Thyroid and parathyroid disease Flashcards
(66 cards)
1
Q
clinical presentation
- generalized metabolic slowing
- fatigue, weakness
- cold intolerance
- weight gain
- decreased hearing
- depression
- menstrual changes, pubertal delay
- bradycardia
A
Hypothyroidism
2
Q
what would present with
- high TSH
- low T4
- normal or low T3
A
primary hypothyroidism
3
Q
what would present with
- high TSH
- normal T4
- normal T3
A
subclinical hypothyroidism
4
Q
what would present with
- normal or low TSH
- normal or low T4
- normal or low T3
A
central hypothyroidism (pituitary and hypothalamic disorders)
5
Q
What antibody tests do you expect to be elevated in Hashimotos thyroiditis
A
- anti thyroid peroxidase (TPO) antibody
- Anti thyroglobulin (Tg) antibody
6
Q
What antibody tests do you expect to be elevated in Graves disease
A
TSH receptor antibody (TRAb)
7
Q
What is the most common cause of hypothyroidism
A
hashimoto’s thyroiditis (chronic autoimmune thyroiditis)
8
Q
is hashimoto’s thyroiditis more common in males or females
A
F>M 7:1
9
Q
increase risk of hashimoto’s thyroiditis associated with
A
- down syndrome
- turners syndrome
10
Q
hashitoxicosis
A
transient hyperthyroidism related to early inflammation
11
Q
precipitating factors to getting hashimoto’s thyroiditis
A
- stress
- infection
- pregnancy
- iodine intake
- radiation exposure
12
Q
management of hypothyroid
A
- synthetic thyroxine (T4) replacement
- leveothyroxine 1.6 mcg/kg/day
- monitoring is important: 6 week f/u to evaluate dosage
13
Q
definition of subclinical hypothyroidism
A
- elevated TSH with normal T4
14
Q
what risks are associated with subclinical hypothyroidism
A
- CV disease
- nonalcoholic fatty liver
- neuropsychiatric
- miscarriage and low birth weight babies
15
Q
managment of subclinical hypothyroidism
A
- repeat TSH and T4 after 1-3 months to confirm dx
- TSH > 10: tx recommended
16
Q
Hyperthyroidism most commonly affects what patient population
A
- W > M 5:1
- smokers
- graves: younger women
- toxic nodular goiter: older women
17
Q
clinical presentation
- exophthalmos, goiter
- weight loss
- tachycardia
- osteoporosis
A
Hyperthyroidism
18
Q
what presents with
- Low TSH
- High Free T4 and T3
A
Hyperthyroidism
19
Q
what presents with
- Low TSH
- normal Free T4 and T3
A
subclinical Hyperthyroidism
20
Q
Hyperthyroidism has what effect on glucose tolerance
A
- impairs glucose tolerance
21
Q
What does high uptake and low uptake mean on a 24 hour radioiodine uptake and scan
A
- high uptake: de novo synthesis of hormone
- low uptake: inflammation/destruction of thyroid gland or extrathyroidal source of thyroid hormone
22
Q
contraindications to 24 hour radioiodine uptake and scan
A
- pregnancy
- breast feeding
23
Q
24 hour radioiodine uptake and scan: HOT -> normal to high radioiodine uptake is consistent with what conditions
A
- Graves
- hashitoxicosis
- toxic nodular goiter
- iodine induced
24
Q
24 hour radioiodine uptake and scan: COLD -> near absent radioiodine uptake is consistent with what conditions
A
- exogenous ingestion of hormone
- thyroiditis
- CA? FNA?
25
clinical presentation
* lid retraction, stare, Exophthalmos, periorbital edema
* pretibial myxedema
* non nodular goiter
* hyperthyroidism symptoms
graves disease
26
graves disease is caused by
autoantibodies to thyrotropin receptor (TRAb)
27
What causes Toxic Multinodular goiter/Toxic adenoma
* diffuse or focal hyperplasia of follicular cells
* likelihood increases with age and iodine deficiency
28
what is a toxic adenoma
nodule with increased radioiodine uptake
29
what is a Toxic Multinodular goiter
palpable or defined goiter with multiple nodules
* focal area of increased radioiodine +/- cold spots
* concerning symptoms: cough, dysphagia, dyspnea
30
medication management of hyperthyroidism
* beta blocker: atenolol
* **thionamides**: added to BB for severe dx
* Methimazonle: daily dosing
* Propylthiouracil: preferred in pregnancy
31
first line treatment for hyperthyroidism
* radioiodine ablation
* typically provided following thionamide
32
tx of toxic adenoma/MNG
surgery
33
What are some other names of Subacute thyroiditis
* granulomatous
* de Quervain's
* gaint cell thyroiditis
34
Subacute thyroiditis is most common in what patient population
middle aged females
35
Subacute thyroiditis is associated with what
* URI
36
clinical presentation
* acute severely painful glandular enlargement (goiter)
* fever, fatigue
* can persist weeks to months
Subacute thyroiditis
37
how is Subacute thyroiditis diagnosed?
