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ClinMed exam III > Thyroid > Flashcards

Thyroid Flashcards

1
Q

What is the function of the thyroid?

A
  • metabolism
  • regulate long bone growth
  • brain development
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2
Q

Hormone overview for thyroid

A

TRH–>TSH–>T3/T4

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3
Q

Physiology of hormone release in the thyroid

A

hypothalamus releases TRH–>triggers anterior pituitary to release TSH–>triggers the thyroid to release thyroxine–>gets converted to T3/T4 in the tissue

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4
Q

Why iodine important to the thyroid

A

needed to produce T3 and T4

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5
Q

What is thyrotoxicosis

A

elevated unbound thyroid hormone circulating in the body

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6
Q

What is the #1 cause of hyperthyroidism in the US

A

Grave’s disease

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7
Q

Typical age of diagnosis of hyperthyroidism? gender?

A

occurs in women 20-40 years of age

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8
Q

What are the primary causes of hyperthyroidism

A
  • Grave’s disease
  • toxic multinodular goiter
  • toxic nodular goiter
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9
Q

Symptoms of hyperthyroid

A
  • irritability/nervousness/anxiety
  • sweating
  • fatigue
  • muscle weakness
  • palpitations
  • increased bowel movements
  • SOB
  • heat intolerance
  • menstrual irregulatities
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10
Q

Finding specific for Grave’s disease

A
  • opthalmopathy/exophthalmos
  • infiltrative dermopathy
  • thyroid acropathy
  • goiter with bruit
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11
Q 
Physical exam findings for hyperthyroid.
   skin/nails
   HEENT
   cardiac
   neuro
   endocrine
A

skin/nails:

  • pruritus
  • moist skin
  • thinning hair
  • hyperpigmentation
  • oncholysis

HEENT:

  • lid lag
  • exopthalmous
  • goiter or nodules

Cardiac:
-tachycardia/afib

Neuro:

  • fine tremor
  • hyperreflexia

Endocrine:
-weight loss despite increased appetite

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12
Q 
Labs in hyperthyroidism.
   TSH
   Free T4
   Total T3
   antibodies
   Serum cholesterol
   calcium
A 
TSH- decreased
T3/T4- increased
antibodies will be present in Grave's disease
serum cholesterol- decreased
hypercalcemia
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13
Q

What imaging studies are done in hyperthyroid? what do they show?

A

Nuclear scintigraphy with radioactive iodine uptake

shows diffuse, increased uptake

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14
Q

Which causes of hyperthyroid present in the elderly

A
  • toxic multinodular goiter

- toxic nodular goiter

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15
Q

What would a thyroid scan show with toxic nodular.multinodular goiter

A

irregular or diminished uptake

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16
Q

Treatment options for hyperthyroid

A
  • symptomatic treatment
  • antithyroid drugs (thionamides)
  • radioactive iodine treatment
  • surgery
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17
Q

What is the treatment of choice for hyperthyroid

A

radioactive iodine treatment

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18
Q

Symptomatic treatment for hyperthyroid

A

-rehydration
-beta blocker
propanolol
atenolol
metoprolol

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19
Q

Thionamides used for hyperthyroid

A
  • Methimazole (preferred)

- PTU (pregnancy)

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20
Q

What is the end result of radioactive iodine treatment

A

permanent hypothyroid, must give levothyroxine

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21
Q

In what patients is surgery indicated for hyperthyroid

A
  • children
  • pts with large goiters
  • non compliant patients
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22
Q

What is a thyroid storm

A

complication of untreated hyperthyroidism

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23
Q

What typically triggers a thyroid storm

A

major stressor

  • trauma
  • heart attack
  • infection
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24
Q

Clinical presentation of thyroid storm

A
  • fever
  • tachycardia
  • hypertension
  • neurological and GI abnormalities
  • delerium
  • N/V/D
  • heart failure
  • pulmonary edema
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25
Q

How do you treat a thyroid storm

A
  • antipyretics
  • IV rehydration
  • beta blocker
  • IV thiourea
  • Lugol’s solution 1 hr after thiourea
  • gluccocorticoids
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26
Q

What is subacute thyroiditis

A

de Quervian thyroiditis

-typically caused by a viral infection

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27
Q

What is the #1 cause of hypothyroid in developing countries

A

iodine deficiency

28
Q

What is the most common cause of hypothyroid in the US

A

Hashimoto

29
Q

Causes of hypothyroid

A
  • autoimmune thyroiditis (hashimoto’s)
  • thyroidectomy
  • central hypothyroidism
30
Q

