Endocrine - Thyroid

Question 0

Hypothyroidism is characterized by a slowing down of almost all bodily processes except for?

Answer 0

Menstrual flow (increased)

Question 1

Most common cause of hypothyroidism? Other, less common causes?

Answer 1

Hashimoto’s

#Iodide deficiency
#amiodarone

Question 2

Treatment of hypothyroidism?

Answer 2

#If TSH over 10 with normal T4, replace hormone
#If TSH 5-10, send serum antibodies (anti-thyroid peroxidase anti-thyroglobulin). If positive, replace hormone

Question 3

Patient with suspected hypothyroidism – best first test? Second test?

Answer 3

TSH; free T4

Question 4

Only thyroid disorder with eye/skin abnormalities?

Answer 4

Graves’ disease

Question 5

Thyroid disorder with tender thyroid? (Treatment?)

Nontender thyroid with normal physical exam? (Treatment?)

Answer 5

Subacute thyroiditis (ASA)

Painless “silent” thyroiditis (supportive)

Question 6

Hyperthyroidism with nonpalpable, involuted gland?

Answer 6

Exogenous thyroid hormone use

Question 7

Only hyperthyroid disease with elevated TSH?

Answer 7

Pituitary adenoma

Question 8

Only thyroid disease with elevated radioactive iodine uptake? Confirmatory test?

Answer 8

Graves’ disease; positive antibody testing (to TSH receptor)

Question 9

Treatment of thyroid storm?

Answer 9

#Propranolol – for symptoms and inhibition of peripheral conversion of T4 to T3
#Methimazole >propylthiouracil (blocks hormone production)
#Iodinated contrast – blocks peripheral conversion of T4 to T3 and blocks release of existing hormone
#Steroids
#Radioactive iodine – oblates gland for permanent cure

Question 10

Treatment for Graves ophthalmopathy? If fails? If that fails?

Answer 10

Steroids. If no response, radiation

If no response, decompressive surgery

Question 11

Pt presents with thyroid nodule. Next steps?

Answer 11

1. TSH and T4

2. If normal, FNA

Question 12

FNA finding that necessitates excisional biopsy?

Answer 12

Follicular adenoma (cannot rule out cancer)