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X Clin Med II Exam 4 > Thyroid and Parathyroid > Flashcards

Thyroid and Parathyroid Flashcards

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1
Q

General sxs of hypothyroidism

A

Generalized metabolic slowing–fatigue, cold intolerance, weight gain, cognitive dysfunction, constipation, hoarseness, decreased hearing, myalgia, arthralgia, paresthesia, depression, menstrual changes, pubertal delay

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2
Q

What might be seen on a PE for hypothyroidism?

A 
Bradycardia, HTN
Dry, coarse skin, thin hair
Puffy face
Ascites
Edema
Delayed DTRs
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3
Q

Labs in primary hypothyroidism

A

High TSH and low FT4 and low T3

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4
Q

Labs in subclinical hypothyroidism

A

High TSH and normal FT4 and T3

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5
Q

Labs in central hypothyroidism

A

Normal/low TSH, FT4 and T3

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6
Q

What antibodies tend to be seen in Hashimotos thyroiditis?

A

Anti thyroid peroxidase antibody (TPO ab)

Anti thyroglobulin antibody (TgAb)

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7
Q

Most common cause of hypothyroidism

A

Hashimotos thyroiditis

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8
Q

What is Hashimotos thyroiditis?

A

Chronic autoimmune thyroiditis

Functional abnormality with associated inflammatory component with a gradual loss of thyroid function

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9
Q

When do you see an increased risk for Hashimotos?

A

Down syndrome and Turners

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10
Q

What is hashitoxicosis?

A

Transient hyperthyroidism related to early inflammation (at first due to dumping of hormones)

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11
Q

Precipitating factors of Hashimotos

A

Stress, infection, pregnancy, iodine intake and radiation exposure

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12
Q

What is the goal for T4 replacement in hypothyroidism?

A

Maintain euthyroid state (.5-5 mU/L), relieve sxs and decrease goiter size if needed

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13
Q

What med is used in hypothyroidism?

A

Levothyroxine (levothyroid, levoxyl, synthroid)

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14
Q

Dosing and considerations for Levothyroxine

A

1.6 mcg/kg/day at starting point (start lower for elderly and people with cardiac probs)
Empty stomach and hr before breakfast (so absorb it all at the same amount every day)

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15
Q

F/u for levothyroxine?

A

6 wks after start to evaluate the dosage

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16
Q

What is subclinical hypothyroidism?

A 
Elevate TSH (4.5-7) with normal T4
Present with mild or vague non specific sxs (fatigue, constipation)
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17
Q

Risks associated with subclinical hypothyroidism when it is not treated

A

Increased risk for CV disease
Nonalcoholic fatty liver disease
Neuropsychiatric sxs
Miscarriage and low birth weight babies

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18
Q

What must you do to confirm the diagnosis of subclinical hypothyroidism?

A

Repeat TSH and T4 after 1-3 mos (if dont have overt sxs)

*if pregnant or during a fertility tx, repeat immediately

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19
Q

Management of subclinical hypothyroidism

A

Most will progress to overt hypothyroidism
If TSH>10: treatment recommended
If TSH 4.5-9.9: tx controversial based on age and sxs

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20
Q

Common complications of hypothyroidism

A

Elevated cholesterol and liver enzymes
HF
Infertility
Myxedema coma

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21
Q

Who do you see myxedema coma in?

A

Older pts with long standing profound hypothyroidism

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22
Q

Sxs of myxedema coma

A

Hypothermia, bradycardia, severe hypotension, seizures, coma (may be due to acute illness or cold weather)

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23
Q

Tx for myxedema coma

A 
IV bolus T4
IV hydrocortisone
Supportive
Hypertonic saline
**medical emergency
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24
Q

