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FNPII Test 3 > Thyroid > Flashcards

Thyroid Flashcards

1
Q

produces TRH which stimulates the pituitary gland to produce TSH. TSH stimulates the thyroid gland to secrete T4, which is converted to T3 in peripheral tissues.

A

hypothalamus

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2
Q

Unbound ___ and ___ is active

___ inhibits TRH and TSH secretion

A

Unbound T3 and T4 is active

T4 inhibits TRH and TSH secretion

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3
Q

TSH <0.3

A

<0.3 → hyperthyroidism

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4
Q

TSH >4

A

> 4 → hypothyroidism

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5
Q

TSH 0.3-4

A

0.3-4 → euthyroidism

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6
Q

_____correlates most to thyroid state

_____ only ordered when evaluating hyperthyroidism

A

Free T4

T3

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7
Q

found in Hashimoto’s and Graves disease

A

Anti-TPO (thyroid peroxidase) antibodies

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8
Q

can distinguish between hot and cold nodules

A

Iodine isotope scans: preferred

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9
Q

Hot nodules: ______

Cold nodules: _______

A

Hot nodules: usually benign

Cold nodules: usually benign, however malignant neoplasms are cold nodules

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10
Q

how to assess goiters

A

CT and MRI

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11
Q

how to differentiate solid from cystic thyroid nodules.

A

US… Can guide fine-needle aspiration.

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12
Q

less physical findings; low TBG level is diagnostic. T4 normal.

A

TBG deficiency

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13
Q

causes mental retardation if not tx; irreversible brain damage, growth failure, deafness, and neurologic abnormalities
Newborn screening and early aggressive tx is necessary to prevent complications. TBG deficiency

A

Congenital Pediatric Hypothyroidism

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14
Q

less physical findings; low TBG level is diagnostic. T4 normal.

A

TBG deficiency…Congenital Pediatric Hypothyroidism

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15
Q

autoimmune condition leading to destruction of the thyroid gland.

A

Hashimoto thyroiditis:

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16
Q

main cause worldwide (not in US d/t iodine-fortified foods)

A

Iodine Deficiency

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17
Q

growth failure, goiter, delayed puberty, delayed dentition, weight gain, fatigue, hyperlipidemia
PE:
Birth: often newborn appears normal; jaundice, constipation, or umbilical hernia. Poor feeders, cool cyanotic extremities
Older children: delayed growth and puberty, goiter, weight gain

A

Pediatric Hypothyroidism

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18
Q

TSH ↑

T4 free = WNL or ↓

A

Primary Hypothyroidism

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19
Q

TSH = WNL

T4 free = ↓

A

Central Hypothyroidism

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20
Q

TSH = WNL
T4 free = WNL
Total T4=

A

TBG Deficiency

order TBG level

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21
Q

How to tx Pediatric Hypothyroidism

A

levothyroxine→ no liquid suspension in US; parents may need to crush and mix. Long half-life- if dose is missed skip and take next day.
Redraw labs 2-4 weeks after initiating therapy. Once TSH is normalized, frequent monitoring 2-4mos to ensure optimal development
TSH elevated in primary hypothyroidism = increase dose
Low T4 free in central = increase dose

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22
Q

thyroid stimulating Ig binds to TSH receptor, causing excessive stimulation
Neonatal is often passed on from mother and resolves in 3mos,however tx is necessary to prevent morbidity and mortality

A

Pediatric Hyperthyroidism:

Graves Disease

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23
Q

CM: palpitations, tremor, emotional lability. Increased appetite and weight loss. fatigue , muscle weakness, hyperdefecation. Poor sleep and concentration
PE: goiter (almost 100%), audible thyroid bruit, tachycardia, wide pulse pressure, underweight, hyperreflexia, warm moist skin; exophthalmos or eyelid lag. Nodule.

A

Pediatric Hyperthyroidism:

Graves Disease

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24
Q

TSH= ↓
T4 free= ↑
Total T4= ↑
T3= ↑↑

A

Pediatric Hyperthyroidism:

Graves Disease

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25
Q

how to tx Pediatric Hyperthyroidism:

Graves Disease

A

refer to pediatric endocrinologist
Methimazole → Graves disease
Propylthiouracil (PTU) → reserved for those allergic to methimazole → high risk of AE (agranulocytosis, vasculitis, hepatitis, and liver failure)

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26
Q

Causes hypothyroidism: blocks the uptake of iodine and the release of thyroid hormone and induce chronic autoimmune thyroiditis.

