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MOHD Keystone Exam 1 > Thyroid > Flashcards

Thyroid Flashcards

1
Q 
Side effects include:
Rash 
Agranulocytosis 
Cholestasis
Fulminant liver failure
A

PTU

–> use only in pregnancy d/t liver SE, Methimazole teratogenic effects

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2
Q 
Side effects include: 
Rash 
Agranulocytosis 
Cholestasis
Teratogenic?
A

Methimazole

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3
Q

May cause iodine-induced thryoiditis or worsening proptosis

A

I-131

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4
Q

Diseases leading to excess thyroid hormone state

A

Graves’ disease (overproduction + oversecretion)
Nodular thyroid disease (overproduction + oversecretion)
Thyroiditis (oversecretion due to inflammation)
Pituitary tumor (overproduction)
Ectopic production (i.e. ovary)

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5
Q

Symptoms of decreased metabolic activity

A 
Fatigue, weakness
Cognitive dysfunction
Cold intolerance
Weight gain
Constipation
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6
Q

Increased free T4 may be of these two origins

A

Pituitary or Thyroid

How do you distinguish?
Check TSH! (high = pituitary, low = thyroid)

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7
Q

What is the disease course of thyroiditis?

A

Initial hyperthyroid phase
Hypothyroid phase
Spontaneous recovery back to normal

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8
Q

What is the composition of thyroid nodules?

A

Most are benign

Of malignant, most are well-differentiated cancers (papillary or follicular)

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9
Q

High FT4 + High TSH –>

A

Pituitary hyperthyroidism

–> most likely tumor

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10
Q

How do you diagnose hypothyroidism?

A

Check TSH and FT4

Low FT4 + High TSH = thyroid origin (history)
Low FT4 + Low TSH = pituitary origin (–> MRI)

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11
Q

What disease would you suspect in a patient with onycholysis (soft nails), goiter/nodules, thinning hair, hypertension, menstrual irregularity, tremors, anxiety, hyperreflexia, palpitations?

A

Hyperthyroidism

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12
Q

High FT4 + Low TSH –>

A

Thyroid origin hyperthyroidism

Follow-up with I-131 uptake

  • -> diffuce decreased = thyroiditis (may test ESR)
  • -> diffuse increased = Graves (may test TSI abs)
  • -> localized increased = nodule (may get scan)
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13
Q

What does the thyroid gland primarily produce?

A

T4

T4 converted to T3 in target tissues/organs

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14
Q

What mechanism has symptoms like heat intolerance, excessive sweating, weight loss, hyperphagia, hyperdefecation and warm, moist palms?

A

Increased metabolic activity

–> think Hyperthyroidism

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15
Q

Symptoms of glycosaminoglycan accumulation

A

dry skin
hoarseness
edema
paresthesia

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16
Q

Low FT4 + Low TSH –>

A

Secondary hypothyroidism

may be pituitary or hypothalamic

17
Q

If a thyroid nodule is overactive, it is _____ likely to be malignant.

A

less likely –> FNA not necessary

18
Q

How do you medically treat Graves’ and nodular hyperthyroidism?

A

Methimazole or PTU

  • -> inhibit synthesis of thyroid hormone
  • -> can cause rash, agranulocytosis, cholestasis
19
Q

Low FT4 + High TSH –>

A

Primary hypothyroidism

may be surgical or Hashimoto’s thyroiditis (high TPO)

20
Q

What do you use to replace thyroid gland hormone?

A

T4 - levothyroxine

21
Q

What mechanism has symptoms like palpitations, tremors, anxiety, irritability, sleep disturbance, tachycardia, atrial fibrillation, lid lag, hyperreflexia?

A

Sympathetic overactivity

–> think Hyperthyroidism

22
Q

If thyroid nodule + low TSH, how do you follow-up?

A

Radionuclide scan

23
Q

Presents with symptoms of increased metabolic activity and sympathetic overactivity

A

Hyperthyroidism

24
Q

How do you treat thyroiditis?

A

Beta blockade

25
Q

What are all treatments for forms of hyperthyroidism?

A

Beta blockade (thyroiditis)
Methimazole, PTU
I-131 –> hypothyroidism
Thyroidectomy/lobectomy

26
Q

What is the goal of treatment for primary (thyroid origin) hypothyroidism?

A

Normal TSH

27
Q

How do you test for hyperthyroidism?

A

Check TSH and FT4

28
Q

These medications may impair the thyroid gland

A

lithium, amiodarone, thionamides

29
Q

Potential causes of decreased thyroid hormone state

A

Autoimmune thyroid failure (Hashimoto’s, chronic lymphocytic)
Surgical/radiologic destruction
Hypothyroid phase of thyroiditis
Medicinal impairment of thyroid
Pituitary or hypothalamic disease that decreases TSH production (tumor)

30
Q

What is the goal of treatment in secondary (pituitary origin) hypothyroidism?

A

Normal FT4 (TSH will always be low in this case)

31
Q

What are side effects of over-replacement of thyroid hormone?

A

atrial fibrillation, accelerated bone loss

MOHD Keystone Exam 1 (14 decks)

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