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Endocrinology > Graves Disease > Flashcards

Graves Disease Flashcards

1
Q

what are 3 things that stimulate the release of TRH by the hypothalamus?

A

low T3/T4
stress
cold exposure

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2
Q

the enzyme that helps with iodination and conjugation of iodine onto the tyrosine rings through endocytosis

A

thyroid peroxidase

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3
Q

which thyroid hormone is the greatest concentration in the blood?

A

T4

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4
Q

what is the major thyroid hormone in the blood?

A

T3

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5
Q

which thyroid hormone do we measure?

A

T4

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6
Q

in which gender is hypothyroidism 5-8 times more common in?

A

females

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7
Q

in which asymptomatic patients should we order a thyroid screening for? (5)

A

hx of autoimmune dx
family hx of thyroid disease
hx of neck radiation
hx of thyroid sx
radiological abnormality

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8
Q

which screening test is the most sensitive test for primary hypothyroidism and hyperthyroidism?

A

TSH

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9
Q

if a screened patient has an abnormal TSH, what should we order next?

A

FT4

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10
Q

what is the most common cause of hyperthyroidism?

A

graves disease

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11
Q

what are the 6 etiologies of hyperthyroidism? (PETES Grave)

A

Pregnancy/Postpartum
Exogenous levothyroxine
Toxic multinodular goiter
Excessive iodine
Subacute thyroiditis
Graves disease

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12
Q

what is the pathogenesis of graves disease?

A

autoantibodies (TRAb) bind to TSH receptors
stimulate thyroid hormone secretion and thyroid growth

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13
Q

what is upper eyelid retraction called?

A

darymple sign

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14
Q

what is staring appearance called?

A

kocher sign

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15
Q

what is lid lag with downward gaze called?

A

von graefe sign

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16
Q

the term used to describe the eye being pushed forward by increased retro-orbital fat

A

exophthalmos

17
Q

what are some signs present in patients with Graves disease? (8)

A

darymple sign
kocher sign
von graefe sign
exophthalmos
diplopia/blurred vision
goiter
pretibial myxedema
sympathetic signs

18
Q

what are 4 labs to order for a patient suspicious for Graves disease/hyperthyroidism?

A

TSH
T4
T3
TRAb

19
Q

what are 2 imagining diagnostics to order for a patient suspicious for Graves disease/hyperthyroidism?

A

thyroid ultrasound
RAIU scan

20
Q

what would we expect to see in the labs and RAIU scan of a patient who is positive for Graves disease? (4)

A

elevated T3/T4
low TSH
elevated RAIU
positive TRAb + ANA

21
Q

what medication can be used for the symptomatic relief of tachycardia, tremors, diaphoresis, and anxiety in Graves disease?

A

beta blocker - atenolol or propranolol

22
Q

what treatment is best for young adults, mild thyrotoxicosis/hyperthyroidism, and small goiters?

A

methimazole or PTU

23
Q

if we Rx a patient methimazole or PTU, what should we watch out for in the first 60-90 days?

A

agranulocytosis

24
Q

what should we do if a patient who is taking methimazole or PTU begins to experience an infection or abnormal bleeding?

A

stop drug and send to ER

25
Q

which thiourea drug is preferred for treatment of Graves disease?

A

methimazole - less hepatic necrosis

26
Q

what medication should we give to a pregnant patient or a patient that is nursing, who has Graves disease?

A

PTU

27
Q

what is the treatment of choice/first line for Graves disease in adult patients?

A

radioiodine therapy

28
Q

in which patients is radioactive iodine therapy contraindicated? (3)

A

pregnancy
nursing
lack of childcare

29
Q

what drug can be continued while doing radioactive iodine therapy?

A

propranolol

30
Q

how does radioactive iodine therapy treat Graves disease?

A

it destroys overactive thyroid tissue

31
Q

a patient has radioactive iodine therapy to treat Graves disease. what will they likely experience after the treatment?

A

hypothyroidism

32
Q

what will a patient need after completing radioactive iodine therapy? (2)

A

lifelong thyroid hormone
calcium monitoring

33
Q

in which patients would we consider a thyroidectomy to treat Graves disease? (3)

A

obstructive/very large goiter

pregnant but not controlled with low dose thiourea

women who plan conception soon

34
Q

what are 2 complications to worry about with a thyroidectomy? what should we monitor after the procedure?

A

damage to recurrent laryngeal nerve
hypoparathyroidism - monitor calcium

35
Q

a patient presents with delirium, severe tachycardia, vomiting, diarrhea, dehydration, and a a high fever. what are they likely experiencing?

A

thyroid storm

36
Q

what are 4 things that can trigger a thyroid storm?

A

stress
illness
surgery
RAI

37
Q

what should we do for a patient that presents with thyroid storm?

A

send to ER

38
Q

how will an ER PA treat a patient with thyroid storm? (3)

A

thiourea drug
lugol solution
hydrocortisone

39
Q

an iodine overload to attempt to force the body to stop making thyroid hormone

A

lugol solution

Endocrinology (17 decks)

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