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Thyroid Disorders Flashcards

1
Q

the state of thyroid hormone excess

A

thyrotoxicosis

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2
Q

the result of excessive thyroid function

A

hyperthyroidism

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3
Q

Primary Hyperthyroidism

A 
Graves Disease
Toxic Multinodular Goiter
Toxic Adenoma
functioning thyroid carcinoma metastases
Activating mutation of TSH receptor
McCune-Albright syndrome
Struma ovarii
Drugs: iodine excess (Jod-Basedow phenomenon)
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4
Q

Thyrotoxicosis without Hyperthyroidism

A

Subacute thyroiditis
Silent thyroiditis
Other causes of thyroid destruction: amiodarone, radiation, infarction of adenoma

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5
Q

Secondary Hyperthyroidism

A

TSH-secreting pituitary adenoma
Thyroid Hormone Resistance Syndrome: some patients may have symptoms of thyrotoxicosis
Gestational thyrotoxicosis

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6
Q

MINOR risk factor for Graves’ disease

A

smoking

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7
Q

MAJOR risk factor for the development of ophthalmopathy

A

ophthalmopathy

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8
Q

Antibodies that (+) TSH receptor

A

thyroid stimulating immunoglobulin (TSI)

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9
Q

Play a major role in thyroid-associated ophthalmopathy

A

cytokines

the release of cytokines such as interferon γ (IFN-γ), tumor necrosis factor (TNF), and interleukin-1 (IL-1) –> fibroblast activation and ↑ synthesis of glycosaminoglycans that trap water –> muscle swelling

LATER - there is irreversible fibrosis of the muscles

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10
Q

Features of thyrotoxicosis may be subtle or masked

A

apathetic thyrotoxicosis

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11
Q

Symptoms of Thyrotoxicosis

A
  1. hyperactivity, irritability, dysphoria
  2. heat intolerance and sweating
  3. palpitations
  4. fatigue and weakness
  5. weight loss w/ increased 6. appetite
  6. diarrhea
  7. polyuria
  8. oligomenorrhea, loss of libido
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12
Q

Signs of Thyrotoxicosis

A
  1. tachycardia
  2. afib in elderly
  3. tremor
  4. goiter
  5. warm, moist skin
  6. muscle weakness, proximal myopathy
  7. lid retraction or lag
  8. gynecomastia
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13
Q

MC cardiovascular manifestation

A

sinus tachycardia

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14
Q

Thyroid gland in patients w/ Grave’s disease

A

usually diffusely enlarged to 2 to 3x its normal size

consistency - firm, but NOT nodular

thrill or bruit

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15
Q

Earliest manifestations of Graves’ ophthalmopathy

A

sensation of grittiness
eye discomfort
excess tearing

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16
Q

Most serious manifestation of Graves’ ophthalmopathy

A

compression of the optic nerve at the apex of the orbit –> PAPILLEDEMA; peripheral field defects; permanent loss of vision (if left untreated)

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17
Q

NO SPECS

A

0 No signs or symptoms

1 Only signs (lid retraction or lag), no symptoms

2 Soft tissue involvement (periorbital edema)

3 Proptosis (> 22mm)

4 Extraocular muscle involvement (diplopia)

5 Corneal involvement

6 Sight loss

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18
Q

Most frequent over the anterior and lateral aspects of the lower leg (pretibial myxedema)

A

Thyroid dermopathy

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19
Q

Refers to a form of clubbing found in <1% of patients with Graves’ disease

A

Thyroid acropachy

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20
Q

Lab result of hyperthyroidism

A

↓ TSH level

↑ total and unbound thyroid hormone levels

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21
Q

May be useful if the diagnosis is unclear clinically but is not needed routinely

A

Measurement of TPO antibodies or TBII

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22
Q

Diagnosis of Graves Disease

A

biochemically confirmed
thyrotoxicosis

diffuse goiter on palpation

ophthalmopathy

dermopathy

often a personal or family history of autoimmune disorders

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23
Q

Distinguish the diffuse, high uptake of Graves’ disease from destructive thyroiditis, ectopic thyroid tissue, and factitious thyrotoxicosis, as well as diagnosing a toxic adenoma or toxic MNG

