thyroid disorders Flashcards Preview

Clin Med-Endocrine > thyroid disorders > Flashcards

Flashcards in thyroid disorders Deck (102):
1

what is the function of the thyroid gland

produced thyroid hormones that control the rates of metabolic processes throughout the body

2

what is the sole purpose of iodine

to maintain euthyroid

3

what are some of the function of T3&T4

regulated catabolism
metabolic rate
heat production
GH secretion and skeletal maturation
CNS development
muscle tone
GI secretions
respiration

4

what are anti thyroid peroxidase

these are circulating antibodies against thyroid peroxidase
used to detect thyroid disorders

5

what is a goiter

an increase in the size of the thyroid gland
can occur in hyer/hypo or euthyroid
can be diffuse or nodular
due to hypertrophy of tissue from thyroid hormone

6

what is the pembertons sign

large substernal goiters can cause superior vena cava syndrome
facial erythema and cyanosis when both arms are raised over the head

7

What is congenital hypothyroidism

very rare and preventable
usually a child born without or half of a thyroid
Can also be due to lack of producing function thyroid

8

what are the signs and symptoms of congenital hypothyroidism

mental retardation
growth impairment
poor psychomotor development

9

that is the treatment for congenital hypothyroidism

screening at birth with hormone supplement

10

what are types of autoimmune hypothyroidism

hasimotos thyroiditis, atrophic thyroiditis

11

what are types of drug induced hypothyroidism

iodine excess, amiodarone, iodine contrast media, lithium, antithyroid drugs

12

what are the most common causes of hypothyroidism world wide

iodine deficiency

13

what is the most common cause of hypothyroidism in the US

autoimmune

14

what are some infiltrative and surgical processes that can cause hypothyroidism

amyloidosis, sarcoidosis, hemochromatosis
thyroidectomy

15

what are causes of transient hypothyroidism

sub acute thyroiditis
withdrawal of thyroxine Tx in individuals with an intact thyroid

16

what are secondary causes of hypothyroidism

hypopituitarism
hypothalamic disease

17

what is the most common form of thyroiditis and most common cause of thyroid disease in the US

hashimotos thyroiditis

18

what symptoms of hypothyroidism

weight gain
fatigue/lethargy
depression
constipation
dry skin
cold interolerance
weakness
DOE
muscle cramps
heavey/light or no period

19

what are signs of hypothyroidism

bradycardia
thin brittle nails
thinning hair
puffy face/eyelids
pale skin

20

what are signs and symptoms that are unique to hashimotos

initially present with transient hypoerthyroidism due to destruction of thyroid
many present b/c of non-tender goiter initially and then later in the disease they will present with the common signs/symptoms of hypothyroidism

21

what will the serum TSH and FT4 be like for primary hypothyroidism

will be elevated
FT4 will be normal or low
if hashimotos antibodies against thyroperoxidase are high

22

what are TSH and FT4 values like with secondary hypothyroidism

low or normal
low or normal

23

what are the other lab abnormalities like with hypothyroidism

increased serum LDL, cholesterol, triglycerides, lipoprotein, liver enzymes, and creatine kinase, hyponatermia, hypoglycemia and anemia

24

what is subclinical hypothyroidism

patients w/ normal FT4 and mildly elevates TSH
maybe benefit thyroid replacement
if they are asymptomatic then there is no need to replace just monitor for symptoms

25

when should you use imaging

usually not necessary
If a goiter is present and asymmetric the ultra-sound should be indicated to show if there is solitary lesion or multinodular goiter
if a solitary lesion/focal nodule is present fine needle aspiration is recommended

26

what are some complications of hypothyroidism

myxedema
infertility
miscarriage
cardiac complications
megacolon
increased risk of bacterial pneumonia

27

what is the mainstay treatment for hypothyroidism

levothyroxine

28

when started on levothyroxine treatments are started when should TSH levels be monitored

6-8weeks after initiation

29

how long will it take for the replacement take to be effective

3-6 months

30

how should the dosages be adjusted for treatment with levothyroxine

small increments of 12.5-25ug/day

31

what should you do with your patient once normal levels are maintained and stable for 1 year

follow up with TSH on annual basis

32

what should you start pt<60 yo with heart disease

50-100ug

33

what is the starting dose for elderly patients?

