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Clin Med II > TH and PTH > Flashcards

TH and PTH Flashcards

1
Q

The thyroid gland secretes what hormones?

A

Secretes T3, T4, and calcitonin

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2
Q

What inhibits the secretion of TSH and TRH?

A

T3/T4

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3
Q

T4 is converted to T3 primarily where?

A

Liver

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4
Q

What is the role fo T3/T4?

A

Regulates metabolism and HR/contractility, involved in normal growth, maturation, and development

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5
Q

What is the best initial test to check thyroid function?

A

TSH levels

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6
Q

Free T4 is biochemically active and used to evaluate what?

A

Abn TSH

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7
Q

Fatigue, constipation, cold intolerance, hair loss, brittle nails, menstrual irregularities, arthralgia, myalgia, depression, decreased libido, and erectile dysfunction are indicative of what?

A

Hypothyroidism

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8
Q

On exam you notice: slow speech, thinning hair, perioribtal edema, bradycardia, muscle weakness and delayed DTRs. What is your suspected DX?

A

Hypothyroidism

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9
Q

What is the cause for the destruction of the thyroid gland in Hashimoto’s?

A

Autoimmune-mediated

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10
Q

What is Hashitoxicosis?

A

Early stage of Hashimoto’s marked by inflammation +/- transient hyperthyroidism

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11
Q

Pregnancy, rediation exposure, and iodine intake can be precipitating factors for what disase?

A

Hashimoto’s thyroiditis

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12
Q

What antibodies will be positive in Hashimoto’s?

A

TPO Ab and TgAb

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13
Q

What is the goal of tx in pt w/ hypothyroidism?

A

Maintain euthyroid state, relieve sx, decrease goiter size if present

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14
Q

What is the pharmacologic treatment for hypothyroidism?

A

Synthetic thyroxine (T4) replacement = Levothyroxine

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15
Q

Ferrous sulfate, calcium carbonate, protein pump inhibitors and bile acid resins will interfere with the absorption of what HRT?

A

T4

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16
Q

What are the most important considerations when treating hypothyroidism with levothyroxine? (3)

A

Weight based (start low and titrate every 4-8 weeks), take on empty stomach, mindful of meds that interfere w absorption

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17
Q

When should you recheck TSH after starting T4 HRT?

A

6 wks (expect sx improvement w/in 2-4 wks)

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18
Q

Once a hypothyroid pt is stable, when should TSH be rechecked?

A

Annually

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19
Q

What pt edu is important for T4 HRT? (2)

A

Life long tx, medication compliance

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20
Q

If TSH persistently elevated, what should you consider? (3)

A

Noncompliance, malabsorptive process, binding substances

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21
Q

How will a pt with subclinical hypothyroidism present?

A

Mild or vague non-specific sxs

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22
Q

The following are consequences to what condition: NASH, neuropsychiatric sxs, infertility/ miscarriages, increased risk of CV disease

A

Subclinical hypothyroidism

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23
Q

Treatment is recommended in pts w/ subclnical hypothyroidism if TSH is ≥ what?

A

10 (tx if controversial if 4.5-9.9)

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24
Q

When should repeat TSH and T4 levels be measured for subclinical hypothyroidism?

A

Repeat TSH and T4 after 1-3 months to confirm dx

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25
Q

When should you repeat TSH and T4 levels immediately with suspicion of subclinical hypothyroidism?

A

Pregnancy or during fertility treatment

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26
Q

Hypothyroidsm induced by stroke, HF, infection or trauma, resulting in high TSH and low T4 is concerning for what?

A

Myxedema coma

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27
Q

TSH levels are tightly regulated by levels of what?

A

Serum levels of T4 and T3

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28
Q

FT4 is more diagnostically relevant than TT4 and is used to evaluted what hormone?

A

TSH levels

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29
Q

Thyrotropin receptor antibody (TRAb) is most often found in?

A

Hyperthyroidism (Grave’s)

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30
Q

What functional study is used to evaluted suppressed TSH?

A

Radioactive Iodine/thyroid uptake scan

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31
Q

What imaging study is used to assess structure of the thyroid gland tissue and nodules?

A

US

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32
Q

What is the single most accurate, reliable, cost effective test to DX thyroid CA?

