Thyroid

Question 1

Fever and sore throat in those taking PTU or methimazole

Answer 1

Agranulocytosis (rare)

Question 2

Tumor that produces calcitonin…

What is this and what else to screen for?

Answer 2

Medullary thyroid cancer (of thyroid parafollicular C cells which produce calcitonin)

Screen for pheo! (Plasma fractionated metanephrine assay)

Question 3

Components of MEN I

Answer 3

3 REAL Ps (NOT THE P THAT STARTS WITH F! = Not FEOCHROMOCYTOMA)
Primary hyperParathyroidism
Pituitary tumors (prolactin, visual defects)
Pancreatic tumors (esp. gastrinomas)

Question 4

Components of MEN II

Answer 4

FMP or FMM

Feochromocytoma
Medullary thryoid (calcitonin)
2a: parathyroid hyperplasia (2a= 1 = MEN I)
2b: mucosal neuromas/Marfanoid habitus (2Ms in 2B)

Question 5

Hyperthyroidism

Diffusely increased radioactive iodine uptake (RAIU)

Answer 5

Graves

de novo hormone synthesis

Question 6

Hyperthyroidism

Nodular increased radioactive iodine uptake (RAIU)

Answer 6

Toxic nodular disease

Question 7

Hyperthyroidism
Low radioactive iodine update (RAIU)

what test to get next?

Answer 7

thyroglobulin (a protein that normally stabilizes T3 or T4 in the blood)
if elevated -> endogenous thyroid hormone release

if decreased: exogenous or factitious thyrotoxicosis

Question 8

metabolic abnormalities in hypothyroidism

Answer 8

hyperlipidemia (especially hypercholesterolemia and hypertrig)
hyponatremia
asymptomatic elevations of CK and transaminases

Question 9

Lab abnormalities in hypothyroidism

Answer 9

High LDL, high trig
Hypothermia
Elevated CK with myopathy
Hyporeflexia

Question 10

Increased risk of what cancer with Hashimoto

Answer 10

Thyroid lymphoma

Question 11

Tender thyroid, malaise, URI symptoms

Answer 11

Subacute thyroiditis (all other forms of thyroiditis are associated with painless goiter)

Question 12

Papillary thyroid cancer

Answer 12

80% of all thyroid cancers (Popular)
A tumor of the Thyroid hormone-producing follicular cells
Papillae (branching)
Palpable lymph nodes
Pupil nuclei (“Orphan Annie” nuclei)
Psammoma bodies
Positive Prognosis

Question 13

Follicular thyroid tumor

Answer 13

17% of all thyroid tumors
Also in Thyroid-hormone producing follicular cells

Hematologic spread

Question 14

Medullary thyroid tumor

Answer 14

Calcitonin-producing C cells
Consider MEN 2A or 2B
80% survive at 10 years

Question 15

Anaplastic thyroid tumor

Answer 15

<2%
Rapidly enlarges and metastasizes
Bad prognosis