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PSBEDM Review > 13 Hypothyroidism and Thyroiditis > Flashcards

13 Hypothyroidism and Thyroiditis Flashcards

1
Q

Absorption of LT4 occurs in (2) (ATA)

A

Jejunum
Ileum

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2
Q

Absorption of orally administered levothyroxine under optimum fasting conditions (ATA)

A

70-80%

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3
Q

For patients unable to take oral medications, the appropriate IV dose of LT4 is approximately what percent of the oral dose? (ATA)

A

75%

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4
Q

Increased / unchanged / decreased levothyroxine absorption (ATA):
Fiber

A

Decreased

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5
Q

Increased / unchanged / decreased levothyroxine absorption (ATA):
Soy products

A

Decreased

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6
Q

Increased / unchanged / decreased levothyroxine absorption (ATA):
Coffee

A

Decreased

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7
Q

Mechanism of coffee in decreasing levothyroxine absorption

A

Sequestration of LT4

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8
Q

Increased / unchanged / decreased levothyroxine absorption (ATA):
Grapefruit juice

A

Unchanged

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9
Q

Levothyroxine is recommended to be taken how many min before breakfast? (ATA)

A

60 min

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10
Q

Levothyroxine is recommended to be taken how many hours after dinner? (ATA)

A

3 hours

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11
Q

Where feasible, levothyroxine should be separated from other potentially interfering medications and supplements by how many hours? (ATA)

A

4 hours

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12
Q

Next step in management if levothyroxine dose requirements are much higher than expected? (ATA)

A

Evaluation for gastrointestinal disorders

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13
Q

Gastrointestinal disorders (3) to be considered in patients in whom levothyroxine dose requirements are much higher than expected (ATA)

A

H. pylori-related gastritis
Atrophic gastritis
Celiac disease

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14
Q

Reassessment of TSH should be done if patient is started on the ff drugs (8) (ATA)

A

Androgens
Carbamazepine
Estrogen
Phenobarbital
Phenytoin
Rifampin
Sertraline
TKIs

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15
Q

Increased / decreased / unchanged in hypothyroidism:
Total and LDL cholesterol

A

Increased

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16
Q

Increased / decreased / unchanged in hypothyroidism:
Lung volumes

A

Unchanged

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17
Q

Increased / decreased / unchanged in hypothyroidism:
Diffusing capacity of the lungs

A

Decreased

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18
Q

Increased / decreased / unchanged in hypothyroidism:
Maximal breathing capacity

A

Decreased

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19
Q

Increased / decreased / unchanged in hypothyroidism:
Appetite

A

Decreased

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20
Q

Weight gain in hypothyroidism does not usually exceed:

A

10% of body weight

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21
Q

Increased / decreased / unchanged in hypothyroidism:
Rate of intestinal absorption

A

Decreased

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22
Q

Increased / decreased / unchanged in hypothyroidism:
Total amount absorbed in the intestine

A

Normal or increased

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23
Q

Increase in risk of cholelithiasis in hypothyroid men

A

3.8x

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24
Q

Increased / decreased / unchanged in hypothyroidism:
Cerebral blood flow

A

Decreased

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25
Q

Increased / decreased / unchanged in hypothyroidism:
Cerebral oxygen consumption

A

Unchanged

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26
Q

Typical reduction in LDL in the treatment of hypothyroidism

A

5-10%

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27
Q

Acute hypothyroidism in the previously hyperthyroid patient seen after radioiodine therapy may be characterized by this symptom

A

Painful cramping of large muscle groups

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28
Q

Hallmark of cretinism

A

Retardation of mental development and growth

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29
Q

In patients with chronic renal insufficiency, these clinical findings (5) may suggest hypothyroidism

A

Anorexia
Torpor
Periorbital puffiness
Sallow complexion
Anemia

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30
Q

Risk of hypothyroidism following surgical lobectomy

A

20%

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31
Q

Risk factors for hypothyroidism following surgical lobectomy (2)

A

Iodine insufficiency
Anti-TPOAb

32
Q

HLA associated with Hashimoto disease

A

HLA-DR3

33
Q

Hodgkin disease survivors have ___ relative risk of developing hypothyroidism

A

17-fold

34
Q

Hallmark of classic Hashimoto disease

A

Goiter

35
Q

Ultrasound findings in Hashimoto disease (2)

A

Patchy heterogenous echotexture
Hypoechoic nodules with echogenic septations

36
Q

In differentiating Hashimoto thyroitis from thyroid carcinoma, this clinical finding is pathognomonic of thyroid carcinoma

A

Compression of RLN with hoarseness

37
Q

Table salt is enriched with this substance for iodine supplementation

A

Potassium iodide 0.01%

38
Q

Pregnant patients should not receive iodide of this dose and duration

A

> 1 mg/day over >10 days

39
Q

Soybean products induced goiter in infants by:

