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SRGRY3 > SRGRY - THYROID > Flashcards

SRGRY - THYROID Flashcards

1
Q

6 steps of thyroid hormone synthesis

A

TOICHD

Trapping - NIS
Organification - TPO
Iodination - TPO
Coupling - TPO
Hydrolysis
Deiodination - Dehalogenase
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2
Q

epithelial lining of thyroid

A

simple cuboidal epithelium

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3
Q

average daily iodine rqt

A

0.1mg

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4
Q

percentage of iodine stored in thyroid

A

> 90%

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5
Q

active form of thyroid hormone

A

T3

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6
Q

percentage of unbound thyroid hormone

A

0.02%

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7
Q

result of deiodination of inner ring of T4, a metabolically inactive compound

A

rT3

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8
Q

half life of T3

half life of T4

A

1 day

7 days

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9
Q

hormone from hypothalamus that stimulates pituitary to release TSH

A

TRH

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10
Q

excessively large doses of iodide lead to initial increased organification followed by suppression

A

Wolf Chaikoff effect

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11
Q

stimulate/depress thyroid function
hCG
Epinephrine
Glucocorticoid

A

stimulate
stimulate
inhibit

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12
Q

peripheral thyroid hormones may be reduced without compensatory increase in TSH levels, giving rise to

A

euthyroid sick syndrome

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13
Q

mechanism of increase in oxygen consumption basal metabolic rate and heat production by thyroid hormone

A

Na-K-ATPase stimulation

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14
Q

effects of thyroid to heart and mechanism

A

positive inotropic and chronotropic effect via increase transcription of Ca ATPase and increase in B adrenergic receptors and concentration of G protein

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15
Q

effects of thyroid hormone except

a. increase heart rate
b. increase GI motility
c. maintain hypoxic drive
d. maintain hypercaonic drive
e. increase speed of muscle contraction and relaxarion

A

AOTA

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16
Q

T about thyroid function test

a. TSH is sufficient to assess thyroid function in all situations
b. T4 is the only test necessary in most patients with thyroid nodules that clinically appear euthyroid
c. Total T4 levels reflect the output from thyroid glabds
d. T3 levels in nonstimulated thyroid gland are more indicative of peripheral thyroid hormone metabolism

A

C and D

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17
Q

normal level of TSH

A

0.5-5 microU/mL

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18
Q

conditions with increased Tg and Total T4 making them not suitable screenung tests

A

increased estrogen
increased progesterone
congenital ds

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19
Q

conditions withe decreased Tg qnd TT4

A

anabolic steroid use

protein losing disorders like nephrotic syndrome

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20
Q

total t4 reference range

A

55-150nmol/L

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21
Q

T3 reference range

A

1.5-3.5nmol/L

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22
Q

end-organ resistance ro T4

A

Refetoff’s syndrome

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23
Q

free T4 reference range

A

12-28pmol/L

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24
Q

free T3 reference range

A

3-9pmol/L

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25
Q

Ft4 test is confined to

A

cases of early hyperthyroidism in which total T4 is normal but FT4 is elevated

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26
Q

FT4 is most useful in

A

confirming diagnosis of early hyperthyroidism

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27
Q

how to evaluate TSH secretory function

A

500micrograms of TRH intravenously, measure TSH levels after 30-60 min

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28
Q

what percentage of Hashimoto’s thyroiditis

have elevated thyroid antibody levels

A

80%

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29
Q

most important use of Tg

A

monitoring px with differentiated thyroid CA for recurrence

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30
Q

serum calcitonin nornal value

A

0-4 pg/mL

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31
Q

halflife of iodine 123

A

12-14 hours

32
Q

halflife of Iodine 131

A

8-10 days

33
Q

risk of malignancy for hot nodules

A

20%

34
Q

risk of malignancy for cold nodules

A

5%

35
Q

thyroid utz most helpful

A

assessing cervical lymphadenopathy and gude biopsy

36
Q

peak incidence of Grave’s (age)

A

40-60 y.o.

