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CLIN MED II- ENDOCRINOLOGY > THYROID DISORDERS- Hyper, Hypo, Thyroiditis, Thyroid Ca, Nodules > Flashcards

THYROID DISORDERS- Hyper, Hypo, Thyroiditis, Thyroid Ca, Nodules Flashcards

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1
Q

thyroid gland endocrine cell types

A
  • follicular cells- synth and secrete TH (T3+4)
  • C (clear) cells- secrete calcium regulating hormone (calcitonin)
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2
Q

thyroid hormones control what
- role in children

A
  • rate of metabolism
  • regulate wt, energy levels, body temp, skin, hair, nail growth, and metabolism

in children
- role in brain development, nl growth/development

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3
Q

thyroid hormones + roles
- TSH
- T4
- T3

A

TSH
- stim thyroid to make T3+4

T4
- main form TH circulating
- free T4 avail to enter body tissue, bound T4 bound to protein preventing tissue penetration

T3
- very active form of TSH
- can be free or bound

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4
Q

thyroid gland hormone pathway

A

TRH—Ant pituitary—TSH—-thyroid—-T3+4—-circ bloodstream and bind to TBG—-convert T4 into T3 in target tissue——neg feedback to prevent over secretion

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5
Q

hyperthyroidism presentation

A

THYROIDISM
- Tremor
- HR inc (tachy)
- Yawning
- Restless
- Oligomenorrhea+amenorrhea
- Intolerance to heat
- Diarrhea
- Irritability
- Sweating
- Muscle wasting + wt loss

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6
Q

hyperthyroidism
- additional signs on PE
- graves ds sx

A

PE
- hyperreflexia (brisk DTRs)
- lid lag
- +/- goiter, nodules

graves
- exophthalmos
- pretibial myxedema
- thyroid bruit

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7
Q

hyperthyroidism origin + cause
- primary
- secondary
- tertiary

A

Primary
- thyroid
- graves ds, thyroid nodules, adenoma, thyroiditis

Secondary (uncommon)
- pituitary (excess TSH)
- carcinoma, TSH secreting tumors

tertiary (rare)
- hypothalamus (excess TRH)
- TRH secreting tumors

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8
Q

hyperthyroidism

graves ds
- patho
- population
- S/Sx

A

patho
- autoimmune, thyroid stim Ab binds to TSH recep–> excess T3/4

population
- MC young females

S/Sx
- exophthalmos, pretibial myxedema, thyroid bruit
- DIFFUSELY enlarged, symmetric, nontender thyroid

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9
Q

hyperthyroidism

multinodular toxic goiter (plummer ds)
- patho
- population
- S/Sx

A

patho
- hyperfunctioning thyroid areas–less TSH–atrophy nl thyroid tissue

population
- MC elderly women

S/Sx
- assym, bumpy, irregular nontender thyroid

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10
Q

hyper/hypothyroidism

subacute thyroiditis
- patho
- labs
- S/Sx

A

patho
- thyroid inflamm secondary to viral illness

labs
- low TSH, high T4/3, HIGH ESR, HIGH CRP
- low uptake on RAIU

S/Sx
- tender, boggy thyroid
- preceding URI
- can cause hyper–hypothyroid

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11
Q

hyperthyroidism

toxic thyroid adenoma
- patho
- S/Sx

A

patho
- single nodule w excesss T3/4

S/Sx
- single large nontender nodule

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12
Q

hyperthyroidism other causes

A

hashimoto thyroiditis (MCC hypo)
- can cause transient hyper then hypo
- nontender rubbery goiter

postpartum thyroiditis
- transient hyper after delivery (1-2mo)– give propanolol for cardiac sx, self resolves

iodine induced
- exposure to iodine, IV contrast

iatrogenic
- amiodarone, overdose of levothyroxine (T4)

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13
Q

hyperthyroidism- secondary and tertiary
- suspect it when?

