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endoII exam2 > Darrow, Hyperthyroid > Flashcards

Darrow, Hyperthyroid Flashcards

1
Q

heat intolerance and palpitations

A

hyperthyroid

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2
Q

clubbing of fingers

A

hyperthyroid

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3
Q

What is higher in graves T3 or T4

A

T3

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4
Q

what are clinical signs of graves

A

goiter, exophthalmos, pretibial myxedema

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5
Q

what type of HS reaction is graves

A

type II
Ab dependent cytotoxicity
IgG

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6
Q

What HLA is graves

A

HLA-DRB1, DR8

HLA DR is MHC II

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7
Q

major cell causing pretibial myxedma

A

TH1

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8
Q

what cell drives graves disease

A

TH2

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9
Q

TH1 CD4 cells do what in graves

A

stimulate effector cells (macrophages, CTLs, NK cells) against TSH R and fibroblast to produce GAGs

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10
Q

What do CD4 TH2 cells do in graves

A

sitmulate TSH R Ab(TSI) that act on follicular cells to stimulate thyroid growth and secretion
cross react with antigens in fibroblasts, adipocytes etc

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11
Q

how do type II HS reactions cause disease

A

C’ mediated lysis through MAC
Ab dependent cytotoxic attack (CTL)
alter cell surface R function toward activation or blockade

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12
Q

What are other type II HS reaction diseases

A

autoimmune hemolytic anemia
blood transfusion reaction
graves
myasthenia gravis

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13
Q

if patient with graves has diplopia what do you have to keep

A

coexistant myasthenia gravis

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14
Q

what causes the proptosis and diplopia in graves

A

firbobalst proliferation with GAG deposits and lymphocytes that is caused by TH2

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15
Q

what can cause clubbing of fingers or ‘hypertrophic osteoarthropathy”

A 
cardiac diseases
pulmonary diseases
GI diseases
Rena failures
thyroid disease (graveS)
malignancies
idiopathic
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16
Q

what classifies tyrotoxid cardiomyopathy

A

tach induced cardiomyopathy, Afib, high output failure, pulm HTN

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17
Q

how do you rule out factitial thyrotoxicosis

A

no thyroglobulin in factitial thyrotoxicosis

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18
Q

why does increased T3 lead to hyperCa

A

more bone turnover

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19
Q

what HLA is responsible for euthyroid Graves orbitopathy

A

HLA B40 DQw3

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20
Q

first line of Tx for graves

A

antithyroid drugs to block oxdation of Iodine, block organification iodine and couling

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21
Q

What are the antithyroid drugs used in graves

A

PTU

methimazole

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22
Q

How does PTU work

A

blocks T4 to T3

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23
Q

what is the first drug of choice for graves

A

methimazole because less hepatic necrosis

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24
Q

side effects of antithyroid drugs

A

agranulocytosis, hepattis, SLE

25
Q

What do you give after starting thiourea drugs in graves

A

iodine to block T4 to T3

wolff chaikoff effect because blocks synthesis and release

26
Q

besdies antithyroid drugs and iodine what other medicaiton is used in graves

A

lithium, K perchlorate

27
Q

What is second line Tx graves

A

radioactive iodine

28
Q

what is the final Tx for graves

A

surgery

29
Q

what can stimulate primary hyperthyroidism by creating low TSH

A 
acute steroid administration
amphetamines
Ca ch blockers
dopamine
NSAIDs
opiates
elderly euthyroid
pregnancy or hCG secretion
severe non-thyroidal illness (IL , TNF)
30
Q

what heart condition can thyrotoxicosis caUSE

A

A FIB

31
Q

Apathetic hyperthyroididsm signs

A

apathy, weight loss, angina, AF, CHF and less adrenergic Sx

32
Q

What cuases apathetic hyperthyroidism

A

somatic mutations of TSH R and G alpha protein leading to cAMP cascade of inositol phosphate pathway

33
Q

what drug can cause an autonomous thyroid nodule to become a toxic multinodular goiter

A

amiodarone excess iodine

34
Q

someone on amiodarone will have what result in an radioactive thyroid scan

A

decreased uptake of iodine from iodine induced TMN goiter

thyroid already saturated of iodine

35
Q

what is Jod basedown phenomenon

A

when patient has ample iodine so induces TMN goiter

36
Q

What are the type I amiodarone induced thyrotoxicosis

A
  • jod basedown type with TMNG and no thyroid Ab

- graves type with Ab

37
Q

what is type II amiodarone induced thyrotoxicosis

A

thyroiditis

38
Q

what can cause increased uptake on iodine scan

A

graves
adenoma(plummers)
inappropriate secretion TSH (pituitary adenoma)
TMN
Trophoblastic (embryonal carcinoma and hydatiform mole)

39
Q

Tx for an autonomous thyroid nodule

A

RAI or surgery or antithyroid drugs

40
Q

Tx for TMNG

A

RAI or surgery of ATDs

41
Q

what should you do for RAI Tx in someone with low uptake

A

prime with PTU or recombinant TSH

42
Q

patient has normal free T4 and low TSH

A

subclinical hyperthyroidism

43
Q

risks of subclinical hyperthryoidism

A

AF and diastolic dysfunction
osteoporosis
dementia

44
Q

Tx for subclinical hyperthyroidism

A

TAI or small dose of antithyroid drug

45
Q

patient with normal T4 and TSH between 0.1- 0.3 (low)

what would you Tx

A

observation and consider beta blocker

46
Q

what can cause thyrotoxic storm

A

acute illness, thyroid surgery or RAI therapy in inadequately Tx patient

47
Q

signs thyroid storm

A

fever, tachycardia, tachypnea, hypotension, vomiting, diarrhea, irritability, delerium, coma and death

48
Q

Tx for thyroid storm

A

thiourea with iodides
must start iodides after thiourea
start metoprolol and hydrocortisone as well

49
Q

thyroid storm presents similar to what

A

sepsis, pheo, malignant hyperthermia

50
Q

male on thyroid hormone replacement has muscle pain and weakness
gynecomastia, severe prosimal muscle weakness and dec reflexes
low K
Dx?

A

thyrotoxic periodic paralysis

51
Q

what is thyrotoxic periodic paralysis

A

channelopathy with muscle weakness (Na/KATPase increased) hypopolarization

52
Q

levels of K in thyrotoxic periodic paralysis

A

serum hypokalemia with heavy meal or post exercise in asian men

53
Q

what drugs can increase ATPase activity in thyrotoxic periodic paralysis

A

thyroid hormone, catecholamines, insuline, testosterone

54
Q 
25 y.o F  postpartum with shakiness, palpitations and heat intolerance
BP 120/50
enlarged non tender thyroid gland
tremor in hands
increased T4
TSH low
TPOAb low
dec uptake on scan
Dx?
A

postpartum

55
Q

what are causes of hyperthyroidism with decreased uptake on RAI

A

Drugs: thyroxine
Iodine: jod basedown
Ectopic: struma ovarii, teratoma
Thyroiditis: painful types and painless types

56
Q

what are the painful types of thyroiditis

A

subacute granulomatous–> viral, high ESR, HLA B-35
suppurative (staph)
radiation
drug induced

57
Q

Amiodarone induced thyroiditis involves what IL?

A

IL-6

58
Q

what are the painless types thyroiditis

A

postpartum- DR3 DR5 (precursor to hashimoto)
subacute or chornic autoimmune lymphocytic (DM, vitiligo, downs or turners)
Riedels fibrosis

endoII exam2 (18 decks)

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