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Endo II > Hyper and hypothyroid > Flashcards

Hyper and hypothyroid Flashcards

1
Q

what type of HS rxn is graves

A

type II- Ab dependent cytotoxicity

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2
Q

what HLA is associated with graves

A 
HLA-DRB1 and DR8
MCH class II cell surface R
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3
Q

MHC class II

A

via CD4:
TH2 -> AbS
TH1 -> macros

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4
Q

MCH class I

A

A,B, C

via CD8

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5
Q

what drives the thyroid disease in graves?

A

TH2 -> activate TSH R

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6
Q

what drives the pretibial myxedema and exopthalamos in graves?

A

TH1 -> secrete cytokines -> cytotoxic T cells, NK cells -> glycosaminoglycans -> deposit -> skin changes

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7
Q

other HLA-DR disease that graves patients may get

A 
alopecia areata
PA
anti-phospholipid Ab syndrome
DM
RA
RHS
PBC
MG
SLE
IgA nephropahty 
MS
hashimotos
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8
Q

causes of clubbing

A 
cardiac
pulmonary (lung CA, CF)
GI (chrons, cirrhosis, celiac)
renal failure
thyroid disease (graves)
malignancies (HL)
idiopathic
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9
Q

random symptoms of graves

A

gynecomastia

increased vaginal bleeding

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10
Q

thyrotoxic cadriomyopathy

A

AF with CHF
pulmonary HTN in 50% of people with hyperthyroidism
WIDE PULSE PRESSURE

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11
Q

euthyroid graves orbitopathy

A

HLA-B40 DQw3

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12
Q

wolff-chaikoff effect

A

transient blockage of TH synthesis after large dose of iodine

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13
Q

jod-basedow effect

A

hyperthyroidism d/t increased iodine

amiodarone can cause this

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14
Q

high TBG

A 
drugs- amphetamines, opiates, 5-FU
hereditary
estrogens- prego
AIDs
liver- hepatitis
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15
Q

decreased conversion of T4-> t3

A

Drugs- amiodarone, propanolol, steroids, PTU

stress- acute medical illness

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16
Q

low TSH

A

drugs- sterioid, CaCh blockers, dopamine, opiates, NSAIDs
elderly euthyroid
pregnancy or hCG decretion
severe non-thyroidal illness

17
Q

causes of pansystolic murmur

A

mitral regurg
tricuspid regurg
VSD

18
Q

causes of AF

A

MISS CH ATRIEL

MVP
idiopathic
sick sinus syndrome
sick

congestive cardiomyopahty
HTN and hypoxia
arteriosclerosis, ASD, alcohol, aminophylline and drugs
thyrotoxicosis
Rheumatic heart disease
infilitrative diseases
embolus, emphysema
lone a-fib
19
Q

apathetic hyperthyroidism

A

apathy, weigh loss, angina, AF, CHF
NOT automimmune
somatic mutationi n TSH R G alpha protein
amiodarone can set off
can be due to toxic adenoma or toxic multinodular goiter

20
Q

type I amiodarone

A

thyrotoxicosis

can be graves or non-autoimmune (TMNG)

21
Q

type II amiodarone

A

thyroiditis

22
Q

causes of increases RAIU

A

graves
adenoma
inappropriate secretion of TSH (pit adenoma, rare)
TMNG
trophoblastic- secretes hCG which binds TSHR

23
Q

risks of subclinical hyperthyroidism

A

AF and diastolic dynsfunction
osteoporosis
dementia
Tx with RAI r small dose antithyroid drug or beta blockers

24
Q

thyroid storms

A 
fever >102
tachy
tachypnea
hypotensive
very sick
25
Q

Tx of thyroid storm

A 
methamizole or PTU
iodides
metopropolol
hydrocortisone
plasmaphoresis
26
Q

neurological malignant syndrome

A

rare, but potentially life threatening rxn to antipsychotics or tranquilizers
high fever, stiffness of mm, altered mental status, autonomic dysfunction

27
Q

thyrotoxic periodic paralysis

A

channelopathy with mm weakness
increased N/K ATPase activity (driven by thyroxine) -> hyperpolarization and hypokalemia
occurs with heavy meal or exercise in asian men

28
Q

what causes decreased RAIU

A 
DIET
Drugs- THYROXINE
Iodine- jod-bassedow, amiodarone type I
ectopic
thyroiditis- painful (dequervains disease), painless- postpartum, lymphocytic
29
Q

ten hypos of hypothyroidism

A 
hyporeflexia
hypopigmentation
hypothermia
hypoventilation
hypotension or diastolic HTN
hypohemoglobinemia
hypoglycemia
hyponatremia
hypometabolism 
hypocortisolism
hypoadrenalism
30
Q

HLA of hashimotos

A

HLA-DR5 (MCH II)

31
Q

risks of subclinical hypothyroidism

A

elevated lipids and decreased cardiac filling

imparied memory, depression

32
Q

when to Tx subclincial hypothryoidism

A

Abs and TSH >7
no Abs and TSH >10
prego with TPO Abs and TSH >2.5

33
Q

what else can cause hypothyroidism

A

drugs

hep C

34
Q

other signs of hypothyroidism

A 
gallaverdin phenomenon (apex systolic murmur)
queen annes sign
diastolic HTN
alopecia
elevated MCV- macrocytosis 
braducardia
elevated CPK-MB
35
Q

myxedema crisis

A

DO NOT GIVE OPIATES

Tx with hydrocortisone first then TH

36
Q

decreased TBG

A 
familial TBG deficiency
severe illness
acute psychiatric problems
cirrhosis
nephrotic syndrome
catabolic states, malnutrition
drugs
37
Q

decreased binding of TBG

A

ASAs

phenytoin

38
Q

euthyroid sick syndrome

A

low TH
high T3 uptake
high rT3
low TSH

39
Q

low TSH in euthyroid sick syndrome

A

d/t steroids, amphetamine, CaCH blockers, dopamine, NSAIDs, opiates
increases IL1 and IL6 and TFN alpha

Endo II (15 decks)

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