Ch. 568 - Hyperthyroidism

Question 1

MCC of hyperthyroidism during childhood

Answer 1

Graves disease

Question 2

Autoimmune disorder with production of thyroid-stimulating Ig resulting in diffuse toxic goiter

Answer 2

Graves disease

Question 3

T/F Subclinical hyperthyroidism carries a risk of late-life atrial fibrillation

Answer 3

T

Question 4

T/F Enlargement of thymus, splenomegaly, lymphadenopathy, are well-established findings in Graves disease

Answer 4

T

Question 5

Cause of proptosis in Graves

Answer 5

Infiltration of retroorbital tissues with lymphocytes and plasma cells; Antibodies

Question 6

Antibody in Graves

Answer 6

Thyrotropin-receptor antibody (TRSAb)

Question 7

Action of TRSAb

Answer 7

Bind to receptor for TSH > stimulates cAMP > thyroid hyperplasia and unregulated overproduction of thyroid hormone

Question 8

T/F Infiltration of retroorbital tissues with lymphocytes and plasma cells is a well-established finding in Graves disease

Answer 8

T

Question 9

Graves Ophthalmopathy appears to be caused by

Answer 9

Ab against Ag shared by thyroid and eye muscle

Question 10

Earliest signs in children with Graves

Answer 10

Emotional disturbances accompanied by motor hyperactivity

Question 11

Characteristics of thyroid gland in Graves

Answer 11

Diffuse goiter, soft with a smooth surface

Question 12

T/F Afib is a rare complication of Graves disease

Answer 12

T

Question 13

Hyperthy : Cause of the apical systolic murmur present in some patients

Answer 13

MR, prob from papillary muscle dysfunction

Question 14

Hyperthy : Reflexes are brisk, especially the return phase of

Answer 14

Achilles reflex

Question 15

Form of hyperthy: Acute onset hyperthermia, severe tachy, heart failure, restlessness

Answer 15

Thyroid crisis/thyroid storm

Question 16

T/F Hyperthy may present with extreme listlessness, apathy, cachexia

Answer 16

T, apathetic or masked hyperthy

Question 17

T/F Measurement of TSI (thyroid-stimulating Ig) and TBII (Thyrotropin binding inhibiting immunoglobulins) is NOT useful in diagnosis of Graves

Answer 17

F, USEFUL

Question 18

Characteristics of thyroid nodule that is suspicious of Plummer disease

Answer 18

Palpable or T3 preferentially elevated in a hyperthy patient

Question 19

Initial therapy mostly recommended for patients with hyperthy

Answer 19

Antithyroid drugs > radioiodine or subtotal thyroidectomy

Question 20

Gaining acceptance as initial treatment in children >10y/o for hyperthy

Answer 20

Radioiodine

Question 21

Methimazole vs PTU: 10x more potent

Answer 21

Methimazole

Question 22

Methimazole vs PTU: Much longer serum half-life

Answer 22

Methimazole

Question 23

Methimazole vs PTU: Heavily protein bound

Answer 23

PTU

Question 24

Methimazole vs PTU: Lesser abbility to cross placenta

Answer 24

PTU

Question 25

Methimazole vs PTU: Lesser ability to pass into breastmilk

Answer 25

PTU

Question 26

Methimazole vs PTU: Preferred during pregnancy and for nursing mothers

Answer 26

PTU

Question 27

Dose of radioiodine

Answer 27

300Ci/g

Question 28

Average time course to hypothy in hyperthy patients treated with radioiodine 300Ci/g

Answer 28

11 weeks

Question 29

T/F Subtotal thyroidectomy is done only after patients has been brought to a euthyroid state

Answer 29

T

Question 30

Known risk factor for thyroid eye disease and should be avoided or discontinued to avoid progression of eye involvement

Answer 30

Cigarette smoking