Thyroid Flashcards
Prevalance of thyroid disease ___ with age and is more prevalent in ___ than in ___.
increases, women, men
In the negative feedback system, the ___ is regulated by the ___ gland, which secretes ___. TSH then stimulates the thyroid to produce ___ and ___. These 2 then feedback on the ___.
thyroid, pituitary, TSH, T3, T4, pituitary
All ___ is secreted by the thyroid, but only about 20% of ___ is secreted. 80% of circulating ___ is produced by conversion of ___.
T4, T3, T3, T4
T4 iodine molecule has ___ atoms, whereas T3 has ___.
4, 3
Thyroid hormone is highly ___ bound (99%). Changes in plasma protein concentrations affect the total ___ hormone. Want to measure ___ T4 and ___, but not ___ T4.
plasma, thyroid, free, TSH, total
Autoimmune thyroiditis (aka ___) is where the immune system attacks the ___ gland as if it does not belong.
Hashimoto’s, thyroid
___ disease is characterized by antibodies that stimulate ___ production and therefore secretes an excess amount of ___ hormones.
Graves’, TSH, thyroid
Hypothyroidism is ___ of thyroid hormone and can be brought on by: ____, ____ or ___, or ___-induced (amiodarone, lithium, interferon, sunitinib).
lack, hashimoto’s, thyroidectomy, radioactive iodone, drug
The weight gain associated w/hypothyroidism is, at most, ___. More associated w/___ retention.
modest, fluid
The easiest test to test for hypothyroidism is ___. Elevated ___ will indicate hypothyroidism. TSH > ___-___.
TSH, TSH, 10-12
Subclinical hypothyroidism indicates an ___ TSH w/___ thyroid hormone levels in an otherwise healthy and ___ pt.
increased, normal, asymptomatic
Indications for tx of subclinical hypothyroidism: TSH > ___, if they have a ___, a significant titre of ___ autoantibodies, or if they are attempting ___.
10, goiter, thyroid, conception
Mainstay tx for hypothyroidism is ___. Only proper treatment option.
thyroxine (T4)
Treatment options to avoid: ___ thyroid, ___, ___-___ combinations.
dessicated, triiodothyronine (T3), T4-T3
___ thyroid is an example of dessicated thyroid and should ___ be recommended.
Armour, never
Thyroxine medication increases ___ O2 consumption, so to be cautious in pt’s w/___disease.
myocardial, cardiac
Instructions for thyroxine replacement: take on ___ stomach, do not take at same time as ___ or ___ supplements, if a dose is missed it is okay to ___ dose, keep pills ___ and ___, be ___ loyal.
empty, iron, calcium, double, dry, dark, brand
A lower dose of thyroxine is often sufficient for ___ thyroid disease. Recheck ___ and ___ every ___-___ weeks after starting on thyroxine therapy.
mild, TSH, Free T4, 6-8
Every pregnant pt will need ___ thyroxine dosage.
increased
Monitor for postpartum ___ every 6-12 wks for the first year postpartum.
thyroiditis
Hyperthyroidism (aka ____). Causes include ___ disease, toxic ___, toxic ___, ___, ___-induced, TSH-producing ___.
thyrotoxicosis, graves’, goiter, adenoma, thyroiditis, iodine, adenoma
Typical symptoms of ___ include: anxiety/irritability, insomnia, palpitations, heat intolerance, wt loss, hyperdefacation. Signs include: lid lag, exopthalmus, goiter.
hyperthyroidism
Symptoms of ___ include: fatigue, depression, cold intolerance, constipation, menstrual irregularities, modest wt gain. Signs include: brady, hair changes, myxedema.
hypothyroidism
Hyperthyroidism will typically cause a ___ TSH level, so you will see a normal-high TSH in a TSH-producing ___ ___.
decreased, pituitary adenoma
When is the only time to use the test thyroglubilin for?
when testing for factitious hyperthyroidism
Medications to tx hyperthyroidism include:___ and ___. Both ___ thyroid hormone synthesis.
methimazole (MMI), propylthiouracil (PTU), inhibit
MMI has serum half-life of ___ hrs, whereas PTU has half-life of ___ hrs. MMI appropriate for ___ administration, and PTU requires ___ administration.
