Ch. 565 & 566 - Hypothyroidism and Thyroiditis

Question 1

T/F Most cases of congenital hypothy is NOT hereditary

Answer 1

T

Question 2

T/F Most cases of congenital hypothy results from thyroid dysgenesis

Answer 2

T

Question 3

Cause of congenital hypothy in which goiter is almost always present

Answer 3

Dyshormonogenesis

Question 4

MC T4 synthetic defect

Answer 4

Thyroid peroxidase defects of organification and coupling

Question 5

Seen in radioiodine test as marked discharge of thyroid radioactivity when perchlorate or thiocyanate is administered

Answer 5

Thyroid peroxidase defects of organification and coupling

Question 6

T/F Congenital hypothy can result from fetal exposure to excessive iodides

Answer 6

T

Question 7

MCC of hypothy worldwide

Answer 7

Iodine deficiency or endemic goiter

Question 8

T/F Most patients with congenital hypothy are asymptomatic at birth, EVEN IF there is complete agenesis of the thyroid gland

Answer 8

T, due to transplacental passage of moderate amounts of maternal T4

Question 9

May be the earliest sign of congenital hypothyroidism

Answer 9

Prolongation of physiologic jaundice caused by delayed maturation of glucuronide conjugation

Question 10

Affected infants cry little, sleep much, have poor appetites, and are generally sluggish

Answer 10

Congenital hypothy

Question 11

Congenital hypothy T/F: Umbilical hernia is usually present

Answer 11

T

Question 12

Congenital hypothy T/F: Temperature is subnormal

Answer 12

T

Question 13

Congenital hypothy T/F: Edema of genital and extremities may be present

Answer 13

T

Question 14

Congenital hypothy: Type of anemia

Answer 14

Macrocytic, refractory to treatment with hematinics

Question 15

Congenital hypothy T/F: Majority have associated congenital anomalies

Answer 15

F, 10%

Question 16

MC congenital anomaly associated with congenital hypothy

Answer 16

Cardiac

Question 17

Congenital hypothy: Full clinical picture with physical and mental retardation is fully developed when

Answer 17

3-6 months of age

Question 18

Can serve as initial sign to the early recognition of congenital hypothy

Answer 18

Widely open anterior and posterior fontanels

Question 19

Hypotonic muscles but affected older children have an athletic appearance because of pseudohypertrophy, particularly of the calf muscles

Answer 19

Congenital hypothyroidism

Question 20

T/F Congenital hyperthyroidism is primarily a thyroid defect

Answer 20

T, TSH elevated >100mU/L

Question 21

Serum thyroglobulin level: Infants with thyroid agenesis

Answer 21

Low

Question 22

Serum thyroglobulin level: Infants with ectopic thyroid glands (thyroid dysgenesis)

Answer 22

Elevated

Question 23

Management for thyroid dysgenesis

Answer 23

Lifelong treatment with T4

Question 24

T/F Demonstration of ectopic thyroid tissue is diagnostic of thyroid dysgenesis

Answer 24

T

Question 25

How often are FT4 and TSH ideally monitored among patients with congenital hypothyroidism

Answer 25

Monthly for the 1st 6 mos, then every 2-3 months until 2 years old

Question 26

Risks of overtreatment with levothyroxine

Answer 26

1) Craniosynostosis 2) Temperament problems

Question 27

MCC of acquired hypothyroidism

Answer 27

Chronic lymphocytic thyroidits

Question 28

Cause of hypothy in Down syndrome

Answer 28

Development of antithyroid antibodies

Question 29

T/F Majority of children with Down Syndrome have overt or subclinical hypothy

Answer 29

F, 15-20%

Question 30

T/F Majority of girls with Turner syndrome develop hypothyroidism

Answer 30

F, 15-30%

Question 31

T/F Risk of subclinical or overt hypothy increases with age in patients with Turner Syndrome