A

Lithium

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27
Q

can cause hyper or hypothyroidism. effects can be seen for 2-3 years after d/c
Usually causes hypothyroidism in the US. No need to stop, replace levels with levothyroxine
Larger than normal dose of levothyroxine may be needed to reach tx goals
Goals: TSH normal-high; free t4 mid-low normal
Hyperthyroidism occurs in iodine-deficient areas of the world; CM often masked d/t beta blocking activity of _____

A

Amiodarone

28
Q

CM: redevelopment of atrial arrhythmias, exacerbation of ischemic heart disease or CHF, restlessness, and low-grade fever.
Tx: oral steroids and antithyroid drug tx. Maybe thyroidectomy.

A

Amiodarone caused hyperthyroid

29
Q

Perform _____ before initiating amiodarone therapy if possible

A

TFT

30
Q

treatment of hep B and C or malignant disease. Use can induce production of thyroid antibodies resulting in hypothyroidism or thyrotoxicosis. Discontinuation will cause the antibodies to disappear.

A

Interferon alfa

31
Q

(sunitinib, sorafenib, imatinib) treat renal cell carcinoma and GI stromal tumors. Increased metabolism of thyroid hormone. Hyperthyroidism may also occur.

A

Tyrosine kinase inhibitors

32
Q

can interfere with diagnostic assays (falsely low TSH and falsely elevated T3 and T4). Hold dose for 3 days prior to checking TFTs.

A

Biotin

33
Q

may be caused by iodine deficiency (many iodine fortified foods in US), previous radiation.

A

Hypothyroidism

34
Q

hypothyroidism with goiter

↑TSH and presence of antithyroid Ab

A

Hashimoto (autoimmune) thyroiditis

35
Q

fatigue, cold sensitivity, weight gain, hoarseness, puffiness of face and hands, heavy and irregular menses, dry skin, dry brittle hair, depression, paresthesias, muscle aches, constipation.
PE: lethargic, expressionless, depression, agitation. Texture and color of skin and hair. Deepened voice, slowed HR. Delay in achilles tendon DTR. elevated DBP.

A

Hypothyroidism

36
Q

Thyroid gland: large or small.

Tenderness suggests ____

A

subacute thyroiditis.

37
Q

Thyroid gland: large or small.

Nontender suggests _____

A

chronic

38
Q

Thyroid gland: large or small.

Rubbery-firm and symmetric = ____

A

Hashimotos

39
Q

↑ TSH. ↓ T4 free. ↓ T4 free index
Anti-TPO Ab elevated in chronic autoimmune
US only to view nodules; FNA if suspicious nodule
EKG: low voltage; cardiac enlargement. Bradycardia

A

Hypothyroidism

40
Q

tx of hypothyroidism

A

levothyroxine to return TSH to normal level; euthyroid levels can be achieved in 4-6wks, then monitor twice yearly
If pt start estrogen therapy recheck TSH in 12 wks (may increase T4 requirements)

41
Q

type of thyroid disease that causes goiter?

A

Hypo and Hyperthyroidism

42
Q

(most common cause): autoimmune. F>M age 20-40yo. Autoantibodies bind to TSH receptor sites and stimulate thyroid hormone secretion

A

Graves disease- Hyperthyroidism

43
Q

1st lab to assess with thyroid

what to order if it is abnormal?

A 
TSH 
Normal range (euthyroid) 0.3-0.4 
If TSH is abnormal request T4 
if elevated= hyperthyroid 
if suppressed= hypothyroid
44
Q

CM: eye changes (NOSPECS) No signs or symptoms, only signs (no symptoms), soft tissue swelling, proptosis, extraocular muscle paresis, corneal involvement, sight loss)

A

Graves disease- Hyperthyroidism

45
Q

can help distinguish Graves vs. thyroiditis

A

Radioiodine uptake

46
Q

identify toxic multinodular goiter or solitary nodular goiter

A

Iodine scan

47
Q

common to see elevated liver enzymes.

