Thyroid CIS

Question 1

Cretinism

Answer 1

Metal retardardaion and growth delays which results form thyroid hormone deficiency during development

Question 2

___ is essential for the development of the CNS

Answer 2

TH

Question 3

Clinical manifestations of Cretinism

Answer 3

• short stature
• potbelly
• enlarged, protruding tongue
• developmentally delayed

Question 4

The most valid and useful assessment of thyroid function is a ____ test.

Answer 4

Serum TSH

Question 5

In hyperthyroidism TSH will be ____ and T4 will be ___

Answer 5

• decreased

- increased

Question 6

Overproduction of thyroid hormone by a nodule with low TSH and gland hypertrophy around the the thyroid gland is ____.

Answer 6

Toxic adenoma or “hot nodule”

Question 7

A toxic nodular goiter is a ____.

Answer 7

is a mulitnodular toxic andenoma

Question 8

What pattern is seen in hyperthyroid thyroiditis?

Answer 8

hyperthyroidism –> euthyroidism –> hypothyroidism –> euthyroidism

Question 9

Thyroiditis with a painful gland is ____ and ____.

Answer 9

Subacute thyroiditis and is viral

Question 10

Thyroiditis with non-tender glands is ____ and ____. An example is ____

Answer 10

• Silent thyroiditis
• transient
• postpartum thyroiditis

Question 11

6 Causes of hyperthyroidism

Answer 11

1. Autoimmune (graves disease)
2. exogenous TH
3. Toxic adenoma
4. Nodular goiter
5. subacute thyroiditis
6. silent thyroiditis

Question 12

Results of a radioactive Iodine test in Hyperthyroidism

Answer 12

Increased uptake of I and less in urine

Question 13

Results of radioactive Iodine test in Hypothyroidism

Answer 13

Small amounts taken up by thyroid and large amounts excreted in urine

Question 14

Silent thyroiditis is also know as ______

Answer 14

Subacute lymphocytic

Question 15

The most common cause of hyperthyroidism is _____.

Answer 15

Graves Disease

Question 16

What the the Triad of Graves Disease?

Answer 16

1. Hyperthyroidism
2. Exophthalmos
3. Shin Edema

Question 17

Graves Disease is an ________ disease in which ______ auto-antibodies are directed towards the _____ receptor.

Answer 17

• autoimmune disease
• activating
• TSH

Question 18

Treatment in graves disease: (4)

Answer 18

• immune suppression
• antibody clearance
• blocking thyroid function
• gland removal

Question 19

Graves disease occurs commonly in ____ages ____

Answer 19

• women ages 20-40

Question 20

Eye changes in graves disease is dt ______.

Answer 20

increased volume of retro-orbital connective tissue and extraocular mm from inflammation

Question 21

Primary hypothyroidism effects the _____

Answer 21

thyroid gland

Question 22

Secondary Hypothyroidism effects the _____. What lab values would we see?

Answer 22

• anterior pituitary

- low TSH and T4/T3

Question 23

Tertiary hypothyroidism effects the ___

Answer 23

hypothalamus

Question 24

Examples of Primary hypothyroidism: (2)

Answer 24

1. Hashimoto’s Disease

2. Radioactive ablation of the thyroid

Question 25

Example of secondary Hypothyroidism: (3)

Answer 25

1. Pituitary insufficiency 2. TBI 3. Sheehan's

Question 26

Example of tertiary Hypothyroidism: (1)

Answer 26

1. hypothalamic disease

Question 27

The most common disorder of hypothyroidism in iodine sufficient areas is _____

Answer 27

Hashimoto's Thyroiditis

Question 28

Autoimmune antibodies present in Hashimoto's Thyroiditis (4) | Type?

Answer 28

1. Thyroid peroxidase 2. TSH receptor 3. thyroglobulin 4. iodine transporter type = blocking

Question 29

Hormone levels in Hashimoto's Thyroiditis:

Answer 29

- Increased TSH and TRH | Decreased T3 and T4

Question 30

Classical Presentation of Hashimoto's / hypothyroidism: (8)

Answer 30

- goiter - skin changes - peripheral edema - constipation - headache - fatigue - anovulation - brittle hair

Question 31

Treatment of Hashimoto's:

Answer 31

T4 replacement therapy with levothyroxine

Question 32

Hashimoto's Thyroiditis is more common in ___ ages ____ and is seen in _____.

Answer 32

- women ages 45-65 | - clusters in families

Question 33

In Hashimoto's Thyroiditis, the thyroid gland is ______ and we see a ______ of the gland.

Answer 33

- inflamed | - gradual failure

Question 34

The absence of iodine for an extended period of time will result in which changes to thyroid laboratory values?

Answer 34

- High TSH | - Low T3/T4

Question 35

Administration of thyroid hormone to a patient with hypothyroidism will have what effect?

Answer 35

Decrease in TSH levels

Question 36

Clinical findings in Hyperthyroidism: (8)

Answer 36

- weight loss - sweating - palpitations - nervousness/ tremors - exophthalmos - diarrhea - hair thinning - shin edema

Question 37

Testing shows a suppressed TSH and an increased homogeneous radioactive iodine uptake. Which finding would be likely in the patient?

Answer 37

- elevated thyroid stimulating immunoglobulins

Question 38

Laboratory findings in hypothyroidism:

Answer 38

- high TSH | - Low T3/T4

Question 39

What physical exam findings would be present in the case of recurrent hyperthyroidism? What would the radioactive iodine test show?

Answer 39

1. Thyroid gland hypertrophy | 2. increase uptake of Iodine

Question 40

What physical exam finding would be present in the case of over replacement of thyroid hormone?

Answer 40

Thyroid gland atrophy (small gland)

Question 41

Why do we see amenorrhea/ | anovulation and increased prolactin in hypothyroidism?

Answer 41

- lack of T3/T4 = no negative feed on anterior pituitary - increase in TRH --> increase in TSH and prolactin Prolactin --> inhibits GnRH causing amenorrhea and anovulation (no LH/FSH)

Question 42

A 33 y/o male takes L-thyroxine 1 μg orally each day. He asks how the thyroxine works on a cellular levels. Which is the best explanation?

Answer 42

It binds to a cytoplasmic receptor, and the hormone-receptor complex diffuses into the nucleus to affect transcription.

Question 43

Role of rT3?

Answer 43

rT3 has little biological effect

Question 44

What is Euthyriod Sick Syndrome? And what value will be elevated? how is it treated?

Answer 44

- mild hypothyroid symptoms are seen in ill patients with normal functioning thyroids - see an elevation in rT3 - treated by treating the illness