Thyroid & Parathyroid Flashcards
(88 cards)
1
Q
Labs for thyroid
A
TSH Total thyroxine (T4) Free T4 Total triiodothyronine (T3) Free T3
2
Q
antibodie
A
Thyroid peroxidase antibody (TPOAb)
Thyroglobulin Antibody (TgAb)
Thyroid-Stimulating Immuniglobulin (TSI)
3
Q
Imaging for thyroid
A
uptake and scan
U/S
4
Q
Sx hypothyroidism
A
intolerance to cold receding hairline facial/eyelid edema dull-blank expression fatigue hair loss lethargy dry skin thick tongue anorexia muscle aches/weakness constipation menstrual disturbance brittle nails/hair pubertal delay decreased hearing
5
Q
Late clinical manifestations of hypothyroidism
A
subnormal temp brady weight gain decreased LOC thickened skin Cardiac complications
6
Q
Hypothyroidism PE
A
vitals: diastolic HTN, bradycardia, weight gain
General: slow movement/speech
Skin: dry, coarse skin, thinning hair
HEENT: puffy facies, loss of eyebrows, periorbital edema, tongue enlargement, goiter
Pulm/cardiac: bradycardia, pleural and pericardial effusion
ABD: ascites
MSK: edema, weakness
Neuro: delayed DTRs
7
Q
Labs for primary hypothyroidism
A
TSH: high
T4: Low
T3: Nml or Low
8
Q
Subclinical hypothyroidism
A
TSH: high
T4: Nml
T3: Nml
9
Q
Central hypothyroidism labs
A
TSH: low
T4: low
T3: low
10
Q
Hashimoto’s antibodies
A
TPO
TgAb
TBII (thyroid binding inhibitory immunoglobulin)
11
Q
Grave’s antibodies
A
TSI (TrAb)
12
Q
Drugs that cause hypothyroidism
A
Lithium
Amiodarone (can cause hyperthyroidism too)
13
Q
Hashimoto’s epidemiology
A
most common cause of hypothyroidism
F>M
Cause: genetic + environmental: increased risk w/ Down Syndrome and Turner’s Syndrome
14
Q
What syndromes are correlated w/ Hashimot’s
A
Down Syndrome
Turner Syndrome
15
Q
Hashitoxicosis
A
transient hyperthyroidism related to early inflammation; then they will become hashimoto
16
Q
Precipitating factors for Hashimoto’s
A
stress, infection, pregnancy, iodine intake, radiation exposure
17
Q
Meds for hashimoto’s
A
Levothyroxine (T4) - levothroid, levoxy synthroid; 1.6 mcg/kg/day
- lower dose in elderly and cardiac concern pts (1-1.2)
- take on empty stomach, 1 hour before breakfast
- MONITOR: 6 week f/u
18
Q
Dosage for hashimotos’
A
Levothyroxine 1.6 mcg/kg/day, one hour before breakfast on empty stomach
19
Q
F/u after beginning hypothyroid meds
A
6 weeks
20
Q
Euthyroid
A
0.5-5 mU/L
21
Q
Goal of tx for hashimotos
A
euthyroid
relieve sx
decrease goiter
22
Q
Subclinical hypothyroidism
A
Elevated TSH (4.5-7) w/ normal T4
23
Q
Presentation of subclinical hypothyroidism
A
+/- mild or vague non-specific sx (fatigue, constipation)
24
Q
Risk w/ subclinical hypothyroidism
A
increased risk of CVD
NAFLD
Neuropsych sx
Miscarriage and LBW babies
25
Management of subclinical hypothyroidism
repeat TSH and T4 in 1-3 months to confirm dx (exception: pregnancy and during fertility tx- repeat immediately)
TSH >10: treatment recommended
TSH 4.5-9.9- tx controversial based on age and sx (deff treat elderly, peds, >60 YO)
26
When to treat for subclinical hypothyroidism
TSH >10
27
Who needs an immediate repeat TSH/T4 for subclinical hypothyroidism
Pregnancy
| During Fertility Tx
28
Complications of hypothyroidism
elevated cholesterol and liver enzymes
HF
infertility
Myxedema Coma
29
Myxedema coma
older pts w/ long standing profound hypothyroidism
| precipitating factors: acute illness, cold weather
30
myxedema coma symptoms
```
hypothermia
bradycardia
severe hypotension
seizures
coma
```
31
Tx for myxedema coma
IV bolus T4, IV hydrocortisone, supportive measures, hypertonic saline
32
Hyperthyroidism sx
```
fine straight hair
heat intolerance
bulging eyes
facial flushing
tachycardia
inceased systolic BP
breast enlargment
weight loss
muscle wasting
diarrhea
amennorhea
```
33