12.5-25ug much lower than younger patients

34

what happens if you do not treat a pregnant women with hypothyroidism

may affect fetal neural development and cause preterm labor

35

when should you check thyroid for pregnant women

2nd and 3rd trimesters

36

what should you do with women who have known hypothyroidism

increase their levothyroxine by 50% during pregnancy

37

what is myxedema crisis

severe life threatening hypothyroidism

38

what are the symptoms of myxedems crisis

impaired cognition
convulsions and abnormal CNS signs
severe hypothermia, hypoventilation, hyponatremia, hypoglycemia, and hypotension and kidney injury

39

who is myxedema crisis most common in

women who have had a stroke or stopped thyroid meds

40

what is the treatment for myxedema crisis

rapid thyroid hormone replacement and supportive therapy

41

what is hyperthyroidism

a condition in which the thyroid gland is overactive, making too much thyroid hormone

42

what are types of primary hyperthyroidism

graves, toxic multinodular goiter
struma ovarii
drugs

43

what are causes of transient hyperthryoidism

subacute thyroiditis
thyroid destruction
thyrotoxicosis factitia

44

what are causes of secondary hyperthyroidism

TSH pituitary adenoma
thyroid hormone resistance
molar pregnancy
gestational thyrotocixcosis

45

what is the most common cause of hyperthyroidism

graves disease

46

when is graves disease

autoimmune disease affecting the thyroid gland characterized y an increase in synthesis and release of thyroid hormones

47

what increases the risk factors for hyperthyroidism

high iodine intake as well as medication use (potassium iodide, amiodarone-contain iodine)
genetics

48

what is the pathogenisis of graves disease

caused by production of antibodies to the thyroid glands TSH receptors
Ab stimulate the receptor and are called thyroid stimulating immunoglobulins which leads to increased thyroid gland hormone production

49

what age group is graves disease most common age

20-50years old
more common in women

50

what is toxic single/multinodular goiter

autonomouslt secreting nodules produced thyroid hormone w/o the need for TSH receptor stimulation

51

what is single toxic nodule hyperthyroidism

plummers disease

52

what is granulomatous thyroiditis (dequervain thyroiditis)

initially inflammation causes thyroid follicle destruction with release of thyroid hormones, followed by period of hypothyroidism while glands are recovering and then euthyroid returns

53

what is lymphocytic thyroiditis

causes brief thyrotoxic state followed by hypothyroidism then resolution
common in postpartum women

54

what are other causes of hyperthyroidism

ovarian teratoma
metastatic thyroid cancer
pituitary tumor
Iodine-induced
amiodarone

55

what is the jod baselow effect

occurs in patients with an endemic goiter who relocated to an iodine abundant geographical area

56

what are symptoms of thyrotoxicosis/hyperthyroidism

hyperactivity
heat intolerance and sweating
palpitations
weight loss despite increased appetite
diarrhea
polyuria

57

what are signs of hyperthyroidism

tachycardia
tremor
goiter
warm moist skin
palmar erythema
lid retraction or lag
fever

58

what are signs specific to graves disease

enlarged thyroid with a bruit due to vascularity of gland
lid retraction, periorbital edema, conjunctival injection proptosis, visual disturbance
pretibial brawny thickening of skin

59

what are the lab values like for hyperthyroidism (TSH,FT4,T3)

TSH-low
FT4-elevated
T3-norm or elevated

60

what is elevated erythrocyte or ESR indicative of

subacute thyroiditis

61

what is ultra sounds useful for with thyroid disorders

helpful for patients with palpable thyroid

62

what is a thyroid scan used for

used to evaluate uptake radioactive iodine in the thyroid scan

63

how to treat graves disease

symptomatic treatment
reduce T4 production
radioactive iodine
ant-thyroid drugs
iodinated contrast agents
surgery

64

what are you going to want to use for symptomatic treatments for graves disease

beta blocker to relieves tachycardia, tremor
propanolol
atenolol

65

How does radioactive iodine work to treat graves disease

destroys thyroid gland so lifelong replacement of thyroid hormone
In adenoma/toxic nodules- the adenomas take up the iodine, destroying it and leaving the normal gland tissue intact

66

when is the use of radioactive iodine contraindicated

pregnant women because of risk of fetus developing hypothyroidism

67

how do antithyroid drugs work

interferes with the production of T4
does not permanently damage thyroid
lower chance of post treatment

