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Endocrine Clin med > Thyroid disease > Flashcards

Thyroid disease Flashcards

1
Q

What is the indication of a slow thyroid

A

High TSH

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2
Q

What is the indication of a fast thyroid

A

Low TSH

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3
Q

What is goiter

A

An enlarged thyroid or abnormal growth of thyroid gland

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4
Q

What is the most common cause of goiter

A

iodine deficiency

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5
Q

What are the types of goiter

A

diffuse
multinodular

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6
Q

What are the primary causes of goiter

A

physiological (puberty/preggers)
Iodine deficiency
Goitrogens
Dysmorphogensis
granulomatous disease

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7
Q

What are goitrogen rich foods that can effect thyroid function

A

broccoli
cauliflwoer
kale
peanuts
red wine
strawberries
peaches
mustard
tea
soy

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8
Q

Which gender is at higher risk for goiter

A

females

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9
Q

When do sporadic goiter from dysmorphogenesis and endemic goiter generally occur

A

in childhood

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10
Q

Why does iodine deficiency lead to goiter

A

It increases the demand of thyroid hormone, causing the pituitary gland to release more TSH

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11
Q

What role does TSH have on the thyroid

A

stimulates follicular cells and with continuous long term stimulation leads to follicular hyperplasia and thyroid enlargement

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12
Q

What is the biggest concern with goiter

A

dysphagia
dyspnea
hoarseness

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13
Q

What is Pemberton maneuver

A

elevating arms may lift goiter into thoracic inlet and cause stridor, dyspnea or enlargement of neck veins

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14
Q

What does it mean if there is non-toxic thyroid or goiter

A

there is no hyper/hypothyroidism present

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15
Q

What are examples of hyperthyroidism

A

graves disease
multi nodular goiter
toxic adenoma

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16
Q

What is an example of hypothyroidism

A

hashimotos
*unless in area with endemic goiter

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17
Q

What is the usual TSH range

A

.45-4.5

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18
Q

IF there is intervention done for non-toxic goiter, what is the mainstay treatment

A

thyroidectomy

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19
Q

What is the most common complication postoperatively with a thyroidectomy

A

hypocalcemia

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20
Q

What is the etiology for hypothyroidism

A

Autoimmune
previous thyroid surgery
radiation
lithium
PTU

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21
Q

What is the etiology for hyperthyroidism

A

Graves
toxic adenoma
toxic multi nodular (plummers dz)
Thyroiditis

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22
Q

What is the clinical presentation with hypothyroidism

A

anorexia
fatigue
anemia
bradycardia
memory impairment
constipation
cold intolerance
Hypo-reflexia

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23
Q

What is the clinical presentation with hyperthyroidism

A

Nervousness
heat intolerance
sweating
weight loss + increased appetite
tachycardiaa
hyperreflexia
loose stool

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24
Q

What is the most common cause of hyperthyroidism

A

Graves disease

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25
Q

What is the etiology of graves disease

A

autoimmune
+FH
HLA association
Female»>Male

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26
Q

What is the patho of graves disease

A

Caused by Thyroid stimulating immunoglobulin (TSI)

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27
Q

What are some graves disease specific symptoms that may occur

A

Graves orbitopathy (TED)
Pretibial myxedema

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28
Q

What is an atypical presentation of graves disease in elderly

A

apathetic thyrotoxicosis

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29
Q

What are signs of extra thyroidal manifestations in Graves disease

A

Thyroid eye disease
Thyroid dermopathy (thickening of skin, difficult to pinch, peau d’ orange appearance)
Bone involvement (swelling is metacarpals)
onycholysis (Plummers nails)

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30
Q

What is a thyroid storm

A

sudden onset with severe symptoms of thyrotoxicosis

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31
Q

What is graves ophthalmopathy (thyroid eye disease)

A

Proptosis
conjunctival irritation
eye dryness
diplopia

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32
Q

What in labs is diagnostic for graves disease

A

TSI

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33
Q

What will be seen in a CBC with hyperthyroidism

A

microcytic anemia
thrombocytopenia

34
Q

What will be seen on CMP with hyperthyroidism

A

bilirubinemia
high transaminase
hypercalcemia
high alkaline phosphatase

35
Q

What tests are done to diagnose Graves disease

A

Blood test
Thyroid radioactive iodine uptake
US to assess blood flow

36
Q

What are some medications to treat hyperthyroidism

A

PTU / methimazole
radioactive iodine treatment
+/- propranolol until thyrotoxicosis resolves

37
Q

What is the recommended first line treatment for graves disease

A

radioactive iodine

38
Q

What is the drug of choice for graves disease during pregnancy

A

PTU

39
Q

How long can it take to control graves disease with hyperthyroidism

A

12-24months

40
Q

What are symptoms of a thyroid storm in graves disease

A

medical emergency!
AMS
N/V/D
hypertension
tachyarrhythmias
fever

41
Q

What is toxic nodular goiter (Plummers disease)

