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Clinical medicine A > Trigger words Thyroid P2 > Flashcards

Trigger words Thyroid P2 Flashcards

1
Q

women >60 who smoke

A

MC demographic for hyper/hypothyroidism

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2
Q

autoantibodies binding to TSH receptorss

A

Graves Disease

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3
Q

positive Thyroid stimulating Ig, Anti-TPO, Anti-Tg

A

graves disease

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4
Q

amiodarone can cause

A

excessive iodine leading to thyrotoxicosis

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5
Q

kelp can cause

A

excessive iodine leading to thyrotoxicosis

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6
Q

nori is known for

A

excessive iodine leading to thyrotoxicosis

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7
Q

polyuria, diarrhea, muscle cramps

A

unexpected symptoms of thyrotoxicosis

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8
Q

lid lag/lid retraction

A

signs of thyrotoxicosis

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9
Q

hyperreflexia indicative of

A

signs of thyrotoxicosis

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10
Q

osteoporosis and resting tremors indicative of

A

signs of thyrotoxicosis

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11
Q

thyroid acropachy seen in

A

graves disease

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12
Q

staring appearance/upper eyelid retraction

A

graves ophthalmology

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13
Q

periosteal reaction of extremity bones, digital clubbing, swelling of the fingers and toes

A

thyroid acropachy indicative of graves disease

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14
Q

erythematous rough plaques and lymphoid infiltration

A

graves dermopathy/pretibial myxedema indicative of graves disease

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15
Q

forceful heartbeat, premature atrial contraction, pulmonary HTN, exertional dyspnea, forceful heartbeat

A

cardiopulmonary manifestations of thyrotoxicosis

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16
Q

most common in 2nd trimester of pregnancy

A

graves disease

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17
Q

hypercalcemia
^ alk phosphate

A

primary hyperthyroidism

also seen: anemia
decreased granulocytes

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18
Q

anemia
decreased granulocytes

A

primary hyperthyroidism

also seen:
hypercalcemia
^ alk phosphate

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19
Q

elevated ESR

A

subacute thyroiditis
suppurative thyroiditis

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20
Q

low serum thyroglobulin levels suggest what manifestation
(there may be multiple of these, check me plz)

A

thyrotoxicosis factitia

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21
Q

used to differentiate thyrotoxicosis etiologies

A

RAI

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22
Q

increased uptake of iodine in RAI

A

graves disease, toxic solitary nodule, toxic multinodular goiter, T1 amiodarone thyrotoxicosis

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23
Q

low uptake of iodine in RAI

A

thyroiditis, iodine induced thyrotoxicosis, T2 amiodarone thyrotoxicosis

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24
Q

RAI contraindication

A

pregnancy

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25
Q

cannot tell benign from malignant

A

thyroid US

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26
Q

cannot be used to measure metabolic activity

A

thyroid US

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27
Q

treat with steroids.
treat with radiation/surgery if severe

A

graves disease with severe ophthalmologic manifestations

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28
Q

symmetric flaccid paralysis

A

common after IV dextrose, oral carbs or vigorous exercise

this is called hypokalemic periodic paralysis and it presents in thyrotoxicosis

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29
Q

high fever, tachycardia, delirium, vomiting/diarrhea, dehydration

A

thyroid storm
(severe life threatening thyrotoxicosis)

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30
Q

treatment for thyroid storm

A

Thiourea drug: methimazole or PTU (inhibits iodine oxidation, preventing formation of thyroid hormone.)
Iodinated contrast agent: ipodate sodium or iopanoic acid (Inhibits peripheral conversion of T4 to T3)
BB: propranolol or atenolol (symptomatic relief)
Hydrocortisone
AVOID ASA

definitive: Radioactive iodine and/or surgery

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31
Q

normal serum FT4 and T3 but low TSH

A

subclinical hyperthyroidism

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32
Q

BB
Iodinated contrast agents
thiourea drugs

A

graves disease treatment

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33
Q

teratogenicity, passed through breast milk

A

methiomazole

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34
Q

Inhibits organification of iodine, preventing formation of thyroid hormone.

Decreases peripheral conversion of T4 to T3.

A

PTU

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35
Q

BBW hepatotoxicity

A

PTU

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36
Q

BB + PTU or methimazole can be used to treat which conditions

A

toxic solitary nodules
amiodarone induced thyrotoxicosis
Toxic multinodular goiter

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37
Q

Thioureas are ineffective

A

thyroiditis

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38
Q

avoid aspirin

A

thyroid storm

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39
Q

use BB for treatment. iodinated contrast agents if severe.