A

if S/Sx AND:
- known hypothalamic or pituitary ds
- mass or lesion in pituitary
- S/Sx of hyperthyroidism assoc w other hormonal deficiencies

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14
Q

hyperthyroidism dx
- overall
- subclinical
- AP or hypothal tumor
- T3 thyrotoxicosis

A

CHECK TSH FIRST (TFTs)

  • overall: low TSH, high free t4, high t3
  • sublinical hyper: low TSH, nl free T4 + T3 (before Sx appear)
  • AP or hypothal tumor: high TSH, high T4 + T3
  • T3 thyrotoxicosis: low TSH, nl free T4, high T3 (test if FT3+4 WNL but hyperthyroid sx persist)
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15
Q

hyperthyroidism dx
- other labs

A

antibodies
- graves pos TSI or TBII (thyroid receptor antibodies/TRAb)

ESR/CRP
- inflamm markers, elevated in any thyroiditis (MC subacute)

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16
Q

hyperthyroidism dx imaging
- graves
- multinod toxic goiter
- toxic thyroid adenoma
- thyroiditis

A

RAUI- radioactive iodine uptake scan

  • graves: diffuse high uptake
  • multinodular toxic goiter: patchy high uptake
  • toxic thyorid adenoma: focal inc uptake
  • thyroiditis: diffuse dec or absent uptake
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17
Q

hyperthyroidism tx types

A
  • pharmacologic
  • radioiodine ablation
  • subtotal thyroidectomy
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18
Q

hyperthyroidism

pharmacologic tx
- uses
- MOA

A

beta blockers- atenolol or propanolol
- use for all cases hyperthyroidsim
- Sx reduction

thionamides- methimazole or PTU (prego)
- use in graves ds, multinodular, adenoma
- block formation TH in thyroid gland

NSAIDS
- subacute thyroiditis, usually resolves itself ~1 yr
- give for pain

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19
Q

hyperthyroidism

radioiodine ablation
- how does it work
- definitive dx for?
- consider for?
- CI + major risk

A

definitive tx for graves

  • oral ingestion radioiodine induce tissue damage + ablation follicular cells
  • consider for pts w multinodular, solitary toxic nodule, graves + failed/cant tolerate thionamides
  • CI prego (stunt growth), risk of hypothyroid overtime
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20
Q

hyperthyroidism

surgical resection/subtotal thyroidectomy
- suggested for what pts
- risks
- MC complication

A
  • suggest in pt w large goiter or unable to take thionamides/radioiodine

risks
- permanent hypo, hyper recurrence
- recurrent laryngeal nerve palsy (MC)—> hoarseness
- hypoparathyroidism- dec Ca (face twitch, spasm, paresthesia, cramp)

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21
Q

hyperthyroidism complication- thyroid storm
- precipitating factors
- presentation

A

factors
- stress (trauma, thyroid surgery)
- levothyroxine OD

presentation
- exaggerated hyperthyroid Sx+
- HIGH fever
- tachy/tachyarrythmia
- GI sx
- confused/psychosis

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22
Q

thyroid storm
- dx
- tx
- supportive care

Study These Flashcards
A

Dx
- severe sx (high fever, CV dysfunc, alt mental status)
- high free t4 and/or T3, low TSH

tx
- BB (propanolol) + PTU + iodine + hydrocortisone

supportive
- IV fluid, cooling blanket, empiric abx?