A

Graves

48
Q

IN this condition TSH (initial) → will remain suppressed for 3 mos after initiating tx, therefore must follow T4 Free or free T4 index

A

Hyperthyroidism

49
Q

Tx of Graves:

A

Beta blockers (tremor, tachycardia) → propranolol or atenolol (caution CHF and bronchospasm; CI pregnancy)
Methimazole (MMI) and propylthiouracil (PTU): thioamides
PTU→ not first line d/t severe AE (liver failure)
Pregnancy→ PTU in first trimester, then MMI

Small goiters and mild hyperthyroidism: MMI 5-10mg daily

50
Q

definitive; recommended if relapse after MMI or PTU tx or for pts OLDER than 20

A

Radioiodine ablation

51
Q

Complications of untreated Graves

A

A fib, CHF, angina, osteoporosis

52
Q

progressive and severe hypothyroidism with skin thickening and CV and renal manifestations…
Slowed mentation, respiratory depression, may progress to death
Triggered by stress, cold, trauma, infection, or medications

A

Myxedema

53
Q

How to tx Myxedema

A

Tx: IV levothyroxine and glucocorticoid therapy; warming, ventilatory support

54
Q

asymptomatic TSH elevation with normal free T4

A

Subclinical hypothyroidism

55
Q

Tx if: TSH>10; consider if TSH 4.5-10 especially in patients with infertility, irregular menses, depression, and fatigue
Risk of tx is development of subclinical hyperthyroidism;
untreated pts are at risk for cardiac dysfunction, elevated LDL and cholesterol, neuropsychiatric dysfunction, progression to overt hypothyroidism
Stabilize TSH then check yearly

A

Subclinical hypothyroidism

56
Q

suppressed TSH with normal T4 and T3.
Initiate tx if TSH< 0.1 as result of Graves or nodular disease, esp if older than 60, increase risk heart disease, osteopenia, or osteoporosis.

A

Subclinical hyperthyroidism

57
Q

Thyroid enlargement is ______ in pregnancy
Dietary iron requirements are higher in pregnancy: supplement with 150mcg potassium iodine.
Free T4 levels may be inaccurate during pregnancy

A

normal

58
Q

is CI during pregnancy, therefore we cannot determine the cause of hyperthyroidism
Graves disease is most common cause: goiter, exophthalmos, and pretibial myxedema
TSH ↓, free T4 ↑, T3 ↑
Consider TRAb
Consider US

A

Radioiodine

59
Q

how to tx hyperthyroid in pregnancy

A

PTU during 1st
1st trimester (MMI is teratogenic)
2nd trimester: d/c PTU (d/c risk of hepatotoxicity) and start MMI
Monitor free T4 and TSH monthly→ goal: t4 high: normal and TSH low-normal
Beta blockers if severe→ atenolol or propranolol preferred. Wean once controlled by thioamide
Monitor fetal HR and growth

60
Q

HYPOTHYROIDISM IN PREGNANCY

A

Goal TSH: 0.5-2.5
Once pregnancy confirmed, increase dose of levothyroxine by 30%
Monitor TSH and T4 free every month for first half of pregnancy, then each trimester.. Adjust dose in 12 - 25mcg increments
Once postpartum, return to prepregnancy dose. Recheck levels 6 wks pp

61
Q

How to dx. Thyroid nodules

A

TSH (initial).
If TSH suppressed and nodule >1cm order free T4, T3 and radionucleotide scan. FNA biopsy on warm and cold nodules.
If TSH elevated: check T4 free. Start levothyroxine as indicated
TSH normal: US then FNA if needed

62
Q

Thyroid masses and thyroid CA

A

T- tumor size
N- lymph nodes
M- metastases

63
Q

how to tx Thyroid masses and thyroid CA

A

Tx: ablation with radioactive iodine when mets, large tumors, or high risk. Thyroid replacement or suppression therapy will be necessary.

64
Q

pt education after r radioiodine treatment or scanning

A

No sharing saliva for 5 days. No close contact with infants, kids <8, or pregnant women for 5 days. No breastfeeding. Flush toilets twice. Acetaminophen or ASA for sore throat.

65
Q

rare, life threatening –HYPERthyroid
Temp 102-105, profuse sweating, pulse 120-140bpm, a fib, restlessness, confusion, agitation, coma.
GI: Severe v/d, and hepatomegaly with jaundice

A

Thyroid Storm

FNPII Test 3 (7 decks)

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