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Endo > Thyroid > Flashcards

Thyroid Flashcards

1
Q

What is the thyroid pathway?

A
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2
Q

_____ cells secrete thyroid hormone
_____ cells secrete Calcitonin

A

Follicular Cells -> Thyroid Hormone
Parafollicular Cells (C-Cells) -> Calcitonin

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3
Q

How does calcitonin control Ca+ and K+ levels?

A

INHIBITING OSTEOCLAST ACTIVITY -> stops bone breakdown and decreases the amount of Ca+ in the blood (pee out less Ca+)

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4
Q

Does Calcitonin want Ca+ in the blood or bones? Is it secreted by the thyroid when serum Ca+ is high or low?

A

bones
Secreted when high serum Ca+

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5
Q

Deposition or Resorption?

Osteoblasts -> bone _____
Osteoclasts -> bone _____

A

Osteoblasts -> Bone Deposition
Osteoclasts -> Bone Resorption

Deposition: “Deposit into the bone”
Resorption: “Reabsorb into bloodstream”

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6
Q

Does T3 or T4 control metabolic rate?

Which is biologically active?

A

T3

Think of T4 as a child on a leash. T3 is a free wild rug rat acting up and causing chaos bc its not on its leash

T4: Thyroxine (Tetraiodothyronine)
T3: Triiodothyronine

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7
Q

Which lasts longer, T3 or T4?

A

T3 (24hrs)
T4 (7-10 days) Reservoir

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8
Q

Most common causes of hypothyroidism?

T4/T3 deficiency

A

Worldwide -> Iron deficiency
US -> Autoimmune thyroid disease (Hashimoto Disease)
Congenital hypothyroidism
Cretinism -> severe neonatal iron deficiency due to maternal iron deficiency

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9
Q

Who needs thyroid screening? how often?

A

35yo (q 5 years)
Pregnant - once in 1st Tri
Women > 60yo
Type I DM or other autoimmune Dz
Hx neck irradiation

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10
Q

Cretinism

A

severe neonatal iron deficiency due to maternal iron deficiency

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11
Q

Hypoparathyroidism: Primary vs Secondary vs Tertiary

A
  • Primary -> thyroid gland itself cannot produce enough T3/T4
  • Secondary -> Abnorm pituitary secretes LOW TSH
  • Tertiary -> Hypothalamus does not secrete enough TRH
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12
Q

Primary vs Secondary hypothyroid Trmnt

A

Both: Levothyroxine (synthetic T4)

Primary: monitor TSH
Secondary: Monitor T4

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13
Q

Liothyronine:
Synthetic T3 or T4?
Used for sole maintenance? Preferred when?

A

T3
NOT used for sole maintenance (can be used in combo with T4 (Levothyroxine) in small doses)
Preferred when GI absorption is impaired

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14
Q

Is Hashimotos hypo- or hyper- thyroid?

A

Autoimmune Hypothyroidism

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15
Q

MCC of Hypothyroidism in the US (for those >6yo)

A

Hashimotos

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16
Q

TSH and T4 labs for Hoshimotos Hypothyroidism

A

Low TSH & Low T4

Hashimotos is autoimmune hypothyroidism (thyroid autoantibodies)

17
Q

3 MC forms of Hyperthyroidism

A
  1. Graves Disease (Diffuse Toxic Goiter)
  2. Plummer Disease (Toxic Nodular Goiter)
  3. Toxic Adenoma
18
Q

What causes Grave’s Disease?

A

Thyroid-stimulating immunoglobulins (TSIs) bind and activate thyroid-stimulating hormone (TSH) -> thyroid gland grows & follicles secrete EXCESS thyroid hormone

19
Q

Which hyperthyroid disease is this?

SS: diffusely big and smooth thyroid gland, wt loss, warm skin, fine hair, bulging eyes, tachypnea, tachycardia, hyperactive bowel sounds, hyperactive DTRs, restlessness, anxiety, irritability, insomnia
WU: Low TSH, diffuse radioactive iodine uptake

A

Grave’s Disease

20
Q

Grave’s Disease Trmnt

A

Radioactive iodine
OR
Antithyroid Meds - Methimazole or PTU (Propylthiouracil)

Use Radioactive iodine over Antithyroid meds if:
- large thyroid gland
- Multi SS of Thyrotoxicosis
- High levels of thyroxine
- High titers of TSI

21
Q

Which Antithyroid med is safe for pregnancy?
Methimazole or PTU (Propylthiouracil)

A

PTU (Propylthiouracil)

Doesn’t cross placenta
Pregnancy Goal: Thyroid Fn norm or HIGH (never low)

22
Q

Which hyperthyroid disease is 2nd MC in US & #1 MCC if elderly or endemic country?

A

Toxic Nodular Goiter (Plummer Disease)

single or multi areas of hyperfunction in the thyroid

23
Q

Hyperthyroid SS in eldery

A
  • Anorexia
  • Wt loss
  • Constipation
  • Palpitations -> Afib
  • CHF SS
  • +/- Angina
  • +/- hoarse voice
24
Q

How can goiter result in hoarseness or voice change? Which nerve is affected?

A

Compression of Laryngeal nerve

25
Q

Are brisk DTRs related to Grave’s Dz or Plummers Dz (Toxic Nodular Goiter)?

A

Brisk DTRs = Plummers Dz
Slow DTRs = Grave’s Dz

26
Q

Thyroid disease Nuclear Radioactive Iodine Scans

Uniform uptake + areas of high and low uptake -> NORM
Diffuse increase -> ______
Diffuse decrease -> ______
Increased uptake + focal areas of decreased uptake -> _____

A

Diffuse increase -> Graves
Diffuse decrease -> Hashimoto
Incr uptake + focal areas of decr uptake -> Multinodular goiter

27
Q

Thyroid nuclear scans:
hot nodules = incr uptake -> _______
Cold nodules = not making thyroid hormone ->

malignant or not malignant?

A

Hot = NOT malignant
Cold = Malignant -> FNA

FNA = Fine Needle Aspiration

28
Q

thyroid nodules > ___cm diameter are of concern

A

1

incr risk of malignancy if:
Cold nodules on nuc scan
Hx of head/neck irradiation

29
Q

Imaging order for discrete nodules that you can’t feel on thyroid palpation

A

US

CT scan if obstructive SS

30
Q

Indications for Sx trmnt for toxic nodular goiter (plummers)

A

young ppl
1+ large nodules
obstructive SS

31
Q

Elderly pt with toxic nodular goiter (plummer) should be Rx _____ prior to starting radioiodine trmnt

A

Antithyroid meds for 2-8wks
(PTU or Methimazole)

32
Q

Are most thyroid nodules benign?

A

yes

33
Q

What does a painful vs painless thyroid nodule suggest?

A
34
Q

Thyroid nodule WU

A

Refer for FNA for any sussy lesion

35
Q

Is Thyroxine (T4) a poss trmnt for Hoshimotos (& other hypothyroid dz) or cancerous nodules?

A

Hypothyroid (like Hoshimotos)

NOT GOOD FOR CANCER

36
Q

4 types of thyroid cancer

A
37
Q

Most thyroid cancers are ____ or ____

A

papillary or follicular

Endo (10 decks)

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