Thyroid disorders: Howell

Question 1

What type of myxedema can be found in hyperthyoridism

Answer 1

pretibial myxedema

Question 2

what type of myxedema can be found in hypothyroidism ?

Answer 2

facial myxedema

Question 3

causes of thyroid disorders

Answer 3

-high dose radiation
-cancer
-excessive intake of thyroid hormone or iodine
-pituitary adenoma (with increased TSH)
-pregnancy
-strum ovari: ovaries that have thyroid tissue

Question 4

what is the most common causes of a goiter in the united states

Answer 4

hashimotos

Question 5

what is the most common causes of a goiter worldwide

Answer 5

iodine deficiency

Question 6

Pt presents with a painless, diffuse goiter.During PE thryoid gland feels rubbery and ntot hard .What is the cause of the goiter

Answer 6

hashimotos thyroiditis

Question 7

pt presents with a painless, firm and nodular goiter. what is the most probable cause

Answer 7

cancer

Question 8

pt presents with a diffuse enlargement of their thyroid. on PE it is tender to the touch. what is the most probable cause

Answer 8

de quervain’s thyroiditis

Question 9

Sx of DeQuervains

Answer 9

-Diffuse enlargement of the thyroid gland
-slight fever, malaise, fatigue

Question 10

Etiology of DeQuervains

Answer 10

viral etiology, high sedementation rate

Question 11

labs in DeQuervains

Answer 11

• low RAI utake
  -high T3 and T4
  -Low TSH
  -no antibodies

Question 12

will you find antibodies associated with DeQuervains

Answer 12

no antibodies

Question 13

prognosis for DeQuervains

Answer 13

usually resolves in a few weeks

Question 14

Labs and sx in silent thyroditis

Answer 14

-high T4
-low RAI
- no pain and milder symptoms

Question 15

when does silent thyroiditis usually occur? when does it resolve?

Answer 15

after pregnancy
usually resolves within 3 months without treatment

Question 16

what is the most common type of thyroid cancer ?

Answer 16

papillary carcinoma

Question 17

incidence of papillar carcinoma

Answer 17

70% of cases

Question 18

sx of papillary carcinoma

Answer 18

-hoarseness of voices and dysphagia

Question 19

what type of spread is papilalry carcinoma

Answer 19

lymphatogenous spread

common to find in cervical chain

Question 20

Incidence of follicular carcinoma

Answer 20

15% of cases

Question 21

what type of spread is follicular carcinoma and where does it commonly spread to ?

Answer 21

hematogenous spread
common metastases to the bones, lungs, liver

Question 22

incidence of medullary carcinoma
sporadic vs familial

Answer 22

6-10% of cases
80% of cases are sporadic
20% are familial

Question 23

sx of medullary carcinoma

Answer 23

secretes calcitonin: decreases serum ca+

Question 24

what syndrome is associated with medullary carcinoma

Answer 24

MEN II (sipple’s syndrome)

multiple endocrine neoplasia II
also hyperparathyroidism and pheochromocytoma

Question 25

incidence and prognosis of anaplastic carcinoma

Answer 25

rare, older patients 80% die within a year

Question 26

sx of anaplastic carcinoma

Answer 26

rapid onset of mass, pain and hoarseness

Question 27

causes of hyperthyroidism

Answer 27

-graves disease -toxic nodular goiter -early thyroiditis -cancer -pituitary adenoma -thyrotoxicosis factitia

Question 28

thyroid storm causes

Answer 28

untreated or inadequately treated hyperthyroidism -borderline controlled but then trauma, surgery, infection etc happens and leads to this storm

Question 29

sx of thyroid storm

Answer 29

presents like excess hyperthyroidism -sudden onset of fever -marked weakness and muscle wasting -extreme restlessness -psychosis -cv collapse, coma

Question 30

Graves diseases diagnostic criteria

Answer 30

hyperthyroidism with at least 1 of the following: -goiter -pretibial myxedema -exopthalmus

Question 31

HLA associations to graves disease

Answer 31

HLAB8 and DR3D antigens

Question 32

pathophysiology of graves diasease

Answer 32

antibodies attach to TSH receptors and continually stimulate thyroid gland

Question 33

sx of graves disease

Answer 33

-wt loss, insomnia, tremors -irritability, heat intolerance, diarrhea -tachycardia, palpitation -pretibial myxedema, goider -exophalmus

Question 34

labs in graves disease

Answer 34

- TSH is the best initial test but is not be used to follow up treatment -follow up with T4 -RAI uptake : high. hot nodule -lows TSH bc free T3 downregulates TRH receptors in the pituitary` to decrease TSH release

Question 35

treatment for graves disease

Answer 35

-propanolol for sx -PTU (propothiol uracil) : blocks increased thyroid hormone response

Question 36

how long after treatment of grave's does it take for thyroid hormone levels to go back to normal

Answer 36

4-6 weeks -40% of patients go into remission and can discontinue PTU after 1-2 years

Question 37

sx of toxic nodular goiter AKA plummers dz

Answer 37

-multiple or solitary nodules -hot nodules: high RAI -similar sx to graves except to ocular involvement, no pretibial myxedema, not autoimmune

Question 38

incidence of toxic nodular goiter

Answer 38

patients usually over 50 years old

Question 39

What type of hypothyroidism is hashimotos

Answer 39

primary hypothyroidism

Question 40

etiology of hashimotos

Answer 40

autoimmune condition where gland is unable to convert iodine into hormne

Question 41

2 major phenotypes of hashimotos

Answer 41

1. goitrous 2. atrophic: 10-20% haven anti-TSHr - both: lymphocytic infiltration of gland, follicular destruction : gih anti-TG and anti-TPO

Question 42

labs for hashimotos

Answer 42

-high TSH -low t4 -initially high RAI uptake: temporary hyperthyroid state -thyroid antibodies in 95% of cases

Question 43

Thyroid antibodies seen in hashimoto's

Answer 43

-Anti-TSH - anti-TG -anti-TPO

Question 44

myxedema coma incidence

Answer 44

severe, acute hypothyroid state I: elderly during winter months

Question 45

sx of myxedema coma

Answer 45

- profoud hypothermia -bradycardia -respiratory depression -slow deep tendon reflexes

Question 46

most common etiology of congenital hypothyroidism

Answer 46

65% of cases are due to thyroid gland dysgenesis

Question 47

clinical manifestation of congenital hypothyroidism

Answer 47

- prolonged jaundice -feeding problems -hypotonia -macroglossia -delayed bone maturation -umbilical hernia (developed over first few wks/months) -permanent neurologic damage if tx is delayed -CHD 4x more common in infants with congenital hypothyroidism

Question 48

possible complications of congenital hypothyroidism

Answer 48

-CHD 4x more common in infants with congenital hypothyroidism permanent neurologic damage if tx is delayed