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Clinical Pathology II > Thyroid > Flashcards

Thyroid Flashcards

1
Q

The Hypothalamus secretes:

A

TRH

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2
Q

The Anterior Pituitary Secretes

A

TSH

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3
Q

Thyoid Gland Secretes

A

T3/T4

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4
Q

T3 is more

A

Metabolically active; In liver and gut microbiome

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5
Q

T4 is more

A

Abundant (85%)

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6
Q

Primary issues of the thyroid indicate issues at:

A

Thyroid gland

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7
Q

Secondary issues of the thyroid occur at:

A

Anterior pituitary

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8
Q

Tertiary issues of the thyroid occur at:

A

Hypothalamus

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9
Q

Primary carrier of T3/T4

A

Thyroid Binding Globulin
-85% of T4
-70% of T3

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10
Q

Hyperthyroidism: Signs/Symptoms

A

-Exopthalamos
-Lid lag
-Increased HR
-Warm skin
-Weight loss
-Missed/infrequent periods
-Fatigue: Lack of sleep

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11
Q

Hypothyroidism: Signs/Symptoms

A

-Loss of hair in outer 1/3 of eyebrows
-Cold, dry skin
-Cold intolerance
-Weight gain
-Heavy menses: First sign
-Fatigue

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12
Q

Thyroxine, Total T4

A

-Total amount of T4: T4 bound to TBG & free T4
-Interference: Altered levels of TBG

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13
Q

Thyroxine (Total T4): Newborn*

A

<7ug/dL: Congenital Hypothyroidism

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14
Q

Thyroxine (Total T4): Adult

A

<2ug/dL: Myxedema coma possible
>20ug/dL: Thyroid storm possible

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15
Q

Thyroxine: increased Levels

A

-Hyperthyroid States:
-Acute Thyroidism
-Pregnancy

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16
Q

Thyroxine Decreased Levels

A

Hypothyroid States

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17
Q

Free Thyroxine Assay (free T4)

A

One of the best tests of thyroid function

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18
Q

T3U Test

A

-Capacity of TBG to bind labeled T3 at unsaturated T4 sites on TBG

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19
Q

T3U: Hyperthyroidism

A

-Less open seats
-More T3 at resin column
-Increase in T3 uptake

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20
Q

Increased TBG Causes

A

-Pregnancy
-Oral Contraceptives (or estrogen therapy)
-Certain liver conditions

-Less T3U at resin column

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21
Q

T3U: Decreased TBG Causes

A

Testosterone Treatment

More T3U at resin column

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22
Q

Free Thyroxine Index

A

Corrects TBG alterations
FTI= T4 X T3U

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23
Q

Triiodothyronine Tests (T3 by RIA) are used to detect

A

T3 thyrotoxicosis

-Not accurate for hypothyroidism

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24
Q

Reflexes

A

-Hypothyroidism: Decreased reflexes
-Hyperthyroidism: Increased reflexes

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25
Q

Cholesterol

A

-Myxedema: Elevated TC (decreased thyroid hormone)
-Hyperthyroidism: low TC (increased thyroid hormone)

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26
Q

TSH is important in differentiating:

A

Primary and secondary hypothyroidism

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27
Q

Primary vs. Secondary hypothyroidism

A

-Primary: Increased TSH
-Secondary: Decreased TSH & T3/T4

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28
Q

TSH: Increased TSH

A

Primary Hypothyroidism

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29
Q

Decreased TSH

A

Secondary Hypothyroidism

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30
Q

TRH Assay

A

Important in differentiating secondary or tertiary hypothyroidism

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31
Q

Secondary vs. Tertiary Hypothyroidism

A

-Secondary: Injected TRH/Low TSH (Anterior Pituitary Issue)
-Tertiary: Inject TRH/High TSH (Hypothalamus Issue)

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32
Q

Thyroid Antibodies are most important in determining

A

Hashimoto’s Thyroditis

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33
Q

Thyroid Antibodies

A

-Anti-TPO* BEST
-Antithyrogloblin Test

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34
Q

Thyroid Screening begins at what age?

