Thyroid/Parathyroid 1

Question 1

Thyroglobulin

Answer 1

–Protein that synthesizes and stores T3 and T4

Question 2

another name for T3

Answer 2

–T3 (3,5,3’-triiodothyronine)

Question 3

–Fatigue, weakness

–Cold intolerance

–Weight gain

–Cognitive dysfunction

–Constipation

–Slow movement/speech

–Delayed relaxation DTRs

–Bradycardia

s/sx of what dz?

Answer 3

Hypothyroidism (generalized metabolic slowing)

Question 4

–Dry, coarse skin

–Hoarseness

–Edema

–Puffy facies

–Loss of eyebrows

–Periorbital edema

–Tongue enlargement

S/sx of what dz?

Answer 4

hypothyroidism (Accumulation of extracellular matrix substances)

Question 5

what labs would you see for primary hypothyroidism?

Answer 5

high TSH: (4-5)

low T4

Question 6

what would you see on labs of subclinical hypothyroidism?

Answer 6

normal T4

High TSH

Question 7

what other labs should you look at when dx hypothyroidism?

Answer 7

BMP (Na, Cr)

Lipids

Drug levels

Question 8

What conditions will you see elevated Anti-TPO antibodies?

Answer 8

Hashimoto’s thyroiditis

Grave’s disease

Question 9

what conditions will you see elevated anti-thyroglobulin antibodies in? (anti-TGB)

Answer 9

Hasimoto’s thyroiditis

Grave’s dz

Question 10

what antibody will be elevated in 65% of pts w/graves dz?

Answer 10

Thyroid Stimulating Immunoglobulin (aka TSH Receptor Antibody)

Question 11

MCC of hypothyroidism

Answer 11

autoimmune thyroiditis (hashimotos)

Question 12

OTHER causes of hypothyroidism

Answer 12

• Iatrogenic
• Iodine deficiency or excess
• Medications
• Transient
• Infiltrative (rare)
• Congenital

Question 13

hypothyroidism tx

Answer 13

Synthetic thyroxine (T4) replacement to achieve and maintain euthyroid state (Levothyroid)

Question 14

PK of T4 (Levothyroxine)

Answer 14

high abs, long 1//2 life

Question 15

what is the avg dose of T4 (levothyroxine)?

Answer 15

1.6 mcg/kg/day

Question 16

T4 dosage for elderly

Answer 16

start on low dose

Question 17

T4 dose for pts with hx of coronary hrt dz

Answer 17

no higher than 25mcg

Question 18

goals of tx for hypothyroidism

Answer 18

–Symptom relief

–Normalization of TSH secretion

–If applicable, decrease in goiter size

Question 19

What are other tx options for hypothyroidism?

Answer 19

T3 (Cytomel)/T4 combo therapy

Dessicated thyroid extract (Armour Thyroid, Nature Throid)

Question 20

About 1/3 to ½ progress to overt hypothyroidism

Answer 20

subclinical hypothyroidism

Question 21

possible conditions associated with subclinical hypothyroidism?

Answer 21

–CV disease

–NAFLD

–Neuropsychiatric

–Reproductive

Question 22

when should you initiate tx for subclinical hypothyroidism?

Answer 22

–TSH > 10

Question 23

MCC of hyperthyroidism

Answer 23

grave’s dz

Question 24

Other etiologies of hyperthyroidism

Answer 24

—Hashimoto’s thyroiditis

—Autonomous thyroid tissue: Toxic adenoma, Toxic multinodular goiter

—TSH-mediated hyperthyroidism: TSH-producing pituitary adenoma, Non-neoplastic TSH-mediated hyperthyroidism

—Human chorionic gonadotropin-mediated hyperthyroidism

Question 25

which condition has **normal or high RAI uptake**?

Answer 25

**_hyper_**thyroidism

Question 26

•Skin changes **•Stare and lid lag** **•Graves’ ophthalmopathy** •Cardiovascular **•Low total and HDL cholesterol** **•Impaired glucose tolerance** Clinical px of what?

Answer 26

Hyperthyroidism

Question 27

•Dyspnea and DOE **•Weight loss** **•Normochromic, normocytic anemia** * Genitourinary * Bone changes * Neuropsychiatric changes Clinical px of what?

Answer 27

hyperthyroidism

Question 28

what labs will you see on hyperthyroidism?

Answer 28

**low TSH** **high T3/T4** **+ TSH receptot a-bodies**

Question 29

What diagnostic test should you order for Hyperthyroidism?

Answer 29

24 hr radioiodine uptake & scan

Question 30

what does a **high uptake vx. low uptake** on a 24-hr radioiodine uptake scan mean?

Answer 30

–High uptake = **_increased hormone synthesis_** –Low uptake = **_inflammation/destruction_ of thyroid gland or extrathyroidal source of thyroid hormone**

Question 31

CI for 24-hr radioiodine uptake and scan

Answer 31

preggos breastfeeding

Question 32

hyperthyroidism tx

Answer 32

**–Beta-blockers** –Thionamides: **Methimazole, Propylthiouracil (PTU)** –Radioiodine ablation **–Surgery**

Question 33

MCC of thyroiditis

Answer 33

subacute granulomatous thyroiditis **(de Quervain's)**

Question 34

–Can present with **acute symptoms or silently** –Common in **young or middle-aged females** –Associated with **viral illnesses** –Acutely **painful glandular enlargement with dysphagia** –Can last from **weeks to months** clinical px of what?

Answer 34

thyroiditis (de Quervain's)

Question 35

dx of thyroiditis

Answer 35

clinical dx w/labs

Question 36

thyroiditis may be followed by what?

Answer 36

hypothyroidism

Question 37

thyroiditis tx

Answer 37

anti-inflammatories **(ASA, NSAIDS, prednisone)** sx mgmt

Question 38

**Rare, endocrine emergency** **High mortality** Usually results from an **acute event** Which dz?

Answer 38

thyroid storm

Question 39

thyroid storm RF

Answer 39

–Surgery –Trauma –Infection –Iodine administration –Childbirth –Withdrawal of antithyroid meds –MI, CVA, PE

Question 40

Main Clinical signs of thyroid storm

Answer 40

Cardiac: tachy, CHF, hypotension Fever aditation, anxiety stupor, coma N/V/D Hepatic failure warm, moist skin lig lag

Question 41

Thyroid storm dx

Answer 41

Clinical presentation of **severe, life-threatening symptoms** PLUS **Low TSH, high free T4/T3** (same as _hyperthyroidism_)

Question 42

thyroid storm tx

Answer 42

ICU **Beta-blocker** – sx control **Thionamide** – block new hormone synthesis **Iodine solution** – blocks release of thyroid hormone from gland **Glucocorticoids** – reduces T4 to T3 conversion, promotes vasomotor stability, treat associated related adrenal insufficiency **Bile acid sequestrants** – decrease enterohepatic recycling of thyroid hormones

Question 43

definitive tx for thyroid storm

Answer 43

radioablation of gland

Question 44

how does beta blocker tx thyroid storm?

Answer 44

sx control

Question 45

how does thionamide tx thyroid storm?

Answer 45

blocks new hormone synthesis

Question 46

how does iodine solution tx thyroid storm?

Answer 46

blocks release of thyroid hormone from gland

Question 47

how do glucocorticoids tx thyroid storm?

Answer 47

**reduces T4 to T3 conversion**, promotes **vasomotor stability,** treat associated related **adrenal insufficiency**

Question 48

how do bile acid sequestrants tx thyroid storm?

Answer 48

**decrease enterohepatic recycling of thyroid hormones**