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thyroid Flashcards

1
Q

what is Primary hyperthyroidism

A

is when the problem is within the thyroid.

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2
Q

what is secondary hyperthyroidism

A

when the problem is with something else in the body which is affecting the thyroid like the pituitary or hypothalamus

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3
Q

the most common cause of hyperthyroidism

A

Graves disease is the most common cause of hyperthyroidism. It is an auto immune disease in which the body creates antibodies that bond to the TSH receptor thereby forcing the thyroid into excessive production.

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4
Q

medication that may cause thyrotoxicosis

A

amiodarone

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5
Q

hyperthyroidism gender and age

A

women > men 8:1; ages 20-40

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6
Q

second common cause of hyperthyroidism

A

toxic multinodular goiter

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7
Q

pregnancy, excessive dietary iodine intake, radiographic contrast, pituitary tumor, hashimoto’s thyroiditis

A

other causes of hyperthyroidism

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8
Q

thyroid cancer an graves

A

they can coincide

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9
Q

Grave’s disease 20-40% of pts will have…

-risk higher in who

A

chemosis(swelling of conjunctiva)
conjunctivitis
exophthalmos or proptosis
-risk higher in smokers

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10
Q 
Eyes: 
stare
lid lag with downward gaze
upper eyelid retraction
diplopia
A

hyperthyroidism

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11
Q 
Heart
Tachycardia
AFib(8% of pts-usually elderly men w/ hrt d/s)
Palpitations/forceful heartbeat
Chest pain
PVCs
A

hyperthyroidism

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12
Q 
Skin
Fine hair
warm
moist
onycholysis (painless detachment of the nail from the nail bed)
3% have myxedema(dermal edema)
A

hyperthyroidism

myxedema in hypothyroidism too

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13
Q

change in bowel habits, menorrhagia, brittle hair, heat intolerance

A

hyperthyroidism

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14
Q

reflexes in hyperthyroidism

A

brisk HYPER-reflexia

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15
Q 
osteoporosis
clubbing
finger swelling
hypercalcemia/nephrocalcinosis
gynecomastia
AFib
decreased libido/sperm count/impotence
A

Chronic symptoms hyperthyroidism/thyrotoxicosis

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16
Q 
fever
tachycardia
vomiting/diarrhea
dehydration
muscle weakness
confusion
A

thyroid storm

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17
Q

what can develop following oral or IV carbohydrates, IV dextrose, or excessive exercise

A

15% develop hypokalemic periodic paralysis lasting 7-72 hours typically in Asian and Native American Men

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18
Q

Hyperthyroid blood work

A 
TSH extremely low (almost all the time)
T4 (thyroxine) elevated
T3 (triiodothyronine ) 
ESR elevated
TSH receptor antibody elevated in Graves disease
hypercalcemia
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19
Q

graves disease antibodies

A

peroxidase antibodies and thyroglobulin antibodies

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20
Q

radioactive iodine uptake study

A

increased uptake in graves and toxic multinodular goiter; uptake is more diffuse and symmetric in graves

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21
Q

avoid radioactive iodine uptake study in who

A

never should be done in pregnant women or in those with laboratory confirmed disease

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22
Q

imaging for hyperthyroidism

A

MRI and CT scanning of orbis is performed for severe or unilateral ocular signs or when causation may be other than graves

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23
Q

hyperthyroidism first line tx

A

Beta blockers are the first line of treatment and propranolol is the one you will hear about with hyperthyroidism and thyroid storm

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24
Q

what meds to control hyperthyroidism

A

Methimazole(MMI) and propylthiourcial (PTU) will actually control hyperthyroidism. radioactive iodine ablates thyroid(MC)

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25
Q

what meds to treat afib with hyperthyroidism

A

Digoxin to treat AFib

Warfarin to treat clotting with AFib

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26
Q

procedures for hyperthyroidism

A

Radioactive Iodine ablation

Surgical removal

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27
Q

drug of choice pregnancy or breast feeding with hyperthyroidism

A

PTU

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28
Q

radioactive iodine ablation for who

A

older pts, those with prior PTU/MMI reaction or failure, or poor compliance

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29
Q

older pts, those with prior PTU/MMI reaction or failure, or poor compliance: hyperthyroidism tx

