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Clinical Med II > Exam 4 - Thyroid/Parathyroid > Flashcards

Exam 4 - Thyroid/Parathyroid Flashcards

1
Q

What is the best initial test of thyroid function?

A

TSH

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2
Q

What is used to evaluate abnormal TSH?

A

Free T4 level

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3
Q

What diagnostic study is used to assess structure of thyroid gland tissue and nodules?

A

Thyroid US

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4
Q

What diagnostic test is a functional study to evaluate suppressed TSH (hyperthyroidism)?

A

Radioactive Iodine Uptake Scan

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5
Q

What are some common signs/symptoms associated with hypothyroidism?

A
  • Weight gain
  • Fatigue
  • Constipation
  • Dry skin
  • Cold intolerance
  • Bradycardia
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6
Q

Will TSH, FT4, and T3 be increased, decreased, or normal in Primary Hypothyroidism?

A

TSH: Elevated
FT4: Decreased
T3: Normal or Decreased

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7
Q

Will TSH, FT4, and T3 be increased, decreased, or normal in Subclinical Hypothyroidism?

A

TSH: Elevated
FT4: Normal
T3: Normal

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8
Q

Will TSH, FT4, and T3 be increased, decreased, or normal in Central Hypothyroidism?

A

TSH: Normal or Decreased
FT4: Normal or Decreased
T3: Normal or Decreased

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9
Q

Why is TSH increased in Primary Hypothyroidism?

A

Reflex effort to stimulate the failing thyroid gland which is represented by the low serum FT4

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10
Q

What is the most common cause of hypothyroidism?

A

Hashimoto’s Thyroiditis

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11
Q

What is an autoimmune-related destruction of the thyroid gland?

A

Hashimoto’s Thyroiditis

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12
Q

What is Hashitoxicosis?

A

Early inflammation of the thyroid which may cause transient hyperthyroidism

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13
Q

What antibodies are associated with Hashimoto’s Thyroiditis?

A
  • TPO

- TgAb

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14
Q

What is the management of hypothyroidism?

How is this medication dosed and what are some important considerations to think about?

A

Levothyroxine (Synthroid, Levoxyl)

Weight based dose at 1.6 mcg/kg/day

Older adults (> 60 y/o) and those with cardiac concerns receive lower dose initially.

Take on empty stomach, one hour before breakfast and avoid taking concurrently with meds that can interfere with its absorption (ferrous sulfate, calcium carbones, proton pump inhibitors, bile acid resins).

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15
Q

How is hypothyroidism treatment monitored?

When should you start to see improvement after starting treatment?

A

Expect symptomatic improvement within 2-4 weeks

Repeat TSH in 6 weeks and titrate med as appropriate

Once stable, a yearly TSH is appropriate unless patient status changes

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16
Q

How is Subclinical Hypothyroidism diagnosed? What are some exceptions?

A

Repeat TSH and T4 after 1-3 months to confirm diagnosis.

Repeat immediately if pregnant or undergoing fertility treatment.

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17
Q

With Subclinical Hypothyroidism, when is treatment recommended versus controversial?

A

Recommended: TSH of 10 or greater

Controversial: TSH of 4.5 - 9.9

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18
Q

What is Myxedema Coma?

A

Severe, life-threatening form of hypothyroidism which can be induced by stroke, heart failure, infection, or trauma.

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19
Q

What is the treatment for Myxedema Coma?

A

IV thyroxine (T4) and triiodothyronine (T3)

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20
Q

What are some common symptoms associated with hyperthyroidism?

A
  • Exophthalmos, lid lag
  • Weight loss despite good appetite
  • Heat intolerance
  • Palpitations/tachycardia
  • Anxiety
  • Tremor
  • Diarrhea
  • Hair loss
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21
Q

Will TSH, FT4, and T3 be increased, decreased, or normal in Primary Hyperthyroidism?

A

TSH: Decreased
FT4: Elevated
T3: Elevated

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22
Q

Will TSH, FT4, and T3 be increased, decreased, or normal in Subclinical Hyperthyroidism?

A

TSH: Decreased
FT4: Normal
T3: Normal

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23
Q

Will TSH, FT4, and T3 be increased, decreased, or normal in T3 Toxicosis (early stage of Grave’s Disease)?

A

TSH: Decreased
FT4: Normal
T3: Elevated

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24
Q

What is Radioactive Iodine Uptake (RAUI) Scan used for?

A

Used to determine the etiology of hyperthyroidism

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25
Q

If there is diffuse elevated uptake on RAUI, what does this indicate is the cause of the hyperthyroidism?

A

Graves Disease

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26
Q

If there is diffuse decreased or absent uptake on RAUI, what does this indicate is the cause of the hyperthyroidism?

A

Thyroiditis or exogenous hormone

27
Q

If there is focal elevated irregular uptake on RAUI scan, what does this indicate is the cause of the hyperthyroidism?

A

MNG or toxic adenoma

Hyperfunctioning “hot” nodules - less likely to be malignant

28
Q

If there is focal decreased irregular uptake on RAUI scan, what does this indicate is the cause of the hyperthyroidism?

A

MNG or toxic adenoma

Hypofunctioning “cold” nodules - more likely to be malignant

29
Q

Are “hot” nodules or “cold” nodules more likely to be malignant?

A

“Cold” nodules

30
Q

What is the most common cause of hyperthyroidism?

A

Graves Disease

31
Q

What is an autoimmune-mediated stimulation of thyrotropin receptor?

A

Graves Disease

32
Q

What is a hallmark presentation of Graves Disease?