23
Q

hypothyroidism presentation

Study These Flashcards
A

MOM’S SO TIRED
- Memory loss
- obesity
- menorrhagia
- slowness
- skin+hair dryness
- onset gradual
- tiredness
- intolerance to cold
- raised BP
- energy levels fall
- depression/delayed relaxation reflexes

24
Q

hypothyroidism additional signs (PE)

Study These Flashcards
A
  • goiter
  • non pitting edema (puffy face, periorbital edema)
  • loss of lateral 1/3 eyebrow hair
  • bradycardia
25
hypothyroidism causes - primary - secondary - tertiary
primary - thyroid ds--> inadequate T3/4 production secondary - pituitary ds (TSH deficiency) tertiary - hypothalamic ds (TRH deficiency)
26
primary hypothyroidism types
hashimotos thyroditis, subacute thyroiditis (IN HYPER AND HYPO), iatrogenic, low iodine
27
# primary hypothyroidism hashimoto's thyroiditis (lymphocytic) - patho - population - S/Sx
MCC of hypo patho - autoimmune w/antithyroid Ab population - MC females 40-60 yo S/Sx - goiter: nontender, rubbery/hard, nodular - pos FHx or PMHx for autoimmune ds
28
# primary hypothyroidism iatrogenic - patho - S/Sx
patho - secondary to hyperthyroid tx (surgical, radioiodine - some drug induced (lithium, amiodarone) S/Sx - use pt pos hx
29
# primary hypothyroidism low iodine - patho - population - S/Sx
patho - iodine needed for synth TH population - endemic area, diet restrictions S/Sx - goiter - pos pt history--endemic area or avoids iodized salt
30
secondary and tertiary hypothyroidism - causes - when to suspect
secondary- pituitary ds (TSH def) tertiary- hypothalamic ds (TRH def) suspect if S/Sx AND: - known hypothal or pit ds - mass or lesion in pit - S/Sx of hypo are assoc w other hormonal deficiencies
31
hypothyroidism dx - overall - hashimotos thyroiditis - subclinical hypo - secondary or tertiary
CHECK TSH (TFTs) - overall: high TSH, low free T4/3 - hashimotos thyroiditis: high antiTPO Ab, high Anti-Tg - subclinical hypo: high TSH, nl free T4/3 - secondary/tertiary: low/nl TSH, low T4/3
32
hypothyroidism tx and monitoring/recheck
tx - levothyroxine (T4) monitor - 2-4 wks for effect, 6-8 for steady state - recheck TSH 4-6 weeks and adjust PRN - lifelong tx, periodic/yearly TSH monitoring needed after reaching goal
33
subacute hypothyroidism tx
TSH<10 = observation, repeat labs 3-6 months TSH >10 = start levothyroxine
34
hypothyroidism complication- myxedema coma - precipitating factors - presentation
factors - stress - cold exposure - meds (amiodarone, lithium, narcotics) presentation- exagerrated hypo Sx+: - depressed consciousness (lead to coma) - profound hypothermia - resp depression - hypotension, bradycardia
35
# hypothyroidism complications myxedema coma - dx - tx - supportive
dx - T4 low, TSH high (low/nl in secondary/tertiary) - cortisol (hypopit and adrenal insuff in second/tertiary) tx - IV hydrocortisone + IV levo (T4) and T3 supportive - mech vent, IVVF, pressors, electrolytes, glc, warming, tx cause
36
congenital hypothyroidism - define - causes
malfunctioning or absent thyroid---hypothyroid at birth causes - agenesis, hypoplasia, ectopy, pit/hypothal ds - maternal Ab, radioactive iodine, iodine def
37
congenital hypothyroidism - presentation - testing - tx
presentation - hypotonia (low musc tone), macroglossia, facial swelling, hoarse cry - difficult feeding, jaundice, constipation, abd distended - untreated--->delayed development, short testing - newborn screen: high TSH, low T4 tx - levo
38
thyroiditis types
- hashimotos thyroiditis - subacute thyroiditis (DeQuervain's) - postpartum thyroiditis - drug induced thyroiditis - bacterial thyroiditis (rare)
39
# thyroiditis bacterial thyroiditis - cause - testing - tx
cause - staph/strep infx - fever, pain, erythema, swelling testing - HIGH WBC tx - abx, surgical drainage
