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Clin Med I - Endocrine > Thyroid Disease > Flashcards

Thyroid Disease Flashcards

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1
Q

What do the follicular cells of the thyroid gland produce?

A
  • thyroid hormone
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2
Q

What do the C cells or parafollicular cells of the thyroid gland produce?

A
  • calcitonin
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3
Q

What is the function of the thyroid gland?

A
  • produce thyroid hormones that control the rates of metabolism throughout the body
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4
Q

In the ______ tissues, ____ is converted to _____.

A
  • body
  • T4
  • T3
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5
Q

Between T4 & T3, which has the greater metabolic effect/is stronger, more potent?

A
  • T3
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6
Q

What is essential to maintain euthyroid function?

A
  • iodine
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7
Q

How is the thyroid gland regulated?

A
  • neg. feedback
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8
Q

How is thyroid function assessed?

A

LABS:

  • TSH (thyroid stimulating hormone)
  • T4 (thyroxine)
  • T3 (triiodothyronine)
  • anti-thyroid antibodies
  • anti-thyroid peroxidase (antiTPO)
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9
Q

What is goiter?

A
  • increased size of thyroid

- usually palpable

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10
Q

When does goiter occur?

A
  • hypothyroid
  • euthyroid
  • hyperthyroid
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11
Q

What causes a goiter?

A
  • hypertrophy of tissue from thyroid hormone output malfunction
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12
Q

What complications can occur as a result of goiter?

A
  • compression of esophagus, trachea, jugular v, and superior vena cava
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13
Q

Define Pemberton’s Sign

A
  • facial erythema and jugular v. distention that progresses to cyanosis and facial erythema when both arms are raised over the head
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14
Q

What is the most preventable cause of mental retardation?

A
  • congenital hypothyroidism
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15
Q

What is the etiology of congenital hypothyroidism?

A
  • thyroid gland dysgenesis or agenesis

- inborn error of thyroid hormone synthesis

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16
Q

What do the S&S of congenital hypothyroidism result in?

A
  • cretinism
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17
Q

What are the S&S of congenital hypothyroidism?

A
  • mental retardation
  • growth impairment (most noticeable)
  • poor psychomotor development
  • permanent neurologic damage (occurs if tx is delayed)
  • infants may appear normal at first d/t maternal hormones
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18
Q

What is the treatment/prevention of congenital hypothyroidism?

A
  • screening at birth

- tx with hormone supplement

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19
Q

What are the types of hypothyroidism?

A
  • primary
  • transient
  • secondary/central
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20
Q

What are the etiologies of primary hypothyroidism?

A
  • autoimmune
  • drugs
  • congenital
  • iodine deficiency
  • acquired (s/p thyroidectomy)
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21
Q

What are the etiologies of transient hypothyroidism?

A
  • subacute thyroiditis

- withdrawal of thyroxine tx

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22
Q

What are the etiologies of secondary/central hypothyroidism?

A
  • hypopituitarism

- hypothalamic disease

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23
Q

What is the most common form of thyroiditis & most common cause of thyroid disease in the US?

A
  • Hashimoto’s thyroiditis
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24
Q

What is the cause of Hashimoto’s thyroiditis?

