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MI Clinical Diagnosis > Thyroid > Flashcards

Thyroid Flashcards

1
Q

what is the main raw material of thyroid hormone

how do we get this raw material

what happens next

A

inorganic iodide

provided by the diet

extracted from the blood and converted to organic iodine

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2
Q

iodide ingested and taken into the blood is converted to

  • -> ___ + ___
  • -> ____ + ____
  • -> ____
A

iodine which binds to tyrosine

which forms monoiodtyrosine which binds with iodine

which forms diiodotyrosine

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3
Q

what forms T4

A

diiodotyrosine + diiodotyrosine = tetra/thyroxin

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4
Q

what is another name for T4

A

thyroxin

tetraiodothyronine

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5
Q

what forms T3

A

monoiodotyrosine + diiodotyrosine

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6
Q

what is another name for T3

A

triiodothyronine

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7
Q

what is thyroid hormone stored in? as what ?

A

acini

thyroglobulin

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8
Q

most of thyroid hormone in circulation is what type

A

T4 90%

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9
Q

99% of T4 and T3 are bound to what in the blood

A

protein

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10
Q

most of T4 is bound to what

most of T3 is bound to what

A

TBG (thyroid binding globulin)

TBG and albumin

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11
Q

thyroid binding globulin is what type of protein

A

alpha 1 globulin

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12
Q

1% of T4 and T3 is found where

A

FREE or unbounded

metabolically active in cells

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13
Q

free T4 is converted to

where

A

T3

in the liver cells for utilization

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14
Q

what percent of daily T3 is converted and utilized by the liver

A

80%

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15
Q

80% of __ is converted and utilized by the liver

A

T3

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16
Q

decreased levels of T3 and T4 cause what to happen

A

TRH production in hypothalamus

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17
Q

increased levels of T3 and T4 cause what to happen

A

inhibit TSH and TRH

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18
Q

TSH high, T3 and T4 are low indicate what

A

primary hypothyroidism

hashimotos

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19
Q

TSH is normal or low
T3 and T4 are low
indicates what

A

secondary hypothyroidism

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20
Q

why is TSH normal or low in secondary hypothyroidism

A

pituitary doest respond to TRH or low T3/T4 doesnt trigger TRH response

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21
Q

TSH is low and

T3 and T4 are high indicates what

A

hyperthyroidism

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22
Q

is T3 or T4 more elevated in hyperthyroidism

A

T3

23
Q

what causes hyperthyroidism

A

due to autonomous hyperfunction or thyroid stimulators in the blood

24
Q

what is graves disease

A

hyperthyroidism

25
Q

what is another name for graves disease

A

diffuse toxic goiter

26
Q

what are the requirements to have graves disease

A

hyperthyroidism and one of the following:
goiter
exophthalmous
pretibial myxedema

27
Q

what causes graves disease

A

due to circulating antobodies against TSH receptors which causes continuous secretion of T3/T4

28
Q

what is the most common cause of hyperthyroidism

A

graves disease

29
Q

what results from the ingestion of thyroid hormone

A

thyrotoxicosis factitia

30
Q

calcitonin is made by what cells of the thyroid gland

A

C cells of thyroid

31
Q

what does calcitonin do

A

reduce Ca in the blood

decrease absorption in GI
decrease osteoclasts
decrease Ca and phosphate reabsorption in the kidney

32
Q

parathyroid hormone is secreted by what

A

parathyroid glands found inside the thyroid gland

33
Q

what does PTH do

A

increase Ca in the blood

increase absorption in GI
increase osteoclasts
increase Ca and phosphate reabsorption in the kidney

34
Q

what is the 5th most abundant element in the body

A

Calcium

35
Q

calcium is the __ most abundant element in the body

A

5th

36
Q

adults have calcium content of what

A

1kg

2% of body weight

37
Q

all but __% of calcium is found in the bone

where is this % found

A

1%

intra and extracellular space

38
Q

in blood, all calcium is found in the

A

plasma

39
Q

what percent of calcium is free

what is this also called

A

50%

ionized calcium

40
Q

what percent of calcium is bound to protein

A

40%

80% - albumin
20% - globulins

41
Q

what percent of calcium exists as anions

examples

A

10%

bicarbonate
lactate
citrate

42
Q

what is normal serum calcium levels

A

8.5 to 10.5 mg

43
Q

what form of calcium is the only form that is regulated by calciotropic hormones

A

free or ionized calcium

44
Q

decisions of total serum calcium concentration should not be made without considering what

A

albumin

plasma proteins

45
Q

total serum calcium is easier or harder to measure than ionized/free calcium

A

easier

..but make sure to consider the protein concentrations to determine the difference bound to protein and free/ionized

46
Q

in patients with multiple myeloma, the ___ concentration is often increased, which leads to excessive binding of Ca to ____ which may elevate total serum calcium concentration, yet the ___ level may be normal

A

globulin

monoclonal paraprotein

ionized calcium

47
Q

when is ionized free calcium considered useful to diagnose a patient

A

multiple myeloma

48
Q

serum calcium levels above what usually cause symptoms

critical levels =

medical emergency =

A

11.5 mg

12mg

15mg (severe hypercalcemia)

49
Q

hypercalcemia results from what

A

increased mobilization of calcium from bones or increased intestinal absorption

primary hyperparathyroidism or bone metastasis from breast, prostate, thyroid, lung

50
Q

what are the symptoms of hypercalcemia

A

ACUTE confusion
fatigue
lethargy

> 13 mg

51
Q

what are the symptoms of chronic hyperparathyroidism

A 
stones - kidney 
moans - abdominal pain
groans - myalgia  
bones - bone pain 
psychiatric overtones
52
Q

PTH and PTHrP levels are normal indicates what

A

rule out PT adenoma

suggest malignancy, hypervitaminosis A or D, milk alkali syndrome, granulomatous disease, meds, lithium, thiazides

53
Q

hypocalcemia results from what

A

absent or impaired parathyroid glands
OR
impaired vitamin D synthesis

54
Q

what causes primary hypothyroidism

A

failure of thyroid gland - hashimotos thyroiditis - MC

iodine deficiency

enzymatic defects

MI Clinical Diagnosis (12 decks)

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