elevated in BOTH Hashimotos and Graves?
Yes, but it will be much higher in Hashimotos
52
Will Anti Thyroglobulin Antibody (TgAb) be elevated in BOTH Hashimotos and Graves?
Yes, but it will be much higher in hashimotos
53
What will cause normal-high radioiodine uptake test results?
Anything that causes increased de novo synthesis of thyroid hormone: Graves’ disease Hashitoxicosis Toxic adenoma or toxic nodular goiter Autonomous nodules (HOT)🔥🔥**** Iodine deficiency
54
What will cause a nearly-absent radioiodine uptake scan?
Exogenous Thyroid hormone aka taking Levothyroxine Nonfunctioning nodules- COLD❄️❄️*** Thyroiditis (subacute, painless, radiation, iodine-induced)
55
If you see a non functioning COLD ❄️ nodule on a thyroid uptake and scan, what do you need to consider?
You should think that it is cancerous and do a Fine Needle Aspiration
56
What increases the risk of developing Graves’ disease?
Genetics Stress Smoking Thyroid injury
57
What is the most common feature of Graves’ disease?
hyperthyroidism
58
How will a patient with Graves’ disease present?
Graves ophthalmopathy**: lid retraction, lid lag, stare, proposes, periorbital edema Pretibial Myxedema**** skin on shins is weird Non-nodular goiter Other sx of hyperthyroidism
59
If someone has Low TSH and Elevated Free T4/T3, as well as TRAb antibodies, and Orbitopathy, what is the next test you need to do?
Thyroid uptake and scan
60
What is a Toxic Multinodular Goiter?
A goiter with multiple nodules that is caused by hyperplasia of follicular cells.
61
What is the 2nd most common cause of hyperthyroidism?
Toxic Multinodular Goiter (MNG) “Toxic” means overactive
62
What is a toxic adenoma?
A nodule with increased radioiodine uptake
63
What are some concerning symptoms when someone has toxic adenoma or toxic MNG?
Cough Dyspnea Dysphagia *****OBSTRUCTIVE SYMPTOMS****** needs IMEMDIATE TREATMENT
64
If you look at a thyroid uptake and scan and you see Focal areas of increased radioiodine +/- “cold spots,” what do you have
Toxic adenoma or toxic MNG ??????
65
If you are unable to differentiate a toxic adenoma or toxic MNG from Grave’s disease, what should you look at?
Antibodies
66
How do you treat hyperthyroidism (other than surgery/ablation)?
Atenolol 25-50mg daily****** Aspirin*** to prevent clots from AFib Thionamides for severe sx: (Methimazole or PTU) Avoid strenuous activity (HR and BP are already too high)
67
What are the two thinoamides?
Methimazole Propylthiouracil (PTU)- preferred in pregnancy🤰🏻
68
What are thionamides taken for?
hyperthyroidism
69
What is the first line definitive treatment for hyperthyroidism?
Radioiodine ablation
70
How is radioiodine ablation done?
Patient takes a thinoamide (PTU/Methimazole) for awhile Takes a single dose of I131 (radioactive iodine) =thyroid dead
71
If you get a a radioiodine ablation, who do you need to avoid for 3 weeks
Childern Pregnant women
72
Radioiodine ablation is contraindicated for:
Pregnant women Women who want to get pregnant in the next few years and active ophthalmopathy (???)
73
When would we do surgery for hyperthyroidism (instead of radioiodine ablation)
Toxic adenoma/MNG*** Large goiter with obstructive sx Pts with moderate-severe ophthalmopathy
74
What are the complications of hyperthyroidism?
Permanent exopthalmos Osteoporosis Stroke, AFib, CHF Thyroid storm**
75
Is a thyroid storm an emergency?
Yes
76
What can cause thyroid storm?
Major stress* Surgery Radioiodine ablation** Iodine contrast Inadequate treatment
77
What are the symptoms of a thyroid storm?
Vomiting/diarrhea Confusion/delirium Tachyarrythimas Dehydration Fever Coma
78
How do you treat thyroid storm?
Fluid replacement Anti-arrhythmia meds IV PTU Electrolyte stabilization
79
What are the other names for subacute thyroiditis?
Granulomatous De Quervain’s Giant cell thyroiditis
80
What happens before subacute thyroiditis?
Viral Illness or URI******!!!**!*!*!**!*!!**!*!**!*!**!
81
Who usually gets subacute thyroiditis?
Young to middle-age women
82
How will a pt with subacute thyroiditis present?
Acute, SEVERELY painful glandular enlargement (goiter)đź’Ąđź’Ąđź’Ą*** Radiating pain to jaw, chest, etc Fever, fatigue, malaise, anorexia, myalgia
83
True or false: Subacute thyroiditis is an inflammatory process
True ~~~~INFLAMMATORY~~~~~~
84
What is the progression of subacute thyroiditis?