A
  • autoimmune

- lymphocytic infiltration of the thyroid

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25
What are the symptoms of hypothyroidism?
- wt gain - fatigue/lethargy - depression - constipation - dry skin - cold intolerance
26
What are the signs of hypothyroidism?
- bradycardia - thin brittle nails - thinning hair - thinning lateral 1/2 eyebrows - non-pitting pretibial edema - puffy face & eyelids
27
What is the name for the constellation of hypothyroid symptoms?
- myxedema
28
What are the S&S unique to Hashimoto's?
- initial transient hyperthyroidism d/t release of T3/T4 from damaged cells - eventually develops into a hypothyroid state d/t destruction of gland - non-tender goiter initially then common S&S of hypothyroidism
29
What labs should be drawn for hypothyroidism?
- *serum TSH* - FT4 (free T4) - anti-thyroid antibodies - anti-thyroid peroxidase (antiTPO)
30
What will the TSH level be in primary hypothyroidism?
- elevated
31
What will the FT4 level be hypothyroidism?
- low or low-normal
32
What are the anti-thyroid antibody levels in hypothyrodism?
- high
33
What other lab abnormalities are common in chronic hypothyroidism?
- increased LDL, cholesterol, triglycerides, liver enzymes, & creatine kinase - hyponatremia - hypoglycemia - anemia
34
What are the lab values for subclinical hypothyroidism?
- normal FT4 | - mildly elevated TSH
35
What is the tx for subtle symptoms of subclinical hypothyroidism?
- thyroid replacement
36
What is the tx for asymptomatic subclinical hypothyroidism?
- close monitoring
37
T/F: Imaging is always necessary for hypothyroidism dx.
- false
38
When is imaging necessary for hypothyroidism?
- asymmetric goiter = US | - solitary lesion/focal nodule = FNA (fine needle aspiration)
39
What are complications of hypothyroidism?
- myxedma crisis (rare) - infertility - miscarriages - sellar enlargement/TSH secreting tumors - cardiac complications - megacolon - increased risk of bacterial PNA
40
What is the tx for hypothyroidism?
- daily levothyroxine
41
When should labs be redrawn s/p hypothyroid tx?
- 6wks
42
How fast are TSH response?
- gradual
43
How are levothyroxine doses adjusted?
- small increments (12.5-25mcg/d)
44
What is the starting dose in elderly patients?
- low (12.5-25mcg qd)
45
What is the risk of untreated preggers with hypothyroidism?
- adverse fetal neural development | - preterm labor
46
What is the dose of levothyroxine in preggers?
- increased by 50%
47
Define myxedema crisis
- severe, life-threatening hypothyroidism
48
What pt pop is myxedema crisis seen in?
- elderly women who have had a stroke or stopped thyroid replacement
49
What causes myxedema crisis?
- underlying infx - cold exposure - drug use
50
What is the tx goal of myxedema crisis?
- rapid thyroid hormone replacement | - supportive therapy to correct other metabolic conditions
51
Define hyperthyroidism
- overactive thyroid making too much thyroid hormone
52
What are the causes of hyperthyroidism?
- primary - transient - secondary
53
What are the etiologies of primary hyperthyroidism?
- graves - toxic multinodular goiter or toxic adenoma - struma ovarii - drugs
54
What are the etiologies of transient hyperthyroidism?
- subacute thyroiditis, Hashimotos - thyroid destruction - thyrotoxicosis factita
55
What are the etiologies of secondary hyperthyroidism?
- TSH secreting pituitary adenoma - thyroid hormone resistance syndrome - molar pregnancy - gestational thyrotoxicosis - metastatic follicular thyroid cancer
56
Define Graves Disease
- autoimmune disorder affecting the thyroid gland | - characterized by an increase in synthesis and release of thyroid hormone
57
What is the most common cause of hyperthyroidism?
- Graves
58
What are the risk factors of Graves?
- high iodine intake as well as medication use | - genetic/family hx
59
What is the pathogenesis of Graves?
- antibodies to the thyroid gland's TSH receptors
60
Define toxic single/multinodular goiter?
- nodules that produce thyroid hormone w/o the TSH receptor stimulation
61
What are the types of subacute thyroiditis?
- granulomatous thyroiditis (de Quervains or painful) | - lymphocytic thyroiditis (painless or silent)
62
Define granulomatous thyroiditis
- initial inflam causes thyroid follicle destruction and release of thyroid hormones followed by hypothyroidism then euthyroid