Etiologies of hyperthyroidism

A

Graves: younger women

Toxic nodular goiter: older women

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25
Presentation of hypethyroidism
Weight loss, sweating, exophthalmos, goiter, tachycardia, a fib, diarrhea, urine frequency, osteoporosis, pretibial myxedema, insomnia, tremor etc
26
Labs in hyperthyroidism
Low TSH and high free T4 and T3 (overproduction of T4 will turn off the pituitary to decrease TSH)
27
Labs in subclinical hyperthyroidism
Low TSH and normal free T4 and T3
28
What else might be seen on the labs in hyperthyroidism?
CBC: normochromic, normocytic anemia Cholesterol: low total and HDL Glucose: impaired glucose tolerance Others: antibodies
29
What antibody is specific to Graves?
TSH receptor antibody (TRAb) which stimulates the thyroid gland---TSI or TBII
30
Reasons for a high radioiodine uptake (due to de novo synthesis of the hormone)
``` Graves (most common) Hashitoxicosis (probs normal tho) Toxic adenoma or toxic nodular goiter Iodine deficiency Autonomous nodule (HOT) ```
31
Reasons for near absent radioiodine uptake
``` Exogenous ingestion of hormone (b/c don't need iodine to make the hormone) Thyroiditis (subacute, painless, radiation, iodine-induced) Nonfunctioning nodules (COLD): cancer and FNA ```
32
When is there an increased risk for Graves?
Stress, smoking, thyroid injury
33
Presentation of Graves
Most common feature is hyperthyroidism (other sxs) Opthalmopathy (lid retraction, lid lag, stare, proptosis or enlarged muscles, periorbital edema) Pretibial myxedema Non nodular goiter
34
2nd most common cause of hyperthyroidism behind Graves
Toxic adenoma or toxic multinodular goiter (MNG)
35
When does the likelihood of toxic adenoma or MNG increase?
With age and iodine deficiency
36
Why does toxic adenoma/MNG happen?
Diffuse or focal hyperplasia of follicular cells (often associated with mutations in TSH receptor gene)
37
Difference between toxic adenoma and MNG
Adenoma: nodule with increased radioiodine uptake MNG: palpable or u/s defined goiter with multiple nodules
38
Concerning obstructive sxs of toxic adenoma or MNG
Cough, dysphagia or dyspnea
39
How to diagnose toxic adenoma/MNG
Focal areas of increased radioiodine (maybe cold spots) | *consider antibodies to differentiate from graves
40
Meds used in hyperthyroidism
Atenolol 25-50 mg daily ASA to prevent clot formation in A fib No strenuous activity Thionamides (for more severe sxs) like methimazole or propylthiouracil (pregnancy)
41
First line definitive tx for hyperthyroidism
Radioiodine ablation with I131
42
How do you do a radioiodine ablation?
Usually done after given thionamide 1 dose Precaution with contact of kids and pregnant women for 3 wks Contraindiated in pregnancy or pregnancy in next few yrs and active opthalmopathy
43
When is surgery usually indicated for hyperthyroidism?
Toxic adenoma or MNG Large goiters with obstructive sxs Pts with active moderate-severe opthalmopathy
44
Complications of hyperthyroidism
Permanent exopthalamos Osteoporosis Cerebral or CV events Thyroid storm
45
Sxs of thyroid storm
Vomiting, diarrhea, confusion/delirium, tachyarrhythmias, dehydration, fever, coma
46
Tx for thyroid storm
Treat aggressively with fluid replacement, anti-arrhythmias meds, electrolyte stabilization and IV PTU
47
What is subacute thyroiditis associated with?
Viral illnesses or post viral inflammatory process URI - also called granulomatous, de Quervains, giant cell thyroiditis - Young to middle aged females
48
Presentation of subacute thyroiditis
Acute severely painful glandular enlargement (goiter) Radiating pain (jaw, neck, throat, chest) Fever, fatigue, malaise, anorexia, myalgia
49
Phases of subacute thyroiditis
Predictable: hyperthyroid, euthyroid, hypothyroid, recovery (euthyroid) Elevated ESR and CRP (usually not with over thyroid diseases)
50
