Thyroid parathyroid

Question 1

Biopsy of large nodule

Answer 1

get more than one sample to avoid false negative

Question 2

If bx comes back as follicular neoplasm

Answer 2

Do thyroid uptake scan to see if hot or cold

Question 3

Bx comes back with atypical cells

Answer 3

Repeat fine needle bx in 2-3 months

Question 4

Thyroid CA worse prognosis

Answer 4

Younger than 20 yo
Older than 45
Male

Question 5

Most common form of thyroid CA (best prognosis)

Answer 5

Papillary

• Follicular is ~10% of thyroid CA
• Anaplastic die w/in 6 mo
• Medullary ~5%

Question 6

Marker for medullary CA

Answer 6

RET mutations as genetic marker

Question 7

Thyroid carcinoma treatment

Answer 7

Surgery (near total thyroidectomy)
TSH suppression, levothyroxine (to prevent future growth)
Radioiodine ablation

Chemo only if recurrence or it has spread

Question 8

Can be a marker for recurrence of thyroid CA

Answer 8

Stimulated Tg (thyroglobin)

Question 9

Thyroid nodule with low TSH

Answer 9

Do uptake scan

If cold, go ahead and bx

Question 10

More a/w thyroid CA

Answer 10

Hyperthyroid

Question 11

Tetany
Muscle cramps
AMS
Convulsion
Chvostek sign
Trousseau sign

Answer 11

Clinical presentation of HYPOparathyroid

Question 12

Low Ca, low PTH

High phosphate and high Mg

Answer 12

Hypoparathyroid

Question 13

Tx of acute tetany

can have stridor d/t muscle contractions

Answer 13

IV calcium gluconate

Airway maintenance

Question 14

What should be part of your workup in an elevated PTH?

Answer 14

Familial hypocalciuruc hypercalcemia (FHH)

They don’t benefit from surgery so need to differentiate from your hyperPTH pts

Question 15

Elevated calcium but no change in PTH

Answer 15

likely malignancy

Question 16

Physical activity
Drink adeq fluids
Avoid lithium and HCTZ
Restrict Ca intake to 1000 mg/d
Get enough vit D

Answer 16

conservative tx for hyperPTH pts who don’t want to do surgery which is the definitive tx

Question 17

Medical management of hyperPTH

Answer 17

IV bisphosphonates can temporarily bring down Ca and treat bone pain

(pamidronate/aredia, zoledronic acid/zometa)

Question 18

Tx for secondary or tertiary hyperPTH

Answer 18

Cinacalcet (Sensipar)

Paricalcitol (Zemplar)

Question 19

Goiter
H/o autoimmune disease
Prev radioactive therapy
Head/neck irradiation
Family h/o thyroid disease
Lithium, amiodarone, interferon, thalidomide, etc

Answer 19

Patients at increased risk for hypothyroid

Question 20

Tx of hypothryoid

Answer 20

Synthetic thyroxine (T4) levo, synthroid etc
1.6 mcg/kg/d

Old folk and heart disease start low with 25 mcg/d and increase by 12 mcg q 6 weeks

Question 21

Warnings for taking synthetic thyroxine (T4)

Levothyroxine, Synthroid, Levoxyl

Answer 21

Take on empty stomach and hour before b-fast
Don’t take MVI bcz Ca and Fe interfere
Bile acid resins also mess up absorption

Question 22

Monitor TSH when tx starts

Answer 22

q 6 weeks until at goal TSH

Avoid over-replacement d/t risk of osteopenia

Question 23

Subclinical hypothyroid
TSH high, normal T4
-33-55% progress to overt hypothyroid

Answer 23

Tx if:
 TSH is >10
Nonalcholic fatty liver
They have neuropsych sx
H/o miscarriage and small babies
If have antibodies

Question 24

Hyperthyroid:

Autonomous thyroid tissue

Answer 24

Toxic adenoma
Toxic multinodular goiter

-localized area of gland that acts independent of TSH

Question 25

Autoimmune hyperthyroid

Answer 25

Grave’s

Can also be early phase of Hashimoto’s

Question 26

Cardiovascular thing that can happen to 10-20% of HYPERthyroid pts

Answer 26

A-fib

Other things: separated nail beds, stare and lid lag, low HDL and total chol

Question 27

Exopthalmus
Periorbital and conjuntival edema
Decreased extraocular muscle function

Answer 27

GRAVE’S ophthalmopathy

Question 28

Anemia in thyroid probs

Answer 28

Normo/normo in Hyper

Macrocytic in hypo

Question 29

Tx for hyperthyroid

Answer 29

Beta blockers (usually atenolol) for sx management
Thionamides (methimazole, PTU)
Radioablation

Surgery - only if can’t do other tx options above

Question 30

Can be acute or silent
Common in young to middle aged females
A/w viral illness
Acutely painful gland enlargmnt w/ dysphagia

Answer 30

Subacute thyroiditis (de quervain’s, graulamatous, gian cell)

Tx with aspirin

Question 31

Approach to thyroid nodules

Answer 31

1) H&P
2) TSH level
3) Ultrasound