Diseases

Question 1

Goiter

Answer 1

hyperplasia of thyroid follicular cells due to chronic stimulation by TSH or TSH like goitrogens
may result from insufficient iodine in the diet, inflammation of the thyroid gland, or an enzyme deficiency

Question 2

Cretinism

Answer 2

Neonatal hypothyroidism characterized by moderate to severe mental retardation and dwarfism due to delayed development of the nervous and skeletal systems
Prognosis is dependent upon time of diagnosis and initiation of replacement therapy

Question 3

Acute thyroiditis

Answer 3

not very common, etiology: staph aureus, step pyogenes, pneumococcus, entire gland may be involved but the infection is usually unilateral
abrupt onset of fever, chills, severe pain in anterior part of neck, dysphagia
regional lymphadenopathy
thyroid function usually remains intact
may be some residual fibrosis after recovery

Question 4

Labs of Acute thyroiditis

Answer 4

ESR increased
leukocyte count 15K-20K
unbound T4 normal or slightly increased
RAI normal except over area of involvement-thyroid scintigraphy demonstates cold area

Question 5

Treatment of acute thyroiditis

Answer 5

abx, rest, analgesics, observation

abscess-incision and drainage

Question 6

Subacute thyroidits (de Quervian’s Thyroditis)

Answer 6

much more common
chronic low grade infection
tender firm enlargement of thyroid
usually preceded by a respiratory viral infection
leuokocytosis minimal and transient
more common in females and ages 21-50 year olds
symptoms mimic acute pharyngitis
present with sore throat, tender or painful swelling in the neck, and dysphagia
little or no cervical adenopathy

Question 7

Labs of de Quervains thyroiditis

Answer 7

unbound T4 often elevated with low RAI uptake then low unbound T4 with normal RAI
thyroid antibody titres low to absent

Question 8

treatment of de Quervains thyroiditis

Answer 8

analgesics, prednisone, occasionallt replacement of T4

complete recovery is expected

Question 9

Silent thyroiditis

Answer 9

painless thyroiditis- NO anterior neck pain
sporadically or postpartum
Hyperthyroid sx in acute stages
hypothyroid symptoms during covalescent stage
significant autoimmune componet

Question 10

labs for silent thyroiditis

Answer 10

elevated T3 and T4 initially and later are low
suppressed serum TSH
50-70% serum thyroid peroxidase Ab concentrations
low RAI

Question 11

Chronic thyroiditis-Hashimoto’s/lymphocytic

Answer 11

strong autoimmune component-high serum thyroid peroxidase antibody concenttrations present in 90% of patients (Ab levels do no correlate with severity of disease)
most common type of hypothyroidism in north america

Question 12

Hashimoto treatment

Answer 12

suppressive dose of replacement therapy or surgery

Question 13

Chronic thyroiditis- riedel thyroiditis

Answer 13

dense fibrous tissue infiltration of thyroid
may represent end stage of either subacute or hashimotos thyroiditis
gradual onset with firm woody or stony hardness involving either or both lobes
neither painful nor tender
may have pressure symptoms

Question 14

lab of Riedel thyroiditis

Answer 14

AI antibodies either absent or low
scintigraphy patchy uptake between areas of fibrosis
RAI usually normal
replacement therapy only if hypothyroidism develops

Question 15

Iatrogenic hypothyroidism

Answer 15

following RAI treatment of hyperthyroidism or following surgery of hyperthyroidism or from amiodarone or lithium

Question 16

Primary Hypothyroidism lab characterizations

Answer 16

decreased thyroid hormone in peripheral blood
elevated serum TSH
abnormally low RAI uptake (not trapping)
EXAGGerated TSH response to exogenous TRH
elevated serum lipids, TC, LDLC
elevated creatine kinase levels

Question 17

secondary hypothyroidism

Answer 17

rarey congenital lack of TSH, destructive disease of pituitary gland (no TSH response to exogenous TRH)

Question 18

Subclinical hypothyroidism

Answer 18

TSH levels high but T3 and T4 normal levels
treatment to .05-2.0 microunits per liter and only indicated if patient is symptomatic or TSH is more than 10 microunits per liter
important to treat in pregnant woman or those consider pregnancy since maternal T4 crosses the placenta

Question 19

rotterdam study

Answer 19

linked risk factors associated with subclinical hypothyroidism- Myocardial infarction
associated with: 
ovulatory dysfunction and infertility 
progression to over hypothyroidism
elevated total and LDL cholestrol
psychiatric and cognitive abnormalities 
increased risk of aortic califications

Question 20

Hallmark of Myxedemic Coma

Answer 20

hypothermia and bradycardia

Question 21

thyrotoxicosis factitia

Answer 21

taking T4 to lose weight

Question 22

thyrotoxicosis medicamentosa

Answer 22

overprescribed T4

Question 23

toxic struma ovarii

Answer 23

dermoid cyst or a teratoma on the ovary producing T3 and T4
palpable abdominal mass
ascites

Question 24

toxic diffuse goiter-graves disease

Answer 24

abnorml IgG acting on TSH receptors stimulating thyroid hormone production
antibody titers are lower than in hashimoto’s

Question 25

triad of Graves disease

Answer 25

hyperthyroidism with diffuse goiter
opthalmopathy
dermopathy

Question 26

Toxic multinodular goiter

Answer 26

hyperplasia superiposed on an old adenomatous goiter
postmenopausal
no exopthalmus
usually elderly with long history of multinodular goiter
initial symptom can be a cardiac symptom

Question 27

Jod-Basedow Syndrome

Answer 27

hyperthyroidism induced by a significant load of exogenous iodine
can persist after discontinuation of iodine
characterized by: Low TSH, decreased I131 uptake, often resolves sponatneously and if treatment is needed-methimazole

Question 28

subclinical thyrotoxicosis

Answer 28

Low TSH and normal unbound T4
clinical consequences: progression to thyrotoxicosis, bone mineral lloss, cardiac effect-atrial fib, neuropsychiatric symptoms, ovulatory dysfunction

Question 29

papillary thyroid carcinoma

Answer 29

50% of all thyroid malignancies
spread throughout lymp
psammoma bodies
treatment: lobectomy or total thyroidectomy, suppressive therapy
5 year survival rate 96%
80% of tumors developing after radiation

Question 30

follicular thyroid carcinoma

Answer 30

25% of all thyroid malignancies
spread hematogenous
tx: lobectomy or total thyroidectomy,
20% or tumor developing after radiation

Question 31

Hurthle Cell adeooma

Answer 31

a non malignant adenoma difficult to distinguish from a follicular malignancy
EOSINOPHILIC granular cytoplasm

Question 32

Medullary carcinoma

Answer 32

5-10% of thyroid malignancies
tumor of parafollicular cells
elevated calcitonin level , may have elevated serotonin level
nonfunctioning do not take up iodine on I131 scan
metastasize early-not suppressed by thyroid hormone
tx: total thyroidectomy node dissection or modified radical neck dissection
associated with Multiple endocrine neoplasia
gain of function mutation

Question 33

anaplastic carcinoma of the thyroid

Answer 33

represents 2-5% pf all thyroid malignancies
40% of deaths from thyroid cancer
5 year survival rate 2%
usually die within first year of discovery
inoperable
chemotherapy and radiation not helpful
if over 40 years old have higher percentage of anaplastic tumors
lungs and brain common metastatic sites
signs and sx: rapidly growing neck mass, dysphagia, cough, neck pain, dyspnea