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Flashcards in Thyroid Disease Deck (34):
1

Presenting symptoms of hyperthyroidism

progressive nervousness, palpitations, weight loss, irritability, fine resting tremor, dyspnea on exertion, concentration difficulties

2

Physical exam findings of hyperthyroidism

fine resting tremor, rapid pulse, elevated BP (more in systolic so greater pulse pressure), atrial fib

3

acute hypermetabolic state associated with sudden release of large amounts of thyroid hormone into circulation

thyroid storm

4

Symptoms of thyroid storm

autonomic instability, confusion, psychosis, restlessness, dysrhythmias,

5

pathophysiology of Graves dx

autoimmuno disorder caused by immunoglobulins (IgG) antibodies that bind to TSH receptors initiating the production and release of thyroid hormone

6

common, distinct feature of Graves dx

exophthalmos

7

second most common cause of hyperthyroidism

autonomous thyroid nodule that secretes thyroxine (ignores TSH)

8

other causes of hyperthyroidism besides Graves and autonomous thyroid nodule

iatrogenic hyperthyroidism (overuse of thyroxine supplement), thyroditis (acute stages)

9

Lab values in hyperthyroidism

elevated thyroxine (free T4) and low TSH

10

Once hyperthyroidism is established with lab values, what test to do next?

radionucleotide imaging (direct scan of gland) with tech99 or iodine123

11

How to Graves appear on radionucleotide scan

diffuse hyperactivity with large amounts of uptake

12

How does thyroiditis appear on radionucleotide scan

patchy uptake with overall reduced activity (reflects release of hormone rather than overproduction of it)

13

How to treat Graves

radioactive iodine

14

Who shouldn't get radioactive iodine

pregnant mothers and children

15

What are alternatives to radioactive iodine?

anti-thyroid meds like PTU, methimazole, carbimazole (inhibit organification of iodine and prevents conversion of T4 into T3; the more active form)

ESP EFFECTIVE IN ADOLESCENTS WITH GRAVES

16

Harmful side effects of antithyroid drugs

hepatotoxicity (PTU; blackbox warning), agranulocytosis

17

If iodine/antithyroid meds aren't working for Graves?

SURGERY; can also do this if huge goiter is compressing nearby structures

18

Symptoms of hypothyroidism

weight gain, cold intolerance, hair loss, lethargy, dry skin, slowed mentation, constipation, depressed

19

What can hypothyroidism be confused with in elderly patients?

Alzheimers

20

Most common cause of noniatrogenic hypothyroidism in the US

hashimoto's thyroiditis

21

Iatrogenic/other causes of hypothyroidism

post-Graves disease thyroid ablation and surgical removal of thyroid gland, secondary to hypothalamus/pituitary dysfunction (i.e. intracranial radiation or removal of pituitary adenoma)

22

Primary hypothyroidism vs secondary hypothyroidism on lab values

Primary - elevated TSH, low T4 (dysfunction with gland)
Secondary - low TSH, low T4 (dysfunction in HPA axis)

23

Once primary hypothyroidism is diagnosed, what workup is needed next?

NOTHING! esp if thyroid gland is normal on physical....just start supplementing with thyroid

24

Once secondary hypothyroidism is diagnosed, what workup is needed next?

need to determine if hypothalamus or pituitary is the problem

IV TRH test! stimulates pituitary to release TSH. If pituitary releases TSH, then hypothalamus done fucked up. If there is no increase in TSH, the pituitary done fucked up

25

Starting dose for thyroid replacement

25-50 ug daily then increase to 25 every 3-4 weeks until optimal dose is reached

26

How to determine is thyroid replacement dose is appropriate?

Serial TSH checks! Check 4-6 weeks after adjustment has been made

Check for TSH between 0.3 (too much thyroid) and 5 (too little thyroid/ bad med adherence)

27

Incidence of malignancy in incidental finding of thyroid nodule

5-6% SO WORK THESE UP

28

Risk factors for thyroid cancer

family history, dysphagia, SOB, cervical lymphadenopathy, new onset hoarse voice

29

How to evaluate a thyroid nodule

Ultrasound for size, character (cystic v solid), presence of other nodules
thyroid function tests (measure TSH)

30

Prognosis of functional adenoma

rarely malignant

31

When to biopsy a nodule

when nodule measure greater than 1cm in person with elevated or normal TSH

do this with FNA

32

Types of thyroid carcinomas and how to diagnose

papillary, medullary, anaplastic thyroid carcinomas

dx by FNA

33

Treatment for thyroid cancer

thyroidectomy followed by radioactive ablation

34

In pregnant patient, when to use PTU vs methimazole

if they aren't pregnant and can't do radioactive iodine METHIMAZOLE IS FIRST LINE

but if they are preggo
PTU 1st trimester
methimazole 2nd and 3rd