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Thyroid Disorders Flashcards

1
Q

Hypothyroidism TSH, T3 and T4 levels

A

High TSH

Low T3 and T4

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2
Q

Hyperthyroidism TSH, T3 and T4 levels

A

Low TSH

High T3 and T4

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3
Q

Goiter

A

Occurs when the thyroid gland is unable to secrete enough thyroid hormone to meet metabolic needs, so it becomes larger.

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4
Q

Endemic Goiter

A

Caused by lack of iodine in the diet.

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5
Q

Sporadic Goiter

A

Related to ingestion of large amounts of certain drugs and foods.

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6
Q

Goiter Sequela

A

Monotone voice
Dysphagia
Tracheal compression

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7
Q

Goiter Labs

A

T3, 4 and TSH are usually normal

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8
Q

Goiter Tx

A

reduce hyperplasia and correct underlying dysfxn.
Fine needle aspiration for fast growing goiters
Surgery for large goiters

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9
Q

Hypothyroidism epidemiology

A

3-5% of population has some form
Women > men
Increases with age
Most common cause = hashimotos thyroiditis

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10
Q

Primary hypothyroidism

A 
Iodine deficiency
Autoimmune:  Hashimotos
Post partom thyroiditis
Drug induced
Normal aging
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11
Q

Secondary Hypothyroidism

A 
Neoplasm
Surgery
Post partom necrosis
Cushings
Radiation
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12
Q

Tertiary Hypothyroidism

A

Hypothalamus dysfxn
Hemochromatosis
Sarcoidosis

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13
Q

Hypothyroidism History

A

fatigue, weakness, lethargy
Cold intolerance
Myalgias, arthralgias
Hair loss, menstrual irregularities

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14
Q

Hypothyroidism physical findings

A 
Dry, course skin and brittle nails
Hoarse voice
Periorbital edema
Delayed reflexes
Bradycardia
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15
Q

Hypothyroidism Tx

A

> 50 + CVD = Levothyroxine .025 - .05 mg/day

>50 NO CVD = .075 mg/day

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16
Q

Hypothyroidism monitoring

A

If hypothalamic-pituitary axis intact: TSH measurements

W/ Pituitary insufficiency: T3 and T4 up to 1.4 and .5 ng/dl

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17
Q

Hashimotos Thyroiditis

A

Most ommon
AKA chronic lymphocytic thyroiditis
Associated with non-hodgkins lymphoma

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18
Q

Hashimotos epidemiology

A

Autoimmune and genetic
5-10x more common in women
Usually occurs between 30 and 60

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19
Q

Hashimotos Dx

A

Anti-thyroid peroxidase antibodies

Goiter, low hormone levels

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20
Q

Hashimotos S/S

A

Painless goiter
Fatigue, weakness, weight gain
Fullness in throat, neck pain
Low grade fever

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21
Q

Hashimotos Tx

A

Thyroid hormone replacement
Levothyroxine (synthroid)
Monitor TSH

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22
Q

When to treat subclinical hypothyroidism?

A

If TSH is >10 mU/L

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23
Q

Myxedema

A 
Tissue proliferation in rxn to increased TSH levels
Usually a hx of hypothyroid dz
Older adults
Droopy eyelids, decreased reflexes
**Facial puffiness**
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24
Q

