Thyroid

Question 1

Prevalance of thyroid disease ___ with age and is more prevalent in ___ than in ___.

Answer 1

increases, women, men

Question 2

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 ___.

Answer 2

thyroid, pituitary, TSH, T3, T4, pituitary

Question 3

All ___ is secreted by the thyroid, but only about 20% of ___ is secreted. 80% of circulating ___ is produced by conversion of ___.

Answer 3

T4, T3, T3, T4

Question 4

T4 iodine molecule has ___ atoms, whereas T3 has ___.

Answer 4

4, 3

Question 5

Thyroid hormone is highly ___ bound (99%). Changes in plasma protein concentrations affect the total ___ hormone. Want to measure ___ T4 and ___, but not ___ T4.

Answer 5

plasma, thyroid, free, TSH, total

Question 6

Autoimmune thyroiditis (aka ___) is where the immune system attacks the ___ gland as if it does not belong.

Answer 6

Hashimoto’s, thyroid

Question 7

___ disease is characterized by antibodies that stimulate ___ production and therefore secretes an excess amount of ___ hormones.

Answer 7

Graves’, TSH, thyroid

Question 8

Hypothyroidism is ___ of thyroid hormone and can be brought on by: ____, ____ or ___, or ___-induced (amiodarone, lithium, interferon, sunitinib).

Answer 8

lack, hashimoto’s, thyroidectomy, radioactive iodone, drug

Question 9

The weight gain associated w/hypothyroidism is, at most, ___. More associated w/___ retention.

Answer 9

modest, fluid

Question 10

The easiest test to test for hypothyroidism is ___. Elevated ___ will indicate hypothyroidism. TSH > ___-___.

Answer 10

TSH, TSH, 10-12

Question 11

Subclinical hypothyroidism indicates an ___ TSH w/___ thyroid hormone levels in an otherwise healthy and ___ pt.

Answer 11

increased, normal, asymptomatic

Question 12

Indications for tx of subclinical hypothyroidism: TSH > ___, if they have a ___, a significant titre of ___ autoantibodies, or if they are attempting ___.

Answer 12

10, goiter, thyroid, conception

Question 13

Mainstay tx for hypothyroidism is ___. Only proper treatment option.

Answer 13

thyroxine (T4)

Question 14

Treatment options to avoid: ___ thyroid, ___, ___-___ combinations.

Answer 14

dessicated, triiodothyronine (T3), T4-T3

Question 15

___ thyroid is an example of dessicated thyroid and should ___ be recommended.

Answer 15

Armour, never

Question 16

Thyroxine medication increases ___ O2 consumption, so to be cautious in pt’s w/___disease.

Answer 16

myocardial, cardiac

Question 17

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.

Answer 17

empty, iron, calcium, double, dry, dark, brand

Question 18

A lower dose of thyroxine is often sufficient for ___ thyroid disease. Recheck ___ and ___ every ___-___ weeks after starting on thyroxine therapy.

Answer 18

mild, TSH, Free T4, 6-8

Question 19

Every pregnant pt will need ___ thyroxine dosage.

Answer 19

increased

Question 20

Monitor for postpartum ___ every 6-12 wks for the first year postpartum.

Answer 20

thyroiditis

Question 21

Hyperthyroidism (aka ____). Causes include ___ disease, toxic ___, toxic ___, ___, ___-induced, TSH-producing ___.

Answer 21

thyrotoxicosis, graves’, goiter, adenoma, thyroiditis, iodine, adenoma

Question 22

Typical symptoms of ___ include: anxiety/irritability, insomnia, palpitations, heat intolerance, wt loss, hyperdefacation. Signs include: lid lag, exopthalmus, goiter.

Answer 22

hyperthyroidism

Question 23

Symptoms of ___ include: fatigue, depression, cold intolerance, constipation, menstrual irregularities, modest wt gain. Signs include: brady, hair changes, myxedema.

Answer 23

hypothyroidism

Question 24

Hyperthyroidism will typically cause a ___ TSH level, so you will see a normal-high TSH in a TSH-producing ___ ___.

Answer 24

decreased, pituitary adenoma

Question 25

When is the only time to use the test thyroglubilin for?

Answer 25

when testing for factitious hyperthyroidism

Question 26

Medications to tx hyperthyroidism include:___ and ___. Both ___ thyroid hormone synthesis.

Answer 26

methimazole (MMI), propylthiouracil (PTU), inhibit

Question 27

MMI has serum half-life of ___ hrs, whereas PTU has half-life of ___ hrs. MMI appropriate for ___ administration, and PTU requires ___ administration.