63
Define lymphocytic thyroditiis
- brief thyrotoxic state followed by hypothyroisim then resolution
64
What is the pt pop of lymphocytic thyroiditis?
- postpartum
65
What are the etiologies of hyperthyroidism?
- ectopic thyroid hormone production - pituitary tumor - iodine-induced hyperthyroidism - amiodarone-induced thyrotoxicosis
66
What are the symptoms of hyperthyroidism?
- hyperactivity/irritability/dysphoric, anxiety - heat intolerance & sweating - palpitations - fatigue & weakness - wt loss w/ increased appetite - diarrhea - polyuria - oligomennorhea, loss of libido - insomnia, impaired concentration
67
What are the signs of hyperthyroidism?
- tachycardia, atrial fib in elderly - tremor - goiter - warm. moist skin
68
What are signs specific to Graves?
- diffusely enlarged thyroid - graves opthalmopathy - thyroid dermopathy (pretibial myxedema)
69
What are the lab findings of Graves?
- low TSH - elevated FT4 - (+) anti-thyroid & anti-thyroid peroxidase Abs
70
What imaging should be done for Graves?
- thyroid US - thyroid scan (RAI uptake) - MRI & CT scan for graves opthalmopathy - EKG (not diagnostic)
71
What is the tx for Graves?
- symptomatic - reduce T4 production via RAI, ATD, iodinated contrast agents, surgery - beta blockers
72
When is RAI contraindicated?
- preggers
73
What are the ATD drugs used to tx Graves/hyperthyroidism?
- methimazole | - propylthiouracil (PTU)
74
How is iodinated contrast agents a tx for hyperthyroidism?
- temporary tx for thyrotoxicosis of any cause | - not used for definitive tx or long term
75
Who is treated with surgery for hyperthyroidism?
- pts who fail rx & RAI | - large goiters causing difficulty swallowing or airway compromise
76
What are potential complications of thyroidectomy?
- recurrent laryngeal n. paralysis | - hypoparathyroidism
77
What is the tx for single toxic adenoma?
- RAI ablation
78
What is the tx for toxic multinodular goiter?
- surgery
79
What is the tx for lymphocytic thyroiditis (painless, autoimmune)?
- symptomatic w/ beta blocker
80
What is the tx for De Quervains thyroiditis (painful, s/p virus)?
- short course NSAIDs or steroids | - ATD are ineffective
81
What are the S&S of thyroid storm?
- marked delirium - severe tachycardia - vomiting - diarrhea - dehydration - very high fever
82
What is the tx of thyroid storm?
- induce euthyroid state (ATD, ipodate sodium, iodide, propranolol, & hyrdocortisone) followed by RAI or surgery
83
What does non-toxic mean in relation to thyroid disorder?
- normal hormone levels
84
What are the S&S of non-toxic thyroid adenomas & multinodular goiters?
- large nodule can cause discomfort, hoarsness, & dysphagia - Pemberton sign - most small are asymptomatic
85
What do all nodules & goiters require?
- labs & initial diagnostic imaging
86
What imaging is obtained for nodules/goiter?
- *US* - RAI scan - CT - FNA bx
87
What is the best method to assess a nodule/goiter for malignancy?
- FNA bx w/ US guidance
88
What is the tx for non-toxic thyroid adenomas & multinodular goiters?
- monitoring w/ regular periodic palpation & US q6m - rebx if growth occurs - levothyroxine suppression therapy (>2cm nodules) - surgery
89
What is the most common malignancy of the endocrine system?
- thyroid CA
90
What are the types of thyroid CA?
- papillary - follicular - medullary - anaplastic - other
91
Describe papillary thyroid CA
- most common | - least aggressive
92
What is the most aggressive type of thyroid CA?
- anaplastic
93
What are the S&S of thyroid CA?
- palpable - firm - non-tender - fixed - large
94
What is the definitive diagnostic test of choice for thyroid CA?
- FNA bx w/ cytology
95
What are the TFT (thyroid function test) for thyroid CA?
- generally normal
96
What (& why) imaging is done for thyroid CA?
- US: helps localize, measure, & asses for metastaitc dz - RAI: used s/p thyroidectomy - CT/MRI/PET: locates metastasis
97
What is the tx for thyroid CA?
- *surgery* - RAI (131 I) - radiation - levothyroxine s/p thyroidectomy
98
What are the complications of thyroid CA?
- metastasis to lungs, bone, brain, adrenals, or LN
99
What are the complications of thyroid CA secondary to surgery?
- hypothyroidism - hypoparathyroidism - vocal cord paralysis

Clin Med I - Endocrine (6 decks)

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