Thyroid part I

Question 1

decreased levels t3T4 stimulate what

Answer 1

release of TRH from hypothalamus and TSH from anterior pituitary

Question 2

increased T3 T4 levels cause what

Answer 2

decreased release of TRH and TSH

Question 3

42 y.o increased sweating, pounding heart and weight loss

phyiscal exam reveals slightly enlarged nontender thyroid with no nodules

Answer 3

enlarged thyroid

Question 4

signs of hyperthyroidism

Answer 4

wide eyed, staring gaze from overactivity SAN

Question 5

What is Graves

Answer 5

hyperthyroidism with protruding eyeballs

Question 6

what are the studies used in thyroid function testing

Answer 6

serum TSH and T4
US and radionucleotide uptake studies
serum Ab

Question 7

if TSH is low and T4 high what is it

Answer 7

hyperthyroidism

Question 8

if TSH is high and low T4

Answer 8

hypothyroidism

Question 9

what will an US of thyroid tell you

Answer 9

cystic or solid

Question 10

what will a toxic multinodular goiter look like on radionucleotide scan

Answer 10

lumpy bumpy in all different areas

Question 11

what will graves look like on radionucleotide scan

Answer 11

increased uptake on both lobes of thyroid

Question 12

what will a toxic adenoma look like on radionucleotide scan

Answer 12

one mass with increased density

Question 13

what is thyrotoxicosis

Answer 13

hypermetabolic state caused by increased levels of free T3 and T4

Question 14

what are the 3 most common casues of thyrotoxicosis

Answer 14

diffuse hyperplasia (Graves)
hyperfuncitonal multinodular goiter
hyperfunctional thyroid adenoma

Question 15

what branch of SAN is turned up in hyperthyroidism

Answer 15

beta adrenergics

Question 16

describe signs hyperthyroidsm

Answer 16

increased in basal metabolic rate, skin is warm and flushed from inc blood floww (vasodilation) heat intolerance, increased sweating, weigh loss despite increased appetite

Question 17

what are the cardiac manifestations of hyperthyroidism

Answer 17

tachy, palpitations, cardiomegaly
arrhythmias, atrial fibrillation
some have L ventricular dysfuntion and low output HF “thyrotoxic cardiomyopathy”

Question 18

what are signs from overactivity of SAN in hyperthyroidism

Answer 18

tremor, hyperreactivity, emotional lability, anxiety, inability to concentrate and insomnia

Question 19

what GI Sx can you have if hyperthyroid

Answer 19

hypermotlity, diarrhea, malabsorption

Question 20

what are the ocular changes contributed to hyperthyroidism

Answer 20

wide, staring gaze an lid lag

Question 21

what can hyperthyroidism lead to in skel system

Answer 21

osteoporosis from increased resoprtion

Question 22

what is the thyroid storm

Answer 22

short onset of severe hyperthyroidism

usually in Graves from acute elevation catecholamine levels

Question 23

signs of thyroid storm

Answer 23

febrile, tachycardia

medical EM because can lead to cardiac arrhythmia

Question 24

seondary causes of hyperthyroidism

Answer 24

TSH secreting pituitary adenoma

Question 25

most common cause endogenous hyperthyroidism

Answer 25

Graves

Question 26

pretibial myxeema

Answer 26

graves disease

Question 27

what causes Graves

Answer 27

autoimmune disorder from autoAb against multiple thyroid proteins (TSH R)

Question 28

what is most common Graves Ab subtype

Answer 28

TSImmunoglobulin which acts like TSH

Question 29

what cells undergo the hyperplasia in hyperthyroid

Answer 29

the thyroid follicular epithelial cells

Question 30

pale follicular lumen with scalloped margins and colloid

Answer 30

graves

Question 31

audible bruit on thyroid

Answer 31

graves

Question 32

what causes the exopthalmus in graves? complicaiton?

Answer 32

fat and inflammation taht push eye forward | can't close lides- corneal abrasion

Question 33

what is the pretibial myxedema seen in graves

Answer 33

scaly thickening and induration of skin on shins

Question 34

patients with graves are at higher risk for what

Answer 34

SLE, pernicious anemia, type I DM, and addisons

Question 35

lab findings in graves

Answer 35

increased free T3 T4 adn depressed TSH

Question 36

Tx graves

Answer 36

beta blockers and thionamides, radioiodine ablation adn thyroidectomy

Question 37

when is surgery used in graves

Answer 37

large goiters that are compressing surrounding structures

Question 38

42 y.o weight gain, constipation and feeling cold | enlarged thyroid

Answer 38

hypothyroid

Question 39

Lab testing for hashimoto hypothyroidism

Answer 39

TPO autoAb, TPO specific T cells, cytokines that lead to thyrocyte damage and thus decrease T4T3 even though increase TSH

Question 40

when do you not do thyroid function testing

Answer 40

hospitalized paitent because sick sinus syndrome- will have abnormal values pregnant women- abnormal thyroid function

Question 41

what are primary causes of hypothyroidism

Answer 41

``` genetic defects thyriod hormone resistance syndrome postablative autoimmune iodine deficiency drugs congenital biosynthestic defect ```

Question 42

what are the secondary causes of hypothyroidism

Answer 42

pituitary failure, hypothalamic failure

Question 43

what is the ww cause of congenital hypothyroidism

Answer 43

endemic iodine deficiency in diet

Question 44

what is the msot common cause of hypothyroidism in the iodine sufficient areas in world

Answer 44

autoimmune

Question 45

what is cretinism

Answer 45

hypothyroidism that develops in infancy or early childhood

Question 46

clinical features of cretinism

Answer 46

impaired development of the skeletal system and central nervous system: mental retardation, short stature, coarse facial features, protruding tongue and umbilical hernia

Question 47

severity of mental impairment in cretinism

Answer 47

related to time at which thyriod deficiency occurs in utero

Question 48

when is a deficiecny in maternal thyroid hormone not at risk to baby in pregnancy

Answer 48

once fetal thyroid has become functional

Question 49

myxedema

Answer 49

slowing of physical and mental activity generalized fatigue, apathy, mental sluggishness (mimic depression) speech and intellectual function slowed listless, cold intolerant, overweight

Question 50

skin of hypothyroid patients

Answer 50

cool and pale

Question 51

wy is SOB a complain in hypothyroid

Answer 51

reduced CO

Question 52

why is there an increased CV mortality rate in patients with hypothyroidism

Answer 52

promotes increase in total cholesterol and LDL levels

Question 53

what causes nonpitting edema, coarsening facial features, enlargement of tongu and deepening of voice in hypothyroidism

Answer 53

accumulateion of gags and hyaluronic acid in skin, subq and viscera

Question 54

what can cause painful thyroid

Answer 54

infecitous thyroiditis, subacute granulomatous thyroiditis

Question 55

what are the non painful types of thyroiditis

Answer 55

subacute lymphcytic thyroiditis and fibrious thyroiditis

Question 56

what are the 3 most common types thyroiditis

Answer 56

hashimoto granulomatou thyroiditis subacute lymphocytic thyroiditis

Question 57

what will fine needle aspiration of hashimoto thyroid look like

Answer 57

lots of lymphocytes

Question 58

Hurthle cells

Answer 58

thyroid follicles in hashimoto

Question 59

what is hashitoxicosis

Answer 59

disruption of thyroid follicles, transient thyrotoxicosis before full blown hashimoto

Question 60

hashimoto patients increase risk for

Answer 60

DM I, autoimmune adrenalitis, SLE, myasthenia gravis and sjogren syndrome

Question 61

what malignancy are hashimoto patients at increased risk for

Answer 61

extranodal zone B cell lymphomas