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Endocrinology USMLE Step 3 > Section 2: Thyroid Disease > Flashcards

Section 2: Thyroid Disease Flashcards

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USMLE® Step 1 flashcards
1
Q

Clinical features of hypothyroidism

A
  • Weight gain
  • Cold intolerance
  • Coarse hair
  • Dry skin
  • Depression
  • Bradycardia
  • Diminished reflexes
  • Muscle weakness
  • Fatigue
  • Menstrual changes
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2
Q

Clinical features of hyperthyroidism

A
  • Weight loss
  • Heat intolerance
  • Fine hair
  • Moist skin
  • Anxious
  • Tachycardia, tachyarrhythmias such as atrial fibrillation
  • Muscle weakness
  • Fatigue
  • Menstrual changes
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3
Q

Best initial tests for hypothyroidism

A
  • TSH (elevated)
  • T4 (decreased)
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4
Q

Rx for hypothyroidism

A
  • T4 or thyroxine replacement
    • T4 will be converted to T3 in the local tissues as needed
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5
Q

Best initial tests for hyperthyroidism

A
  • TSH (often decreased)
  • T4 (increased)
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6
Q

Name the four forms of hyperthyroidism

A
  • Grave’s disease
  • Silent thyroiditis
  • Subacute thyroiditis
  • Pituitary adenoma
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7
Q

Findings in diagnostic testings for Grave’s disease

A
  • TSH - low
  • T4 - high
  • RAIU - elevated

RAIU is radioactive iodine reuptake

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8
Q

Findings in diagnostic testings for “Silent” thyroiditis

A
  • TSH - low (not specific for this form of hyperthyroidism)
  • T4 - high
  • RAIU (radioactive iodine reuptake) - low
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9
Q

Which form of hyperthyroidism may present with antibodies to thyroid peroxidase and antithyroglobulin antibodies

A

Silent thyroiditis

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10
Q

Name the only cause of hyperthyroidism with an elevated TSH

A

Pituitary adenoma

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11
Q

Rx for the different forms of hyperthyroidism

  1. Graves disease
  2. Silent thyroiditis
  3. Subacute thyroiditis
  4. Pituitary adenoma
A
  1. Radioactive iodine ablation
  2. None
  3. Aspirin
  4. Surgical removal
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12
Q

Outline the Rx of thyroid storm and the role of medications used

A
  • Iodine: Blocks uptake of iodine into the thyroid gland
  • Propylthiouracil or methimazole: Blocks production of thyroxine
  • Dexamethasone: Blocks peripheral conversion of T4 to T3
  • Propranolol: Blocks target organ effect
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13
Q

List the clinical features unique to Grave’s disease

A
  1. Ophthalmopathy
    • Exophthalmos
    • Proptosis
  2. Dermopathy
    • Thickening of the skin below the knee
    • Reddening of the skin below the knee
  3. Onycolysis (separation of the nail from the nailbed)
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14
Q

Causes of hypothyroidism

A
  • Failure of the thyroid gland from burnt-out Hashimoto thyroiditis
  • Dietary deficiency of iodine
  • Amiodarone
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15
Q

True or False:

  1. Methimazole is preferred over propylthiouracil
  2. Only Graves disease has eye and skin abnormalites
  3. Only Graves disease has TSH recptor antibodies
  4. Double normal level of TSH (high TSH) and normal T4 require Rx with thyroid hormone replacement
  5. Atithyroid peroxidase tell who needs thyroid replacement when T4 is normal and TSH is high
A
  1. True
  2. True
  3. True
  4. True
  5. True
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16
Q

Thionamide medications are the 10 Rx for hyperthyroidism in pregnancy.

  1. Drug of choice in the first trimester
  2. Drug of choice in the second and third trimesters
A
  1. Propylthiouracil
  2. Methimazole
17
Q

Radioactive iodine Rx for Graves disease is associated with worsening of ophthalmopathy. How can this be prevented?

A

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<![endif]-->Concurrent administration of **glucocorticoids**
18
Q

A 46-year-old woman comes to the office because of a small mass she found on palpation of her own thyroid. A small nodule is found in the thyroid. There is no

tenderness. She is otherwise asymptomatic and uses no medications. What is the most appropriate next step in the management of this patient?
a. Fine-needle aspiration
b. Radionuclide iodine uptake scan
c. T4 and TSH levels
d. Thyroid ultrasound
e. Surgical removal (excisional biopsy)

Fischer, Conrad (2012-11-01). Master the Boards USMLE Step 2 CK (Page 115). Kaplan Medical Test Prep. Kindle Edition.

A

C. If the patient has a hyperfunctioning gland (i.e., the T4 is elevated or the TSH is decreased), the patient does not need immediate biopsy. Malignancy is not hyperfunctioning. Ultrasound of thyroid is done to evaluate the size of the lesion, but does not change the need for either thyroid function testing or needle aspiration.

Fischer, Conrad (2012-11-01). Master the Boards USMLE Step 2 CK (Page 115). Kaplan Medical Test Prep. Kindle Edition.

19
Q

A 46-year-old woman with a thyroid nodule is found to have normal thyroid function testing. The fine-needle aspirate comes back as “indeterminant for follicular

adenoma. ” What is the most appropriate next step in the management of this patient?
a. Neck CT
b. Surgical removal (excisional biopsy)
c. Ultrasound
d. Calcitonin levels

Fischer, Conrad (2012-11-01). Master the Boards USMLE Step 2 CK (Page 115). Kaplan Medical Test Prep. Kindle Edition.

A

B. A follicular adenoma is a histologic reading that cannot exclude cancer. The only way to exclude thyroid malignancy is to remove the entire nodule. This is an
indeterminant finding on fine-needle aspiration. A sonogram cannot exclude cancer. Calcitonin levels are useful if the biopsy shows medullary carcinoma.

Fischer, Conrad (2012-11-01). Master the Boards USMLE Step 2 CK (Page 115). Kaplan Medical Test Prep. Kindle Edition.

20
Q

Outline the management of a thyroid nodule

Fischer, Conrad (2012-11-01). Master the Boards USMLE Step 2 CK (Page 115). Kaplan Medical Test Prep. Kindle Edition.

A
  • Perform thyroid function tests (TSH and T4).
  • If tests are normal, biopsy the gland

Thyroid nodules >1 cm must be biopsied with a fine-needle aspirate if there is normal thyroid function (T4/TSH)

Nodules in those who are euthyroid
should be biopsied

There is no need to ultrasound or do radionuclide scanning because these tests cannot exclude cancer

Fischer, Conrad (2012-11-01). Master the Boards USMLE Step 2 CK (Page 115). Kaplan Medical Test Prep. Kindle Edition.

21
Q

True or False:

In patients with thyroid cancer in remission, the dose of levothyroxine is adjusted to suppress the TSH below normal range, usually between 0.1-0.3 microU/mL

A

True

22
Q

Some medications inhibit monodeiodination, which converts T4 to T3. List these medications

A
  • Glucocorticoids
  • Amiodarone
  • Beta blockers
  • Propylthiouracil

Endocrinology USMLE Step 3 (6 decks)

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