A

Autonomously functioning thyroid nodules with resulting hyperthyroidism

42
Q

When does hyperthyroidism generally occur with toxic adenomas

A

Adenomas >2.5cm diameter

43
Q

Which populations are at greater risk for TNG

A

Women, >50y/o
toxicity peaking in 6th-7th decade of life

44
Q

What is the most common lab finding for TNG

A

Low TSH with normal free Thyroxine (T4)

45
Q

What substances are used for nuclear scintigraphy with TNG imagine

A

Technetium-99
Iodine-123 **(preferred)

46
Q

How is nuclear scintigraphy useful in determining TNG vs Graves

A

Graves usually homogenous diffuse uptake where as thyroiditis has low uptake

*TNG have patchy areas of increased and decreased uptake

47
Q

When is an FNA indicated with TNG

A

Autonomously functioning thyroid nodule

Dominant cold nodule in multinodular goiter

Clinically sig nodule>1cm

non-palpable nodules

48
Q

What increases the risk for malignancy with TNG

A

Head/neck radiation in childhood and as an adult

49
Q

How do you treat TNG with autonomously functioning nodules

A

radioactive iodine or surgery

50
Q

Which patients should you treat vs just observe with subclinical hyperthyroidism

A

elderly
pregnant
women w/ osteopenia
risk for afib

51
Q

What is the treatment of choice for TNG

A

I-131

52
Q

What Is hashimotos thyroiditis

A

Autoimmune dx that destroys thyroid cells and antibody mediated immune processes

53
Q

What are the most common lab findings for hashimotos

A

elevated TSH
low T4
increased antithyroid peroxidase (TPO)

54
Q

what is the most common cause of hashimotos

A

iodine insufficient

55
Q

What is the conventional treatment for hashimotos

A

levothyroxine (T4 gets converted to T3)

56
Q

How do you diagnose hashimotos

A

Clinical sx
lab results of elevated TSH and normal to low T4

57
Q

What is myxedema

A

Edema like skin condition caused by increased glycosaminoglycan deposition

58
Q

What are common signs of hashimotos

A

Scaly and dry
alopecia
bradycardia
fatigue
exercise intolerance
muscle weakness/myopathy

59
Q

What are early symptoms of hashimotos

A

constipation
fatigue
dry skin
weight gain

60
Q

What are advanced sx of hasimotos

A

cold intolerance
goiter
apnea
menorrhagia
joint pain

61
Q

What findings might be seen on physical exam for hypothyroidism

A

elevated BP
delayed relaxation of tendon reflexes
brittle nails
bradycardia
ataxia
macroglossia

62
Q

What are rare but urgent concerns for hasimotos

A

accumulation of fluid in pleural and pericardial cavities

*myxedema coma is most severe presentation

63
Q

What confirms diagnosis of primary hypothyroidism

A

T4, elevated TSH
+ TPO and TGab

64
Q

What other labs will be elevated within a patient with hashimotos

A

CK
prolactin
total cholesterol
LDL
TG

65
Q

What is the TOC for hypothyroidism

A

titrated levothyroxine sodium

*do not give with iron or calcium and take early am on empty stomach

66
Q

What is myxedema coma

A

extreme form of hypothyroidism
-stupor
hypoventilation
hypothermia
hyponatremia
shock&death

67
Q

How do you treat myxedema coma

A

icu admission
IV levothyroxine
respiratory supportive care
fluid status

68
Q

What other disorder is hashimotos associated with

A

gastric and other autoimmune

69
Q

What is chronic autoimmune gastritis

A

partial or complete loss of parietal cells leading to impairment of hydrochloric acid and intrinsic factor production

70
Q

What is cretinism

A

Congenital hypothyroidism from a deficiency in thyroid hormone during early fetal development

71
Q

What are the signs and symptoms of cretinism

A

intellectual disability
deaf/mute
gait disturbances
short stature
puffy hands&feet
spasticity

72
Q

What are the diagnostic tests for thyroid nodules

A

thyroid US
TSH
T4
*if nodule >.6, strongly consider bx

73
Q

What are the most common types of thyroid cancer

A

papillary thyroid cancer
follicular thyroid cancer
medullary thyroid cancer
anaplastic thyroid cancer

74
Q

What forms of thyroid cancer have the best prognosis

A

Papillary and follicular

*ATC=worst

75
Q

How does thyroid cancer typically present

A

as a single nodule

76
Q

What is diagnosis of thyroid cancer contingent on

A

cytologic or histologic findings on biopsy

77
Q

What is the best first step for thyroid cancer dx

A

biopsy

*if micro calcification, hypo echoic interiors ill defined margins, modularity, chaotic vascular flow = malignant suspicion

78
Q

What is the mainstay of treatment for thyroid cancer

A

Surgical resection
*recommended in >1cm lesion

79
Q

Why can surgery not be preformed of ATC CA

A

Local invasion into trachea or vasculature generally makes it unresectable

80
Q

What is the mortality rate for ATC CA

A

5 years

81
Q

What is a common surgical complication with thyroid resection

A

recurrent laryngeal nerve injury

Endocrine Clin med (6 decks)

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