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Endocrinology > Disorders of the Thyroid > Flashcards

Disorders of the Thyroid Flashcards

1
Q

Inflammation of the thyroid

Multiple causes and forms

Acute and subacute forms

A

Thyroiditis

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2
Q

What is the most common thyroid disorder in the United States?

A

Hashimoto Thyroiditis

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3
Q

Most common thyroid disorder in the United States

Autoimmune condition

Often progresses to hypothyroidism

More common in white females

Familial trend

A

Hashimoto Thyroiditis

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4
Q

What are some comorbidities that are also associated with Hashimoto thyroiditis?

A

DM type 1
Autoimmune gonadal failure
Hypoparathyroidism
Adrenal insufficiency

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5
Q

What are some risk factors for Hashimoto thyroiditis?

A

More common in smokers
Family history
Common in Hepatitis C
Drug induced
Head-neck radiation exposure

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6
Q

What levels are usually elevated in Hashimoto thyroiditis?

A

Serum anti-thyroperoxidase and anti-thyroglobulin antibody levels

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7
Q

1/3 of patients with Hashimoto thyroiditis may also have what other autoimmune condition?

A

Sjogren Syndrome

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8
Q

15% of Hashimoto thyroiditis patients also have serum antibodies associated with what disease?

A

celiac disease

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9
Q

Autoimmune thyroiditis

Occurs in 7.2% of women after delivery

Fetal cells in maternal thyroid

Most common in women with high thyroid peroxidase in first trimester or after delivery

A

Painless Postpartum Thyroiditis

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10
Q

What are the signs and symptoms of painless postpartum thyroiditis?

A

Hyperthyroidism 1-6 months after delivery, lasts about 1-2 months

Hypothyroidism 4-8 months after delivery

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11
Q

Subacute form of Hashimoto’s thyroiditis

Similar to painless postpartum thyroiditis, but not related to pregnancy

A

Painless Sporadic Thyroiditis

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12
Q

Also called de Quervain, granulomatous, or giant cell thyroiditis

Presumed to be caused by a viral infection or a postviral inflammatory process (Usually follows an URI)

Peak incidence in summer

Young and middle aged women (Most often occurs at 40-50 years of age)

A

Subacute Thyroiditis

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13
Q

What is the hallmark presentation of subacute thyroiditis?

A

Anterior localized neck pain, with or without fever

Thyroid gland is always tender on exam

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14
Q

How is subacute thyroiditis diagnosed?

A

Imaging:

Radioactive iodine uptake will show low uptake or a faint heterogeneous pattern of radionuclide uptake during the hyperthyroid phase

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15
Q

What is the first line treatment in subacute thyroiditis?

A

ASA/NSAIDs to relieve pain and inflammation

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16
Q

Rare

Non-viral infection of the thyroid gland (Usually bacterial)

Patients with pre-existing thyroid disease

A

Suppurative Thyroiditis

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17
Q

Rarest form

Normal thyroid tissue is replaced with connective tissue = fibrosis

Can extend deep into the neck causing the thyroid to become attached with the neck

Cause is unknown, butusually manifestation of multifocal systemic fibrosis syndrome

A

Reidel Thyroiditis

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18
Q

What are the signs/symptoms of Reidel thyroiditis?

A

Asymmetric enlargement

Stony hard and adhere to neck structures

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19
Q

What is the treatment of choice for Reidel thyroiditis?

A

Treatment of choice is Tamoxifen

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20
Q

dramatic enlargement of the thyroid gland

A

goiter

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21
Q

Large retrosternal goiters can cause venous distension over the neck and difficulty breathing, especially when the arms are raised. This is called what?

A

Pemberton’s Sign

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22
Q

Encompasses a heterogeneous group of disorders:

Grave’s disease

Toxic multinodular goiter (TMNG)

Toxic adenoma (TA)

A

Hyperthyroidism

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23
Q

What is the most common cause of hyperthyroidism and thyrotoxicosis?

A

Grave’s Disease

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24
Q

Autoimmune disorder associated with diffuses thyroid enlargement, excessive secretion of thyroid hormone, and antibodies against the thyroid

Females > males (8:1)

Young to middle-aged

Enlarged thymus and elevated ANA

Exophthalmos

A

Grave’s Disease

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25
Q

What is a risk factor for Graves disease, especially for ophthalmopathy

A

Smoking

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26
Q

Painless lumps composed of edematous subcutaneous tissue and thickening of overlying skin on lower legs

Resembles the skin of an orange and is thickened and rough, erythematous

A

Graves Dermopathy - pretibial myxedema

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27
Q

What percentage of Grave’s patients have ophthalmopathy manifestations/symptoms?