A

thyroiditis

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40
Q

radioactive iodine interferes with

A

TSI labs

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41
Q

hepatitis C
iodine deficiency
family Hx
head/neck radiation

A

risk factors for hashimotos

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42
Q

diffusely enlarged, firm, finely nodular thyroid
presents with no pain/tenderness

A

hashimotos typical presentation

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43
Q

more prone to depression even if labs are w/i normal limits

A

hashimotos

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44
Q

enlarged thyroid w/ transient hyperthyroid for 1-6 mo, then transient hypothyroid for 1-2 mo

A

painless postpartum thyroiditis

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45
Q

50% w/small nontender goiter. transient hyper for 1-2 mo then hypo

A

painless sporadic thyroiditis (subacute form of hashimoto)

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46
Q

subacute form of hashimoto

A

painless sporadic thyroiditis

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47
Q

acute enlargement of thyroid w pain radiating to ear/jaw

A

subacute thyroiditis

presents w/
Acute enlargement of thyroid gland.
Pain and dysphagia, usually referred to ear or jaw.
Malaise and fever
Hx of recent URI
Short-term thyrotoxicosis followed by long hypothyroidism

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48
Q

due to viral infection

A

subacute thyroiditis

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49
Q

low grade fever, malaise, and painful dysphagia

A

subacute thyroiditis

Acute enlargement of thyroid gland.
Pain and dysphagia, usually referred to ear or jaw.
Malaise and fever
Hx of recent URI
Short-term thyrotoxicosis followed by long hypothyroidism

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50
Q

Short-term thyrotoxicosis followed by long hypothyroidism

A

subacute thyroiditis

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51
Q

Severe pain, tenderness, redness, fluctuance
presents w fever

A

suppurative thyroiditis

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52
Q

Hx of immunosuppression common with

A

suppurative thyroiditis
strongly correlated w hashimotos as well

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53
Q

Assymetric, stony, adherent thyroid gland

A

ridel thyroiditis

associated dysphagia, dyspnea, pain, hoarseness also present

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54
Q

positive Anti-TPO or Anti-Tg antibodies.
TSI not necessarily important.
sometimes have labs consistent w celiac disease

A

hashimotos

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55
Q

low antithyroid antibodies

A

subacute thyroiditis

56
Q

elevated Leukocytes

A

suppurative thyroiditis

57
Q

elevated ESR w NORMAL thyroid antibody labs

A

suppurative thyroiditis

58
Q

elevated ESR w LOW thyroid antibody labs

A

Subacute thyroiditis

59
Q

Fever

A

thyroid storm
subacute thyroiditis
suppurative thyroiditis

60
Q

diffuse, heterogeneous texture on ultrasound

A

hashimotos

61
Q

increased vascularity on US

A

graves disease

62
Q

normal or decreased vascularity on US

A

thyroiditis

63
Q

FNA biopsy w gram stain and culture

A

suppurative thyroiditis

64
Q

1st trimester miscarriage risk

A

hashimotos

65
Q

abscess or chronic sinus tract formation

A

suppurative

66
Q

can use levothyroxine for hypothyroid
may try levo suppression for hyperthyroid

A

hashimotos treatment

67
Q

High dose ASA or NSAIDS

A

subacute thyroiditis

use BB for s/s
severe = iodinated contrast agents

68
Q

antibiotics and surgical drainage of abscess

A

suppurative thyroiditis

69
Q

tamoxifen and/or steroid therapy

A

riedel thyroiditis

70
Q

due to systemic fibrosis

A

common cause of riedel thyroiditis

71
Q

for viewing vascularity

A

thyroid US

72
Q

HPT axis dysfunction

A

sick euthyroid syndrome

73
Q

abnormal thyroid function with nonthyroid illness

A

sick euthyroid syndrome

74
Q

impaired deiodination of T4 to T3 and decreased clearance of reverse T3

A

sick euthyroid syndrome

75
Q

cytokine based inhibition of thyroid hormone production

A

sick euthyroid syndrome

76
Q

specifically due to IL-6 cytokine

A

sick euthyroid syndrome

77
Q

Observation unless s/s or previous hx.
Correcting the underlying disease is typically sufficient.

A

sick euthyroid syndrome

78
Q

MC in asian and american indian men

A

Hypokalemic periodic paralysis

79
Q

vocal cord paralysis
LAN
adherence to local structures
large size

A

cancerous thyroid nodule characteristics.

80
Q

Retrosternal: dyspnea, facial erythema, JVD

A

large multinodular goiter characteristics

81
Q

Cold RAI uptake

A

higher cancer risk

82
Q

hot RAI uptake

A

lower cancer risk

83
Q

warm RAI uptake

A

normal thyroid cells

84
Q

FNA biopsy

A

evaluates for malignancy in nodules

85
Q

Biopsy or no?
nodule >1cm w suspicious appearance.

A

yes

86
Q

Biopsy or no?
nodule <1cm w LAD

A

yes

87
Q

Biopsy or no ?
1.5 cm w/o suspicious appearance

A

no

88
Q

Biopsy or no?
.7cm w suspicious appearance

A

no

89
Q

heart disease exacerbation, osteoporosis, hyperthyroidism

A

risks of LT4 suppression

90
Q

treatment for thyroid goiter with s/s of thyrotoxicosis

A

thiourea drug +/- BB

91
Q

treatment for thyroid goiter that is cancerous, hyperfunctioning or toxic

A

surgery

92
Q

ethanol injections

A

treatment for thyroid goiter w benign nodules to shrink them

93
Q

toxic thyroid adenoma or toxic MNG treatment

A

RAI therapy.

