Jack's Thyroid Questions

Question 1

What is the most common cause of hyperthyroidism?

Answer 1

Graves Disease, an autoimmune disease in which the body creates antibodies that bond to the TSH receptors and thereby force the thyroid into excessive production.

Question 2

What drugs can cause hyperthyroidism/thyroid toxicosis?

Answer 2

-amiodarone, lithium

Question 3

Which symptom is specific for Graves disease?

Answer 3

-pretibia myxedema

Question 4

What is exophthalmos?

Answer 4

-proptosis or bulging eyes

Question 5

When is exophthalmos seen?

Answer 5

in hyperthyroidism/Graves

Question 6

What is Thyroid Storm?

Answer 6

-severe hyperthyroidism, is rare

Question 7

What are risks for thyroid storm?

Answer 7

• stressfull illness
• thyroid surgery
• radioactive iodine treatment

Question 8

Who might get a thyroid storm? What are the signs of thyroid storm?

Answer 8

• a hyperthyroid patient with symptoms

- and, Fever, Tachycardia, Dehydration, Muscle weakness, Confusion, nausea and vomiting

Question 9

What tests do you do for Graves?

Answer 9

-the typical thyroid tests and

• radioactive iodine uptake scan
• ultrasound of the thyroid

Question 10

What is the initial tx for Graves or hyperthyroidism? After stabilization in a couple days then what is done for Tx?

Answer 10

• propranolol is initial tx

- then tx with Methimazole to control hyperthyroidism

Question 11

Propylthiourcial is used to tx what type of thyroid patient?

Answer 11

-a pregnant patient with hyperthyroidism

Question 12

What is the most common cause of Hypothyroidism?

Answer 12

-Hashimoto’s thyroiditis

Question 13

What meds can cause hypothyroidism?

Answer 13

• Amiodarone, structurally similar to thyroxine
• Lithium
• Propylthiouracil, used to tx hypothyroid in pregnancy
• Methimazole; used to tx hypothyroidism

Question 14

What is the TSH level like in hypothyroidism?

Answer 14

-elevated

Question 15

What thyroid specific tests are helpful in Dx hypothyroidism?

Answer 15

• Antithyroid peroxidase

- Antithyroglobulin antibodies

Question 16

What drug is used to tx hypothyroidism?

Answer 16

-Levothyroxine, a synthetic T4

Question 17

What is the dosing for Levothyroxine?

Answer 17

-start at lowest dose and slowly add more while monitoring symptoms and TSH levels

Tx is forever

Watch for symptoms of hyperthyroidism?

Question 18

A hypothyroid patient presents with typical symptoms and confusion and near coma, convulsions, and hypothermia. What is the Dx and how do you tx?

Answer 18

-Myxedema

• Tx, is IV levothyroxine
• slowly warm with warm blankets only
• intubation if needed

Question 19

45 year old female presents with and enlarged, firm and nodular thyroid, chronic fatigue and has known Sjogren’s syndrome? What is the Dx and Tx?

Answer 19

Dx is Hashimoto’s

Tx is Levothyroxine, and it will help shrink the thyroid

Question 20

27 year old female 5 mo post partum presents with and enlarged thyroid and fatigue. What is the Dx and Tx?

Answer 20

• Postpartum throiditis

- Tx if necessary, this is usually self limiting

Question 21

34 year old female presents with a painful thyroid and decrease T4 level? What is the Dx and Tx?

Answer 21

• Dx is subacute thyroiditis

- Tx, is aspirin for pain, Levothyroxine for sx of hypothyroidism

Question 22

37 year old female has an enlarged thyroid and fever? What is the Dx and Tx?

Answer 22

• Dx is Suppurative thyroiditis

- Tx is appropriate antibiotics, possible I&D

Question 23

What are the 4 types of Thyroid Cancer’s?

Answer 23

• Pappillary Carcinoma
• Follicular Thyroid Cancer
• Medullary Thyroid Cancer
• Anaplastic Thyroid Cancer

Question 24

What is MEN type II and its relation to the thyroid gland?

Answer 24

-Multiple Endocrine Neoplasia

• is an hereditary condition involving three endocrine tumors,
  
  • Medullary Thyroid Cancer
  • Parathyroid Tumors
  • Pheochromocytoma (tumor of the adrenal glands)

Question 25

Which is the most aggressive Thyroid Cancer?

Answer 25

-Anaplastic and it is least prevalent of the thyroid cancers

Question 26

Which is the least aggressive of the Thyroid Cancers?

Answer 26

-Papillary and it is the most prevalent

Question 27

Childhood head or and neck radiation increases the risk of what type of thyroid cancer?

Answer 27

-Papillary

Question 28

Which thyroid cancer can cause a thyroid storm?

Answer 28

-Follicular thyroid cancer, by increased secretion of T4.

Question 29

TSH is normal to thyroid cancer except in which thyroid cancer?

Answer 29

-TSH is decreased in Follicular thyroid cancer because the increased T4 levels secondary to the cancer suppresses TSH production by the negative feedback loop.

Question 30

Where does thyroid cancer metastasis to?

Answer 30

• bone and lung, mri the lungs, CT the bones

- PET for metastasis

Question 31

What is the tx of thyroid cancer?

Answer 31

• Total thyroidectomy
• lymph node removal if indicated
• Levothyroxine following thyroidectomy
• whole body radioactive iodine scans, remission is when you have 2 successive negative scans
• monitor TSH level for levothyroxine dose
• Medullary cancer family members should get a genetic workup and thyroid surveillance.
• Mets to the brain need Gamma knife
• Radioactive iodine ablation for postoperative residual disease, metatastic disease and to prevent recurrence