A

Enhancing fecal loss

40
Q

Increased / decreased / unchanged:
Effect of cigarette smoking on development of hypothyroidism in those with underlying autoimmune thyroid disease

A

Decreased

41
Q

Cassave meal contains this cyanogenic glycoside which may lead to the formation of thiocyanate

A

Linamarin

42
Q

Reduction in T4 dose after treatment for 4 months of those with nonautoimmune primary hypothyroidism

A

50% for 6 weeks

43
Q

Prevalence of hypothyroidism in patients treated with sunitinib after 37 weeks of follow-up

A

62%

44
Q

Fraction of thyroid gland function that is independent of TSH

A

~10-15%

45
Q

~10% of patients with RTH beta have this neuropsychologic illness

A

ADHD

46
Q

Typical dose of levothyroxine

A

1.6-1.8 mcg/kg IBW

47
Q

The long half life of T4 means that it is safe for a patient to take any missed doses of T4 for up to how long after missing tablets

A

1 week

48
Q

Dessicated thyroid have how many fold higher ratios of T3 to T4 than the 1:15 value in normal human thyroglobulin

A

Twofold to threefold

49
Q

The T3 content of 1 grain tablet Liotrix (T4 + liothyroinine) would be approximately equivalent to that obtained in what dose of levothyroxine

A

100 mcg

50
Q

Initial recommended dose of levothyroxine in elderly px with heart disease

A

25 mcg/day

51
Q

Recommended titration strategy of levothyroxine in elderly px with heart disease

A

Increase by 12.5 mcg at 2-3 month intervals

52
Q

Pseudotumor cerebri as an adverse effect of LT4 therapy occurs in patients aged:

A

8-12 years old

53
Q

Amount of diuresis in moderate to severe hypothyroidism

A

2-4 kg

54
Q

Amiodarone can remain in tissues for up to how long

A

1 year

55
Q

Dose of parenteral levothyroxine after loading dose in myxedema coma

A

80% of appropriate oral dose but not in excess of 1.4 mcg/kg IBW
OR
100 mcg daily

56
Q

Initial serum T4 target for infants with congenital hypothyroidism

A

> 10 mcg/dL or >130 nmol/L

57
Q

After what age is normal TSH an appropriate target of Lt4 therapy in congenital hypothyroidism

A

2 years

58
Q

Adverse effects of maternal hypothyroidism to the offspring (3)

A

Fetal loss
Preterm delivery
Intellectual deficit

59
Q

Normal to elevated serum FT4 and elevated TSH in a patient on LT4 therapy should make one suspect:

A

Poor adherence

60
Q

Risk factors for progression from subclinical to overt hypothyroidism (2)

A

TSH >10
Positive antiTPOAb

61
Q

Liothyronine improved cardiac indices in these patients (3)

A

Advanced CHF
After CABG
After surgery for congenital heart disease

62
Q

Screening of hypothyroidism in older women

A

5-year intervals after 50 years

63
Q

Neurodevelopmental effects on children of mother with isolated hypothyroxinemia (4)

A

Reduced IQ
Reduced cortical volume
Language delay
Autism

64
Q

Mortality in myxedema coma

A

20% or higher

65
Q

Bolus dose of LT4 in myxedema coma

A

500-800 mcg IV

66
Q

Hydrocortisone dose in myxedema coma

A

5-10 mg/hr

67
Q

Most common cause of repeated childhood infectious thyroiditis, particularly in the left lobe

A

Internal fistula extending from the pyriform sinus to the thyroid

68
Q

More common in acute thyroiditis vs subacute thyroiditis:
Preceding upper respiratory infection

A

Acute thyroiditis

69
Q

More common in acute thyroiditis vs subacute thyroiditis:
Fever

A

Acute thyroiditis

70
Q

More common in acute thyroiditis vs subacute thyroiditis:
Painful thyroid swelling

A

Acute thyroiditis

71
Q

More common in acute thyroiditis vs subacute thyroiditis:
Elevated WBC

A

Acute thyroiditis

72
Q

More common in acute thyroiditis vs subacute thyroiditis:
Abnormal thyroid function

A

Subacute thyroiditis

73
Q

More common in acute thyroiditis vs subacute thyroiditis:
Increased alkaline phosphatase, transaminases

A

Subacute thyroiditis

74
Q

More common in acute thyroiditis vs subacute thyroiditis:
Lymphocytes, macrophages, polyps, giant cells on FNA

A

Subacute thyroiditis

75
Q

More common in acute thyroiditis vs subacute thyroiditis:
Clinical response to glucocorticoid

A

Subacute thyroiditis

76
Q

Treatment of Riedel thyroiditis

A

Tamoxifen 10-20 mg/day with or without corticosteroids

PSBEDM Review (20 decks)

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