Endocrine - Thyroid

Question 1

Which hormone is more active: T4 or T3?

Answer 1

T3 (T4 is converted peripherally to T3)

Question 2

How does a thyroglossal duct cyst present?

Answer 2

anterior neck mass - cystic dilation

Question 3

What is lingual thyroid?

Answer 3

persistence of thyroid tissue at the base of the tongue

Question 4

What is the effect on cholesterol and fats in hyperthyroidism?

Answer 4

hypocholesterolemia and hyperglycemia

-stim of gluconeogenesis and glycogenolysis

Question 5

What occurs in graves disease?

Answer 5

stimulating autoantibody to TSH receptor

Question 6

What causes exopthalmos in graves disease? What other symptom occurs due to a similar mechanism?

Answer 6

fibroblasts behind the eye secrete GAGs

pretibial myxedema

Question 7

Graves disease:
free T4
total T4
TSH

Answer 7

inc total and free T4

dec TSH

Question 8

What is the pathognomonic appearance of the thyroid in graves disease?

Answer 8

colloid is depleted and moth eaten and scalloped

Question 9

What is thyroid storm?

Answer 9

feared complication of hyperthyroidism
excess catecholamines and hormone excess
arrythmia, hyperthermia, vomiting, hypovolemic shock

Question 10

What does toxic in relation to goiter mean?

Answer 10

hyperthyroidism

Question 11

What is the main cause of multinodular nontoxic goiter?

Answer 11

iodine deficiency

Question 12

What can nontoxic goiter progress to?

Answer 12

toxic goiter and hyperthyroidism

Question 13

What is the treatment for nontoxic goiter?

Answer 13

thyroid hormone to reduce TSH and stim of growth

Question 14

If a neonate presents with a short stature, coarse face, enlarged tongue anemia, dilated heart what would you suspect?

Answer 14

cretinism

Question 15

Who is cretinism more common in?

Answer 15

girls

Question 16

What are four causes of cretinism?

Answer 16

1. maternal hypothyroidism
2. thyroid agenesis
3. dyshormonogenenic goiter - thyroid peroxidase deficient
4. iodine deficiency

Question 17

What is myxedema?

Answer 17

severe hypothyroidism in an adult

Question 18

How would myxedema affect the heart?

Answer 18

dilated heart and pericardial effusion

Question 19

How would myxedema affect the GI system?

Answer 19

severe constipiation, delayed peristalsis can lead to fecal impaction and megacolon

Question 20

What drug can cause myxedema?

Answer 20

lithium - supresses thyroid hormone synthesis

Question 21

What is hashimotos?

Answer 21

autoimmune destruction of the thyroid gland

Question 22

What HLA complex is hashimotos associated with?

Answer 22

HLA DR5

Question 23

What is the presentation of hashimotos?

Answer 23

initially present with hyperthyroidism - destruction of follicles
progresses to hypothyroidism

Question 24

What type of cancer does hashimotos inc the risk of?

Answer 24

B cell lymphoma

Question 25

What is seen pathologically in hashimotos?

Answer 25

infiltrate of lymphocytes, destruction and atrophy
metaplasia of follicular epithelial cells rich in mito
- herthl cell change

Question 26

What causes subacute dequervain granulomatous thyroiditis?

Answer 26

a viral infection

Question 27

What is the presentation of subacute dequervain granulomatous thyroiditis?

Answer 27

tender thyroid, transient hyperthyroidism

Question 28

What is seen pathologically in subacute dequervain granulomatous thyroiditis?

Answer 28

granulomatous inflam. - due to release of colloid

Question 29

What is reidel fibrosing thyroiditis?

Answer 29

chronic inflam of thyroid with extensive fibrosis

Question 30

How does reidel fibrosing thyroiditis present?

Answer 30

hypothyroidism with hard as wood, nontender thyroid

-fibrosis can spread to other nearby structuers

Question 31

who usually gets reidel fibrosing thyroiditis?

Answer 31

middle aged women