Answer 27

6, 1.5, daily, TID

Question 28

___ is preffered over ___ d/t lower risk of drug-induced hepatitis. ___ is preffered during ___ trimester of pregnancy or pt’s who have allergy to ___.

Answer 28

MMI, PTU, PTU, first, MMI

Question 29

Adverse/serious effect of thionamides is ___, where the pt has a fever and pharyngitis. Pt needs to go straight to ER.

Answer 29

agranulocytosis

Question 30

Thionamide drugs include:

Answer 30

methimazole (MMI) and propylthiouracil (PTU)

Question 31

___-___, 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.

Answer 31

beta-blockers, propranolol, D/C

Question 32

Radioiodine is another tx for ___ and delivers a killing dose of local ___ w/little exposure elsewhere. It is given ___ and only ___ time. Contraindicated in ___.

Answer 32

hyperthyroidism, radiation, orally, one, pregnancy

Question 33

___ must be d/c’ed 3-7 days prior to giving radioiodine b/c otherwise it will be ineffective.

Answer 33

thionamides

Question 34

___ or ___ should be used for pain in thyroiditis

Answer 34

NSAIDS, corticosteroids

Question 35

___-___ are most affective initial tx for hyperthyroidism.

Answer 35

beta-blockers

Question 36

___ thyroid hormone is best tx during hypothyroid phase.

Answer 36

exogenous

Question 37

You want to taper ___ gradually over a few months.

Answer 37

thyroxine

Question 38

Tx for iodine-induced hyperthyroidism includes: high dose of ___ medication, ___-___, and ___ once controlled w/medication.

Answer 38

antithyroid, beta-blockers, thyroidectomy

Question 39

Multinodular glands are almost always d/t ___ causes, which includes MNG or thyroiditis. A ___ is typically the best course of tx.

Answer 39

benign, thyroidectomy

Question 40

___, ___, or ___ nodules are a cause of concern for thyroid cancer.

Answer 40

single, dominant, enlarging

Question 41

Risk factors indicative of a malignant thyroid nodule:

Answer 41

firm, hard, irregular, fixed nodule

Question 42

Upon evaluation for thyroid nodules, check ___ and if suppressed, perform a ___. Otherwise do an ___.

Answer 42

TSH, scan, ultrasound

Question 43

___ ___ ___ is the best initial diagnostic procedure for a thyroid nodule > 1cm.

Answer 43

fine needle aspiration

Question 44

If nodule is malignant upon FNA, need to do ___. If benign, just ___-___.

Answer 44

thyroidectomy, follow-up

Question 45

If nodule is < ___ cm and ___, then just follow up. If > ___ cm and ___, then perform biopsy.

Answer 45

1, nonpalpable, 1, palpable

Question 46

Thyroxine should be taken at least ___-___ mins before any other meds or breakfast.

Answer 46

20-30

Question 47

Recheck ___ and ___ every ___-___ wks while on thyroxine therapy. Need ___ half-lives to reach therapeutic state.

Answer 47

TSH, Free T4, 6-8, 5

Question 48

Normal levels for TSH during pregnancy differs and is < ___ during first trimester, < ___ during second, and < ___ during third.

Answer 48

2.5, 3.0, 3.5

Question 49

Increase thyroxine dose by ___-___ mcg once pregnancy is diagnosed.

Answer 49

25-50

Question 50

Euthyroid sick syndrome occurs in everyone who is ___ ___. TSH, T4, and T3 will all be ___.

Answer 50

critically ill, suppressed

Question 51

Major sign of hyperthyroidism is if a pt seems ___ and can’t sit still.

Answer 51

hyperkinetic

Question 52

___-___ 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.

Answer 52

Beta-blockers, thyroid, cause, propranolol, thyroid

Question 53

Wait ___ months to try to conceive after receiving radioactive iodine.

Answer 53

6

Question 54

___ medication can be used to “cool down” Grave’s disease, but the definitive therapy for is ___.

Answer 54

antithyroid, ablation

Question 55

___ will restore normal thyroid function in Toxic MNG and adenoma. ___ is best option if size of goiter is an issue.

Answer 55

radioiodine, thyroidectomy

Question 56

Hyperthyroidism can also result in disease of ___ where the thyroid leaks out ___ hormone and you have a roller-coaster of both ___ and ___ states.

Answer 56

inflammation, hyper, hypothyroidism

Question 57

Hx of ___ tx to face or neck, ___, or ___ are risk factors for malignant thyroid nodule.

Answer 57

radiation, dysphagia, hoarseness

Question 58

Giving thyroid hormone to suppress ___ is not an effective diagnostic maneuver.

Answer 58

TSH