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Clin Med 2 > Thyroid and PTH > Flashcards

Thyroid and PTH Flashcards

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1
Q

T3

A

3,5,3’-triiodothyronine

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2
Q

T4

A

thyroxine

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3
Q

What are some signs of accumulation of matrix substances that accompany hypothyroidism?

A

Puffy facies
Loss of eyebrows
Periorbital edema
Tongue enlargement

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4
Q

What are some less common sx of hypothyroidism?

A 
–Decreased hearing
–Myalgias/arthralgias/paresthesias
–Depression
–Menstrual changes
–Pubertal delay
–Diastolic HTN
–Pleural and pericardial effusions
–Ascites
–Galactorrhea
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5
Q

What labs should you check with hypothyroidism?

A

TSH, Free T4, T3, BMP (for decreased Na+ and elevated creatinine), lipids and DRUG LEVELS

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6
Q

What two antibodies should be elevated in Hashimotos?

A

anti-TPO and anti-thyroglobulin

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7
Q

What patients should you screen for hypothyroidism?

A 
Goiter
Hx of autoimmune dz
hx of head/neck radiation
family hx thyroid dz
pt on meds that impair thyroid function
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8
Q

What meds impair thyroid function?

A 
lithium
amiodarone
aminogluthimide
interferon alpha
thalidomide
betaroxine
stavudine
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9
Q

What labs do you expect to see in subclinical hypothyroidism?

A

High TSH and normal T4

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10
Q

What labs do you expect to see with secondary hypothyroidism?

A

TSH normal (not appropriately elevated) and low T3

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11
Q

What are three T4 replacement drugs?

A

Levothroid, Levoxyl, Synthroid

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12
Q

Who should you replace T4 in slowly?

A

elderly and people with cardiac abnormalities

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13
Q

What are two important things to note about replacement of T4 (pt ed)?

A

Missing a dose should not change levels too drastically

Take on an empty stomach

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14
Q

How fq should you monitor T4?

A

every 6 weeks initially

eventually yearly

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15
Q

What will bind up T4 and lower therapeutic levels?

A

estrogen

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16
Q

What should you remember about armour thyroid?

A

Monitor it more frequently

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17
Q

What are symptoms of subclinical hypothyroidism?

A

CVD
Nonalcoholic fatty liver disease
Neuropsychiatric symptoms
Miscarriage and low birth weight babies

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18
Q

What lab is unique to Grave’s disease?

A

Thyroid Stimulating Immunoglobulin (TSH Receptor Antibody)

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19
Q

What are common causes of hyperthyroidism?

A 
Graves
early Hashimoto's
Autonomous thyroid tissue (adenoma or multinodular goiter)
TSH-mediated hyperthyroidism 
hCG mediated
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20
Q

What are some common causes of thyroiditis?

A 
subacute granulomatous
painless
postpartum
amiodarone induced
radiation
palpation
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21
Q

What are some common sx of hyperthyroidism?

A 
Skin changes (sweating)
Stare and lid lag
Graves’ ophthalmopathy
Cardiovascular
LOW TOTAL AND HDL
Impaired glucose tolerance
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22
Q

Signs of hyperthyroidism

A

normochromic normocytic anemia
bone changes
irritability

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23
Q

What is Grave’s ophthalmopathy?

A

decreased ocular muscle movement
periorbital edema
conjunctival edema

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24
Q

In addition to Thyroid stimulating immunoglobulin, what other labs are elevated in Graves disease?