A

-Begins at 35 (Every 5 years)

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35
Q

Suspected Hypothyroidism: Needed tests for diagnosis

A

TSH, Free T4, anti-TPO at minimum

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36
Q

Hypothyroid Conditions

A

-Primary Hypothyroidism: Most Common
-Post-therapeutic Hypothyroidism: 2nd MC
-Goitrous Hypothyroidism: Pregnancy, Menopause..
-Secondary Hypothyroidism: Can’t Secrete TSH

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37
Q

Primary Hypothyroidism is typically due to:

A

An autoimmune disease usually as sequela of Hashimoto’s thyroiditis

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38
Q

Post-Therapeutic Hypothyroidism is due to:

A

• Radioactive iodine treatment or surgery for hyperthyroidism

39
Q

Causes of Goitrous Hypothyroidism

A
  • Pregnancy, Menopause, Iodine Deficiency Hashimotos
40
Q

Secondary Hypothyroidism is the failure of:

A

Anterior Pituitary (Can’t secrete TSH)

41
Q

Tertiary Hypothyroidism is due to a failure of:

A

Hypothalamus (Decrease in TRH)

42
Q

Congenital Hypothyroidism: Key Signs/Symptoms

A

• Drooling
• Broad face
• Umbilical hernia, out belly

43
Q

Hypothyroidism: Most Common Symptoms

A

MC Symptoms (can have 1+ but varies): Weakness/fatigue/lethargy, decreased memory, modest weight gain (10 lbs), coarsening/huskiness of voice, menstrual changes (typically first sign), sensitivity to cold

44
Q

Hypothyroidism: Key Neurological Complications

A

Neurological Complications: Headaches, bilateral carpal tunnel, symmetrical/primarily sensory peripheral neuropathy

45
Q

Hypothyroidism: Musculoskeletal Complaints

A

Musculoskeletal: Myalgia (morning stiffness; Affects hips/thighs & shoulders), Arthralgia (spine, hands, knees, hips), muscle spasms

46
Q

Hypothyroidism: Mental Symptoms

A

Mental: Mental apathy, Drowsiness, Personality changes

47
Q

Myxedema Coma

A

Myxedema Coma (more serious): Long-standing hypothyroidism, coma with severe hypothermia, areflexia/seizures/respiratory depression

48
Q

Myxadematous Facies

A

• Large tongue
• Slow, deep-toned speech
• Dry, thick skin
• Puffy hands and face
• Dull facial expression, eyelids droo

49
Q

Congenital Hypothyroidism: Labs

A

• Increased serum TSH
•T3/ T4 decreased
• ALP decreased
• Cholesterol increased

50
Q

Primary Hypothyroidism: Labs

A

-Primary Hypothyroidism: T4 decreased T3U decreased, TSH increased

51
Q

Primary Hypothyroidism: Thyroid Labs

A

-Thyroid: T4 decreased T3U decreased, TSH increased

52
Q

Secondary Hypothyroidism: Labs

A

-Secondary Hypothyroidism: T4 decreased, T3U decreased, TSH decreased*

53
Q

Hypothyroidism: Cholesterol/Anemia/Enzyme Labs

A

-Cholesterol: Increased
-Anemia: Any morphological type
-Other: ALP decreased, increased CPK (d/t muscle atrophy, increased AST

54
Q

Hyperthyroidism: Etiologies

A
  1. Toxic diffuse goiter: Autoimmune (Grave’s Disease)
  2. Toxic nodular goiter: Plummer’s Disease
  3. Thyroiditis Factitial: “Fake”
  4. Thyroiditis forms
  5. Secondary Hyperthyroidism: Space Occupying Lesion
  6. T3 Thyrotoxicosis
  7. Thyroid Storm: Emergency
55
Q

Hyperthyroidism: Main Signs/Symptoms

A

• Nervousness (85%)
• Increased sweating (70%)
• Hypersensitivity to heat (70%)
• Dyspnea (75%)
• Fatigue and weakness (60%)
• Increased appetite (40%)
• Weight loss (50%)

56
Q

Grave’s Disease: Eye Signs

A

• Lid lag
• Stare
• Exophthalmos
• Increased lacrimation
• Orbital pain
• Ocular muscle weakness

57
Q

Grave’s Disease: Thyroid Dermopathy

A

• Thyroid dermopathy – lesions of skin due to deposition of hyaluronic acid

58
Q

Primary Hyperthyroidism: Thyroid Labs

A

• T4: Increased
• T3U: Increased
• TSH: Decreased

59
Q

Primary Hyperthyroidism: Cholesterol

A

Decreased

60
Q

Hyperglycemia can occur in:

A

BOTH hyper and hypothyroidism

61
Q

Primary Hyperthyroidism: Antibodies

A

-Anti-Body Tests: + Thyroid-Stimulating Immunoglobulin (TSIs)**, + TSH receptor antibodies;

-Possible: + TPO, + thyroantibodies

62
Q

Hypothyroidism: Management

A

Management: Thyroid Hormone for Life
-Referral to endocrinologist

63
Q

Hyperthyroidism: Management

A

• Iodine in pharmacologic doses
• Antithyroid drugs
• Radioiodine therapy
• Surgery
-Referral to Endocrinologist

