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Endocrine > Hyperthyroidism > Flashcards

Hyperthyroidism Flashcards

1
Q

What are the cardiac ssx of hyperthyroidism?

A

HTN
Tachycardia
Increased contractility

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2
Q

What are the sequelae of the cardiac effects of hyperthyroidism?

A

A0fib

high output failure

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3
Q

What is Grave’s dermopathy

A

Thickening of the skin, especially in the dependent areas

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4
Q

What are the eye findings of hyperthyroidism?

A

Lid lag

Lid retraction

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5
Q

What are the eye ssx that are specific to Grave’s disease?

A

Proptosis
Ophthalmoplegia
Periorbital edema

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6
Q

What is the pathophysiology of primary and secondary hyperthyroidism?

A 
Primary = inherent thyroid issue
Secondary= increased TSH levels
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7
Q

What primary pathology may cause hyperthyroidism, but is not causing increased synthesis?

A

Inappropriate leakage of premade T4

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8
Q

What happens to the TSH levels and FT$ or FT# levels?

A

Decreased TSH, increased FT4/FT3

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9
Q

What is subclinical hyperthyroidism?

A

Normal ft4, but increased TSH

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10
Q

What is the basis for the radionuclide scan?

A

Thyroid uptake and scan after pt given radioactive iodine I-123

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11
Q

Who is usually affected with Grave’s?

A

Young females

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12
Q

What is the cause of Grave’s disease?

A

Antibodies to TSH receptors stimulate growth and hormone productions

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13
Q

What are the antibodies that are found with Grave’s disease?

A

TRAb

TSIg

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14
Q

True or false: there usually is no familial predisposition of Grave’s disease

A

False

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15
Q

What are the ssx of Grave’s disease?

A

Hyperthyroidism + Graves ophthalmopathy + dermopathy

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16
Q

What is Graves ophthalmopathy?

A

abs stimulate inflammation of the eyes in the orbit, as well as deposition of GAGs, lipogenesis, and orbital muscle hypertrophy.

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17
Q

What are the risk factors for developing Grave’s ophthalmopathy?

A

Smokers

High TSI

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18
Q

True or false: Grave’s ophthalmopathy correlates with the thyroid status

A

False–independent

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19
Q

What causes the goiter formation with Grave’s disease?

A

TSH stimulation

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20
Q

What is the sensitivity/specificity of a bruit in Grave’s disease?

A

Insensitive, but specific

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21
Q

What are the uptake and scan findings with Grave’s disease?

A

Uptake is NOT low

Scan is homogenous

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22
Q

What is the treatment for Grave’s disease?

A

Beta blockers
Steroids
Antithyroids

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23
Q

What is the MOA of antithyroids?

A

Inhibits the organification of iodine to iodotyrosine and coupling

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24
Q

What is the MOA of Propylthiouracil? Use? Side effects?

A

Inhibits the organification of iodine to iodotyrosine and coupling

Treats hyperthyroidism

Hepatitis, agranulocytosis

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25
Q

What are the labs that should be monitored with Grave’s disease?

A

Thyroid function
CBC
Transaminases

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26
Q

How long is PTU used for Grave’s disease?

A

Less than two years, since a bit less than 50% have a long term remission

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27
Q

What is the permanent treatment for Grave’s disease?

A

Radioactive ablation of thyroid gland, with I-131, causing destruction in 4 weeks to 6 months

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28
Q

What is the goal of radioactive ablation of the thyroid? Why is this used instead of chronic PTU?

A

Destroy it to give them Levothyroxine

PTU has more side effects than levothyroxine

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29
Q

What are the radiation precautions that must be taken for radioactive ablation of the thyroid?

A

no prego
No sexy time
Sleep alone

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30
Q

What may happen with the eye disease of Grave disease with radioactive ablation of the thyroid?

A

May worsen

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31
Q

What are the prep procedures for a thyroidectomy?

A
  • Antithyroids to render euthyroid

- Beta blockers

32
Q

Why give SSKI preop of a thyroidectomy?

A

To decrease T4 and vascularity

33
Q

Who should get a thyroidectomy as opposed to radioactive ablation?

A

Pts on amiodarone

Prego

34
Q

What are “hot” nodules?

A

autonomously functioning nodule

35
Q

What is Plummer’s disease? IN whom is this common?

A

Toxic multinodular goiter

Older patients greater than 50 yo

36
Q

What is the pathophysiology of autonomously functioning nodules?

A

Hyperplasia of follicular cells, overproduction of T4 independent of T4

37
Q

What are the PE finding with autonomously functioning nodules?

A

Nodular thyroid

38
Q

What are the chances that plummer’s disease will resolve on its own

A

will not

39
Q

What are the uptake and scan findings of autonomously functioning nodules?

A

Patchy hyperactivity, with other areas suppressed

40
Q

What is the treatment for autonomously functioning nodules? Why is the outcome for this different than in other thyroid diseases?

