Thyroid Disorders

Question 1

Hypothyroidism main Etiology

Answer 1

almost always from a single cause: failure of the thyroid

gland from burnt-out Hashimoto thyroiditis.

Question 2

Hypothyroidism less common Etiology

Answer 2

Dietary deficiency of iodine

AmIODArone

Question 3

Hypothyroidism cx fx

Answer 3

almost all bodily processes being slowed

down—except menstrual flow, which is increased.

Question 4

Hypothyroidism management if TSH is very high (more than double the upper limit of normal) with
normal T4,

Answer 4

replace hormone. thyroxine (Synthroid)

Question 5

Hypothyroidism management if TSH is less than double the normal
… wait old note that sounded weird..

here is a new one
Remaking the question:
You have low T4 and T3, High TSH. How would you confirm primary hypothyroidism?

Answer 5

get antithyroid peroxidase/antithyroglobulin antibodies. If antibodies are positive, replace thyroid hormone.

they are typical for Hashimoto’s thyroiditis= the classic one (but may also be present in Graves’ disease).

Think of Hashimoto as jaPanese Tyrona de Globos

Question 6

Hypothyroidism intestinal transit

Answer 6

Constipation

Question 7

Hypothyroidism refelxes

Answer 7

Decreased reflexes

Question 8

Hypothyroidism cold or hot

Answer 8

Cold intolerance

Question 9

Hyperthyroidism intestinal transit

Answer 9

Diarrhea (hyperdefecation)

Question 10

Euthyroid Sick Syndrome patho

Answer 10

nonthyroidal systemic illness + low serum levels of thyroid hormones

Question 11

Euthyroid Sick Syndrome Dx

Answer 11

t3 low
reverseT3 high
+- t4 low (t4 is converted into rT3)
TSH NO HIGH!

Question 12

Euthyroid Sick Syndrome tx

Answer 12

treat the underlying cause. NO hormone replacement

Euthyroid is written with E like the number 3= the only affected hormone is T3. This is all because a non-thyroidal disease

Question 13

Don’t order thyroid function tests in
patients with ____________. The results will not be
accurate.

Answer 13

nonthyroid critical

illness

Question 14

What Is the Most Likely Diagnosis?” Eye (proptosis) (20%–40%) and skin (5%)
findings

Answer 14

Graves disease

Question 15

What Is the Most Likely Diagnosis? Tender thyroid

Answer 15

Subacute thyroiditis

Question 16

Painless “silent” thyroiditis cxfx

Answer 16

Nontender, normal exam results

Question 17

What Is the Most Likely Diagnosis? Involuted gland is not palpable

I guess + High t3t4

Answer 17

Exogenous thyroid hormone

use

Question 18

Etiology/“What Is the Most Likely Diagnosis?” high tsh level

Answer 18

Pituitary adenoma

Question 19

Hyperthyroidism dx

Answer 19

All forms of hyperthyroidism have an elevated T4 (thyroxine) level.

Question 20

Graves disease dx

Answer 20

only kind of hpth that has TSH receptor antibodies.

Indication: if Graves disease is suspected but classic clinical features are absent

Question 21

Thyroglobulin Significance

Answer 21

Detects recurrence of thyroid cancer

Question 22

Thyroid-stimulating immunoglobulin TSI) Significance

Answer 22

Confirms Graves disease

Not positive in toxic multinodular goiter

Question 23

Thyroperoxidase antibody (TPO) Significance

Answer 23

Confirms presence of Hashimoto

thyroiditis

Question 24

Graves disease

labs: TSH, RAIU, Confirmatory

Answer 24

TSH low, RAIU ↑, Confirmatory: positive antibody test (TSI)

[TSH receptor antibody =TRAb]

Question 25

Subacute thyroiditis | labs: TSH, RAIU, Confirmatory

Answer 25

TSH low, RAIU ↓, Confirmatory: tenderness

Question 26

Painless “silent” thyroiditis | labs: TSH, RAIU, Confirmatory

Answer 26

TSH low, RAIU ↓, Confirmatory:none

Question 27

Exogenous thyroid hormone use labs: TSH, RAIU, Confirmatory

Answer 27

TSH low, RAIU ↓, Confirmatory: History and involuted, nonpalpable gland

Question 28

Pituitary adenoma | labs: TSH, RAIU, Confirmatory

Answer 28

TSH ↑, RAIU not done, Confirmatory MRI oh head

Question 29

Radioactive iodine uptake measurement (RAIU test):

Answer 29

a test that quantifies the percentage of the administered amount of radioactive iodine taken up by the thyroid gland

Question 30

Toxic nodule: | labs: TSH, RAIU, Confirmatory

Answer 30

``` ↓ TSH ↑ RAIU Focal uptake of radioactive iodine Graves is diffuse ```

Question 31

Graves disease Tx

Answer 31

Radioactive iodine. thioamides: PTU or methimazol

Question 32

Subacute thyroiditis tx

Answer 32

Aspirin

Question 33

Painless “silent” thyroiditis tx

Answer 33

None

Question 34

Exogenous thyroid hormone use tx

Answer 34

Stop use

Question 35

Pituitary adenoma tx

Answer 35

Surgery

Question 36

Treatment of Acute Hyperthyroidism and “ Thyroid Storm

Answer 36

cold IV fluids 1 Propranolol: blocks target organ effect, inhibits peripheral conversion of T4→T3 2 Thiourea drugs (****methimazole**** or propylthiouracil): blocks hormone production 3 Iodinated contrast material (iopanoic acid and ipodate): blocks the peripheral conversion of T4 to the more active T3; also blocks the release of existing hormone 4 Steroids (hydrocortisone) 5 Radioactive iodine: ablates the gland for a permanent cure for all ...qx resection for Graves is rarely done alternative!

Question 37

Graves Ophthalmopathy tx

Answer 37

Steroids are the best initial therapy. Radiation is used in those not responding to steroids. Severe cases may need decompressive surgery.

Question 38

Graves disease important cxfx

Answer 38

esophtalmos | pretibial myxedema

Question 39

hashimoto's tyroditis patho

Answer 39

after inflamated, it dies

Question 40

multiondular goiter | toxic adenoma

Answer 40

tons of t4.

Question 41

factitious disorder hyperthyroidism

Answer 41

someone who intentoinaly takes t4

Question 42

struma ovarii

Answer 42

ovarian lesion produciong t4

Question 43

struma ovarii and factitious disorder hyperthyroidism

Answer 43

both have cold tyroid

Question 44

when to treat a subclinical hypothyroidisim

Answer 44

only if tsh>=10 OR | if there arre symptoms

Question 45

myxedema coma

Answer 45

coma+hypothermica+hypotensjon dur to too low t4.

Question 46

myxedema coma tx

Answer 46

IVF blankets give t4. not working? t3 amboss:IV combination of levothyroxine and liothyronine plus IV hydrocortisone o sea t4+t3