Meds for subacute thyroiditis
ASA or NSAID initially and prednisone if no sx improvement in several days
51
When is screening for thyroid disorders usually recommended?
Over 60
52
Pts at increased risk for thyroid disorders
``` Goiter Hx of autoimmune Previous radioactive iodine therapy Hx head/neck irradiation Faily hx Meds that impair thyroid function ```
53
Most common cause of thyroid cancer
Papillary carcinoma
54
When do you have a higher concern for a thyroid nodule being cancerous?
Kids, men, <30 or >60 Hx of head/neck radiation Hx hematopoietic stem cell transplant Family hx
55
What to always remember a bout a hot nodule?
Never stick a needle in it!!! | -cancers are cold
56
Concern for malignancy on thyroid US
``` Hypoechoic Microcalcifications >1 cm and solid Irregular margins Tall>wide Extracapsular growth Associated cervical nodes ```
57
Benign features of thyroid US
Purely cystic Colloid <1 cm without suspicious characteristics
58
What is a fine needle aspiration biopsy?
Procedure of choice to evaluate nodules and to select surgical candidates
59
When is there a worse prognosis in thyroid cancer?
<20 >45/60 Male gender
60
Differentiated thyroid cancer
-have the highest cure rates Papillary (most common) Follicular
61
Undifferentiated thyroid cancer
Anaplastic-poor prognosis
62
Familial thyroid cancer
Medullary
63
Management of thyroid cancer
#1: surgery (near total or total thyroidectomy) Radioiodine ablation (after surgery a lot) Thyroid hormone suppression to prevent further growth- levothyroxine (lower thresholds tho) Radiation or chemo
64
Etiologies of hypoparathyroidism
Acquired (usually post thyroidectomy but can be neck irradiation or alcoholism) Autoimmune Congenital -destruction of parathyroid gland
65
Labs in hypoparathyroidism
Decreased Ca, vit D, PTH and Mg and increased PO4
66
Presentation of hypoparathyroidism
Neuro-tetany, twitching, laryngospasm, paresthesia, weakness Cardiac- HF, hypotension, arrhythmia, prolon gQT Papilledema
67
Tests for hypoparathyroidism
(For hypocalcemia) | Chvostek's (face tap) or Trousseau's (BP cuff spasm) sign
68
Presentation of chronic hypoparathyroidism
Ectopic calcifications, parkinsonism, dementia, cataracts, dry coarse skin, hair loss, impaired dentition
69
Management for hypoparathyroidism
Based on sxs | *watch for hypercalcemia with the tx
70
Emergent tx of severe hypocalcemia sxs
IV calcium gluconate and airway maintenance
71
Maintenance tx for hypoparathyroidism
Oral calcium (1-2 g/day) and vit D supplements Replace Mg if needed Monitor weekly and then every 3-6 mos
72
Etiologies of primary hyperparathyroidism
Parathyroid adenoma (most common) that secretes PTH Parathyroid hyperplasia Parathryoid carcinoma
73
Etiologies of secondary or tertiary hyperparathyroidism
Chronic renal failure mostly Vit D deficiency renal osteodystrophy
74
Presentation of hyperparathyroidism
Asymptomatic a lot (malignancies have more sxs) Bones (bone pain, arthralgia), stones (kidney stones and DI), abdominal moans (GI sxs, polyuria, constipation) and psychiatric groans (depression, delirium)
75
Diagnostics in primary hyperparathyroidism
High Ca, low PO4, high PTH
76
Diagnostics in secondary hyperparathyroidism
Low Ca, High PO4 (renal) or low PO4 (vit D), high PTH
77
Diagnostics in tertiary hyperparathyroidism
High Ca and PTH
78
Diagnostics used in hyperparathyroidism
DEXA scan Kidney function (24 hr urine, imaging) U/s Sestamibi parathyroid scan (radioactive) with CT scan (common parathyroid adenoma)
79
Definitive management for hyperparathyroidism
Surgical resection
80
Conservative tx for hyperparathyroidism
``` When can't do surgery or waiting Physical activity Fluids Avoid lithium and HCTZ Restrict Ca intake to 1 g Vit D 400-800 IU daily IV bisphosphanates for bone pain ```

X Clin Med II Exam 4 (6 decks)

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