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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
What do you give after starting thiourea drugs in graves
iodine to block T4 to T3 | wolff chaikoff effect because blocks synthesis and release
26
besdies antithyroid drugs and iodine what other medicaiton is used in graves
lithium, K perchlorate
27
What is second line Tx graves
radioactive iodine
28
what is the final Tx for graves
surgery
29
what can stimulate primary hyperthyroidism by creating low TSH
``` acute steroid administration amphetamines Ca ch blockers dopamine NSAIDs opiates elderly euthyroid pregnancy or hCG secretion severe non-thyroidal illness (IL , TNF) ```
30
what heart condition can thyrotoxicosis caUSE
A FIB
31
Apathetic hyperthyroididsm signs
apathy, weight loss, angina, AF, CHF and less adrenergic Sx
32
What cuases apathetic hyperthyroidism
somatic mutations of TSH R and G alpha protein leading to cAMP cascade of inositol phosphate pathway
33
what drug can cause an autonomous thyroid nodule to become a toxic multinodular goiter
amiodarone excess iodine
34
someone on amiodarone will have what result in an radioactive thyroid scan
decreased uptake of iodine from iodine induced TMN goiter | thyroid already saturated of iodine
35
what is Jod basedown phenomenon
when patient has ample iodine so induces TMN goiter
36
What are the type I amiodarone induced thyrotoxicosis
- jod basedown type with TMNG and no thyroid Ab | - graves type with Ab
37
what is type II amiodarone induced thyrotoxicosis
thyroiditis
38
what can cause increased uptake on iodine scan
graves adenoma(plummers) inappropriate secretion TSH (pituitary adenoma) TMN Trophoblastic (embryonal carcinoma and hydatiform mole)
39
Tx for an autonomous thyroid nodule
RAI or surgery or antithyroid drugs
40
Tx for TMNG
RAI or surgery of ATDs
41
what should you do for RAI Tx in someone with low uptake
prime with PTU or recombinant TSH
42
patient has normal free T4 and low TSH
subclinical hyperthyroidism
43
risks of subclinical hyperthryoidism
AF and diastolic dysfunction osteoporosis dementia
44
Tx for subclinical hyperthyroidism
TAI or small dose of antithyroid drug
45
patient with normal T4 and TSH between 0.1- 0.3 (low) | what would you Tx
observation and consider beta blocker
46
what can cause thyrotoxic storm
acute illness, thyroid surgery or RAI therapy in inadequately Tx patient
47
signs thyroid storm
fever, tachycardia, tachypnea, hypotension, vomiting, diarrhea, irritability, delerium, coma and death
48
Tx for thyroid storm
thiourea with iodides must start iodides after thiourea start metoprolol and hydrocortisone as well
49
thyroid storm presents similar to what
sepsis, pheo, malignant hyperthermia
50
male on thyroid hormone replacement has muscle pain and weakness gynecomastia, severe prosimal muscle weakness and dec reflexes low K Dx?
thyrotoxic periodic paralysis
51
what is thyrotoxic periodic paralysis
channelopathy with muscle weakness (Na/KATPase increased) hypopolarization
52
levels of K in thyrotoxic periodic paralysis
serum hypokalemia with heavy meal or post exercise in asian men
53
what drugs can increase ATPase activity in thyrotoxic periodic paralysis
thyroid hormone, catecholamines, insuline, testosterone
54
``` 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? ```
postpartum
55
what are causes of hyperthyroidism with decreased uptake on RAI
Drugs: thyroxine Iodine: jod basedown Ectopic: struma ovarii, teratoma Thyroiditis: painful types and painless types
56
what are the painful types of thyroiditis
subacute granulomatous--> viral, high ESR, HLA B-35 suppurative (staph) radiation drug induced
57
Amiodarone induced thyroiditis involves what IL?
IL-6
58
what are the painless types thyroiditis
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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