Etiology of hyperthyroidism
F>M (5:1)
older women and smokers
graves: younger
toxic nodular goiter: older
34
PE for hyperthyroidism
```
weight loss
warm, smooth, sweating skin
stair and lid lag, exopthalmos, goiter
Cardio: increased output, tachycardia, palpitations, systolic HTN, a Fib
Pulm: SOB, dyspnea, DOE
GI: frequency, diarrhea
GU: urine frequency and nocturia
MSK: OSTEOPOROSIS, pretibial myxedema
Neuro: tremor, neuropsych (depressionm anxiety, etc)
```
35
Hyperthyroidism labs
TSH: low
| T4/T3: high
36
Subclinical hyperthyroidism
TSH: low
| T4/T3: normal
37
Hyperthyroid labs
CBC: normochromic, normocytic anemia
Cholesterol: low total and HDL
Glucose: impaired glucose tolerance
Others: TSH receptor antibody, TgAb, TPAAb ANA anti-dsDNA
38
antibodies for grave's
TRab - TSI
| maybe TPO, TgAb
39
Normal-high radioiodine uptake
```
Graves - most common
Hashitoxicosis: nml/slight uuptake
Toxic ademona, toxic nodular goiter
iodine deficiency
autonomous nodules (HOT)
```
40
Decreased uptak
exogenous ingestion of hormone
thyroiditis
nonfunctioning (COLD) nodules
41
Grave's disease presentation
opthalmopathy: lid retraction, lid lag, stare, proptosis (enlarged muscles), periorbital edema
pretibial myxedema
non nodular goiter
42
Dx of Grave's
Low TSH, high T4/T3
Presence of Trab (TSI)
orbitopathy
43
2nd leading cause of hyperthyroidism
Toxic adenoma
| TMG
44
Etiology of toxic adenoma/MNG
increases w/ age and w/ iodine deficiency
| result of diffuse or focal hyperplasia of follicular cells - mutations in TSH receptor gene
45
Concerning obstructive sx for MNG
cough, dysphagia, dyspnea
46
Dx of toxic adenoma/MNG
focal areas of increased radioiodine +/-cold spots; get antibodies if you can't differentiate from graves
47
Hyperthyroidism Management
Atenolol 25-50 mg daily (increase as needed)
ASA: prevent clot from A.fib
avoid strenuous activity
Thionamide (PTU, methimazole)- severe sx; methimazole q daily or PTU for pregos
Radioiodine ablation (1st line definitive tx) - typically following thionamide
48
Radioiodine ablation C/I
pregnancy
desire for pregnancy in new few years
active opthalmopathy
near kids
49
Thyroidectomy indications
TOXIC ADENOMA/MNG
large goiters w/ obstructive sxs
pt. w/ active moderate-severe opthalmopathy!
50
Complications of hyperthyroidism
permanent exopthalmos
osteoporosis
cerebral or CVD events- stroke, a.fib, CHF
THYROID STORM
51
Thyroid storm
medical emergency- high mortality
| precipitating factors: major stress, surgery, RAI, iodine contrast, inadequate tx
52
Sx of thyroid storm
```
vomiting, diarrhea
confusion/delirium
tachyarrhythmias
dehydration
fever, coma
```
53
Tx of thyroid storm
fluid replacement
anti-arrhythmia medications
electrolyte stabilization
IV PTU!
54
Subacute thyroiditis aka
granulomatous, de Quervain's giant cell thyroiditis
55
Who gets thyroiditis
- young to middle-aged females
| - associated w/ viral illnesses or postviral inflammatory process (URI)
56
Presentation of subacute thyroidits
ACUTE SEVERELY PAINFUL glandular enlargement (goiter)
- radiates pan to jaw, neck, throat, chest
- fever, fatigue, malaise, anorexia, myalgia
- sudden onset or gradual; can last weeks to months
57
Dx of subacute thyroiditis
clinical; ESR/CRP elevated
58
phases of subacute thyroiditis
Hyperthyroid, euthyroid, hypothyroid, recovery (euthyroid)
59
Management of subacute thyroiditis
ASA or NSAID ( usually goes away on its own)
| prednisone if no sx improvement in several days
60
Screening for thyroid disorder
older women
>60 YO
patients at risk: goiter, autoimmunde disease, radioactive iodine therapy, head/neck irradiation, family hx, meds that impair thyroid function, pts w/ lab or radiologic abnormalities that could be caused by hypothyroidism
