clinical thyroid Flashcards

1
Q

what is HP-T axis

A

hypo(TRH)>pit(TSH)> thyroid T3/4

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2
Q

4 thyroid presentations

A
  1. hyper
  2. hypo
  3. mass effect
  4. associated issues
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3
Q

hormones in primary hyper

A

TSH down, TH up

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4
Q

hormones in secondary hyper

A

TSH up, TH up

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5
Q

hormones in primary hypo

A

TSH down, TH up

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6
Q

hormones in secondary hypo

A

TSH down, TH down

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7
Q

presentation of hyper-thyroid

A
  1. hypermatabolism
  2. overactiv adrenergic system - anxiety etc
  3. may have orbiopathy if graves
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8
Q

physical appearance in hyper

A
  1. general: warm, anxious, silky skin
  2. vitals: increased HR, syst. hypertension
  3. Eyes: stare, lid lag
  4. thyroid: enlarged, bruit
  5. neuro: tremor, proximal muscle weakness
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9
Q

4 common causes of primary hyperthyroid

A
  1. graves disease
  2. multinodule goiter - benign
  3. toxic adenoma - benign
  4. subacute thyroidisitis
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10
Q

how to identify hyper

A

increased radioactive iodone uptake

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11
Q

what if uptake is low

A
  1. PT taking thyroid drugs

2. subacute thyroiditis - leaking

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12
Q

treatment if uptake high

A

thionamide and B-bloacker

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13
Q

treatment if uptake is low

A

B-blocker only

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14
Q

4 treatment options for graves

A
  1. Thionamide drugs - block t3/4 production
  2. B-blocker - reduce symp symptoms
  3. radioactive iodine - kills cells
  4. surg
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15
Q

hypo presentation

A
  1. everything slowed down
  2. constipation
  3. dry skin and hair
  4. swelling around eyes, heart and lung
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16
Q

4 possible causes of primary hypo

A
  1. congential
  2. hashimotos - autoimmune destruction
  3. subacute thyroiditis
  4. drug/radiation
17
Q

treatment for hypothy

A

l-thyroxine

18
Q

what is DDx for thyroid mass

A
  1. solitary - benign or thyroid cancer

2. multiple - multinodular goiter

19
Q

approach to thyroid nodule

A
  1. asses risk for cancer (fam, growth speed)
  2. check TSH
    - if okay go to 3, if supress radio scan - if hot not cancer
  3. utrasound and fine needle biopsy
20
Q

best imaging for thyroid

A

ultrasound

21
Q

2 types of nodules

A
  1. hot - take up isotope - zero cancer risk

2. cold - looks blank - 5% cancer risk

22
Q

2 structures at risk in thyroid surgery

A
  1. parathyroid -PTH

2. recurrent laryngeal nerve - voice

23
Q

treatment of thyroid cancer (4)

A
  1. total thyroidectomy
  2. RAI to ablate remaining thyroid
  3. thyroid replacment homrones
  4. follow levels and neck US