64
Q

Euthyroid Goiter

A

• Enlarged thyroid gland w/o clinical or lab evidence of thyroid dysfunction

-MC during: Pregnancy, Menopause, Puberty

65
Q

Euthyroid goiter: Signs & Symptoms

A

• Soft, symmetric, smooth goiter
• History of iodine intake or ingestion of goitrogen

66
Q

Euthyroid Goiter: Thyoid Labs

A

• T4 and T3U normal
• TSH increased
• Thyroid antibodies should be ordered to rule out Hashimoto’s thyroiditis

67
Q

Thyroiditis

A

• A variety of inflammatory thyroid disorders that can cause thyroid enlargement and atrophy
• May lead to hypothyroidism or hyperthyroidism

68
Q

Subacute Granulomatous Thyroiditis: Signs/Symptoms

A

• Pain in neck: Radiates to jaws, arms, or chest
• Aggravated by swallowing or turning head
• Low grade fever
• Lassitude, malaise, prostration
-Recent Viral Infection

69
Q

Subacute Granulomatous Thyroiditis: Signs/Symptoms

A

• Pain in neck: Radiates to jaws, arms, or chest
• Aggravated by swallowing or turning head
• Low grade fever
• Lassitude, malaise, prostration
-Recent Viral Infection

70
Q

Subacute Granulomatous Thyroiditis: Progression

A

• Hyperthyroidism, phase of mild hypothyroidism, resolution

71
Q

Subacute Granulomatous Thyroiditis: Expected Labs

A

• ESR, CRP elevated
• T4 increased
• WBC normal or decreased (viral)
• Anti-thyroglobulin antibodies may be present

72
Q

Hashimoto’s Thyroiditis: Signs/Symptoms

A

• Fullness in throat
• Gland is painless, firm

73
Q

___% of Hashimoto’s will end up with hypothyroid

A

90%

74
Q

Hashimoto’s Thyoiditis: Early Stages

A

-Early Stages: T4/TSH normal & high levels of TPO antibodies

75
Q

Hashimoto’s Thyroidism: Thyroid/Cholesterol Labs
(If Hypothyroid)

A

decreased T3 &T4 /increased TSH
-Cholesterol: Elevated

76
Q

Hashitmoto’s Thyroiditis: Antibodies

A

Anti-TPO antibodies*, anti-thyroglobulins

77
Q

Hashimoto’s Thyroiditis: IF hyperthyroidism

A

If hyper: Hashitoxicosis (Low TSH/High T3/T4)

78
Q

Most common form of thyroiditis

A

Hashimoto’s

79
Q

Hashimoto’s Thyroiditis often presents as:

A

Asymptomatic diffuse goiter

80
Q

Hashimoto’s is most prevalent in: Gender/Age

A

-Women
-30-50 years of age

81
Q

“Silent” Lymphocytic Thyroiditis

A

• Spontaneously resolving hypothyroidism and/or hyperthyroidism associated with pregnancy
• Occurs in about 5-10% of postpartum women

82
Q

Thyoid Neoplasm (Cancer): Signs/Symptoms

A

• Mass in neck (painless)
• Pain and tenderness are infrequent
• Hard, irregular, fixation of gland to adjacent structures
• Symptoms due to metastasis
-Hoarseness, voice change

83
Q

Thyroid Neoplasm: Lab Findings

A

• Thyroid function tests usually normal
• Hormone levels normal
• Fine Needle Aspiration (FNA)
• Thyroid scan, sonogram

84
Q

Thyroid Neoplasm: Treatment

A

• Surgery
• Hormone for life

85
Q

Subclinical Hyperthyroidism: Symptoms

A

• Asymptomatic or minimal symptoms of hyperthyroidism

86
Q

Subclinical Hyperthyroidism: Labs

A

Low TSH, normal free T4 and T3 levels
-Hyperglycemia

87
Q

SC Hyperthyroidism is _____ common than SC hypothyroidism

A

Less

88
Q

SC Hyperthyroidism: Most Common Cause

A

Administration of thyroid hormone

89
Q

SC Hyperthyroidism: Other Causes

A

Other causes – developing Grave’s disease, autonomous thyroid nodules

90
Q

SC Hypothyroidism: Symptoms

A

• No or minimal symptoms suggestive of hypothyroidism

91
Q

SC Hypothyroidism: Labs

A

• High TSH, normal free T4 and T3 levels
-Hyperglycem

92
Q

______ should be measured in all cases of subclinical hypothyroidism

A

TPO antibodies

93
Q

SC Hypothyroidism: Screening

A

-Hypercholesterolemia
-TPO antibodies
-TSH
-Thyroid Hormones

Clinical Pathology II (10 decks)

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