A

Fine needle aspiration

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33
Q

Endogenous hyperthyroidsm is due to what?

A

Overproduction of thyroid hormone

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34
Q

What are the 4 most common causes of endogenous hyperthyroidism?

A

Graves’ disease, toxic multinodular goiter (MNG), toxic adenoma, thyroiditis

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35
Q

What are the most common causes of exogenous hyperthyroidism? (3)

A

Iatrogenic (over-replacement in hypothyroidism, suppressive therapy, intentional for thyroid cancer)

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36
Q

What lab values would you expect to see with primary hyperthyroidism?

A

Low TSH, high FT4, high T3

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37
Q

What is the most common cause of primary hyperthyroidism?

A

Grave’s disease

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38
Q

What lab values would you expect to see with subclinical hyperthyroidism?

A

Low TSH, normal FT4, normal T3

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39
Q

What lab values would you expect to see with T3 toxicosis?

A

Low TSH, normal FT4, high T3

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40
Q

Opthalmopathy (exophthalmos, proptosis, lid retraction, lid lag, stare) is a common sign of what?

A

Graves’ disease

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41
Q

Radioactive iodine uptake and scan is used to evaluate/dx what?

A

Hyperthyroidism

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42
Q

What uptake % is normal on radioactive iodine uptake and scan?

A

15% uptake after 6 hrs

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43
Q

Diffuse high/ elevated uptake on radioactive iodine uptake and scan indicates what?

A

De novo synthesis of hormone

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44
Q

Diffuse low/decreased uptake after a radioactive iodine and uptake sckin can indicate what? (2)

A

Inflammation/destruction of thyroid tissues (thyroiditis) or extrathyroidal source of thyroid hormone (factitious thyrotoxicosis)

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45
Q

What will Graves’ show on a radioactive iodine and uptake scan?

A

Diffuse uptake

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46
Q

What will a nodule or toxin MNG show on a radioactive iodine and uptake scan?

A

Focal Irregular uptake

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47
Q

What is indicated by a hyperfunctioning “hot” nodule? (2)

A

Increased focal/irregular uptake, rarely malignant

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48
Q

What is indicated by a hypofunctioning “cold” nodule? (2)

A

Decreased focal/irregular uptake, more likely to be malignant

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49
Q

If you identify a cold nodule on radioactive iodine scan, what additional test should you consider?

A

FNA

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50
Q

What are the treatment options for Graves’? (4)

A

Beta blockers (sx control), antithyroid drugs (Methimazole, PTU), radioactive iodine ablation, surgery

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51
Q

What is the most common cause of primary hypothyroidism?

A

Hashimoto’s thyroiditis (autoimmune)

52
Q

What are the 2 different types of central hypothyroidism?

A

Pituitary (secondary) or hypothalamic (tertiary)

53
Q

What will TSH and FT4 levels show with central hypothyroidism?

A

Both low

54
Q

If TSH and FT4 levels are low and you suspect central hypothyroidism, what should the next step be?

A

Pituitary MRI

55
Q

What is the non-pharmacologic treatment for iatrogenic hypothyroidism?

A

Radioactive Iodine uptake scan

56
Q

What medications can cause iatrogenic hypothyroidism? (4)

A

Lithium, amiodarone, other iodine-containing drugs, contrast agents

57
Q

What labs would you expect to see w/ primary hypothyroidism?

A

High TSH, low FT4, normal or low T3

58
Q

What labs would you expect to see w/ subclinical hypothyroidism?

A

High TSH, normal FT4, normal T3

59
Q

What labs would you expect to see w/ central hypothyroidism?

A

N/low TSH, low-normal or low FT4, normal or low T3

60
Q

In primary hypothyroidism, the serum TSH is increased in a reflex effort to stimulate what?

A

The failing gland (represented by low serum FT4)

61
Q

Pt presents for a routine PE when you note a thyroid nodule. How do you proceed?

A

TSH and US first

62
Q

What % of nodules are benign vs cancerous?

A

95% benign, 5% cancerous (nodules are common, but rarely malignant)

63
Q

Most malignant thyroid nodules are what?

A

Papillary carcinoma (most common but least aggressive and spreads locally)

64
Q

When evaluating a thyroid nodule, if TSH is N or elevated, what should be ordered next?

