Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Block 2 FCM > Grave's Disease > Flashcards

Grave's Disease Flashcards

1
Q

What lab panel result is consistent with hyperthyroidism?

A

Depressed TSH, elevated FT3 and FT4

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

What exam finding is specific for Grave’s disease?

A

Pretibial Myxedema

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

Where on the thyroid would you see radio iodine uptake during scintigraphy?

A

Diffuse uptake bilaterally

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

First line treatment for Grave’s disease in pregnancy?

A

PTU

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

MOST COMMON FORM OF HYPERTHYROIDISM in US

A

Grave’s disease

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Dopamine and somatostatin can both put negative feedback on the TRH to inhibit ______.

A

pituitary gland.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

TRH is released from hypothalamus and causes release of ____ to stimulate thyroid gland.

A

TSH

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

There are receptors on the thyroid gland to receive the TSH, which then produce T3 and T4 which goes to surrounding tissues and then there is again another feedback loop, T3 and T4 will act as ________ on hypothalamus and pituitary gland to try and keep everything in homeostasis.

A

inhibitors

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

What is hyperthyroidism?

A

abnormally elevated levels of thyroid hormone (T3 and T4)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

What can Hyperthyroidism lead to?

A

thyrotoxicosis (hypermetabolic condition)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

what is thyrotoxicosis?

A

disturbances of the normal homeostatic mechanism (at the level of the pituitary gland, the thyroid gland, or in the periphery) increasing basal metabolic rate

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q
  • Binding of TSH to receptors on the thyroid gland leads to the release of ___.
A

T4, T3

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Elevated levels of these hormones act on the hypothalamus to decrease TRH secretion and thus the synthesis of TSH

A

T4, T3

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

> 99.9% of T4 and T3 in the peripheral circulation is active or inactive?

A

inactive- it is bound to plasma proteins,

very few is free

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Is Free T3 or T4 more biologically active?

A

T3

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

the body’s sensitivity is increased to catecholamines when there is elevated ___ count

A

T3

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

These are Essential to proper development and differentiation of all cells of the human body. They Regulate protein, fat, and carbohydrate metabolism, affecting how human cells use energetic compounds. They also Stimulate vitamin metabolism

A

thyroid hormones

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

T3/T4 synthesis requires ___.

A

iodine

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

Lack of dietary iodide causes ___.

A

goiter

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

what happens when iodide is introduces to a person with goiter?

A

thyrotoxicosis. Can act as a immune stimulator, triggering autoimmune disease.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

In hyperthyroidism, what are levels of T3, T4, and TSH

A

high T3 and T4 and low TSH

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

what is grave’s disease also known as?

A

Diffuse Toxic Goiter

“Basedow Disease”- europe

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

is grave’s an autoimmune disorder?

A

yes

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q
  • Thyroid –stimulating immunoglobulins (TSI) or TSH receptor antibodies bind to TSH receptor sites on thyroid cell membranes – this will stimulate gland to hypersynthesize hormones- when they bind to them they tell the thyroid to produce _____.
A

