Thyroid disease Flashcards by Melissa Ring

What is the indication of a slow thyroid

High TSH

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What is the indication of a fast thyroid

Low TSH

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What is goiter

An enlarged thyroid or abnormal growth of thyroid gland

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What is the most common cause of goiter

iodine deficiency

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What are the types of goiter

diffuse
multinodular

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What are the primary causes of goiter

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

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What are goitrogen rich foods that can effect thyroid function

broccoli
cauliflwoer
kale
peanuts
red wine
strawberries
peaches
mustard
tea
soy

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Which gender is at higher risk for goiter

females

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When do sporadic goiter from dysmorphogenesis and endemic goiter generally occur

in childhood

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Why does iodine deficiency lead to goiter

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

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What role does TSH have on the thyroid

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

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What is the biggest concern with goiter

dysphagia
dyspnea
hoarseness

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What is Pemberton maneuver

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

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

there is no hyper/hypothyroidism present

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What are examples of hyperthyroidism

graves disease
multi nodular goiter
toxic adenoma

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What is an example of hypothyroidism

hashimotos
*unless in area with endemic goiter

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What is the usual TSH range

.45-4.5

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

thyroidectomy

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What is the most common complication postoperatively with a thyroidectomy

hypocalcemia

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What is the etiology for hypothyroidism

Autoimmune
previous thyroid surgery
radiation
lithium
PTU

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What is the etiology for hyperthyroidism

Graves
toxic adenoma
toxic multi nodular (plummers dz)
Thyroiditis

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What is the clinical presentation with hypothyroidism

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

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What is the clinical presentation with hyperthyroidism

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

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What is the most common cause of hyperthyroidism

Graves disease

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What is the etiology of graves disease

autoimmune +FH HLA association Female>>>Male

What is the patho of graves disease

Caused by Thyroid stimulating immunoglobulin (TSI)

What are some graves disease specific symptoms that may occur

Graves orbitopathy (TED) Pretibial myxedema

What is an atypical presentation of graves disease in elderly

apathetic thyrotoxicosis

What are signs of extra thyroidal manifestations in Graves disease

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

What is a thyroid storm

sudden onset with severe symptoms of thyrotoxicosis

What is graves ophthalmopathy (thyroid eye disease)

Proptosis conjunctival irritation eye dryness diplopia

What in labs is diagnostic for graves disease

TSI

What will be seen in a CBC with hyperthyroidism

microcytic anemia thrombocytopenia

What will be seen on CMP with hyperthyroidism

bilirubinemia high transaminase hypercalcemia high alkaline phosphatase

What tests are done to diagnose Graves disease

Blood test Thyroid radioactive iodine uptake US to assess blood flow

What are some medications to treat hyperthyroidism

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

What is the recommended first line treatment for graves disease

radioactive iodine

What is the drug of choice for graves disease during pregnancy

PTU

How long can it take to control graves disease with hyperthyroidism

12-24months

What are symptoms of a thyroid storm in graves disease

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

What is toxic nodular goiter (Plummers disease)

Autonomously functioning thyroid nodules with resulting hyperthyroidism

When does hyperthyroidism generally occur with toxic adenomas

Adenomas >2.5cm diameter

Which populations are at greater risk for TNG

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

What is the most common lab finding for TNG

Low TSH with normal free Thyroxine (T4)

What substances are used for nuclear scintigraphy with TNG imagine

Technetium-99 Iodine-123 **(preferred)

How is nuclear scintigraphy useful in determining TNG vs Graves

Graves usually homogenous diffuse uptake where as thyroiditis has low uptake *TNG have patchy areas of increased and decreased uptake

When is an FNA indicated with TNG

Autonomously functioning thyroid nodule Dominant cold nodule in multinodular goiter Clinically sig nodule>1cm non-palpable nodules

What increases the risk for malignancy with TNG

Head/neck radiation in childhood and as an adult

How do you treat TNG with autonomously functioning nodules

radioactive iodine or surgery

Which patients should you treat vs just observe with subclinical hyperthyroidism

elderly pregnant women w/ osteopenia risk for afib

What is the treatment of choice for TNG

I-131

What Is hashimotos thyroiditis

Autoimmune dx that destroys thyroid cells and antibody mediated immune processes

What are the most common lab findings for hashimotos

elevated TSH low T4 increased antithyroid peroxidase (TPO)

what is the most common cause of hashimotos

iodine insufficient

What is the conventional treatment for hashimotos

levothyroxine (T4 gets converted to T3)

How do you diagnose hashimotos

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

What is myxedema

Edema like skin condition caused by increased glycosaminoglycan deposition

What are common signs of hashimotos

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

What are early symptoms of hashimotos

constipation fatigue dry skin weight gain

What are advanced sx of hasimotos

cold intolerance goiter apnea menorrhagia joint pain

What findings might be seen on physical exam for hypothyroidism

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

What are rare but urgent concerns for hasimotos

accumulation of fluid in pleural and pericardial cavities *myxedema coma is most severe presentation

What confirms diagnosis of primary hypothyroidism

T4, elevated TSH + TPO and TGab

What other labs will be elevated within a patient with hashimotos

CK prolactin total cholesterol LDL TG

What is the TOC for hypothyroidism

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

What is myxedema coma

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

How do you treat myxedema coma

icu admission IV levothyroxine respiratory supportive care fluid status

What other disorder is hashimotos associated with

gastric and other autoimmune

What is chronic autoimmune gastritis

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

What is cretinism

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

What are the signs and symptoms of cretinism

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

What are the diagnostic tests for thyroid nodules

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

What are the most common types of thyroid cancer

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

What forms of thyroid cancer have the best prognosis

Papillary and follicular *ATC=worst

How does thyroid cancer typically present

as a single nodule

What is diagnosis of thyroid cancer contingent on

cytologic or histologic findings on biopsy

What is the best first step for thyroid cancer dx

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

What is the mainstay of treatment for thyroid cancer

Surgical resection *recommended in >1cm lesion

Why can surgery not be preformed of ATC CA

Local invasion into trachea or vasculature generally makes it unresectable

What is the mortality rate for ATC CA

5 years

What is a common surgical complication with thyroid resection

recurrent laryngeal nerve injury

Thyroid disease Flashcards

(81 cards)