Hyperthyroid Euthyroid Hypothyroid Recovery (Euthyroid) This is a PREDICTABLE progression of phases **********THIS WAS CIRCLED IN BLUE****
85
How do you treat subacute thyroiditis?
NSAIDs/Aspirin Prednisone **We DON’T block the thyroid or give levothyroxine: all we do is try to bring down inflammation**
86
Who needs to be screened for thyroid disorders?
EVERYONE over 60*** Goiter Hx of autoimmune disease Prior radioactive iodine therapy Family hx of thyroid disease Certain meds: lithium**, amiodarone*, aminoglutethimind, interferon a, thalidomide, betaroxine, stavudine (Probably only need to know lithium and amiodarone)
87
What are the 4 types of thyroid cancer in order of most common to least common*******
Papillary 76% Follicular 16% Medullary 4% Anaplastic 1% (VERY aggressive)
88
So you find a thyroid nodule. Now what do you need to know/
Is it cancer? Is it causing thyroid dysfunction?
89
A thyroid nodule in what groups of people should make you very concerned about cacner?
Kids Men** Younger than 30 Older than 60 Head/neck radiation Stem cell transplant Family hx of thyroid cancer
90
When is a thyroid nodule more concerning: in a man or in a woman?
Man | Women get benign nodules alll the time so we are less concerned
91
How do you work up a thyroid nodule?
1. History and exam to determine high or low risk 2. Measure TSH 3. Thyroid ultrasound (if concerning, ~then~ do FNA) ??? 4. Thyroid uptake and scan 5. If nodule is COLD- do fine needle aspiration 6. If nodule is HOT- DO NOT stick a needle in it!! (This slide was sort of unclear!! I’m sorry!)
92
(Hot/Cold) nodules are NOT cancer
Hot
93
What happens if you stick a needle in a Hot nodule?
You will cause thyroid storm**
94
As TSH levels go up, the likelihood of cancer (increases/decreases)
Increases
95
What findings on a thyroid ultrasound are more likely to be malignant?
Hypoechoic** Microcalcifications** >1cm and solid/hypoechoic Irregular margins Tall>wide Extracapsular growth Associated cervical nodes
96
What findings on a thyroid ultrasound are more likely to be benign?
“Purely cystic” ***** Colloid <1 cm without other suspicious characteristics
97
Hypoechoic and Microcalcifications on a thyroid ultrasound should make you think (malignant/benign)
Malignant
98
“Purely cystic” and “Colloid” on a thyroid ultrasound should make you think (Malignant/Benign)
Benign
99
What is the procedure of choice to evaluate nodules and to select surgical candidates?
Fine Needle Aspiration Biopsy
100
What is the most common result of a FNA biopsy?
Benign (60-75%)
101
Is thyroid cancer more common in men or women
Women
102
What ages have a worse prognosis for thyroid cancer?>
Younger than 20 Older than 45
103
Do men or women have a worse prognosis of thyroid cacner
Men
104
What are the 2 types of “Differentiated” thyroid cancer?
Papillary Follicular ***************
105
Which kind of thyroid cancer is “Undifferentiaed”?
Anaplastic ****
106
Which has the highest cure rates: | Differentiated or Undifferentiated Thyroid Cancer
Differentiated
107
What is the prognosis like for Anaplastic thyroid cacner
Poor | *****
108
Which type of thyroid cancer is “Familial”?
Medullary | ***********
109
Medullary Thyroid cancer is “Familial.” Can it also occur spontaneously?
Yes | ****
110
What genetic marker should you test for when you discover medullary thyroid cancer?
RET mutations *****
111
What is the treatment for Thyroid cancer?
Surgery- total thyroidectomy Radioiodine Ablation after surgery Thyroid hormone suppression to prevent further growth- levothyroxine at lower therapeutic thresholds***** Radiation/chemotherapy
112
Hyper or Hypo thyroidism: Brittle nails
Hypothyroidism
113
Hyper or Hypothyroidism: Cold intolerance
Hypothyroidism
114
Hyper or Hypothyroidism: Depression
Hypothyroidism
115
Hyper or Hypothyroidism: Increased Appetite
Hyperthyroidism
116
Hyper or Hypothyroidism: Hand tremors
Hyper
117
Hyper or Hypothyroidism: Frequent bowel movements
Hyper | 🧻
118
Hyper or Hypothyroidism: Sleeplessness
Hyper
119
What causes PTH to be released?
Low serum calcium
120
What is the MOT common cause of hypoparathyroidism?
Damage after a thyroidectomy🔪 | *****
121
What are 2 other causes of Acquired hypoparathyroidism, other than damage during surgery?
Neck irradiation Alcoholism
122
Which the most common cause of hypoparathyroidism: Acquired Autoimmune Congenital
Acquired (Due to damage during surgery)
123
If you have hypoparathyroidism, what will your levels be: Calcium: PO4:
Calcium: Low PO4: HIGH** (Even though there’s less resorption of phosphate from the bone and gut, there’s a lot more phosphate reabsorption in the kidney, and the kidney always wins)
124
What are the neuromuscular symptoms of hypoparathyroidism?