94
Q

initial labs for a pt w/ thyroid goiter or nodule(s)

A

TSH +/- FT4 and autoimmune labs

95
Q

MC thyroid cancer

A

papillary thyroid cancer

96
Q

can occur as autosomal dominant

A

papillary thyroid carcinomas

97
Q

slow growing, often remains confined to thyroid/regional lymph nodes

A

papillary thyroid carcinoma.

98
Q

cancer with high RAI uptake

A

Follicular thyroid carcinoma

99
Q

presents with flushing and diarrhea.

A

medullary thyroid carcinoma

100
Q

can sometimes appear as cushings syndrome

A

medullary thyroid carcinoma

101
Q

nodule that is palpable, firm, nontender

A

indicative of thyroid carcinoma

102
Q

carcinoma w elevated serum Tg

A

metastatic papillary or follicular carcinomas

103
Q

elevated calcitonin and serum CEA

A

medullary thyroid carcinoma

104
Q

used to evaluate distant metastases

A

CT/MRI

105
Q

thyroid mass that is 2cm is found to be cancerous. treatment plan?

A

total thyroidectomy + cervical lymph node disection

106
Q

thyroid mass is .5 cm and found to be cancerous. Treatmnt plan?

A

consider lobectomy

107
Q

lesion found that is 6 cm but is undetermined to be cancerous or noncancerous. treatment plan?

A

total thyroidectomy

108
Q

lesion found to be 2cm but is undetermied to be cancerous or noncancerous. treatment plan?

A

lobectomy (+/- lacter thyroidectomy)

109
Q

differentiated thyroid cancer treatment

A

RAI therapy
chemotherapy
thyroxine suppression

110
Q

hypothermia, hypotension, hyponatremia…. finish the symptoms and state diagnosis

A

hypothermia
hypotension
hyponatremia
hypoventilation
hypoglycemia
cognitive impairment

myxedema crisis

111
Q

IV LT4, may need IV LT3

A

myxedema crisis. use LT3 if in coma

112
Q

labs show increased lipids and elevated prolactin

A

hypothyroidism.

113
Q

labs show normal FT4 with TSH above normal range

A

subclinical hypotyroidism.

114
Q

CI for acute MI, thyrotoxicosis and adrenal insufficiency

A

levothyroxine (LT4), liothyronine (LT3), dessicated thyroid (LT3/LT4 combo aka armour thyroid)

115
Q

CI for allergy to beef/pork

A

desiccated thyroid (LT3/LT4 combo aka armour thyroid)

116
Q

not reccomended medication in elderly patients

A

desiccated thyroid (LT3/LT4 combo aka armour thyroid)

117
Q

Increased risk of megacolon

A

Hypothyroidism

118
Q

what is the job of deiodinases

A

convert T4 to T3

119
Q

what converts T4 to T3

A

deiodinases

120
Q

what enzyme processes iodine for thyroid use

A

TPO

121
Q

what does increased rT3 indicate other than stress inceased in the body

A

hypothyroidism because it is metabolically inactive

122
Q

which thyroid hormone binds better to proteins? receptors?

A

T4 - proteins
T3 - receptors`

123
Q

what alters gene expression, usually causing a target gene to be expressed

A

T3 receptor complex aka TR-RXR complex

124
Q

what thyroid problem could cause heavy menses

A

hypothyroidism

125
Q

when are TSH levels highest and lowest

A

highest at 10pm
lowst at 10am

126
Q

affect of lithium on TSH, T3 and T4

A

increases TSH
decreases T3 and T4

127
Q

what would cause decreased T3/FT3

A

Decreased conversion of T4 to T3, aka liver disease or severe illness.

128
Q

what two things could cause increased TBG

A

high estrogen levels
infectious hepatitis

129
Q

hat 4 things can cause low TBG

A

Hypoproteinemia
Ovarian failure
Elevated testosterone levels
Major Stress

130
Q

differentiate between primary, secondary and tertiary hypothyroidism

A

primary - decreased thyroid function

secondary - decreaseed pituitary function

tertiary - decreased hypothalamus function

131
Q

A TRH stimulating test shows no increase in TSH, what is the diagnossi

A

secondary hypothyroidism. pituiatry problem

132
Q

there is a delayed increase in baseline TSH after a TRH stimulation test, what is the diagnosis

A

tertiary hypothyroidism

133
Q

MCC hypothyroidism in US

A

hashimotos

134
Q

what does enlarged thymus suggest

A

autoimmune thyroiditis

135
Q

CI for levothyroxine

A

angina (acute MI)
adrenal insufficiency (uncontrolled)
thyrotoxicosis

Clinical medicine A (32 decks)

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