A

radioactive iodine ablation

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30
Q

afib from hyperthyroidism tx

A

digoxin in large doses and beta blockers

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31
Q

opthalmopathy from hyperthyroidism tx

A

IV methylpredisone

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32
Q

RAI administration, pregnancy, trauma, sepsis, illness

A

all can precipitate a thyroid storm

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33
Q

thyroid storm mortality

A

high

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34
Q

PTU for thyroid storm- administer how

A
  • orally but monitor for liver dysfunction
  • IV Na iodine may be considered as well as IV hydrocortisone 50-100 mg every 6 hrs
  • iodine may be administered as lugol solution
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35
Q

how to alleviate thyroid storm symptoms

A

propanolol

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36
Q

how to treat hypokalemic periodic paralysis

  • medication and MOA
  • avoid what
A

propanolol- normalizes serum potassim and phosphate levels and reverses paralysis within 3 hrs
- avoid IV dextrose or oral carbohydrates

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37
Q

heat vs cold intolerance

A

heat is hyperthyroidism

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38
Q

pts presents with afib, fever, delirium

  • disease
  • tx
A

thyroid storm

- anti-thyroid drugs, then iodine, IV esmolol, steroids, admit

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39
Q

hyperthyroidism intial test

A

TSH then T4

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40
Q

hyperthyroidism definitive tx

A

radioactive thyroid ablation or total thyroidectomy

- give levothyroxine (oral T4) and steroids

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41
Q

1st and 2nd most common endocrine disorder in US

A

1st is diabetes, 2nd is hypothyroidism

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42
Q

hypothyroidism is autoimmune and this causes what

-what causes the disease

A

antibodies against TSH receptors, antiperoxidase, and thyroglobulin
- anti-TSH antibodies cause the disease. antiperoxidase and antithyroglobulin are disease markers

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43
Q

most common cause of hypothyroidism

A

hashimotos thyroiditis

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44
Q

Medications that can cause hypothyroidism

A

Amiodarone which is structurally similar to thyroxine
Lithium
Propylthiouracil (PTU) and Methimazole – used to control hyperthyroidism

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45
Q

hypothyroidism labs
add CBC and BMP findings
what imaging

A

**TSH — elevated in primary hypothyroidism.
total T4 — decreased; free T4 — decreased
T3 — may be normal
Antithyroid peroxidase andAntithyroglobulin antibodies
CBC — may show anemia from iron def or chr disease (decreased absorption of iron and folate as well as GI motility)
BMP — low sodium(from alteration of renal tubular Na reabsorption)
imaging only if a concern for malignancy

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46
Q

up to 30% of downs pts will have this

A

hypothyroidism

47
Q

labs in euthyroid state

A

nml or low free T4 and TSH

48
Q

labs in primary hypothyroid state

A

low free T4 and elevated TSH

49
Q

labs in secondary hypothyroid state

A

low free T4 and low/nml TSH

50
Q

levothyroxine

A

converts to T3. adjust dose every 4-6 weeks based on TSH value
- assess for adrenal insufficiency and angina

51
Q

severe hypothyroidism

  • disorder
  • presentation
  • hallmark symptom
  • mortality
A

myxedema crisis- obtundation, CO2 retention, maybe coma
** altered mental status
mortality 20-30%

52
Q 
pt presents with ...
mental changes from confusion to coma
convulsions
hypotension
hypothermia
hypoventilation
rhabdomyolysis and acute kidney damage
hyponatremia
hypoglycemia
acute kidney injury
A

myxedema crisis

53
Q

myxedema crisis tx

A

IV levothyroxine or thyroxine bolus
consider hydrocortisone if adrenal insufficiency is suspected
intubation if necassary
slow warming with warm blankets if necessary

54
Q

suppurative thyroiditis organism

A

st aureus

55
Q

thyroiditis dx tests

A

FNA with gm stain and culture

56
Q

most common cause of sporadic goiter in kids

A

hashimoto

57
Q

Sjogren’s syndrome

A

xerostomia — dry mouth

keratoconjuctivitis — dry eyes

58
Q

hashimoto

  • gender
  • FH?
  • what has the incidence risen over the past 50 years?
A
  • female 6 times more likely
  • may be familial
  • related to increase in iodine content in diet
59
Q

hashimoto may also present with what

A
  • 30% will have sjogrens syndrome

- often concomitant with myasthensia gravis

60
Q

most common painful thyroid gland

A

subacute

61
Q 
acute pain to thyroid
glandular enlargement → dysphagia
low grade fever
fatigue
dysphagia/otalgia for months
?thyrotoxicosis
A