Tetany Muscle twitching Carpopedal spasms Seizures Weakness Laryngospasm Paresthesia ********* All due to hypocalcemia
125
What are the cardiac symptoms of hypoparathyroidism?
Heart failure Hypotension Arrhythmia Prolonged QT
126
Chvostek’s Sign and Trousseau’s sign will be positive in what condition?
Hypocalcemia******
127
Will Chvostek’s and Trousseau’s sign be positive in Hyper or hypoparathyroidism
Hypoparathyroidism (causes low calcium)
128
What is Chvostek’s sign?
Spasm of the facial muscles following facial nerve tapping
129
What is Trousseau’s sign?
Muscle spasm of the hand and wrist when you inflate a BP cuff around the upper arm
130
What do you think this person has: Ectopic calcification Parkinsonism (jerky, spasms) Dementia Cataracts Shitty teeth Dry coarse skin Brittle nails Hair loss Renal stones
Hypoparathyroidism
131
Expected lab results for hypoparathyroidism: PTH Calcium Magensium Vit D Phosphate
PTH: Low Calcium: Low Magnesium: Low Vitamin D: normal/low Phosphate: HIGH**!!*!*!**!**!*!**!*!*!*
132
How do you treat emergency hypoparathyroidism?
IV Calcium Gluconate Airway maintenance (often need to be intubated due to all the spasms etc)
133
How do you treat hypoparathyroidism once they are out of the “danger zone?” (No more tetany, seizures, prolonged QT)
Oral calcium 1-2 g/day Vitamin D Magensium if needed
134
True or False: | We treat hypoparathyroidism with PTH replacement
False. We replace calcium
135
What is the MOST common cause of PRIMARY hyperparathyroidism?
Parathyroid adenoma****!!!** ON TEST
136
What are three possible causes of primary hyperparathyroidism?
Parathyroid adenoma **MOST COMMON Parathyroid hyperplasia Parathyroid carcinoma (rare)
137
What is the main cause of secondary or teritiary hyperparathyroidism?
Chronic renal failure!!**!* | Hyperphosphatemia and low renal Vitamin D production —> low calcium, which stimulates the parathyroid
138
Expected lab values for hyperparathyroidism: PTH: Calcium: Phosphate: Magnesium:
PTH: high Calcium: High Phosphate: LOW** Magensium: high
139
What is the most common presentation of hypercalcemia?
Asymptomatic!!! ********************* Was bold, large, and had stars on it**** (Even though we have that little bones stones moans and groans thing for hyperparathyroidism)
140
What does condition does “Bones, Stones, Abdominal Moans, Thrones, and Psychiatric Groans” refer to?
Hyperparathyroidism
141
What are the symptoms of hyperparathyroidism that “Bones, Stones, Abdominal Moans, Thrones, and Psychiatric Groans” refers to?
Bones: arthralgia, bone pain*** MAIN SYMPTOM Stones: kidney stones and diabetes insipidus Abdominal moans: vague GI sx Psychiatric groans: psychosis, depression delirium Thrones: constipation and polyuria
142
Lab values for Primary Hyperparathyroidism: Calcium: Phosphate: PTH:
\Calcium: high** Phosphate: low-normal** PTH: high
143
Lab values for secondary hyperparathyroidism Calcium: Phosphate: PTH:
Calcium: LOW**** Phosphate: High if due to renal, and Low if due to vitamin D PTH: High
144
What diagnostic tests do you need to do if you suspect your patient has hyperparathyroidism?
DEXA scan- PTH is chewing up their bones! Kidney function- 24 hr urine and imaging Parathyroid ultrasound Sestamibi parathyroid scan (radioactive) with CT scan- noooooo fuckin clue what this is
145
What is the definitive treatment for hyperparathyroidism?
Parathyroidectomy | might need lifelong calcium supplementation after
146
What is the conservative treatment for hyperparathyroidism (aka you’re not doing surgery)
Physical activity- keep bones strong Hydration- no kidney stone Avoid lithium and HCTZ- cause high calcium Restrict calcium intake to 1g/day Vit D IV Bisphosponates*****Protects bones from PTH*****
147
Whenever you measure PTH levels, you must ALWAYS measure ________ as well
Calcium levels********
148
Hyperparathyroidism Calcium: PTH:
Calcium: high PTH: high
149
Hypoparathyroidism Calcium: PTH:
Calcium: low PTH: low
150
Hypercalcemia of malignancy Calcium: PTH:
Calcium: high PTH: low
151
Secondary Hyperparathyroidism (renal disease) Calcium: PTH:
Calcium: low PTH: High

Clin Med II FINAL (Annie & Lauren) (the answer is always lifestyle modifications) (3 decks)

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