* clinical presentation
* predictable phases: hyperthyroid, euthyroid, hypothyroid, recovery (euthyroid)
* ESR and CRP elevated
38
treatment of Subacute thyroiditis
* ASA or NSAID
* prednisone if no improvement in several days
39
thyroid screening is recommended
* not in favor of routine screening
40
What factors put someone at a higher concern for cancerous thyroid nodules
* kids, men, adults \< 30 or \> 60
* hx head/neck radiation
* hx hematopoietic stem cell transplant
* fam h/o thyroid ca
41
Thyroid nodules 3 step approach
1. history and physical
2. TSH
3. thyroid US
42
high risk patients should have thyroid biopsy if nodule is
* 5-10 mm
* all solid nodules: 5 mm
43
low risk patients should have thyroid biopsy if nodule is
* solid nodule: 10-15 mm (Hypoechoic: 10 mm)
* mixed cystic and solid: 15-20 mm
44
when is FNA/biopsy indicated for all patients
* all patients with cervical lymphadenopathy
45
is FNA/biopsy indicated if nodule is purely cystic
no
46
Thyroid carcinoma is more common in what patient population? What worsens the prognosis?
* more common in females
* worse prognosis
* \< 20 yo
* \> 45 yo
* male
47
Causes of differentiated thyroid CA
* papillary: most common
* follicular
48
Causes of undifferentiated thyroid CA
* anaplastic
* poor prognosis
49
Causes of familial thyroid CA
* medullary
* test for RET mutations as a genetic marker
50
Management of thyroid ca
1. surgery
2. radioiodine ablation (follows surgery)
3. thyroid hormone suppression
* levothyroxine
51
Hypoparathyroidism causes
* **acquired**
* ****usually occurs post-thyroidectomy
* rarely, neck irradation
* autoimmune
* congenital
52
clinical presentation
* tetany
* sz
* weakness
* heart failure, hypotension, arrhythmia, prolonged QT interval
* papilledemia
acute Hypoparathyroidism
53
what specialized tests should you do when assessing for Hypoparathyroidism
* Trousseau's sign
* Chvostek's sign
54
clinical presentation
* ectopic calcifications
* parkinsonism
* dementia
* cataracts
* dry, coarse skin
* impaired dentition
* brittle nails
* hair loss
* renal stones, renal failure
chronic Hypoparathyroidism
55
what lab results would you expect in Hypoparathyroidism
* serum Ca2+
* serum phosphate
* urinary Ca2+
* alk phos
* PTH
* magnesium
* serum Ca2+: Low
* serum phosphate: High
* urinary Ca2+: Low
* alk phos: Nml
* PTH: Low
* magnesium: often elevated
56
tx for acute, emergent hypoparathyroidism
* IV calcium gluconate
57
treatment for chronic hypoparathyroidism
* calcium and vit D supplementation
58
most common cause of primary hyperparathyroidism
parathyroid adenoma
59
causes of secondary hyperparathyroidism
* chronic renal failure
* vit D deficiency
* renal osteodystrophy
60
clinical presentation
* **asymptomatic hypercalcemia**
* **bones, stones, abdominal moans, psychiatric groans"**
* ****fragile bones
* kidney stones, DI
* abd pain, N/V
* psychosis, depression
hyperparathyroidism
61
what lab results would you expect in secondary hyperparathyroidism
* serum calcium
* serum phosphate
* PTH
* serum calcium: low
* serum phosphate
* high (renal)
* low (Vit D)
* PTH: high
62
what diagnostics would you get to assess for hyperparathyroidism
* DEXA scan
* kidney function
* 24 hr urine
* parathyroid US
* sestabibi parahyroid scan (radioactive) with CT scan
63
definitive tx of hyperparathyroidism
* surgery: parathyroidectomy
* may be hypocalcemic post-op
64
conservative tx of hyperparathyroidism
* physical activity
* fluids
* avoid lithium and HCTZ
* restrict Ca2+ intake
65
medical management of primary hyperparathyroidism
* IV bisphosphonates
* can temporarily decrease hypercalcemia and treat bone pain
* pamidronate
* zoledronic acid
66
medical management of secondary or tertiary hyperparathyroidism
* phosphate binders: calcium carbonate or calcium acetate
* calcimimetics
* vitamin D