Subacute Thyroiditis

50% will have thyrotoxicosis followed by hypothyroid followed by euthyroid within 12 months

62
Q

50% will have thyrotoxicosis followed by hypothyroid followed by euthyroid within 12 months

A

Subacute Thyroiditis

63
Q

EBV, influenza, coxsackie virus, mumps, measles, adenovirus

A

can all cause subacute thyroiditis

64
Q

Subacute thyroiditis tx

A
  • Aspirin is the first line drug of choice for pain and inflammation
  • Propranolol (betablocker) for symptoms of hyperthyroid
  • Levothyroxine for symptoms of hypothyroid
  • no benefit of steroids
65
Q

Subacute thyroiditis labs

A

markedly elevated ESR with antithyroid antibody titers low

66
Q 
thyroid:  disease and etiology
painful
tender
red
fluctuant
A

Suppurative Thyroiditis

st aureus

67
Q

hashimoto’s with a thyroid nodule

A

A patient with Hashimoto’s thyroiditis and a nodule in the thyroid should undergo FNA as the risk of associated thyroid cancer is significant

68
Q 
hypothyroid symptoms
the thyroid becomes enlarged and  hard
dysphagia
hoarseness
pain
dyspnea
typically goes along with systemic fibrosis
A

Reidel thyroiditis

69
Q

Reidel thyroiditis tx

A

short course of steroids for symptomatic relief

Tamoxifen for years after will result in partial to complete remission

70
Q

woody assymetric hard thyroid

A

reidel

71
Q

Reidel thyroiditis

  • gender
  • common or rare
A

80% females

the rarest

72
Q

2 rare thyroiditis

A

suppurative and reidel

73
Q

drug induced thyroiditis

  • from what
  • half life
  • serum increase in what
  • results in what
A
  • amiodarone: causes thyroid dysregulation in 20% of pts due to iodine content
  • 100 day half life
  • cause serum increase of T4 by 20-40% during first month but causes cellular resistance to T4.
  • resultant hypothyroid picture ensues with elevated TSH and symptoms typical of hypothyroidism
74
Q

aspirin tx for what

A

subacute painful thyroiditis

75
Q

tamoxifen tx for what

A

riedel thyroiditis

76
Q

steroids tx for what

A

suppurative thyroiditis

77
Q

leukocytosis and increased ESR for what thyroiditis

A

suppurative

78
Q

subacute thyroiditis peaks what season

and ages

A

summer

young and middle aged women

79
Q

believed to be autoimmune in nature

occurs in 7.2% of women post delivery

A

Postpartum thyroiditis

80
Q

hyperthyroid followed by hypothyroid
painless
palpable goiter
beings 1-6 months postpartum

A

Postpartum Thyroiditis

beings 1-6 months postpartum

81
Q

Postpartum Thyroiditis tx

A

self limiting

82
Q

imaging in thyroiditis

A
  • U/S used to distinguish thyroiditis from nodular goiter or possible malagnancy
  • Radioiodine uptake scan may be helpful
83
Q

thyroiditis labs

A

TSH
T4
Antithyroperoxidase levels increased in 90% of Hashimoto’s thyroiditis
Antithyroglobulin antibodies increased in 40% of Hashimoto’s thyroiditis
Thyroid autoantibodies
sed rate

84
Q

Antithyroperoxidase levels increased in 90% of ___ thyroiditis
Antithyroglobulin antibodies increased in 40% of ___ thyroiditis

A

Antithyroperoxidase levels increased in 90% of Hashimoto’s thyroiditis
Antithyroglobulin antibodies increased in 40% of Hashimoto’s thyroiditis

85
Q

endemic goiters
% of population
found where

A

10%

found in iodine deficient areas

86
Q

sorghum, millet, maize, cassava, mineral deficiencies of selenium and iron

A

may enhance risk in iodine deficient states

87
Q

solitary thyroid nodule

  • gender
  • size
  • symptoms
  • benign or malignant
A

females
over 1 cm
asymptomatic
benign usually. only 5% of palpable nodules are malignant

88
Q

what solitary thyroid nodules are encapsulated

A

nodule of an adenoma is encapsulated, but the nodules of multinodular goiters are not encapsulated

89
Q

most common type and rare type of solitary thyroid nodule

A

common: follicular adenoma
rare: papillary adenomas

90
Q

hurtle cell

A

solitary thyroid nodule that has eosinophilic staining and has malignant potential

91
Q

adenomas cancerous?