T3 and T4

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Circulating auto-antibodies against the thyrotropin (TSH) receptors results in?
continuous stimulation of the thyroid gland
26
Grave’s Auto-Antibodies
thyroid-stimulating immunoglobulin (TSI), thyroid-stimulating antibody (TSab), or TSH-receptor antibody (TRab)
27
what Stimulate iodine uptake, protein synthesis, and thyroid gland growth?
Grave’s Auto-Antibodies
28
Pituitary thyrotropin secretion is suppressed due to increased _____ (negative feedback)
thyroid hormones
29
what Causes 60-80% of cases of thyrotoxicosis in the US
Grave's
30
occurence rate of graves in US
30/100k
31
Grave's Peak occurrence in people aged ____.
20-40 years
32
Lower rates of Grave's in ___.
African Americans
33
is there a higher male or female ratio in Grave's disease?
higher female. m:f= 1:5-10
34
Graves ophthalmopathy is more common in women or men?
women
35
presentation of grave's in younger patients?
Younger patients tend to exhibit symptoms of sympathetic activation (eg, anxiety, hyperactivity, tremor)
36
presentation of grave's in older patients?
Older patients have more cardiovascular symptoms (eg, dyspnea, atrial fibrillation) and unexplained weight loss, fewer presenting signs, don’t present with as many signs as younger patients do
37
________ suggests Graves disease
Ophthalmopathy suggests Graves disease
38
Symptoms (ROS) in Grave's
- Gen: Fatigue, general weakness - Derm: warm moist skin, sweating, pretibial myxedema (very specific for Grave’s) - Neuro: tremors, prox muscle weakness - CV: palpitations, CP, edema, DOE - Resp: Dyspnea - GI: increased motility (Bowel Movements) - OPH: tearing, Gritty Foreign Body sensation, photophobia, eye pain, protruding eye, diplopia (issues with tracking), visual loss - Renal: polyuria, polydipsia - Metabolic: heat intolerance, weight loss, poor glycemic control - GU: irregular menses, decreases flow, amenorrhea, gynecomastia, impotence - PSYCH: restless, anxiety, irritable, insomnia
39
Physical Exam findings for Grave's
- Irregular heart rhythm, tachycardic, tachypnea, murmur - Hyperactive BS, hand tremor, ↑DTR, prox muscle weakness, warm, moist skin, alopecia, edema, acropachy (clubbing of fingers and fatty deposits between joints- unique to grave’s), restless, anxious,
40
Symptoms/signs Unique to Grave’s?
Ophthalmopathy and dermopathy: | - Pretibial myxedema, proptosis, lid lag/retraction, EOM changes, periorbital edema, visual loss, chemosis, injections
41
what % of grave’s patients have proptosis/eye changes
30%
42
How is thyroid gland in patient with Grave's?
- Thyroid gland is diffusely enlarged and smooth (should feel both lobes equally, not focused in isthmus it should be all over), thyroid bruits
43
will there be thyroid nodules in persons with gRAVE'S?
There can be, +/- thyroid nodules
44
% of Grave’s patient have at least mild ophthalmopathy
50%
45
Thyrotropin receptors are very expressive in _____.
fat and connective tissue
46
Ophthalmopathy in Grave's is Mostly just periorbital edema, but can include: ? -
chemosis (inflammation of mucosal layer in skin), injection, lid retraction, diplopia, proptosis, acropachy
47
2 phases in ophthalmopathy for Grave's
Inflammatory and fibrotic
48
first phase in ophthalmopathy for Grave's
Inflammatory: deposition of glycosaminoglycan (polysaccharide) in muscles, periorbital edema, pain
49
second phase in ophthalmopathy for Grave's
Fibrotic: diplopia, further lid retraction- when lid starts retracting you see more of eye and it becomes even more pronounced
50
what increases risk of getting ophthalmopathy with grave's?
Higher risk in smoker receiving radioactive iodine
51
Symptomatic ophthalmopathy pts require ______.
full retinal/fundoscopic exam
52
Work up for Grave's
- Thyroid function tests (first step is to do a thyroid panel) - ↓TSH - ↑T3, T4 - TSI autoantibodies positive in up to 80% Grave’s (diagnostic) - Anti–thyroid peroxidase (anti-TPO) antibody not diagnostic but present in 85% of patients with Grave’s - Baseline LFTs for anti-thyroid Rx (methinazole can be liver toxic) - HgA1c
53
If the etiology of thyrotoxicosis is not clear after physical examination and other laboratory tests, it can be confirmed by ____
Radioactive Iodine Scanning
54
what is Iodine Uptake?
- the degree and pattern of isotope uptake indicates the type of thyroid disorder