A

Check for TPO antibodies

65
Q

If low TSH and low FT4 what is the most likely cause of hypothyroidism?

A

Central (secondary or tertiary)

66
Q

What is the treatment for myxedema coma?

A

IV T4 and T3 (and supportive measures)

67
Q

Weight loss, increased appetite, heat intolerance, tachycardia, papitations, anxiety, and nervousness are concerning for what?

A

Hyperthyroidism

68
Q

In primary hyperthyroidism, the serum TSH is decreased in response to whatt?

A

Excess T4/T3 (negative feedback loop)

69
Q

What test is used to determine the etiology of hyperthyroidism?

A

Radioactive iodine uptake scan

70
Q

When is a radioactive iodine uptake scan contraindicated?

A

Pregnancy and breastfeeding

71
Q

What is the cause of Graves’ disease?

A

Autoimmune-mediated stimulation of thyrotropin receptor

72
Q

What is the 2nd most common cause of hyperthyroidism?

A

Toxic adenoma / toxic multinodular goiter (MNG)

73
Q

Focal hyerplasia of thyroid follicular cells is aka what?

A

Toxic adenoma

74
Q

What is toxic MNG?

A

Thyroid nodules

75
Q

Pt presents with obstructive sxs such as cough, dysphagia, dyspnea. What should you be concerned for?

A

Toxic adenoma / toxic multinodular goiter (MNG)

76
Q

Will TRAb be postive or negative with Toxic adenoma or toxic MNG?

A

Negative

77
Q

What is an extreme form of severe thyrotoxicosis that is an immediate threat to life?

A

Thyroid storm

78
Q

What are the triggers of a thyroid storm? (3)

A

Stressful illness, thyroid surgery, RAI administration

79
Q

What is the tx for thyroid storm? (3)

A

ICU, PTU/methinmazole (thionamides), B-blocker, iodine, glucocorticoids

80
Q

What medication do you give for sx control in hyperthyroid pts?

A

B-blockers (typically combine w/ thionamides (methimazole, PTU))

81
Q

What will labs for TSH, T4 and T3 show for thyroid storm?

A

Low TSH, high T4 and T3

82
Q

Marked agitation, delirium, fever, tachycardia, vomiting/ diarrhea, dehydration, and psychosis is concerning for what?

A

Thyroid storm

83
Q

What is the 1st line tx for hyperthyroidism?

A

Thionamides: Methimazole (DOC), PTU if pregnant

84
Q

What is definitive tx for hyperthyroidism? (2)

A

Radioiodine ablation (1st line) or surgery

85
Q

When is radioiodine contraindicated? (3)

A

Pregnant, breast feeding, contact w/ children/pregnant women

86
Q

What are the indications for thyroidectomy over radioiodine ablation? (5)

A

obstructive symptoms, toxic adenoma, MNG, active ophthalmopathy, mod-severe disease

87
Q

What is defined as inflammation of the thyroid gland that may be painful or painless and characterized by dysfunction?

A

Thyroiditis

88
Q

Hx of viral illness, glandular enlargement with radiating pain, and associated fever, fatigue, malaise, anorexia and myalgia is concerning for what?

A

Subacute thyroiditis

89
Q

What is the course of thyroiditis?

A

hyperthyroid (weight loss) → euthyroid → hypothyroid (weight gain) → recovery/euthyroid

90
Q

Is subacute thyroiditis more of a clinical or laboratory diagnosis?

A

Clinical

91
Q

What is used in the management of subacute thyroiditis?

A

Aspirin/ NSAIDS +/- prednisone

92
Q

What levels should be monitored in subacute thyroiditis?

A

TSH

93
Q

What are the RFs for malignant thyroid nodules? (3)

A

Hx of head/ neck radiation or family hx of thyroid cancer, multiple endocrine neoplasia (MEN) type 2

94
Q

Thyroid US will help guide what procedure?

A

FNA biospy

95
Q

What characteristics of a thyroid nodule are benign? (4)

A

Purely cystic, colloid, <1.0 cm, no suspicious features

96
Q

What characteristics of a thyroid nodule are concerning for malignancy? (8)

A

Hypoechoic, > 1.0 cm, taller > wide, solid, irregular margins, microcalcifications, extrahyroidal extension, associated cervical lymph nodes

97
Q

What are the types of thyroid cancer? (4)

A

Papillary, follicular, medullary, anaplastic

98
Q

What is the most aggressive type of thyroid cancer?