A

Anti-thyroid and anti TPO

ANA and Anti-ds DNA may also be elevated

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25
What test confirms hyperthyroidism?
24 hour radioiodine uptake scan high uptake=endogenous hormone synthesis low uptake=inflammation or destruction of gland CI in PGN/Breastfeeding
26
Tx options for Graves (hyperthyroidism)
``` –Beta-blockers –Thionamides •Methimazole •Propylthiouracil (PTU) –Radioiodine ablation –Surgery (last resort) ```
27
What signs/symptoms are a/w subacute thyroiditis? How do you treat?
Painful glandular enlargement leads to DYSPHAGIA, sometimes associated with VIRUS Tx with aspirin
28
What are the causes of benign thyroid nodules?
multinodular goiter Hashimoto's cysts Follicular adenoma
29
What are some causes of malignant adenomas?
CARCINOMAS: Papillary, follicular, medullary, anaplastic Primary T lymphoma metastatic carcinoma
30
What is the most common type of thyroid cancer?
Papillary, best prognosis until stage 4
31
What is the most aggressive form of thyroid cancer?
anaplastic, highly aggressive
32
What two questions do you ask when treating a nodule?
Are they cancerous? Think high risk groups | Are they causing dysfunction?
33
What does a very high TSH mean?
Higher risk for thyroid cancer
34
You have a suspicious thyroid nodule with normal TSH. What is your first choice for evaluation?
Fine needle aspiration
35
You have a suspicious thyroid nodule with low TSH. What is your first choice for eval?
Thyroid scan looking for hot nodule or cold nodule
36
What if you have a hot nodule on thyroid scan?
DON'T BIOPSY IT!
37
In what high-risk groups are fine needle biopsies recommended for nodules?
Anyone with a high risk history and a nodule greater than 5 MM, with or without suspicious sonograph features anyone with accompanying cervical node enlargement Anyone with microcalcifications in nodules
38
When is FNB recommended for patients with solid nodules?
when HYPOECHOIC and greater than 1 CM | when HYPERECHOIC and less than 1 CM
39
When is FNB recommended for patients with multi-cystic nodules?
with suspicious ultrasound features and greater than 1.5-2.0 cm with no suspicious ultrasound features and greater than 2.0 cm
40
What is FNA not recommended?
with a purely cystic nodule
41
What should you do when approaching a nodule that is greater than 4 cm?
obtain multiple samples, in general hold off on small samples (less than 1 cm) unless they are high risk
42
Macro or microfollicular thyroid lesion... Which is more benign?
Macrofollicular with abundant colloid
43
Pt with irritability, stridor, cataracts, thin/brittle nails, dry/scaly skin, loss of eyebrows, and hyperactive DTRs
hypoparathyroidism
44
Labs of hypoparathyroidism
Low Ca2+, high phosphate, low urine calcium, normal alk phosphatase Mg is often elevated
45
Treatment in ER for acute tetany
IV calcium gluconate and AIRWAY
46
Treatment for hypoparathyroidism
Ca2+ and vitamin D, +/- Mg
47
What do you need to avoid in hypoparathyroidism?
Furosemide (loop diuretics)
48
Symptoms of hyperparathyroidism
Bones, stones, abdominal moans, psychiatric moans, fatigue overtones, SHORT QT
49
Most likely hyperparathyroidism labs
PTH from 60-500, total serum Ca2+ less than 15
50
Most likely malignancy labs (ddx hyperparathyroid)
PTH less than 20 with total calcium being less than 15 (mild PTH)
51
What are normal PTH and Ca2+ labs?
PTH less than 70 with total serum calcium less than 11 (ish... just focus on hypers)
52
What should you supplement in hyperparathyroidism? Avoid?
Supplement Vit D | Avoid lithium and thiazide diuretics
53
What is medical management for hyperpara?
IV bisphosphonates (you know the -dronates) or estrogen in post menopausal women
54
In which diseases is thyroglobulin typically elevated? In which is it typically monitored most closely?
Acute thyroiditis Graves’ disease THYROID CANCER
55
When are TgAb (thyroglobulin antibodies) typically elevated?
Hashimotos>>Graves | Used to evaluate the likelihood that Graves patient will eventually become hypothyroid with no destruction of the gland
56
When are microsomal TPO antibodies seen?
Hashimotos>>Graves, also in post-partum thyroiditis
57
What are Thyrotropin Receptor Blocking Antibodies (TBAb or TSBAb)? In what disease are they elevated?
Antibodies which prevent TSH from binding to the cell receptor, etiology for HYPOTHYROIDISM since it prevents binding SEEN ONLY IN HASHIMOTO'S
58
TBI and TBII
GRAVEs>>Hashimotos
59
Low TSH, what do you evaluate?
FT4, FT3, Tg, TPO Ab’s, TgAB’s, TSI
60
High TSH, what do you evaluate?
FT4 and AB’s (all)
61
What types of cysts are typically benign?
Homogenous (same types of tissues as opposed to degeneration of tissue)
62
What if you encounter a heterogenous cyst?
Get T3, T4, antibodies, repeat u/s in 6 months. BIOPSY NODULES GREATER THAN 4MM, wait on smaller than 4 mm (per Roch)
63
You find a follicular nodule on U/S... What do you do next?
FINE NEEDLE ASPIRATION (TEST QUESTION)
64
Which PTH test is most indicative of parathyroid disease?
intact PTH (as opposed to total)

Clin Med 2 (13 decks)

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