A

Graves ophthalmopathy: lid retraction, lid lag, stare, proptosis

33
Q

What antibodies are associated with Graves Disease?

A

TRAb

34
Q

What type of symptoms can be associated with Toxic Adenoma or Toxic Multinodular Goiter?

A

Obstructive symptoms: cough, dysphagia, dyspnea

35
Q

Will TRAb be positive or negative in Toxic Adenoma or Toxic Multinodular Goiter?

A

Negative TRAb as not an autoimmune process

36
Q

What is the treatment for thyroid storm?

A
  • ICU admission
  • Beta blocker
  • Thionamide (PTU/methimazole)
  • Iodine
  • Glucocorticoids
37
Q

In addition to beta blockers for symptom control, what is the 1st line treatment to decrease thyroid hormone synthesis in hyperthyroidism?

A

Thionamides:
Methimazole (DOC)
PTU (pregnancy)

***Caution agranulocytosis or acute liver injury

38
Q

What are the definitive treatment options for hyperthyroidism? Which is the 1st line option of these?

A
  • Radioiodine ablation (1st line)

- Surgery

39
Q

When is thyroidectomy considered in hyperthyroidism?

A
  • Severe disease
  • Obstructive symptoms
  • Active ophthalmopathy
  • Toxic adenoma or MNG
40
Q

What is the characteristic course/phases of Thyroiditis?

A

Hyperthyroidism, Euthyroidism, Hypothyroidism, Euthyroidism

41
Q

What is the typical presentation of subacute thyroiditis?

A
  • Associated with preceding viral illness
  • Acute painful glandular enlargement with radiation pain to jaw, neck, throat
  • Can persist for weeks to months
  • Associated fever, fatigue, anorexia
42
Q

What is the management for subacute thyroiditis?

A
  • Aspirin or NSAIDs for pain
  • +/- prednisone
  • Monitor TSH
43
Q

Are the majority of thyroid nodules benign or malignant?

A

Thyroid nodules are very common, but very few are malignant.

44
Q

Of the thyroid nodules that are malignant, what is the most common form?

A

Papillary carcinoma

45
Q

If your patient is found to have a thyroid nodule, what should your next step be?

A
  • Thyroid ultrasound

- TSH

46
Q

What sonographic features are concerning for malignant thyroid nodules?

A
  • Hypoechoic (darker)
  • > 1.0 cm
  • Tall > Wide
  • Solid
  • Irregular margins
  • Microcalcifications
  • Extrathyroidal extension
  • Associated cervical nodes
47
Q

What sonographic features are associated with benign thyroid nodules?

A
  • Purely cystic
  • Colloid
  • < 1.0 cm
  • No suspicious features
48
Q

On an ultrasound of the thyroid, you note that the nodule is > 1.0 cm, taller than it is wide, solid, and has irregular margins.

What are you suspicious of and what should your next step be?

A

Concerned for malignancy

Obtain FNA

49
Q

Which form of thyroid cancer is the least aggressive?

A

Papillary (most common form)

50
Q

Which form of thyroid cancer is associated with the elderly?

A

Anaplastic

51
Q

Which form of thyroid cancer is the most aggressive?

A

Anaplastic

52
Q

What is the treatment for thyroid cancer?

A
  • Thyroid lobectomy or total thyroidectomy
  • Iodine ablation (often follows surgery) to destroy remaining tissue
  • T4 hormone therapy following surgery to prevent hypothyroidism and minimize potential TSH stimulation of tumor growth
  • Radiation +/- chemo
53
Q

What are some clinical presentation that can be associated with hypoparathyroidism?

A

Symptoms of hypocalcemia:

  • Asymptomatic
  • Prolonged QT interval on EKG
  • Tetany, parathesias, carpopedal spasm
  • Chvostek sign
  • Trousseau phenomenon
54
Q

What would be the expected results of the following labs in hypoparathyroidism?

PTH
Calcium
Vitamin D
Magnesium
Phosphate
A 
PTH: Low
Calcium: Low
Vitamin D: Normal or low
Magnesium: Normal or low
Phosphate: High
55
Q

What is the management of mild hypoparathyroidism?

A
  • 1,25 dihydroxycholecalciferol (calcitriol)
  • Oral calcium carbonate
  • Monitor serum calcium regularly
56
Q

What is the management of severe hypoparathyroidism with tetany or prolonged QT interval?

A
  • Emergent treatment with IV calcium gluconate

- Monitor serum calcium regularly

57
Q

What is the most common reason for Primary Hyperparathyroidism?

A

Parathyroid adenoma

58
Q

What is the most common reason for Secondary Hyperparathyroidism?

A

Chronic Kidney Disease

59
Q

What is the clinical presentation of hyperparathyroidism?

A
  • May be asymptomatic

- “Bones, Stones, Abdominal Moans, Psychiatric Groans”

60
Q

What would be the expected results of the following labs in primary hyperparathyroidism?

PTH
Calcium
Phosphate

A

PTH: High
Calcium: High
Phosphate: Low

61
Q

What would be the expected results of the following labs in secondary hyperparathyroidism?

PTH
Calcium
Phosphate

A

PTH: High
Calcium: Low
Phosphate: High

62
Q

If patient has labs consistent with hyperparathyroidism, what should you order?

A

DEXA to evaluate bone mineral density (osteopenia and osteoporosis)

63
Q

What is the management for hyperparathyroidism?

A
  • Restrict calcium intake
  • Avoid HCTZ (hydrochlorothiazides)
  • Bisphosphonates
  • Parathyroidectomy (definitive)

Clinical Med II (17 decks)

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