Hyperthyroidism

Question 0

Effect of hyperthyroidism on Neuromuscular system?

Answer 0

Brisk reflexes, inability to concentrate, proximal muscle weakness, insomnia

Question 1

Treatment of hyperthyroidism?

Answer 1

Antithyroid drugs, radioactive iodine ablation

Question 2

Effect of hyperthyroidism on cardiac system?

Answer 2

Wide pulse pressure, heart murmurs, tachycardia, AFIB, High-output heart failure

Question 3

Effect of hyperthyroidism on G.I. tract?

Answer 3

Increased food intake with weight loss and hyperdefecation

Question 4

Effect of hyperthyroidism on eyes?

Answer 4

Lid lag and retraction upper eyelid

Exophthalmos if Graves’ disease

Question 5

Effect of hyperthyroidism on the reproductive system?

Answer 5

Women: infertility and oligomenorrhea

Men: reduced sperm count, impotence, gynecomastia

Question 6

Effect of hyperthyroidism on skin?

Answer 6

Warm, moist, velvety, alopecia

Question 7

Effect of hyperthyroidism in older patients?

Answer 7

Less adrenergic features and instead present with depression, weight loss, Afib, worsening angina or CHF

Question 8

Thyroid storm?

Answer 8

Decompensated thyrotoxicosis
Tachycardia >140
Fever (104-106)
Agitation/delirium
Vomiting and diarrhea

Question 9

Treatment of thyroid storm?

Answer 9

1 fluids
2 antibiotics
3 Anti-thyroid medications:
IODINE SOLUTION (to block the release of thyroid hormone,)
PROPRANOLOL to control adrenergic symptoms, GLUCOCORTICOIDS to decrease T4 to T3 conversion

Question 10

Causes of thyrotoxicosis?

Answer 10

1 Graves' disease
2 toxic multinodular goiter
3 adenoma
4 thyroiditis
5 medications

Question 11

Graves’ disease: epidemiology? Mechanism?

Answer 11

Women ages 30 to 50

Autoantibodies that activate TSH receptor

Question 12

Thyrotoxicosis in pregnant patients can cause?

Answer 12

Antibodies cross placenta and cause neonatal thyrotoxicosis

Question 13

Physical exam signs of Graves’ disease?

Answer 13

Goiter, thyroid bruit, Exophthalmus, diplopia, dermopathy (Raised hyperpigmented orange peel papules) and myxedema

Question 14

Confirmatory tests for Graves disease?

Answer 14

1. Thyroid-stimulating immunoglobulin

2. Thyroid uptake scan showing diffusely increased iodine uptake

Question 15

Methimazole versus PTU?

Answer 15

Peripheral effects versus the peripheral and central effects

Question 16

Toxic multinodular corridor: test? treatment?

Answer 16

Focal increased iodine uptake on scan

Radioactive iodine or surgery

Question 17

Pummer disease: Mechanism? Radioactive scan results? Risk of malignancy if?

Answer 17

Hyper functioning adenoma (no symptoms unless nodule >3 cm)

Iodine scan shows hot nodule with suppressed rest of gland (Flag of Japan)

Hot nodules are never malignant. Cold nodules have 5 to 10% risk

Question 18

Subacute thyroiditis caused by? Sx? Treatment?

Answer 18

de Quervain is an inflammatory viral illness with thyroid pain and tenderness. Last for several weeks to months. NSAIDs and beta blockers

Question 19

Medication can cause hyperthyroidism?

Answer 19

Amiodarone

Question 20

Masses outside thyroid that can cause thyrotoxicosis?

Answer 20

Pituitary adenoma
Hydatidiform mole
Choriocarcinoma
Ovarian teratomas (struma ovarii)