Thyroid & Parathyroid Flashcards by Anthony Carli

Three functions of T3/T4

metabolism
HR & Contractility
Development

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+ TPO Abs…

hashimotos

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MC Cause of primary hypothyroidism…

hashimoto thyroiditis

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Increased TSH
Decreased FT4
Decreased FT3

Primary hypothyroid

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Increased TSH

Normal FT4/FT3

Subclinical hypothyroid

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Normal/low TSH
Low-Normal/low FT4
Normal/low FT3

Central Hypothyroid

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Transient hyperthyroid common with early Hashimoto’s Thyroiditis

hashitoxicosis

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This is autoimmune mediated destruction of thyroid gland

Gradual loss of fxn w/ inflamation

Hashimoto Thyroiditis

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2 factors that cause hashimoto thyroiditis?

genetic susceptibility, environmental factors

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The below are precipitating factors for…

Viral infx
Stress
Pregnancy
Iiodine intake
Radiation

Hashimoto thyroiditis

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What Abs are (+) in hashimoto thyroiditis?

TPO Ab (MC)
TgAb

+/-TRAb

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Tx for hashimoto thyroiditis

levothyroxine 1.6 mcg/kg/day

*weight based dosing

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Who should receive a lower synthroid dose initially?

> 60, cardiac concerns

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Describe the dosing regimen for synthroid?

empty stomach 1 hr before breakfast

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The below can have what effect on hashimoto thyroiditis tx?

ferrous sulfate
calcium carbonate
PPIs
Bile acid resins

interfere w/ synthroid absorption

take them 4 hours after T4

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When should hashimoto thyroiditis sxs begin resolving after starting synthroid?

2-4 weeks

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When should a repeat TSH after starting synthroid for Hashimotos occur?

6 weeks after tx

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How long is therapy with synthroid for hashimotos over the life-cycle?

life-long tx

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Patient presents with…

mild or vague sxs of constipation, fatigue, depression

Normal T4, elevated TSH

Subclinical hypothyroidism

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The below are consequences of…

NAFLD
Neuropsych sxs
Infertility
Miscarriage
CV disease

subclinical hypothyroidism

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How do you confirm a dx of subclinical hypothyroidism?

Repeat TSH/T4 after 1-3 mo

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Tx for subclinical hypothyroidism should occur if TSH is _____ or higher

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Increased TSH and Decreased T4

Presents w/

AMS, hypothermia, hypoventilation

hyponatremia, hypotension, fatal arrhythmia

Myxedema coma

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What 4 things can precipitate myxedema coma?

stroke, HF, infx, Trauma

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Tx for myxedema coma?

IV thyroxine & triiodothyronine (T3)

Pt. presents w. weight gain, fatigue, constipation... hypo or hyper

hypothyroid

3 causes of hyperthyroid

Graves (MC) Toxic Adenoma Toxic Multinodular Goiter

Pt. presents w. Weight loss, exopthalmos, periorbital edema, increased appetite, tachy, palpitations hyper or hypothyroid?

Hyperthyroid

TSH decreased | FT4/T3 Increased

Primary hyperthyroidism | graves

TSH Decreased | FT4/T3 Normal

Subclinical hyperthyroidism

TSH Decreased Normal FT4 T3 Increased

T3 toxicosis (early graves)

RAIU Scan is contraindicated for (2)

pregnancy | breast feeding

RAIU result for Graves...

diffuse elevated

RAIU Result... Diffuse decreased/absent uptake

thyroiditis/exogenous hormone

RAIU Result Focal Elevated uptake

hot nodule

RAIU Result Focal decreased uptake

cold nodule

This is an autoimmune mediated stimulation of the thyrotropin receptor. It is the MC cause of hyperthyroidism

Graves

What two conditions are the 2nd most common cause of hyperthyroidism?

``` Toxic MNG (hyperplasia) Toxic adenoma (nodules) ```

Patient presents with: ``` lid retraction lid lag ptosis goiter proptosis ```

Graves

(+) TRAb indicates...

graves

TRAb result for toxic adenoma and toxic mng...

negative TRAb

RAIU results for toxic adenoma/toxic mng...

focal uptake

A patient presents with the following labs and S/S. Decreased TSH, Increased T4/T3 Agitation, delirium, fever, tachy, vomiting, dehydration

Thyroid storm

What is symptomatic treatment for hyperthyroidism?

Atenolol/Propranolol

What medications decrease thyroid hormone synthesis?

Methimazole (DOC) | PTU (pregnancy)

What are two definitive txs for hyperthyroid?

``` radioiodine ablation (1st line) surgery (obstructive sxs/severe dz) ```

This thioamide has the below characteistics QD dosing Rapid efficacy low sfx

methimazole

Three C/I for radioiodine ablation...

active ophthalmopathy pregnancy lactation

What is the progression of thyroid levels with subacute thyroiditis?

Hyperthyroid, Euthyroid, Hypothyroid, Euthyroid

What are you concerned for? Preceding viral illness painful gland enlargement radiating pain to jaw/neck fever, fatigue, anorexia

subacute thyroiditis

How is subacute thyroiditis diagnosed?

clinical

Management for subacute thyroiditis

aspirin/NSAIDs +/- prednisone monitor TSH

MC malignant thyroid nodule...

papillary carcinoma

Thyroid nodules are associated with FHx of...

thyroid CA, MEN-2

Benign or malignant US results? colloid < 1 cm cystic

benign

Benign or malignant US results? ``` taller than wide solid irregular margins microcalcification > 1 cm ```

malignant

What is the most aggressive form of thyroid cancer?

anaplastic

which type of thyroid cancer mets to bone, brain, lung, liver

follicular

What is the diagnostic workup for thyroid cancer? | 4

US RAIU FNA CT/MRI/PET

What does tx of thyroid Ca look like?

``` thyroid lobectomy/total thyroidecomy + iodine ablation + Levothyroxine ```

surgery on thyroid ca can result in what two complications?

injury to left recurrent laryngeal hypoPTH

Patient presents with... ``` Prolonged QT chvostek Trousseau tetany carpopedal spasm ```

hypoPTH

The following labs indicate... Low PTH Low Ca Normal/low Vit. D Normal/low Mg High PO4

HypoPTH

mild hypoPTH can be treated with...

calcitriol (1,25) and calcium carbonate

If hypoPTH with tetany or prolonged QT, tx with

emergent IV calcium gluconate

If hyperphosphatemia with hypoPTH, add...

phosphate binders

If hypomagnesemia with hypoPTH, add..

magnesium

MC cause of primary hyperPTH...

parathyroid adenoma

Secondary hyperparathyroidism is often caused by...

CKD (decreased vit. D production)

What is the common presentation of hyperPTH?

bones, stones, abdominal moans, psychiatric groans

High PTH High Ca Low PO4

primary hyperPTH

High PTH Low Ca High PO4

secondary hyperPTH

What additional imaging modality should be used to evaluate for osteopenia/porosis with PTH disorders?

DEXA

What drugs must be avoided for fear of aggrevated hypercalcemia with hyperPTH?

HCTZ

What is definitive tx for hyperPTH?

parathyroidectomy

Primary hyperPTH with parathyroid ademona PTH/Ca...

high

Secondary HyperPTH with renal disease PTH/Ca...

High PTH | Low Ca

Thyroid & Parathyroid Flashcards

(77 cards)