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endoII exam2 > Darrow, hypothyroid > Flashcards

Darrow, hypothyroid Flashcards

1
Q

What is myxedma in hypothyroid

A

lymphadema with accumulation of GAGs in skin with doughy feeling on palpation

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2
Q

myxedema with diastolic HTN

A

hypothyroid

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3
Q

10 hypos hypothyroid

A 
hyporeflexia
hypomentia
hypothermia
hypoventilaion
hypotension or diastolic HTN
hypoHbinemia
hypoglycemia
hyponatremia
hypometabolism of drugs and lipids (HLD)
hypocortisolism
hypoadrenalism
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4
Q

causes of hypothyroidism

A

iodine deficiency and congenital defects in children

chronic lymphocytic thyroiditis (hashimotos in adults)

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5
Q

what is HLA of hashimoto

A

HLA DR5

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6
Q 
patient with large thyroid gland
\+FMH celiac and pernicious anemia
dry eyes and dry mouth
hgih TSH normal T4
additional test to confirm Dx?
A

TPO Ab

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7
Q

normal T4
hgih TSH
Dx?

A

subclinical hypothyroidism

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8
Q

risk of subclinical hypothyroidism

A

eleated lipids
CHF and ASHD
early dementia
poor iron absorption (anemia)

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9
Q

Tx criteria subclinical hypothyroidism

A

if no TPO Ab but TSH >10 Tx

if TPO Ab and TSH>5 Tx

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10
Q

Tx criteria for pregnant patients with TPO Ab

A

TSH> 2.5

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11
Q

causes of hypothyroidism

A 
chronic lymphocytic (hashimoto)!!
RAI induced!!
subacute lymphcytic thyroiditis!!
drugs: PTU, iodine, lithium!!, interferon!!, amiodarone!!, thalidomide etc
irradiation and thyroidectomy
infiltrative diseases
Hep C!!
central hypothyroidism
congenital
iodine deficient
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12
Q

other autoimmune diseases assoc with hashimoto

A

addisons, hypoPTH, DM , PA, sjogrens, vitiligo, PBC and IBD

HLA B8- DR, DQ

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13
Q 
65 F nubness in thumbs and index fingers
weak  and dizzy with chest pain
constipation, pedal edema
diastolic HTN
ywllowing skin
speech hoarse
bradycardia with II/VI systolic ejection murmur at base with high pitched systolic murmur at apex
hair thin and + Tinels sign
DTRs 1+ b/l
A

hypothyroidism

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14
Q

Dec Fe levels increased TIBC

A

Fe deficiency

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15
Q

what is gallavardin phenomenon

A

II/VI systolic ejection murmur at base with high pitched systolic murmur at apex

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16
Q

what can cause gallavardin phenomenon

A

diastolic HTN

17
Q

hypothyroidism can change Na how

A

hypotonic euvolemic hyponatremia from decreased NA/K ATPase

18
Q

urinary Na from hypothyroidism?

Usom?

A

> 20meq/L

Uosm >150-200 mOsm/L

19
Q

first line for hypothyroid Tx

A

L thyroxine 25-75/day unless pregnant or history of CAD

20
Q

L thyroxine levels for pregnant women

A

100-150 mcg

21
Q

what is the euthyroid dose level to stay near in Tx hypothyroidism

A

1.6 mcg/kg/day

22
Q

if patient is being Tx for hypothyroid and has TSH <2 and is still tired what shoul dyou look for

A

anemia, B12 deficiency, sleep apnea

23
Q

what are modifications in patients being Tx with L thyroxine

A

monitor oral intake drugs: imatinib, omeprazole and food:soy milk coffee, fiber and Ca

24
Q

what will precipitate a myxedema crisis

A

on compliance to meds, surgery, stress, infections

25
Q

mortality of myxedema crisis

A

20-50%

26
Q

Tx mxyedema crisis

A

hydrocortisone IV
levothyroxine
LT3

27
Q

what is definition bacterial peritonitis ascites

A

if there is >250 PMNs in sear from pericentesis

28
Q

what are common pathogens that cause bacterial peritonitits ascites

A

E coli and serratia

29
Q

what do yo worry about if pericentesis shows ?1 bacteria type

A

bowel perforation

30
Q 
55 y.o M with alcoholic cirrhosis and ascites with encephalopathy
has bacteral peritonitis
severe hypotension
lethargy
low TSH
Dx?
A

svere non thyroidal illness (TNF-euthyroid sick syndrome)

31
Q

What can cause low TSH

A

Autonomous functioning thyroid nodule
drugs: steroids, amphetamines, Ca Ch blockers, dopamine, NSAIDs, opiates
elderly euthyroid
pregnancy or hCG secretion

32
Q

causes of euthryoid sick syndrome

A

non thyroidal illness

major surgery

33
Q

T3 levels in euthyroid sick syndrome

A

LOW

34
Q

what causes low T3 in euthryoid sick syndrome

A

decreased 5’ deiodinase

increased IL that displaces binding of T4 (increases T3 uptake)

35
Q

What causes low TSH in euthyroid sick syndrome

A

severe
drugs: acute steroid, amphetamines, Ca Ch blockers, dopamine, NSAIDs, opiates
increased IL-1, IL-6 and TNF alpha

36
Q

how do TNF alpha and IL-1 decrease TSH

A

increast somatostatin which dec TRH so dec TSH

37
Q

how does IL-6 decrease TSH

A

increases CRH which inc ACTH which inc cortisol which dec both TRH and tSH

38
Q

50 y.o F with hoarsness, diminished sense tast and smell, menorrhagia, thinking of eyebrowns, thick tongue, cardiac enlargement and galactorrhea
pituitary enlarged on CT
best approach?

A

thyroid replacement

39
Q

TRH activates release of what

A

TSH and prolactin

endoII exam2 (18 decks)

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