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thyroid disorders Flashcards

1
Q

what is the function of the thyroid gland

A

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

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2
Q

what is the sole purpose of iodine

A

to maintain euthyroid

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3
Q

what are some of the function of T3&T4

A 
regulated catabolism
metabolic rate
heat production
GH secretion and skeletal maturation
CNS development
muscle tone
GI secretions 
respiration
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4
Q

what are anti thyroid peroxidase

A

these are circulating antibodies against thyroid peroxidase

used to detect thyroid disorders

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5
Q

what is a goiter

A

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

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6
Q

what is the pembertons sign

A

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

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7
Q

What is congenital hypothyroidism

A

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

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8
Q

what are the signs and symptoms of congenital hypothyroidism

A

mental retardation
growth impairment
poor psychomotor development

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9
Q

that is the treatment for congenital hypothyroidism

A

screening at birth with hormone supplement

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10
Q

what are types of autoimmune hypothyroidism

A

hasimotos thyroiditis, atrophic thyroiditis

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11
Q

what are types of drug induced hypothyroidism

A

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

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12
Q

what are the most common causes of hypothyroidism world wide

A

iodine deficiency

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13
Q

what is the most common cause of hypothyroidism in the US

A

autoimmune

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14
Q

what are some infiltrative and surgical processes that can cause hypothyroidism

A

amyloidosis, sarcoidosis, hemochromatosis

thyroidectomy

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15
Q

what are causes of transient hypothyroidism

A

sub acute thyroiditis

withdrawal of thyroxine Tx in individuals with an intact thyroid

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16
Q

what are secondary causes of hypothyroidism

A

hypopituitarism

hypothalamic disease

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17
Q

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

A

hashimotos thyroiditis

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18
Q

what symptoms of hypothyroidism

A 
weight gain
fatigue/lethargy
depression
constipation
dry skin
cold interolerance
weakness
DOE
muscle cramps
heavey/light or no period
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19
Q

what are signs of hypothyroidism

A 
bradycardia
thin brittle nails
thinning hair
puffy face/eyelids
pale skin
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20
Q

what are signs and symptoms that are unique to hashimotos

A

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

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21
Q

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

A

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

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22
Q

what are TSH and FT4 values like with secondary hypothyroidism

A

low or normal

low or normal

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23
Q

what are the other lab abnormalities like with hypothyroidism

A

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

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24
Q

what is subclinical hypothyroidism

A

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

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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

Clin Med-Endocrine (8 decks)

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