40
thyroid cancer types - best to worst prognosis, MC to least common
papillary carcinoma (MC/best prognosis) follicular carcinoma medullary carcinoma anaplastic carcinoma
41
thyroid cancer RFs
- children - adults <30, >70 - Hx radiation tx to neck - pos FHx thyroid ca or syndromes (MEN2)
42
thyroid cancer Sx
- rapid development - fixed firm nodule - recurrent laryngeal nerve paralysis (hoarseness) - cervical lymphadenopathy - irreg or solitary nodule
43
papillary carcinoma - presentation - RFs - prognosis - dx - tx (adjuvant, other options based on tumor size)
- presentation: nodule, multiple sometimes - RFs: h/o head/neck radiation, FHx thyroid ca - prognosis: slow growth good, rarely metastasize but can affect LN - dx: FNA - tx: lobectomy w isthmusectomy if tumor >3cm, bilat, or mets = total thyroidectomy adjuvant tx= TSH suppression tx, radioactive iodine tx
44
follicular carcinoma - presentation - RFs - prognosis - dx - tx
- presentation: solitary thyroid nodule - RFs: iodine def - prognosis: > aggressive than pap, slow grow, distant mets possible via blood - dx: histologic eval after surgical removal - tx: total thyroidectomy + post op iodine ablation
45
medullary carcinoma - presentation - RFs - prognosis - dx - tx
- presentation: solitary thyroid nodule - RFs: part of MEN2, check for pheochromocytoma, pos FHx - prognosis: quick mets, pos cervical LN involvement - dx: FNA, pos calcitonin, pos CEA - tx: total thyroidectomy + modified radial neck dissection if LN involved ## Footnote parafollicular c cells
46
anaplastic carcinoma - presentation - RFs - prognosis - dx - tx
- presentation: rapidly enlarging neck mass (see dyspnea, dysphagia, hoarse) - RFs: female, age>50 , Hx thyroid ca - prognosis: aggressive w poor outcome, spread to trach/esoph/lung - dx: FNA Bx - tx: palliative care, surgery? chemo/rad for sx? ## Footnote undifferentiated cells
47
thyroid nodules
discovered by palpation or incident during imaging - usually benign - many d/o cause them
48
benign v. malignant causes of thyroid nodules
benign - multinod goiter, hashimotos, cysts, adenomas malignant - papillary, follicular, medullary, anaplastic carcinoma - primary thyroid lymphoma - metastatic carcinoma (breast, renal)
49
thyroid nodule workup
- Hx + PE - TSH + Neck/thyroid US - +/- thyroid scintigraphy, FNA, or both
50
thyroid nodules - neck/thyroid US purpose
determine solid v cystic (most Ca solid) - size and anatomy of adj structure - determine need for FNA
51
thyroid nodules - criteria for FNA - high, intermed, low suspicion
high - hypoechoic and >1 cm, w >=1 sus feature - irreg margins, microcalcifications, rim calcif, extrathyroidal extension intermed - hypoechoic >1 cm w smooth margins low - isoechoic, hyperechoic solid nodule, partially cycstic w solid areas + >1.5 cm
52
thyroid nodules - FNA purpose
23-27 gauge needle to obtain tissue for histo/cytology exam - dx all thyroid Ca EXCEPT FOLLICULAR
53
thyroid nodules - thyroid scintigraphy - purpose - classification
purpose - determine functional status of nodule - hot (inc) or cold (dec) accum compared to reg tissue classification - cold= hypofunctional, refer for FNA, risk of malignant - warm= nl function - hot= hyperfunctional
54
thyroid nodules workup
1. check TSH + US 2. if TSH low--> scintigraphy (RAUI) determine hot or cold - cold= send for FNA - nl or hot= send for T3/4 - --> ifT3/4 high = hyper, tx pt --->T3/4 nl = sublinical hyper, monitor pt 3. if TSH nl or high - US suspicious= send for FNA - US benign= monitor pt

CLIN MED II- ENDOCRINOLOGY (11 decks)

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