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General Medicine & Family Medicine > Endocrinology_Hyperthyroidism and thyrotoxicosis > Flashcards

Endocrinology_Hyperthyroidism and thyrotoxicosis Flashcards

1
Q

What is thyrotoxicosis?

A

A condition resulting from exposure of body tissues to excessive levels of thyroid hormones.

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2
Q

what causes thyrotoxicosis?

A
  • hyperthyroidism
  • thyroiditis
  • exogenous thyroid intake.
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3
Q

dermatologic manifestation of thyrotoxicosis

A
  • sweating
  • hair thinning
  • onycholysis or separation of nail from nail bed
  • warm skin.
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4
Q

Cardiovascular manifestation of thyrotoxicosis

A
  • Tachycardia
  • wide pulse pressure
  • elevated systolic blood pressure
  • atrial fibrillation in 10 to 20% of patients with hyperthyroidism.
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5
Q

Respiratory manifestation of thyrotoxicosis

A
  • increased oxygen consumption
  • respiratory muscle weakness leading to dyspnea.
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6
Q

gastrointestinal manifestation thyrotoxicosis

A
  • increased basal metabolic rate
  • increased gut motility leading to weight loss and diarrhea.
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7
Q

hematologic manifestations of thyrotoxicosis

A
  • plasma volume increases more than red blood cell mass leading to normocytic anemia.
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8
Q

Genitourinary manifestation of thyrotoxicosis

A
  • urinary frequency
  • anovulatory infertility
  • oligomenorrhea
  • amenorrhea
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9
Q

musculoskeletal manifestation of thyrotoxicosis

A
  • proximal muscle weakness
  • tremor best seen in the outstretched hands, or in the tongue
  • increased bone resorption leading to osteoporosis.
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10
Q

psychiatric manifestation of thyrotoxicosis

A

anxiety.

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11
Q

What is the single best lab test to assess thyroid function?

A

thyroid stimulating hormone (TSH)

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12
Q

high free T4 and low TSH

A

thyrotoxicosis

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13
Q

Normal free T4 and low TSH

A

subclinical hyperthythyroidism

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14
Q

what test should you order, if both free T4 and TSH are elevated?

A
  • MRI to look for a TSH producing pituitary adenoma
  • can also present with a visual defect.
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15
Q

differentiate the causes of thyrotoxicosis based on Thyroid size

diffusely enlarged goitre

A
  • Graves disease
  • toxic multinodular goite - in countries with low iodine intake
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16
Q

differentiate the causes of thyrotoxicosis based on Thyroid size

palpable nodule

A

thyroid adenoma

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17
Q

differentiate the causes of thyrotoxicosis based on Thyroid size

Normal thyroid size

A
  • subacute thyroiditis
  • exogeneous hyperthyroidism (factitious vs. iatrogenic)
  • ectopic hyperthryroidism (struma ovarii)
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18
Q

What is struma ovarii?

A
  • Functioning thyroid tissue in an ovarian neoplasm
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19
Q

what physical findings are unique to Graves disease?

A
  • ophthalmopathy
  • infiltrative dermopathy
20
Q

Describe the ophthalmology seen with graves disease?

A
  • stare
  • lid lag
  • exophthalmos
21
Q

What is lid lag?

A

When a person with Graves disease looks down, the upper sclerae can be seen since the upper eyelid closes slowly

22
Q

What causes the exophthalmos in Graves disease?

A
  • The eyes pushed outward secondary to inflammation of the extraocular muscles and orbital fat
23
Q

Describe the infiltrator dermopathy seen and Graves disease

A
  • pretibial myxedema with raised hyperpigmented, violaceous, orangepeel textured papules
24
Q

Describe the pathology behind Graves disease

A
  • An autoimmune disorder characterized by TSH receptor antibodies
25
Q

Besides the physical examination how can you diagnose cause of thyrotoxicosis

A
  • radioactive iodine uptake (RAIU) scan
26
Q

What does high radio iodine uptake on a radioactive iodine uptake (RAIU) scan indicate

A
  • de novo hormone synthesis.
27
Q

is a treatment with radioiodine ablation, or thionamides.
(methimazole and prophylthiouracil) appropriate when radioiodine uptake scan show a high uptake?

A

either will decrease hormone synthesis.

28
Q

What does low radio iodine uptake (on a radioactive iodine uptake scan) indicate?

A

destruction of thyroid tissue with release of preformed hormone or extrathyroidal source.

29
Q

If a patient has low radioiodine uptake - is treatment with radioiodine ablation or thionamides appropriate?

A

NO

30
Q

What are causes of high radioiodine uptake ?

A
  • Graves disease causes a diffuse uptake.
  • Toxic adenoma
  • toxic multinodular goitre
  • TSH producing pituitary adenoma
  • beta human chorionic gonadotropin (bHCG) mediated hyperthyroidism.
31
Q

What are causes of beta hCG mediated hyperthyroidism?

A
  • hydatidiform mole
  • choriocarcinoma
  • Testicular germ cell cancer
32
Q

Why does high beta hCG cause hyperthyroidism?

A
  • beta hCG has some TSH-like activity due to their shared alpha subunit
33
Q

What are causes of low radioiodine uptake?

A
  • thyroiditis
  • exogenous thyroid ingestion, or
  • ectopic thyroid.
34
Q

What is thyroiditis?

A
  • transient increase in thyroid hormones, secondary to the release of preformed.
35
Q

What are some causes of thyroiditis?

A
  • viral/subacute
  • postpartum
  • Chemical(amidarone induced)
  • post radiation.
36
Q

How do you differentiate between the causes of subacute thyroiditis?

A
  • subacute granulomatous thyroiditis is painful
  • subacute lymphocytic thyroiditis is painless, and often occurs postpartum approximately six weeks postpartum.
37
Q

How do you treat thebeta-adrenergic symptoms (tachycardia, tremor) of thyrotoxicosis?

A
  • propranolol
38
Q

What are the main treatments of hyperthyroidism ?

A
  • Thionamides
  • radioactive iodine ablation (ablation within six to 18 months)
  • thyroidectomy
39
Q

What supplementation will a patient need after undergoing ablation or thyroidectomy?

A
  • Livothyroxine
40
Q

Which thionamed should be used during pregnancy?

A
  • propylthiouracil PTU, because he does not readily cross the placenta.
41
Q

What characteristics would make you more concerned that a thyroid nodule was malignant?

A
  • History of neck irradiation
  • “cold” nodule
  • male sex
  • firm and fixed solitary nodule.
42
Q

What is a cold nodule?

A
  • The absence of uptake in one nodular region on radioiodine uptake scan
43
Q

What should you order to evaluate a cold nodule?

A
  • fine needle aspiration (FNA) of the nodule.
44
Q

How do you treat subacute thyroiditis?

A
  • beta blockers for thyrotoxicosis or
  • levothyroxine for hypothyroidism
  • anti inflammatory medications.
45
Q
A

General Medicine & Family Medicine (150 decks)

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