A

25%

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28
Q

List some causes of hyperthyroidism

A

Grave’s disease
Toxic adenomas
Subacute (de Quervain) thyroiditis
Factitial thyrotoxicosis
Hashimoto’s thyroiditis
Amiodarone
Pituitary Adenoma
Struma ovarii

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29
Q

Found in 3% of dermoid ovarian tumors

Means goiter of the ovary that contains mostly thyroid tissue leading to
hyperthyroidism

Most are benign, however can be malignant in a small percentages in
cases

A

Struma ovarii

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30
Q

What is the best test for thyrotoxicosis?

A

TSH

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31
Q

Provides a life-sized picture of thyroid uptake

Also useful for detecting metastatic thyroid cancer

A

Radioiodine Scans

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32
Q

Helpful in patients who have palpable thyroid nodules

A

Ultrasound

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33
Q

Methods of choice for scanning orbits in Graves ophthalmopathy
when extraocular muscles are involved

Severe exophthalmos

A

MRI/CT

34
Q

Initial treatment of choice in thyroid storm

A

Propranolol

35
Q

Medication class that inhibits thyroid hormone formation in the gland

A

Thiourea Drugs

36
Q

Excellent method of destroying overactive thyroid tissue

Treatment of choice for a “hot nodule” or Grave’s disease

Do NOT give in pregnant women

A

Radioactive iodine ¹³¹I

37
Q

Triggered by stressful illness, thyroid surgery, or RAI

Underlying cause is commonly Grave’s disease or TMNG

Manifestations – typically have an exaggeration of the usual
symptoms of hyperthyroidism

A

Thyroid Storm (Crisis)

38
Q

What is the initial treatment of choice in a thyroid storm and why?

A

Propranolol 🡪 cardio protectant

39
Q

Common disorder

Affects 1% of the general population 🡪 5% older than 60

20% in the elderly

3x higher in women than in men

Has an effect on most body functions

A

Hypothyroidism

40
Q

What is the most common cause of hypothyroidism?

A

Hashimotos thyroiditis

41
Q

List some causes of hypothyroidism

A

Hashimoto’s thyroiditis
Older age
Amiodarone
Hepatitis C
Chemotherapy

42
Q

Anti-arrhythmic with a high iodine content

A

Amiodarone

43
Q

Single best screening test for hypothyroidism is what lab?

A

TSH

44
Q

Abnormal thyroid function tests 🡪 low T4 and FT4

Do not have thyroid disease

Severe illness, caloric deprivation, major surgery

A

Euthyroid Sick Syndrome

45
Q

List some complications of hypothyroidism

A

Cardiac (Pre-existent CAD and CHF)
Bacterial pneumonia
Megacolon
Myxedema
Myxedema madness

46
Q

Infiltration of skin by mucopolysaccharides

Giving a waxy or coarsened appearance

A

Myxedema

(complication of hypothyroidism)

47
Q

Organic psychosis with paranoid delusions

A

Myxedema madness

(complication of hypothyroidism)

48
Q

What is the drug of choice in the treatment of hypothyroidism?

A

Levothyroxine

49
Q

Severe, life-threatening hypothyroidism

Medical emergency!!

Mortality rate is high if you don’t catch it

Most often seen in elderly women

A

Myxedema Crisis

50
Q

List some causes of the myxedema crisis

A

CVA
Stop taking thyroxine
Underlying infection
Cardiac illness
Respiratory illness
CNS illness
Cold exposure
Drug use

51
Q

Second most common pediatric endocrine disease

A

Hypothyroidism

52
Q

Condition of severely stunted physical growth and mental growth
due to untreated congenital deficiency of thyroid hormones

Usually due to maternal hypothyroidism

A

Cretinism

53
Q

What tests mandatory when you find a nodule?

A

Thyroid function tests

54
Q

In thyroid nodules, do single or multiple nodules carry a higher risk of progression to thyroid cancer?

A

Neither - Same overall risk of thyroid cancer

55
Q

Large substernal goiter

Facial erythema

JVD

Progresses to cyanosis and facial edema when arms are raised above head (Pemberton sign)

A

Superior Vena Cava Syndrome

56
Q

What is the preferred imaging in evaluation of thyroid nodules?

A

Neck ultrasound - Preferred over CT/MRI

57
Q

What symptoms accompanying a thyroid nodule are concerning for cancer?

