Lecture 12 - Thyroid Clinical Aspects

Question 1

Thyroid Binding Globulin (TBG) binds T4 and T3 (a bit more so T4). It is increased in ____, use of _____ contraceptives, and acute _____ disease.

Answer 1

Pregnancy

Oral contraceptive

Acute Liver disease

Question 2

Radioiodine uptake can indicate if the Thyroid is hypo, hyper, or normally active.

Hypo = < ____-____% uptake

Euthyroid (normal) = ____-____%

Hyper = > ___-___%

Answer 2

Hypo = < 15-20%

Euthyroid = 15-35%

Hyper = > 50-60%

Question 3

Pretibial _______, deposition of collagen matrix causing the appearance of swelling in the shins (though it cannot be depressed like with edema), is a complication of Graves’ disease.

Answer 3

Pretibial Myxedema

Question 4

Thyroiditis occurs in three phases:

1. _____ during acute inflammation.
2. _____ during post-acute phase.
3. _____ during healing/fibrosis.

Answer 4

1. Hyperthyroid
2. Euthyroid
3. Hypothyroid

Question 5

Both Thyroiditis and Graves’ disease will show elevated _____ and/or _____ with low _____, but which disease shows LOW uptake of radioactive Iodine on thyroid scan and which shows HIGH uptake?

Answer 5

T4 and/or T3

TSH

Thyroiditis –> low uptake

Graves’ –> high uptake

Question 6

600mg of _____ twice daily can be used to treat hyperthyroidism in patients who need urgent treatment and cannot tolerate other medication.

Answer 6

Lithium

Question 7

Thyroid Storm is a clinical diagnosis and may be made even if Thyroid levels are not very high. Look for patients presenting with Fever, ____ instability, and/or neurological symptoms.

Answer 7

Cardiac instability

Question 8

Sub-clinical Hyperthyroidism is defined ONLY by abnormally low ______ (< 0.45). Patients > ____ years old are at risk of Afib and should be treated with _____. Patients under 60 should likely just be observed/NOT treated.

Answer 8

TSH

60 years old

RAI

Question 9

Are single or multinodular growths in the thyroid more suspicious for cancer?

Growths > ____cm are suspicious for thyroid cancer as well.

Answer 9

Single

4cm

Question 10

Measurement of _______ allows for detection of metastatic Thyroid cancer once the thyroid is removed. If it is present, there is obviously another source of production.

Answer 10

Thyroglobulin

Question 11

_____ thyroid cancer has the best prognosis at 95% 10 year survival rate. _____ has second best prognosis at 50-85% 10 year survival rate.

Answer 11

Papillary

Follicular

Question 12

TNM Staging for Thyroid tumors:

T1 = primary tumor < ___cm

T2 = __-__ cm

T3 = > ___cm

T4 = extracapsular extension, subQ larynx, trachea

N0 = no lymph node involvement
N1a= \_\_\_\_\_\_, pre-\_\_\_\_\_
N1b = Unilateral, bilateral, contralateral superior mediastinal
Nx = not assessed 

M0 = no mets
M1 = mets
Mx = not assessed

Answer 12

T1 = < 2cm
T2 = 2-4cm
T3 = > 4cm

N1a = Paratracheal, prelaryngeal

Question 13

Hyperthyroidism: TSH < _____ and FT4 > ____.

Hypothyroidism: TSH > ____ and T4 < __-__.

Answer 13

0.05

2

20

2-4