Symptoms of hypothyroidism

A
  • fatigue/lethargy
  • depression
  • weakness
  • arthralgia
  • constipation
  • headache
  • paresthesias
  • cold intolerance
  • infertility
31
Q

Exam findings for hypothyroidism

A
  • dry skin
  • weight gain
  • thinning of hair
  • puffy face/eye
  • goiter
  • bradycardia
  • delayed reflex
32
Q

Labs for Hashimoto’s

A
  • TSH (elevated)
  • T3/T4 (low)
  • antibodies
  • hyponatremia
  • hypoglycemia
  • anemia
  • decrease basic metabolic rate
33
Q

pathophys of chronic lymphocytic thyroiditis

A

invasion of B lymphocytes in the thyroid gland

34
Q

Treatment of choice for hypothyroid

A

levothyroxine (T4)

35
Q

Myxedema coma

A

severe hypothyroidism

36
Q

Who is myxedema coma most often seen in

A

elderly that stop taking their medication

37
Q

Signs of myxedema coma

A
  • hypothermia
  • hypoventilation
  • hyponatremia
  • hypoglycemia
  • hypotension
  • rhabdo/AKI
38
Q

Treatment of myxedema coma

A
  • high IV dose levothyroxine
  • warm with blankets
  • intubation
  • treat infections
  • hydrocortizone if adrenal insufficiency present
39
Q

Euthyroid sick syndrome

A

abnormal finding on a thyroid function tests that occur in the setting of a nonthyroidal illness

40
Q

Common illnesses that cause euthyroid sick syndrome

A

MI, DKA, CRF, cirrhosis

41
Q

What are the TSH levels in euthyroid sick syndrome? T3/T4?

A

TSH is NORMAL

normal to low T3/T4

42
Q

What levels are elevated in euthyroid sick syndrome

A

cortisol

43
Q

What causes subacute lymphocytic thyroiditis

A
  • autoimmune mediated

- exposure to certain medication (lithium, interleukin-2, interferon-alpha, tyrosine kinase inh)

44
Q

What do most patients with post partum thyroiditis get

A

Hashimoto’s

45
Q

Signs of subacute granulomatous thyroiditis

A
  • low grade fever
  • viral sx
  • painful nodule
  • dysphagia
46
Q

What is chronic lymphocytic thyroiditis

A

Hashimoto’s thyroiditis

47
Q

What drugs can cause thyroiditis

A
  • amiodarone
  • lithium
  • phenytoin
  • radioactive iodine
48
Q

What two values are elevated in subactute granulomatous thyroiditis but not subactue lymphocytic thyroiditis

A

SED rate and CRP

49
Q

Amiodarone thyroiditis type 1

A

active production of excessive hormones due to too much free iodine

50
Q

Amiodarone thyroiditis type 2

A

destructive thyroiditis that releases stored hormones

51
Q

How do you treat thyroiditis

A
  • treat symptoms
  • levothyroxine in hypo
  • do not give thionamide if hyper*
52
Q

Risk factors for thyroid cancer

A
  • history of radiation exposure
  • multiple endocrine neoplasia (MEN)
  • family history
53
Q

Four types of thyroid cancer

A

papillary, follicular, medullary, anaplastic

54
Q

What is present in papillary thyroid cancer

A

Psammoma bodies- cleaved nuclei

55
Q

What put a person at an increased risk for papillary thyroid cancer

A

Hashimoto’s

56
Q

What is medullary thyroid cancer associated with

A

MEN 2A and 2B

57
Q

Where is follicular thyroid cancer more common

A

iodine deficient regions

58
Q

How does papillary thyroid cancer spread

A

lymphatic and hematogenously (bone, lung)

59
Q

How does follicular thyroid cancer spread

A

hematogenously (bone,lung, CNS)

60
Q

What are poor prognostic indicators for follicular thyroid cancer

A
  • hurthle cell
  • > 4cm
  • > 50 y/o
  • distant mets
  • vascular invasion
61
Q

What causes anaplastic thyroid cancer

A

inactivation of the p53 gene

62
Q

Which thyroid cancer has the worse prognosis

A

anaplastic

63
Q

What is the diagnostic tool of choice for thyroid cancer

A

fine needle aspiration

64
Q

What labs are checked fro medullary thyroid cancer

A
  • serum calcitonin and CEA

- PCR germline mutation

65
Q

Hot vs cold. Which one is better

A

Hotter the better

66
Q

Treatment of thyroid cancer

A

thyroidectomty

ClinMed exam III (7 decks)

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