Myxedema Tx

A

Levothyroxine

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25
Myxedema Coma
True life-threatening emergency End-stage expression of hypothyroidism Most frequently seen in elderly women
26
Myxedema Coma S/S
Coma, hypothermia, CV collapse | Metabolic disorders
27
Myxedema Coma Tx
Supportive measures Correct CV and hemodynamic abnormalities Prevention!
28
Certinism
Severely stunted mental and physical growth Usually due to maternal hypothyroidism Severely delayed puberty Infertility
29
Cretinism Tx
Thyroid replacement
30
Hyperthyroidism
AKA Thyrotoxicosis 102 cases in 1,000 each year Most common cause is Grave's Most common in women 20-40
31
Hyperthyroidism Symptoms
Nervousness, diaphoresis heat intolerance Palpitations, fatigue, weight loss Frequent bowel movements
32
Hyperthyroidism Signs
``` Tachycardia Goiter, skin changes Pretibial myxedema Tremor Exopthalmos Lid Lag Osteoporosis ```
33
Hyperthyroidism Lab Findings
Low TSH | Increased T3 and T4
34
Tx for grave's or toxic goiter
``` Methimazole (Tapazole) 5-15 mg/day Propylthiouracil (PTU) 100-150 mg/day radioactive iodine Tx Surgical Tx Propranolol (For less severe hyperT) ```
35
Radioactive iodine treatment
Permanent cure for hyperthyroidism
36
Hyperthyroid Surgery can result in?
Hypothyroidism | Severed recurrent laryngeal nerve
37
Grave's Disease
Organ-specific autoimmune disorder | Body produces anti-TPO, anti-TG and TSI
38
TSI
Thyroid Stimulating Immunoglobulin | Acts as a TSH agonist
39
Graves epedemiology
Females 4:1 Age 20-50 Spontaneous remission in 1/4 of pts
40
Graves Tetrad of symptoms
Nontender, smooth symmetric thyroid enlargement Hyperthyroid state Exopthalmos Pretibial Myxedema
41
Other Graves S/S
Extremely thin digits Excess sweating Flat affect, weakness, Afib
42
Graves Dx
Most specific = ELISA for TSHR-Ab Evelates TSI Radioactive iodine uptake
43
Graves Tx
``` Methimazole (Tapazole) Propylthiouracil (PTU) Beta Blockers Radioactive Iodine and Steroids Surgery ```
44
Multinodular Goiter
"Plummers Disease" Characterized by functionally autonomous nodules Older people, iodine insufficiency
45
Multinodular Goiter Dx
Decreased TSH Elevated T3, T4 Thyroid scan shows multiple functioning nodules
46
Factitous Hyperthyroidism
Ingestion of levothyroxine by eithyroid individuals Health care workers, dieters, body builders.... Attempt to lose weight T3 and 4 are elevated, Decreased TSH
47
Thyroid Storm
Life-threatening crisis Hyperthyroidism Stress, infxn, DKA, Trauma
48
Thyroid Storm S/S
Very febrile Cardiovascular Effects CNS effect N/V
49
Thyroid Storm Tx
``` Peripheral cooling Replace fluids, glucose, electrolytes Propranolol Glucocorticoids Propylthiouracil and Methimazole ```
50
Thyroiditis
Similar to hyperthyroidism Leakage of thyroid hormone **RAIU is Low**
51
What differentiates thyroiditis from Hyperthyroidism?
RAIU is Low
52
Acute Thyroiditis
``` Rare complication of septicemia Fever, skin redness **Tender Thyroid** Treat with IV Abx I&D of gland may be required ```
53
Subacute Thyroiditis
Secondary to viral infxn Fever, anterior neck pain Exquisitely tender thyroid NO RAIU
54
Postpartum Thyroiditis
Occurs in 5-10% of women post-partum 3-12 months post-delivery Eventually resolves 25-30% will develop hypothyroid within 5 yrs
55
Postpartum Thyroiditis S/S
**Thyroid gland is NONtender** | Low uptake of RAI
56
Postpartum Thyroiditis Tx
Propranolol | Levothyroxine if hypothyroidism develops
57
Iodine Induced thyroiditis
Jod-Basedow | Contrast agents for angiography or CT
58
Amiodarone Induced Thyroiditis
Amio is iodinated | Can occur in normal pt's or pt's w/ thyroid dz.
59
Riedel's Struma
Chronic Thyroiditis Rare Thyroid gland is stony hard and adheres to surrounding tissue. Tx with steroids, tamoxifen
60
Thyroid Nodules
Most often a benign neoplasm Usually solitary Often painless Appear cold on thyroid scan
61
Solitary Thyroid Nodule
Usually benign and occurs in most everyone by death. Hard, fixed nodule Lymphadenopathy Cold nodule on scan
62
T of F: A hot nodule is suspicious for Cancer.
False. A cold nodule is suspicious for cancer. | Hot nodules are very low risk for cancer
63
Thyroid Cancer
1% of malignant neoplasias Painless swelling of thyroid Normal thyroid fxn test Scan usually shows cold lesions
64
Papillary Carcinoma
``` Most common Slow growing Generally asymptomatic Painless neck mass Elevated thyroglobulin levels Good prognosis ```
65
Follicular Carcinoma
Slow growing Regional nodes Spread to lung or bone
66
Medullary Carcinoma
Familial affiliation C-cells of thyroid Nodule in upper half of thyroid **Calcitonin is tumor marker**

Endocrinology (16 decks)

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