A

Anaplastic

99
Q

What type of thyroid cancer is more aggressive than papillary, and has the ability to metastasize to bone, brain, lung, and liver?

A

Follicular

100
Q

What is the first imaging performed when evaluating for thyroid CA?

A

Thyroid US

101
Q

What type of thyroid cancer is sporadic, familial and assocaited with MEN?

A

Medullary

102
Q

A palpable, firm, nontender nodule that can cause neck discomfort, dysphagia, or hoarsenss is concerning for what?

A

Thyroid CA

103
Q

What is 1st line treatment for thyroid cancer?

A

Thyroid lobectomy or total thyroidectomy (pending features)

104
Q

What might follow surgery for the treatment of thyroid cancer to destroy remaining tissue?

A

Iodine ablation

105
Q

Following surgical intervention of thyroid cancer, what is used to prevent hypothyroidism and to minimize potential TSH stimulation of tumor growth?

A

HRT (T4 hormone therapy)

106
Q

What does PTH regulate and what impact will elevated levels of PTH have?

A

Regulates Ca. Excess PTH can lead to hypercalemia (low levels of PTH will lead to hypocalcemia)

107
Q

What is the most common etiology of hypoparathyroidism?

A

Acquired (post-thyroidectomy, head and neck radiation)

108
Q

What are functional etiologies of hypoparathyroidism?

A

Hypo or hypermagnesemia

109
Q

Hypoparathyroidism presents w/ sx of hypocalcemia. What would you expect to see on exam?

A

Prolonged QT on EKG, chovestek sign, trousseau phenomenon (carpel spasm after brachial artery occlusion), tetany or seizures

110
Q

What lab values will be expected to be low with hypoparathyroidism? (2)

A

PTH and calcium

111
Q

What lab values will be expected to be N or low with hypoparathyroidism? (2)

A

Vit D and magnesium

112
Q

What lab values will be expected to be high with hypoparathyroidism? (1)

A

Phosphate

113
Q

If tetany or prolonged QT interval (sever hypoparathyroid), what is the medication tx?

A

IV calcium gluconate

114
Q

If hyperphosphatemia what is the medication tx?

A

Phosphate binders to protect kidney and help w/ excretion

115
Q

What is defined as deficient or absent secretion of PTH?

A

Hypoparathyroidism

116
Q

If mild hypoparathyroidism what is the tx?

A

Calcitriol and oral Ca carbonate and vit. D

117
Q

What is the most common cause of primary hyperparathyroidism?

A

Parathyroid adenoma (parathyroid CA = rare)

118
Q

What is defined as dysfunction of normal regulatory feedback mechanisms resulting in excess PTH?

A

Hyperparathyroidism

119
Q

Excess secretion of PTH in response to hypocalcemia/ hyperphosphatemia is defined as what?

A

Secondary hyperparathyroidism

120
Q

CKD results in a decreased GFR, what impact does this have on phosphate, Ca and PTH?

A

Increase phosphate, Decreased Ca and increased PTH

121
Q

What does “bones, stones, abd moans, psychiatric groans” represent?

A

Fragile bones/ arthralgia/ bone pain, kidney stones, abd pain/ N/ V, psychosis, depression, delirium

122
Q

“Bones, stones, abd moans, psychiatric groans” related to what condition?

A

Hyperparathyroidism

123
Q

What additional test do you need to order to evalute bone mineral density in pts with hyperparathyroidism? What disease are you evaluating for?

A

DEXA scan (duel energy XR absorptiometry). Osteopenia & osteoprosis

124
Q

What labs will you expect to see with secondary hyperparathyroidism?

A

High PRH, low calcium, high phosphate

125
Q

What labs will you expect to see with primary hyperparathyroidsm?

A

High PTH and Ca. Low Phosphate

126
Q

Ca restriction, avoidance of HCTZ, and bisphophonates is the tx for what disease?

A

Hyperparathyroidism

127
Q

What is the definitive treatment for hyperparathyroidism?

A

Parathyroidectomy

Clin Med II (12 decks)

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