A

Hoarseness
Vocal cord paralysis
Large nodule
Adhere to trachea or strap muscles
Lymphadenopathy
History of radiation

58
Q

Hyperfunctioning nodules are rarely what?

A

malignant

59
Q

What lab needs to be obtained in all patients with a thyroid nodule?

A

TSH

60
Q

On a neck ultrasound, a nodule having these features are at an increased likelihood of malignancy

A

Irregular or indistinct margins
Heterogenous nodule echogenicity
Intranodular vascular changes
Microcalcifications
Complex cyst
Diameter > 1cm

61
Q

Best method to assess thyroid nodule for malignancy

A

Fine Needle Aspiration Biopsy

62
Q

Most accurate and cost-effective method for evaluating thyroid nodules

A

Fine Needle Aspiration Biopsy

63
Q

Malignant nodules on FNA biopsy warrant what type of treatment?

A

Total Thyroidectomy

64
Q

Surgery is limited in the treatment of benign thyroid nodules. List some reasons why a patient would be a surgical candidate with benign nodules

A

Indeterminant or suspicious cytology

Compression syndromes

Discomfort

Cosmetic embarrassment

65
Q

Radioiodine therapy is used in patients with thyroid nodules with what?

A

Hyperthyroid patients with toxic thyroid adenomas, multinodular
goiter, or Graves disease

66
Q

Presents as painless swelling in region of the thyroid

Majority present with an asymptomatic nodule on the thyroid

Increased incidence with age (most common after age 30)

More common in females; 3:1

Aggressiveness increases significantly in older patients

Thyroid function tests usually normal

A

Thyroid Neoplasia and Cancer

67
Q

What are some risk factors for thyroid carcinoma?

A

History of childhood head and neck irradiation and/or total body
radiation for bone marrow transplantation

Family history of thyroid carcinoma or thyroid cancer syndrome
(multiple endocrine neoplasia 2) in a first-degree relative

Nodules - Rapidly growing, Hoarseness, Fixation of nodule to surround tissue

Associated cervical lymphadenopathy

68
Q

What are the four types of thyroid carcinomas?

A

Papillary
Follicular
Medullary
Anaplastic

69
Q

Which type of thyroid carcinoma is described below?

Most common – 80%

Less aggressive

Confined to thyroid and regional lymph nodes

Overall cure rate very high 🡪 near 100% for small lesions in young patients

Exposure to head and neck radiation

A

Papillary

70
Q

What is the most common type of thyroid carcinoma?

A

Papillary

71
Q

Which type of thyroid carcinoma is described below?

Second most common – 14%

More aggressive than papillary carcinoma

Slightly older age group than papillary (less common in children)

Invasion into vascular structures (veins and arteries) within the thyroid gland is common

Age is a very important factor in terms of prognosis

Occurs rarely after radiation therapy

A

Follicular

72
Q

What is the second most common type of thyroid carcinoma?

A

Follicular

73
Q

Which type of thyroid carcinoma is described below?

3% of cases

Associated with MEN 2

Originates from parafollicular cells (C cells)

Secretes peptides

Regional metastasis occurs early 🡪 cervical lymph nodes

Distant metastases occurs late 🡪 liver, bone, brain, and adrenal medulla

Not associated with radiation exposure

Initial presentation – 30% - Flushing and diarrhea (carcinoid symptoms)

A

Medullary

74
Q

Which type of thyroid carcinoma is described below?

Rarest – 3%

Most aggressive thyroid cancer

Extremely poor prognosis

Usually presents in older patient (rare in young patients)

May arise many years (~20) following radiation exposure

Cervical metastasis is present in the vast majority (over 90%) of cases at the time of diagnosis (survival at 3 years is less than 10%)

A

Anaplastic

75
Q

Which type of thyroid cancer has the best prognosis?

A

Papillary

76
Q

Which type of thyroid cancer has the worst prognosis?

A

Anaplastic

77
Q

Which two types of thyroid cancer are associated with radiation exposure?

A

Papillary
Anaplastic

78
Q

Which two types of thyroid cancer are not associated with radiation exposure?

A

Follicular
Medullary

79
Q

What is the MOST important treatment variable influencing prognosis in thyroid cancer?

A

Adequate surgery (thyroidectomy)

80
Q

List some adjunctive therapies that may be utilized in treating thyroid cancer

A

Radioactive iodine treatment
TSH suppression
External beam irradiation

Endocrinology (7 decks)

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