A

Radioactive ablation. This will not render them hypothyroid, since only the overactive areas pick up the I, while the under active areas do not

41
Q

Why are antithyroids contraindicated for autonomously functioning nodules?

A

Will not spontaneously resolve like Grave’s disease

Side effects more likely the longer you’re on it

42
Q

What is the usual thyroid levels with thyroiditis?

A

Inflammation of the thyroid causes leakage of preformed T3/T4

43
Q

What are the etiologies of thyroiditis?

A

Viral
Radiation
Iodine exposure
Postpartum

44
Q

What are the PE findings with thyroiditis?

A

Usual hyperthyroid signs

Tender thyroid

45
Q

What are the thyroid uptake scans with thyroiditis? Why?

A

Low, since you’re not making more hormone, you’re just leaking.

46
Q

What is the treatment for thyroiditis?

A
  • NSAIDs
  • Prednisone
  • beta-blockers
  • Antithyroids
47
Q

What is the natural h/o thyroiditis?

A

Triphasic—Hyperthyroid-euthyroid–hypothyroid

48
Q

What is the role of radioactive Iodine and antithyroids in thyroiditis?

A

Since it is not an overproduction pathology, antithyroids and radioactive ablation are not very useful

49
Q

What is the typical cause of Iodine-induce hyperthyroidism?

A

Pts who take amiodarone, or other high dose iodine treatments

50
Q

How do you diagnose amiodarone induced hyperthyroidism?

A

US may show increased vascularity, but not specific

51
Q

What are the results of thyroid uptake with amiodarone?

A

Low

52
Q

What are the therapeutic options for amiodarone induced hyperthyroidism?

A

Glucocorticoid

53
Q

Why isn’t radioactive ablation or PTU useful for amiodarone induced hyperthyroidism?

A

Thyroid already supersaturated with iodine

Antithyroids only inhibit new uptake of iodine–again, already super saturated

54
Q

Why is it difficult to treat amiodarone-induced hyperthyroidism?

A

Very long half-life, and needed for cardiac reasons

55
Q

What is the most effective means for treating amiodarone hyperthyroidism?

A

Thyroidectomy

56
Q

What are the labs like with a TSH-producing pituitary tumor?

A

Increased T4, with non suppressed or increased TSH

57
Q

What are the clinical features of a TSH producing pituitary adenoma?

A

Hyperthyroid features
Goiter
Bitemporal hemianopsia

58
Q

What are the diagnostic tests for a TSH producing adenoma?

A

High alpha subunit

MRI showing pituitary adenoma

59
Q

What is the treatment for a TSH producing pituitary adenoma?

A

Transsphenoidal resection

Octreotide

60
Q

What is hCG-mediated hyperthyroidism?

A

HCG weakly stimulate the thyroid, but TSH will deccrase

61
Q

In what conditions is hCG-mediated hyperthyroidism seen in (2)?

A
  • Hyperemesis gravidarum

- Molar pregnancy

62
Q

If there is no pathological cause of hCG mediated-hyperthyroidism, what is the treatment?

A

No Rx needed

63
Q

When should hCG-mediated hyperthyroidism be treated? What should be used?

A
  • If T4 elevated
  • PTU first trimester
  • Methimazole
64
Q

What is thyroid storm?

A

Severe exacerbation of a preexisting hyperthyroidism, causing:

  • tachy
  • hyperthermia
  • n/v/d
  • Mental status change
65
Q

What are the triggers for thyroid storm?

A
  • Omission of anti thyroid drugs
  • surgery
  • infx
  • MI
  • CVA
66
Q

What is the treatment for thyroid storm?

A
  • Supportive (cooling, IVFs, oxygen etc)
  • Beta blockers
  • Glucocorticoids
  • antithyroids
  • Iodine
67
Q

What is the mortality rate of thyroid storm?

A

20-30%

68
Q

What is euthyroid sick syndrome?

A

Fluctuation of thyroid hormones during some sort of stress, but does not actually reflect any thyroid pathology

69
Q

What are the classic lab findings of euthyroid sick syndrome?

A

TSH low
FT4, FT3 low
rT3 high

70
Q

What is the purpose of putting patients on SSKI prior to surgery?

A

Decreases T4 secretion (through Wolff-Chaikoff phenomenon)

Decreases vascularity of thyroid gland

71
Q

What is the phenomenon of increased T4 synthesis with increase iodine concentrations?

A

Jod Basedow effect

72
Q

What is the phenomenon of decreased T4 synthesis with very highly increase iodine concentrations?

A

Wolff-Chaikoff phenomenon

73
Q

What is Type 1 amiodarone induced hyperthyroidism?

A

Increases synthesis of T4 d/t Jod Basedow effect

74
Q

What is Type 2 amiodarone induced hyperthyroidism?

A

Thyroiditis

75
Q

How can HCG reduce hyperthyroidism?

A

HCG’s alpha subunit, which TSH has in common, may cause feedback inhibition

Endocrine (32 decks)

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