61
Concern for CA
kids, men, adults <30, or >60 YO
hx of head/neck radiation
hx HSCT
family hx of thyroid CA
62
Approach to thyroid nodules
1. Hx and PE
2. TSH (increased TSH = more likelihood of malignancy)
3. U/S- FNA? Uptake scan?
63
Malignant features
```
hypoechoic
microcalcifications
>1cm and solid/hypoechoic
irregular margins
talls>wide
extracapsular growth
associated cervical nodes
```
64
Benign features
purely cystic
colloid
<1cm w/o suspicious characteristics
65
FNA results
```
benign (most)
follicular lesion/neoplasma
suspicious
malignant
non-diagnostic
```
66
Thyroid carcinoma
increases w/ age as does mortality
| F>M
67
Worse prognosis for thyroid carcinoma
<20 Yo
>45 YO
male gender
68
Types of thyroid CA
differentiated (highest cure rates):
- Papillary (most common)
- follicular
Undifferentiated: (poor prognosis)
- anaplastic
familial:
- medullary
69
4 thyroid CA
papillary (most common)
follicular
Anaplastic (poor prognosis)
Medullary (familial)
70
Genetic marker for thyroid cancer
RET mutation: sporadic
71
Thyroid CA Tx
```
surgery** - thyroidectomy
Radioiodine ablation (following surgery)
Thyroid hormone supression to prevent further growth- Levothyroxine (lower therapeutic threshold)
palliative external radiotherapy
chemo
```
72
Hypoparathyroidism cause
destruction of parthyroid gland
- usually due to post-thyroidectomy
- rarely, neck irradiation
- alcoholism
- autoimmune
- congenital
73
Presentation of acute hypoparathyroidism
NM: tetany, muscle twitch, carpopedal spasm, seizures, laryngospasm, paresthesia, weakness
Caridac: HF, hypotension, arrhythmia, prolonged QT
Papilledema
Specialized tests: Chvostek's sign and trousseau's
74
Signs of low Ca (hypoparathyroidism)
Chvostek's sign
| Trousseau's
75
Chronic hypoparathyroidism presentation
```
ectopic calcifications
PARKINSONISM
dementia
cataracts
impaired dentition
dry, course skin
brittle nails
hair loss
renal stones, renal failure
```
76
Labs for hypoparathyroidism
```
PTH: Low
Ca: low
Mg: Low
Vit D: normal or low
Phosphate: high
```
77
Management of hypoparathyroidism
Based on sx:
- emergency tx for ACUTE TETANY, SEIZURES, PROLONGED QT (IV calcium gluconate) + airway maintenance
Maintenance tx (monitor weekly initially, then every 3-6 mo) - oral Ca (1-2g/day) and Vitamin D supplement; replace Mg if needed
watch for hypercalcemia w/ treatment
78
Emergency hypoparathyroidism
acute tetany
seizures
prolonged QT
79
Ca dosage
1-2 g/day
80
Etiology of hyperparathyroidism
Primary
- parathyroid adenoma (most common)
- parathyroid hyperplasia
- parathyroid carcinoma (rare0
Secondary/tertiary:
- CHRONIC RENAL FAILURE - hyperphosphatemia and decreased renal vit D production --> decreased ionized Ca, which stimulates parathyroid
- Vit D deficiency
- Renal osteodystrophy
Multiple endocrine neoplasia (MEN)
81
Presentation of hyperparathyroidism
asymptomatic hypercalcemia (malignancy more like to have sx)
```
"Bones, stones, abdominal moans, psychiatric groans"
Bone- fragile, arthralgia, bone pain
stones: kidney stones, DI
Abdominal moans: abdominal pain, n/v
Psychosis, depression, delirium
polyuria, constipation
```
82
Primary hyperpara labs
Ca: high
Phosphate: low
PTH: high
83
Secondary hyperpara labs
Ca: low
Phosphate: high (renal), low (vit D)
PTH: high
84
Tertiary hyperpara
Ca: high
PTH: High
85
Dx hyperparathyroidism
DEXA - osteopenia/osteoporosis
Kidney function: 24-hrs urine; imagine
Parathyroid U/S
Sestamibi parathyroid scan (radioactive) w/ CT scan- paraythyroid adenoma common
86
Sestamibi scan
parathyroid adenoma
87
Tx for hyperparathyroidism
Surgical resection*** - parathyroidectomy (may be hypocalcemic post-op)
Conservative tx (when surgery criteria not met):
- physical activity
- drink plenty of fluids
- avoid lithium and HCTZ (aggravate hypercalcium)
restrict Ca to 1000 mg/day
vit D 400-800 IU daily
IV bisphosphonates?
88
Drugs to avoid when hyperparathyroid
lithium
| HCTZ
