Masse cervicale, goitre, maladie thyroïdienne

Question 1

Thyroxine overreplacement may cause…?

Answer 1

subclinical hyperT4 or event overt hyperT4

and is treated with medication dosage reduction

Question 2

Principal risk of subclinical hyperT4?

Answer 2

FA

Question 3

[…] is the most commonly used tx for Graves’ dz.

Answer 3

Radioactive iodine

Question 4

C-i au tx de iodine radiactif?

Answer 4

grossesse

c-i seule et absolue!

Question 5

Befor starting tx with radioiodine, we should stop ..?

Answer 5

antithyroid medication

carbimazole ou propylthiourcil

Question 6

dx?
perte de poids
masse cervicale
exophtalmie
mx AI se caractérisant par hyperT4
épisode de chaleur
peau moite
sueur
tremblements
palpitations
dlr thoracique
photophobie
polyurie
intolérance à la chaleur
aménorrhée

Answer 6

Maladie de Graves (goitre toxique diffus)

Question 7

dx?
présence d’auto-anticorps contre TSH
T4 L aug
T3 L aug

Answer 7

Mx Graves

Question 8

Graves’ orbitopathy may flare and worsen when treated with..?

Answer 8

radioiodine tx

Question 9

In patients with high cardiac output heart failure, [1…] should be excluded by measurment of [2…]

Answer 9

1. Thyrotoxicose

2. TSH

Question 10

Although serum TSH is the most sensitive test for dx hyperT4, it is insensitive for evaluating the effect of tx and titration of the dose of antithyroid medication; […] should be used instead.

Answer 10

T4 libre

Question 11

tx hyperT4 en grossesse?

Answer 11

rx Thioamide (propylthiouracil, methimazole, carbimazole) (ATDs)

dosage: le plus bas possible

+/-BB (atenolol, nadolol, propranolol)

si échec: thyroidectomie subtotale

Question 12

[…] is useful for treating the symptoms of mild hyperT4: decreases tachycardia, tremor, has a role in the tx of throid storm. At high doses, it blocks the conversion of T4 to T3, in addition to providing beta-blockade

Answer 12

Propranolol

*antithyroid agents (propylthiouracil) are beneficial but require an extended period for sx control

Question 13

If TSH < 0,5 mlU/L, the immediate next step it to measure?

Answer 13

T3 et T4 libres

• si aug = hyperT4
• si N = hyperT4 subclinique

Question 14

ddx hypoT4 primaire?

Answer 14

AI: Hashimoto
ioatrogénique: iode 131 ou thyroïdectomie
déficit en iode
rx: amiodarone, produit de contraste, Li
congénital

Question 15

ddx hypoT4 secondaire?

Answer 15

hypopit
tumeur
chx
Sd Sheehan

Question 16

investigations hypoT4?

Answer 16

TSH,
T4 libre
anticorps TPO

Question 17

DDX hyperT4?

Answer 17

captation +++:
mx Graves
nodule toxique (unique ou multiple)

dim captation:
thyroïdite:
AI, deQuervian (viral), iduite par iodine, amiodarone

Question 18

investigations hyperT4?

Answer 18

TSH,
T4 libre
anticorps TPO (positif dans les mx AI de la T4)
imagerie (captation, écho, scan)

Question 19

dx? tx?
severe form of thyrotoxicosis characterized by agitation, fever, delirium, seizure, vomiting, diarrhea, FA and high output cardiac failure.

Answer 19

tempête thyroïdienne

tx: propylthiouracil, BB, dexamethasone, iodide

Question 20

dx? conduite?
painful thyroid
\+/- sx hypert4
infectious sx
VS aug, leucocytose

Answer 20

thyroïdite aigue
bactérienne

aspiration à l’aiguille fine, Gram.
tx infection

Question 21

dx? évolution attentude? conduite?
painful thyroid
\+/- sx hypert4
aug VS
low iodine uptake

Answer 21

thyroïdite sub aigue
initialement en thyrotoxicose x 1mois
puis hypot4 x 1-3 mois

sx hyper: BB
AINS pour dlr, ad prednisone

levothyroxine pendant phase hypo

Question 22

ddx histologique de nodule cancéreux thyroïdien?

Answer 22

papillaire
folliculaire
médullaire
anaplasique
métastatique

Question 23

indication bx nodule T4?

Answer 23

nodule euthyroïdien hypoéchogène > 1 cm

Question 24

bilan nodule T4?

Answer 24

TSH

imagerie:
si TSH dim= scan (permet de dire si nodule chaud ou froid) (nodule chaud rarement malin)
si TSH N ou aug = écho

si < 1 cm sans aspect suspect : observation/monitoring
si +/- 1 cm et élément suspect: bx (si neg, refaire la bx!)