68

When is methimazole preferred

second line therapy for pregnant/ breastfeeding women

69

when to use PTU

in pregnancy and breastfeeding

70

how do iodinated contrast agents like iopnanoic acid or ipondate sodium work

temprorary tx for thyrotoxicosis
bloack conversion of T4 to T3
NOT USED FOR DEFINITIVE LONG TERM TX

71

when should surgery be used to treat hyperthyroidism

pts who fail medication and RAI with large goiters compromising airway
pts are treated with antithyroid drug prior to surgery to obtain euthyroid state

72

what are complications of thyroid surgery

recurrent laryngeal nerve paralysis or hypoparathyroidism

73

what is the treatment of choice for single toxic adeoma

RAI
surgical resection

74

what is the treatment for toxic multinodular goiter

medical tx for symptomatic tx to normalize thyroid function
followed by surgery which is the definitive treatment

75

how do you treat lymphocytic thyroiditis

improves over weeks on own
symptomatic treatment with beta blocker

76

what is the treatment for De Quervain thyroiditis

will subside spontaneously with in week to months
short course of NSAID of steriods
ANTI THYROID medis ineffective

77

what triggers thyroid storm

stressfull illness, thyroid surgery or RAI

78

what are signs and symptoms of thyroid storm

marked delirium
severe tachycardia, vomiting, diarrhea, dehydration and very high fever

79

what is the goal of treatment for thyroid storm

induce a euthyroid state
anti-thyroid drugs, ipodate sodium, iodine tx, propanolol, hydrocortisone then followed by radioactive iodine ablation or surgery

80

the risk of malignancy of non-toxic thyroid adenomas and multinodular goiters are higher in which of the following patients?

hx of head and neck radiation
total body radiation for bone marrow transplant
FH of thyroid cancer
hoarsness
vocal cord paralysis
thyroid nodule

81

what are signs and symptoms of non-toxic thyroid adenomas mutinodular goiters

cosmetically embarrassing
cause discomfort and dyphagia
cause dyspnea d/t tracheal compression

82

what is the labs you want to order for a patient with a thyroid nodule

serum TSH
antithyroperoxidase Ab and antithyroglobulin Ab

83

what imaging is the initial test of choice for nodules

ultrasound- this measures the size and if there is multinodular goiter present

84

what increases the risk of the nodule being malignant

irregular or indistinct margins, greater than 1cm

85

what is the best method to determine if a nodule id benign or malignant

fine needle aspiration or biopsy done with US guidance

86

what is done to nodules including benign

monitoring with regular periodic palpation and US 6 months and re-biopsied if growth occurs

87

when is levothyroxine use for non-toxic thyroid adenomas

for larger benign nodules >2cm

88

when is the use of levothyroxine contraindicated

pts with cardiac disease

89

surgery is required for all types of what kind of nodules

malignant

90

what is the most common malignancy of endocrine system

thyroid cancer

91

Who is most at risk for thyroid cancer

increased incidence with age
more likely in females than males but males have a worse prognosis

92

what are risk factors for thyroid cancer

head and neck radiation
bilateral disease
nodule>4cm
iodine deficiency
FH of thyroid cancer
hoarse voice
nodule fixed to other structures
lymph involvement

93

what is the most common type of thyroid cancer

papillary
presents with single nodule
related to childhood history of radiation
genetics
lest agressive

94

what is the second most common type of thyroid cancer

follicular
more aggressive than papillary
due to gene mutations or translocation

95

what makes up about 3% of thyroid cancers

medullary
1/3 sporadic
1/3 familial
1/3 associated with MEN type2

96

what makes up 2% of thyroid cancer

anaplastic
present in older pts
most aggressive
due to gene mutations

97

what are signs and symptoms of thyroid cancer

palpable firm non-tender nodule
most are asymptomatic some can cause neck discomfort

98

how would a thyroid cancer be diagnosed

FNA biopsy with cytology testing

99

what is usually high in metastatic disease

high serum thyroglobulin

100

what is elevated with medullary carcinoma

serum calcitonin
carcinoembryonic antigen

101

What can you use for imaging

U/S help localize and measure
RAI scan-post
thyroidectomy
CT/MRI-located metastasis

102

what is the first line treatment for thyroid cancer

surgery
RAI therapy
radiation therapy
thyroid hormone supplementation