37
Q

diffusely and smoothly enlarged with a concomitant increase in vacularity

A

Grave’s

38
Q

what percentage of patients of Grave’s have ophthalmopathy

A

50%

39
Q

lid lag in Grave’s

A

Von Graefe’s

40
Q

spasm of upper eyelid revealing sclera above corneoscleral limbus

A

Dalrymple’s sign

41
Q

etiology of Grave’s ophthalmopathy

A

orbital fibroblasts and muscles have TSH-r result from inflammation caused by cytokines released from sensitized killer T lymphocytes and cytotoxic antibodies

42
Q

findings in Grave’s except

a. exophthalmos
b. gynecomastia
c. onycholysis
d. NOTA

A

D

43
Q

confirmatory test for grave’s

A

I-131 elevated uptake with diffusely enlarged gland

44
Q

The following are diagnostic of Grave’s

a. elevated Anti-Tg
b. elevated Anti- TPO
c. elevated TSH-R
d. elevated TSAb

A

C and D

45
Q

Dosage of PTU

A

100-300mg 3x daily

46
Q

dosage of methimazole

A

10-30mg 3x daily

47
Q

MOA of methimazole and PTU

A

reduce thyrois hormone production by inhibiting the organic binding of iodine and the coupling of iodotyrosines (mediated by TPO)

48
Q

additional MOA of PTU

A

inhibits peripheral conversion of T4 and T3

49
Q

anti thyroid drug of choice

A

methimazole

50
Q

anti thyroid DOC for pregnant

A

PTU

less placental transfer

51
Q

Antithyroid drug associated with congenital aplasia

A

methimazole

52
Q

anti thyroid DOC for breastfeeding

A

PTU

53
Q

side effect of anti thyroid medication

A 
grabulocytopenia
skin rashes
fever
peripheral neuritis 
polyarteritis
vasculitis
hepatitis

rarely: agranulocytosis and aplastuc anemia

54
Q

management of agranulocytosis resulting from anti thyroid med

A

admission to the hospital
discontinuation of drug
broad spectrum antibiotics

55
Q

granulocyte level that must be achieved for surgery to proceed

A

1000cells/mm3

56
Q

rekoase rate for Grave’s with anti thyroid medications

A

40-80%

57
Q

The following will most likely have recurrence EXCEPT

a. nontoxic goiters 50g
b. markedly elevated thyroid hormone levels
c. nrgative or low titers of thyroid hormone receptor antibodies
d. rapid decrease in gland size with anti thyroid medications

A

C and D

58
Q

dose if oroprabolol for B blockade in symptomatic thyrotoxicosis

A

20-49mg 4x daily

59
Q

symptomatic medication for tachycardia in thyrotoxicosis in asthmatic px

A

Calcium channel blocker

60
Q

aside from control of tachycardia additional benefit does B blocker have?

A

decrease peripheral conversion of T4 to T3

61
Q

in ox wih Grave’s given RAI, px will become euthyroid after

A

2 mos

62
Q

what percentage will becime hypothyroid after 1 yr RAI

A

2.5%

63
Q

% of ox with progression if Grave’s ophthalmopathy after RAI? after surgery?

A

33% 16%

64
Q

thyroid gland is pale, gray-tan cut surface that is glandular, nodular, firm

a. Grave’s
b. Riedl’s thyroiditis
c. Hashimoto’s thyroiditis
d. painless thyroiditis

A

C

65
Q

% Hashimoto’s with with hyperthyroidism

A

5%

66
Q

% Hashimoto’s with hypothyroidism

A

20%

67
Q

what confirms diagnosis of hashimoto’s thyroiditis?

A

elevated TSH and presence of thyroid autoantibodies

68
Q

Riedl’s thyroiditis is a.k.a

A

invasive fibrous thyroiditis

69
Q

mainstay trewtment for riedl’s thyroiditis

A

surgery

70
Q

thr goal of surgery in riedl’s thyroiditis

A

decompress trachea

tissue diagnosis

71
Q

riedl’s thyroiditis medical mgt

A

corticosteroids
tamoxifen
mycophenolate mofetil - most dramatic

72
Q

px with goiter and hoarseness, what do you suspect?

A

malignancy

73
Q

FNAB is recommended in the ff except

a. dominant thyroid nodule
b. painful enalrging thyroid nodule
c. both
d. neither

A

D

74
Q

true about mtc

a. amyloid is a diagnostic finding
b. calcitonin is a diagnostic tumor marker
c. polygonal or spindle shaped cell
d. stain positively for CEA

A

AOTA

75
Q

percentage of MTC with familial ds

A

25%

76
Q

tx of choice for MTC

A

thyroidectomy

SRGRY3 (44 decks)

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