Thyroid Disorders

Question 1

What is the most common cause of Hypothyroidism?

Answer 1

Failure of the thyroid gland due to burnt-out Hashimoto Thyroiditis

Question 2

What are more rare causes of Hypothyroidism?

Answer 2

Amiodarone
Dietary Deficiency of Iodine

Question 3

If TSH is less than double normal What do you do first?

Answer 3

get Antithyroid peroxidase/antithryroglobulin antibodies

Question 4

If Antithyroid Peroxidase/ Anti-thyroglobulin Ab are Positive what do you do next?

Answer 4

Replace thyroid hormone with Thyroxine

Question 5

If TSH is 2x normal and T4 is normal what should you do?

Answer 5

Replace thyroid hormone

Question 6

How do you treat Hypothyroidism?

Answer 6

Replace with Thyroxine

Question 7

What is Euthyroid Sick Syndrome?

Answer 7

Patient is clinically Euthyroid with a systemic illness and low serum thyroid hormone levels

Question 8

What Antibodies are common in Hashimoto’s?

Answer 8

Antithyroid Peroxidase
Antithyroglobulin

Question 9

What Thyroid function values are see in Euthyroid Sick Syndrome?

Answer 9

T3 is low
rT3 is high
T4 can be low

Question 10

What causes the lab abnormalities in Euthyroid Sick Syndrome?

Answer 10

T4 is converted to rT3 which is inactive instead of the active T3: this does not trigger an increase in TSH so it is not real hypothyroidism

Question 11

How do you treat Euthyroid Sick Syndrome?

Answer 11

Treat the underlying illness: thyroid replacement is not indicated

Question 12

What cause of Hyperthyroidism is T4 (thyroxine) elevated in?

Answer 12

All forms of Hyperthyroidism

Question 13

What Happens to TSH in Hyperthyroidism?

Answer 13

TSH decreases in all causes except Pituitary Adenomas

Question 14

What is the only form of Hyperthyroidism with an elevated TSH?

Answer 14

Pituitary Adenomas

Question 15

What lab value is used to monitor the disease in Hyperthyroidism?

Answer 15

Free T4: because TSH lags

Question 16

What are the common causes of Hyperthyroidism?

Answer 16

Graves Disease
Subacute Thyroiditis
Painless “silent” Thyroiditis
Exogenous thyroid hormone use
Pituitary adenoma
Medullary Cancer
Papillary cancer/Follicular cancer

Question 17

What are the unique features of Hyperthyrodism in Graves Disease?

Answer 17

Eye Proptosis
Skin findings
Bruit

Question 18

What unique feature is associated with hyperthyroidism in Subacute Thyroiditis?

Answer 18

Tender thyroid

Question 19

What unique feature is associated with hyperthyroidism in Painless “Silent” Thyroiditis?

Answer 19

Nontender thyroid with normal physical exam

Question 20

What unique feature is associated with hyperthyroidism in exogenous thyroid hormone use?

Answer 20

Involuted thyroid gland is non palpable

Question 21

What unique feature is associated with hyperthyroidism in Pituitary Adenoma?

Answer 21

High TSH level

Question 22

What unique feature is associated with Hyperthyroidism in Medullary cancer?

Answer 22

Increased calcitonin level

Question 23

What unique feature is associated with hyperthyroidism in Papillary cancer and Follicular cancer?

Answer 23

Increased Thyroglobulin

Question 24

What Diagnostic tests are available for Hyperthyroidism?

Answer 24

T4: elevated in all
TSH: only elevated in Pituitary adenoma
Thyroid-stimulating Ig
TPO Ab
Thyroglobulin

Question 25

What is the value of Thyroid -stimulating Ig in hyperthyroidism?

Answer 25

Confirms Graves disease

Question 26

What antibodies are associated with Graves Disease?

Answer 26

Thyroid-Stimulating Immunoglobuiln (TSI)

Question 27

What is the value of TPO antibodies in Hyperthyroidism?

Answer 27

Confirms the presence of an autoimmune thyroid disease

Question 28

What is the value of Thyoglobulin in Hyperthyroidism?

Answer 28

Confirms the presence of an autoimmune thyroid disease

Question 29

What happens to Radioactive Iodine Uptake in Graves Disease?

Answer 29

Elevated

Question 30

What happens to Radioactive Iodine Uptake in Subacute Thyroiditis?

Answer 30

Decreased

Question 31

What Happens to Radioactive Iodine Uptake in Painless 'silent" Thyroiditis?

Answer 31

Decreased

Question 32

What Happens to Radioactive Iodine Uptake in Exogenous thyroid hormone use?

Answer 32

Decreased

Question 33

What Happens to Radioactive Iodine Uptake in pituitary adenomas?

Answer 33

not performed

Question 34

What Happens to Radioactive Iodine Uptake in Toxic nodule?

Answer 34

Increased

Question 35

How do you treat Graves Disease?

Answer 35

Methimazole or PTU then radioactive Iodine

Question 36

How do you treat Subacute Thyroiditis?

Answer 36

Aspirin

Question 37

How do you treat exogenous thyroid hormone use?

Answer 37

Stop using

Question 38

How do you treat Pituitary adenoma?

Answer 38

Surgery

Question 39

How do you treat Postpartum Thyroiditis?

Answer 39

Beta blockers only

Question 40

How does The RAIU differ in Graves Disease and toxic nodule?

Answer 40

Toxic nodule has a focal uptake where as Graves Disease has diffuse uptake

Question 41

How do you treat Acute Hyperthyroidism "Thyroid Storm"?

Answer 41

Propranolol: blocks organ effect: inhibits T4 to T3 Thiourea drugs: Methimazole preferred (PTU preferred in pregnancy) -block hormone production Iodinated Contrast: blocks T4 to T3 Steroids: hydrocortisone Radioactive iodine: ablates the gland

Question 42

What are common side effects of PTU and Methimazole?

Answer 42

Neutropenia (decreased Neutrophils)

Question 43

What do you do if a patient has a thyroid nodule?

Answer 43

Chest TSH and T4: if tests are normal biopsy the gland

Question 44

If biopsy of a thyroid nodule shows follicular adenoma how do you treat?

Answer 44

Resection

Question 45

If biopsy of a thyroid nodule shows Cancer how do you treat?

Answer 45

Remove

Question 46

What is the best initial therapy for Graves Ophthalmopathy?

Answer 46

Steroids

Question 47

What worsens Graves Opthalmopathy?

Answer 47

Radiation if the patient is not pretreated with steroids because the thyroid will release Ag that worsens the eye

Question 48

If Graves Ophthalmopathy is not controlled with Steroids and radiation what can be used?

Answer 48

Teprotumumab

Question 49

How do you treat Painless "silent" Thyroiditis?

Answer 49

no treatment