6, 1.5, daily, TID
___ is preffered over ___ d/t lower risk of drug-induced hepatitis. ___ is preffered during ___ trimester of pregnancy or pt’s who have allergy to ___.
MMI, PTU, PTU, first, MMI
Adverse/serious effect of thionamides is ___, where the pt has a fever and pharyngitis. Pt needs to go straight to ER.
agranulocytosis
Thionamide drugs include:
methimazole (MMI) and propylthiouracil (PTU)
___-___, such as ___ also can be used to tx hyperthyroidism b/c they block the effect of thyroid hormone. They are the quickest way to relieve symptoms in a pt but do not tx the underlying disease. ___ once thryoid levels are normallized.
beta-blockers, propranolol, D/C
Radioiodine is another tx for ___ and delivers a killing dose of local ___ w/little exposure elsewhere. It is given ___ and only ___ time. Contraindicated in ___.
hyperthyroidism, radiation, orally, one, pregnancy
___ must be d/c’ed 3-7 days prior to giving radioiodine b/c otherwise it will be ineffective.
thionamides
___ or ___ should be used for pain in thyroiditis
NSAIDS, corticosteroids
___-___ are most affective initial tx for hyperthyroidism.
beta-blockers
___ thyroid hormone is best tx during hypothyroid phase.
exogenous
You want to taper ___ gradually over a few months.
thyroxine
Tx for iodine-induced hyperthyroidism includes: high dose of ___ medication, ___-___, and ___ once controlled w/medication.
antithyroid, beta-blockers, thyroidectomy
Multinodular glands are almost always d/t ___ causes, which includes MNG or thyroiditis. A ___ is typically the best course of tx.
benign, thyroidectomy
___, ___, or ___ nodules are a cause of concern for thyroid cancer.
single, dominant, enlarging
Risk factors indicative of a malignant thyroid nodule:
firm, hard, irregular, fixed nodule
Upon evaluation for thyroid nodules, check ___ and if suppressed, perform a ___. Otherwise do an ___.
TSH, scan, ultrasound
___ ___ ___ is the best initial diagnostic procedure for a thyroid nodule > 1cm.
fine needle aspiration
If nodule is malignant upon FNA, need to do ___. If benign, just ___-___.
thyroidectomy, follow-up
If nodule is < ___ cm and ___, then just follow up. If > ___ cm and ___, then perform biopsy.
1, nonpalpable, 1, palpable
Thyroxine should be taken at least ___-___ mins before any other meds or breakfast.
20-30
Recheck ___ and ___ every ___-___ wks while on thyroxine therapy. Need ___ half-lives to reach therapeutic state.
TSH, Free T4, 6-8, 5
Normal levels for TSH during pregnancy differs and is < ___ during first trimester, < ___ during second, and < ___ during third.
2.5, 3.0, 3.5
Increase thyroxine dose by ___-___ mcg once pregnancy is diagnosed.
25-50
Euthyroid sick syndrome occurs in everyone who is ___ ___. TSH, T4, and T3 will all be ___.
critically ill, suppressed
Major sign of hyperthyroidism is if a pt seems ___ and can’t sit still.
hyperkinetic
___-___ are the fastest way to make pt’s w/hyperthyroidism feel better. They block the excess ___ hormone, but do not tx underlying ___. ___ is used most commonly and is d/c’ed once ___ levels are normalized.
Beta-blockers, thyroid, cause, propranolol, thyroid
Wait ___ months to try to conceive after receiving radioactive iodine.
6
___ medication can be used to “cool down” Grave’s disease, but the definitive therapy for is ___.
antithyroid, ablation
___ will restore normal thyroid function in Toxic MNG and adenoma. ___ is best option if size of goiter is an issue.
radioiodine, thyroidectomy
Hyperthyroidism can also result in disease of ___ where the thyroid leaks out ___ hormone and you have a roller-coaster of both ___ and ___ states.
inflammation, hyper, hypothyroidism
Hx of ___ tx to face or neck, ___, or ___ are risk factors for malignant thyroid nodule.
radiation, dysphagia, hoarseness
Giving thyroid hormone to suppress ___ is not an effective diagnostic maneuver.
TSH