Answer 31

T

Question 32

Cause of hypothy in patient's with Turner syndrome

Answer 32

Development of antithyroid antibodies

Question 33

T/F Removal if ectopic thyroid tissue can cause hypothyroidism

Answer 33

T

Question 34

T/F Protracted ingestion of medications that contain iodides can cause hypothyroidism

Answer 34

T, usually accompanied bbyb goiter

Question 35

Medication containing 37% iodine by weight that causes hypothyroidism in about 20% of treated children

Answer 35

Amiodarone

Question 36

Usually the first clinical manifestation of acquired hypothy

Answer 36

Deceleration of growth

Question 37

Nontender, firm enlargement of the thyroid gland with a rubbery consistency and a pebbly surface

Answer 37

Goiter

Question 38

T/F Weight gain in acquired hypothyroidism is mostly due to fluid retention

Answer 38

T, called myxedema, not true obesity

Question 39

T/F School work and grades usually do not suffer in acquired hypothyroidism, even in severely hypothyroid children

Answer 39

T

Question 40

T/F Osseous maturation is often strikingly delayed in patients with acquired hypothyroidism

Answer 40

T, it is an indication of the duration of the hypothy

Question 41

T/F There is no indication for thyroid imaging in acquired hypothy

Answer 41

T

Question 42

Most accurate method to follow nodule size in acquired hypothy

Answer 42

UTZ

Question 43

Treatment of choice for acquired hypothy

Answer 43

Levothyroxine

Question 44

MCC of thyroid disease in children and adolescents

Answer 44

Lymphocytic thyroiditis

Question 45

MCC of acquired hypothyroidism, with or without goiter

Answer 45

Lymphocytic thyroiditis

Question 46

Accounts for majority of infiltrating cells in lymphocytic thyroiditis

Answer 46

T cells (60%

Question 47

MC clinical manifestations of thyroiditis

Answer 47

Goiter and growth retardation

Question 48

Cause most cases of non-goitrous (atrophic) hypothy

Answer 48

Thyroiditis

Question 49

Chromosomal disorders particularly associated with lymphocytic thyroiditis

Answer 49

Down syndrome and Turner syndrome

Question 50

T/F TFT in thyroiditis are OFTEN normal

Answer 50

T, TSH may be slightly or even moderately elevated in some

Question 51

Antibodies found in patients with lymphocytic thyroiditis

Answer 51

Antibody to TPO and thyroglobulin

Question 52

Definitive diagnosis of lymphocytic thyroiditis can be established by

Answer 52

Biopsy of the thyroid

Question 53

Biopsy of the thyroid is always indicated to establish a diagnosis of lymphocytic thyroiditis

Answer 53

F

Question 54

T/F Subclinical thyroiditis is an indication for replacement therapy with levothyroxine

Answer 54

T

Question 55

Characteristics of nodules that should be examined histologically using FNA

Answer 55

Prominent (ie >1cm) that persist despite suppressive therapy

Question 56

Why is FNA indicated in suspicious thyroid nodules

Answer 56

Thyroid CA or lymphoma has occurred in patients with lymphocytic thyroiditis

Question 57

Uncommon cause of thyroiditis usually preceded by a respiratory infection and affects the LEFT LOWER LOBE predominantly

Answer 57

Acute suppurative thyroiditis

Question 58

Typical infectious agent of Acute suppurative thyroiditis

Answer 58

Anaerobic organisms

Question 59

MCC of Acute suppurative thyroiditis

Answer 59

Viridans strep > S aureus > pneumococcus

Question 60

Hypothy associated with exquisite tenderness of the gland, swelling, erythema, dysphagia, and limitation of head motion

Answer 60

Acute suppurative thyroiditis

Question 61

Rare cause of hypothy in children and is thought to have a viral cause

Answer 61

Subacute granulomatous thyroiditis (DeQuervain)

Question 62

T/F Subacute granulomatous thyroiditis remits spontaneously

Answer 62

T