A

radionuclide (99mTc, 123I, or 131I) scan and uptake of the thyroid

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24
Q

Thyrotoxicosis w/ ELEVATED RAI uptake

A

Graves disease
Toxic adenoma
Toxic MNG

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25
Thyrotoxicosis w/ LOW RAI uptake
Painless (silent) thyroiditis Amiodarone-induced thyroiditis Subacute thyroiditis (granulomatous, de Quervain's) Others: thyrotoxicosis factitia, struma ovarii
26
Frequent finding in patients with hyperthyroidism
fine tremor
27
Drugs that DECREASE serum T4 and T3
``` glucocorticoids androgens L-asparaginase salicylates mefenamic acid antiseizure medications - phenytoin, carbamazepine furosemide ```
28
Conditions that DECREASE serum T4 and T3
genetic factors | acute and chronic illnesses
29
Low TSH, Low FT4
secondary/central hypothyroidism sick euthyroid syndrome
30
Low TSH, Normal FT4
subclinical hyperthyroidism (if normal FT3) T3 toxicosis (high FT3) early phase of treatment of thyrotoxicosis w/ antithyroid medications
31
Low TSH, High FT4
Primary Thyrotoxicosis: Graves' disease, MNG, toxic adenoma Destructive thyroiditis, excess iodine intake, excess thyroid hormone
32
Reduces thyroid hormone synthesis
antithyroid drug
33
Reduces the amount of thyroid tissue
radioiodine treatment or thyroidectomy
34
Antithyroid drug indicated in EARLY gestation (1st trimester), THYROID STORM and those experiencing adverse reactions to methimazole
Propylthiouracil
35
MOA of propylthiouracil
(-) thyroid peroxidase (TPO), reducing oxidation and organification of iodide
36
Thioamide that inhibits peripheral deiodinization of T4 to T3
Propylthiouracil
37
Most DANGEROUS complication of thioamide use
AGRANULOCYTOSIS- severe reduction in the number of white blood cells (granulocytes) in the circulating blood
38
MOST COMMON adverse effect of thioamide use
MACULOPAPULAR PRUTITIC RASH
39
Antithyroid drug of choice in adults and children
Methimazole
40
Inhibits hormone release through inhibition of thyroglobulin proteolysis and is often used to decrease the size and vascularity of the hyperplastic gland (used in preoperative preparation for surgery)
Iodide
41
PTU dosage
100-200 mg PO q6-8h (initiation) 50-100 mg PO/day (maintenance)
42
Methimazole dosage
10-20 mg PO q8-12 h (initiation) 2.5 - 10 mg PO/day (maintenance)
43
Common minor side effects of antithyroid drugs
rash urticaria fever arthralgia (1-5% patients)
44
Rare but major side effects of antithyroid drugs
hepatitis (propylthiouracil) cholestasis vasculitis AGRANULOCYTOSIS – most important
45
Selective β1 receptor blocker without sympathomimetic activity which is indicated for THYROID STORM and THYROTOXICOSIS
Propanolol
46
Used in the early stages before antithyroid drugs take effect
Propanolol
47
Inhibit the peripheral conversion of T4 to T3 and is used in thyroid storm and Graves ophthalmopathy
Steroids (Dexamethasone, Hydrocortisone, Prednisone)
48
Used to control TACHYCARDIA in patients with hyperthyroidism whom beta blockers are C.I. (asthma)
Diltiazem
49
Accelerates T4 breakdown by hepatic enzyme induction
Barbiturates
50
Lower T4 levels by increasing the fetal excretion of T4
Cholestyramine
51
Maximum effect of thyroid preparations will be achieved after how many weeks of therapy
6-8 weeks
52
Methimazole/carbimazole embryopathy
APLASIA CUTIS CHOANAL ATRESIA TRACHEOESOPHAGEAL FISTULA
53
Thyroid Storm
Rare and life-threatening exacerbation of hyperthyroidism fever, delirium, seizures, coma, vomiting, diarrhea and jaundice
54
Burch and Wartofsky's Criteria
> 45 - HIGHLY suggestive of thyroid storm
55
Precipitants of Thyroid Storm
pre-existing thyrotoxicosis, untreated or partially treated surgery (poorly prepared patient w/ diffuse toxic goiter for thyroidectomy) ``` withdrawal of anti-thyroid drug therapy radioiodine therapy vigorous thyroid palpation iodinated contrast dyes salicylates ```
56
Laboratory Findings (Thyroid Storm)
``` Increased FT4 and FT3 Decreased TSH Leukocytosis Mild hypercalcemia (increased bone turnover) Liver function test abnormalities Mild-moderate hyperglycemia ```
57
Antithyroid DOC for thyroid storm
PTU - 500 - 1000 mg LD and 250 mg q4h PO or per rectum /per NGT
58
Primary Hypothyroidism
Iodine deficiency Autoimmune thyroiditis (Hashimoto's thyroiditis) Iatrogenic Hypothyroidism Subacute Lymphocytic Thyroiditis
59
Secondary Hypothyroidism
Lesions compressing the pituitary (adenoma, craniopharyngioma, meningioma, empty sella) Sheehan syndrome Autoimmune diseases (polyglandular disorders) Infectious (TB, syphilis)
60
Symptoms of Hypothyroidism
``` tiredness, weakness dry skin cold tolerance hair loss difficulty concentrating and poor memory constipation weight gain w/ poor appetite dyspnea hoarse voice menorrhagia paresthesia impaired hearing ```
61
Signs of Hypothyroidism
``` Dry coarse skin Cool Peripheral Extremities Puffy face, hands and feet (myxedema) Diffuse alopecia Bradycardia Peripheral Edema Delayed tendon reflex relaxation Carpal Tunnel Syndrome Serous Cavity Effusions ```
62
High TSH, Low FT4
Primary (overt) Hypothyroidism | Autoimmune Hypothyroidism
63
High TSH, Normal FT4
Mild (subclinical) Hypothyroidism Early phase treatment of primary hypothyroidism w/ levothyroxine
64
High TSH, High FT4
TSH producing adenoma Generalized resistance to thyroid hormone
65
Preparation of choice for treatment of hypothyroidism
Levothyroxine (LT4)

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