A

true adenomas are not cancer precursors

92
Q

solitary thyroid nodule workup:

if TSH is low

A

assess for hyperthyroidism and undergo radionuclide thyroid scan

93
Q

most sensitive test for a solitary thyroid nodule

A

high resolution ultrasonography

94
Q

why u/s over a CT for a solitary thyroid nodule

A

u/s has higher accuracy, lower cost, and lack of radiation

95
Q

solitary thyroid nodule has irregular or indistinct margins,
heterogenous echogenicity,
intranodular vascular margins, size over 1 cm
microcalcification, complex cyst patterns

A

suspect malignancy and should undergo ultrasound guided FNA

75% of solitary nodules show benign lesions

96
Q

FNA of solitary thyroid nodule

A

75% of solitary nodules show benign lesions

97
Q

solitary thyroid nodule found to be benign- tx?

A

T4 replacement is shown to decrease nodule size by 20%

98
Q

what if the benign solitary thyroid nodule has no response to T4 therapy and the pt is euthyroid

A

discontinue

99
Q

thyroid cancer

  • gender
  • prognosis
A

women 3:1
prognosis is worse in men
9% fatal

100
Q

thyroid cancer could have hyper or hypothyroid symptoms

A

May have hyperthyroid symptoms due to excess T4 production including thyroid storm.

101
Q

painless neck swelling and a palpable, single form nodule

A

thyroid cancer

102
Q

thyroid cancer- diagnostic test

  • RAIU to do what
  • other test that is useful
A
  • FNA diagnostic
  • RAIU helpful to assess risk of malignancy and help plan surgical approach
  • PET for detecting thyroid cancer mets with limited iodine uptake
  • U/S to determine size and location as well as neck metastasis
103
Q

thyroid cancer blood work

A

T4 normal except for Follicular cancer which produces T4
TSH normal except for Follicular cancer were the excess T4 will suppress TSH
There are tumor markers like serum carcinoembryonic antigen, calcitonin and serum thyroglobulin which can be followed.

104
Q

thyroid cancer mets where? get what tests?

A

CT – for metastasis especially lung
MRI – for metastasis especially bone
U/S to determine size and location as well as neck metastasis

105
Q

thyroid cancer tx

A
  • Total or near total thyroidectomy

- Neck dissection and lymph node removal if indicated

106
Q

thyroid cancer post op thyroidectomy tx

A
  • Levothyroxine (synthetic T4) immediately post op for thyroidectomy patients
  • Radioactive iodine ablation is used postoperatively for residual disease, metastatic disease and to prevent recurrence.
  • Patients should receive whole body radioactive iodine scans. Remission is defined as two successive negative scans
107
Q

medullary cancer thyroid cancer pts

A

Those with medullary cancer should have family members get a genetic work up and thyroid surveillance

108
Q

Radioactive iodine ablation for brain mets

A

It should be noted that this is ineffective with mets to the brain which must be removed surgically with gamma knife

109
Q
  • childhood irradiation to head and neck

- FH, gardner syndrome, MEN type II syndrome

A
  • confers a 25 fold increase in thyroid cancer and may emerge 10-40 post exposure
  • other risk factors for thyroid cancer
110
Q

thyroid cancer

  • most common
  • MEN
  • most aggressive
  • least aggressive
A
  • most common is papillary
  • MEN is Medullary
  • most aggressive is anaplastic
  • least aggressive is papillary
111
Q

thyroid cancer

  • early mets
  • lymphatic spread
  • slow growing
  • rapidly enlarges
A
  • early mets is medullary
  • lymphatic spread- papillary
  • slow growing- papillary
  • rapidly enlarges- anaplastic
112
Q

thyroid cancer

  • good prognosis
  • found in older pts
  • may cause thyroid storm
  • childhood head/neck radiation
A
  • good prognosis is papillary and follicular
  • found in older pts is anaplastic
  • may cause thyroid storm is follicular
  • childhood head/neck radiation is at risk for papillary
113
Q

thyroid cancer

  • found in calcitonin producing C cells
  • often causing dysphagia or vocal cord paralysis
  • often mets to lung, brain, bone, liver
  • rapidly enlarges and early mets to local and distant sites
A
  • found in calcitonin producing C cells is medullary
  • often causing dysphagia or vocal cord paralysis is anaplastic
  • often mets to lung, brain, bone, liver is follicular
  • rapidly enlarges and early mets to local and distant sites is anaplastic

endocrine (9 decks)

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