55
Radiology report for Radioactive Iodine Scanning in pt with Grave's
“normoechogenic and large glands with increased radioresistance”- fancy talk for large on both sides
56
What will iodine uptake look like in patients with Grave's disease?
Diffuse enlargement of both thyroid lobes, with uniform uptake of isotope and elevated radioactive iodine uptake
57
first treatment for grave’s
Radioactive Iodine
58
Indications for Radioactive Iodine treatment for Grave's
large diffuse gland, multiple thyrotoxicosis symptoms, elevated thyroxine (T4), titres of TSI
59
what medication should be withheld before doing Radioactive Iodine treatment for Grave's?
o Withhold anti-thyroid drugs prior to tx (preferably two days- best results for two weeks) can require higher doses of RI if on anti-thyroids
60
Radioactive Iodine treatment will cause what long term?
Hypothyroidism within 2-3months- requires lifelong replacement
61
Concerns with Radioactive Iodine?
- can spark thyroid storm especially in the elderly- this can be mitigated by pretreating with anti-thyroid meds PTU/Methimazole.
62
Contra Indication with Radioactive Iodine?
pregnancy, breast feeding, and recent lactation ,Children under 5- increases risk of thyroid cancer, severe ophthalmopathy
63
Can Radioactive Iodine exacerbate pre-existing ophthalmopathy?
yes
64
Do Anti-thyroid drugs/thyroidectomy influence course of ophthalmopathy?
no
65
Ablation of ____ may help in long term treatment of ophthalmopathy
thyroid
66
]Correction of ______ is treatment for ophthalmopathy
hyper/hypothyroidism
67
ophthalmopathy treatment
Mild-Moderate Dz: local tx- eye patches, sunglasses, elevating head at night, artificial tears and ointments. If that not helpful: high dose steroids, orbital radiotherapy or orbital decompression
68
how to treat Severe or progressing ophthalmopathy?
- high dose steroids (40mg/d) continued until evidence of improvement. Tapered over 1-3 months.
69
You can do Surgical decompression for ____ reduction for disfigurement (generally to be done during the fibrotic phase when patient is euthyroid).
proptosis
70
Pretibial Myxedema Treatment
- Tx: topical steroids with occlusive dressing (saran wrap) 3-10 weeks - Severe: high burst PO steroids
71
How does Pretibial Myxedema present?
- Elevated firm, non-pitting thickening of lower legs bilaterally
72
percentage of Grave's patients with Pretibial Myxedema ?
- Observed in 5-10% pts | - Tend to be same patient w/ophthalmopathy
73
Is thyroidectomy recommended 1st line therapy for Grave’s?
no
74
When can Thyroidectomy | be a treatment option for Grave's?
``` o Non-compliance or intolerant of anti-thyroid medication o Moderate to severe ophthalmopathy o Large Goiters/Compressive symptoms o Refusal or CI to Radioiodine therapy o Questionable thyroid carcinoma o Permanent cure o Severe hyperthyroid in children ```
75
consults for Grave's
``` - Refer to Endocrinologist o Pregnancy o Newborns o Not responsive to usual therapy - Refer to Ophthalmologist o Proptosis o Follow up visual acuities, prevention, eye muscle functions - Refer to Dermatology o myxedema not responsive to topical steroids ```
76
2016 Guidelines | for Grave's
- Beta blockers for symptomatic thyrotoxicosis (HR >90) - Overt Grave’s: RI therapy, anti-thyroid medications, surgery - Methimazole used for 12-18 months, d/c if T4 & TR Abys are normal - Children (<5) with Grave’s: avoid RI (risk of thyroid CA later). Can use methimazole, thyroidectomy
77
Anti-thyroid medications
Methimazole, Propylthiouracil (PTU)
78
what antithyroid do you use during first trimester?
Propylthiouracil (PTU)
79
what antithyroid is usually reserved for use in thyroid storm?
Propylthiouracil (PTU)
80
which antithyroid is more potent and longer-acting
Methimazole
81
Prognosis for Grave's untreated?
severe thyrotoxicosis (thyroid storm)- potentially fatal
82
chronic complication of Grave's
o Weight loss, muscle atrophy, bone resorption o Psychocognitive complications o Ophthalmologic complications (blindness) o Osteoporosis o Cardiac Hypertrophy o Arrhythmias Atrial fibrillation/flutter
83
usual prognosis after Grave's treatment
hypothyroid after treatment (require replacement)

Block 2 FCM (21 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2025 Bold Learning Solutions. Terms and Conditions