Thyroid Flashcards
1
Q
Jod-Boseman phenomenon?
A
Iodine-induced Hyperthyroidism
2
Q
Cardiac Complications of Hyperthyroidism?
A
- Increased heart rate, contractility, cardiac output
- Cardiomegaly
- Hypercalcemia-induced ECG changes (d/t bone turnover)
- Arrhythmia
3
Q
Nervous System Complications of Hyperthyroidism?
A
- Fine tremor (hands)
- Anxiety
- Insomnia
- Emotional lability
- Inability to concentrate
- Brisk deep tendon reflexes
4
Q
GI Complications of Hyperthyroidism?
A
- Malabsorption
- Diarrhea
5
Q
Endocrine Complications of Hyperthyroidism?
A
- Increased bone turnover -> Osteoporosis
- Oligomenorrhea
6
Q
Clinical Presentation of Hyperthyroidism?
A
- Increased Basal Metabolic Rate, Tachypnea
- Weight loss
- Myopathy (muscle weakness)
- Heat Intolerance
7
Q
Diagnostic tests for Hyperthyroidism?
A
TSH, T3, T4
- Primary Hyperthyroidism: Decreased TSH
- Secondary Hyperthyroidism: Increased TSH
8
Q
Treatment for Hyperthyroidism?
A
- β-blockers
- Thioamides
- High-dose iodide
- Radioactive iodine (131I)
9
Q
Additional Lab Findings in Hyperthyroidism?
A
- Hypercalcemia due to increased bone resorption
- Hyperglycemia due to increased glycogenolysis and impaired peripheral insulin activity
- Hypocholesterolemia due to increased low density lipoprotein (LDL) receptor synthesis
10
Q
Neurologic Complications in Hypothyroidism?
A
- Slow deep tendon reflexes,with a prolonged relaxation phase
- Fatigue and lethargy
- Mental slowness
- Perinatal intellectual disability
11
Q
Cardiac Complications in Hypothyroidism?
A
- Bradycardia
- Decreased Contractility, Stroke Volume, Cardiac Output
- Increased LDL levels
12
Q
Dermatologic Complications in Hypothyroidism?
A
- Coarse, brittle hair andnails
- Dry, sometimes yellow skin
- Facial & periorbital myxedema
13
Q
Endocrine Complications of Hypothyroidism?
A
Hyperprolactinemia
14
Q
GI Complications of Hypothyroidism?
A
Constipation (d/t decreased gut motility)
15
Q
Only serious complication of Hypothyroidism?
A
Myxedema Coma
16
Q
Clinical Presentation of Myxedema Coma?
A
- Hypothermic stupor/coma
- Hypoventilation with CO2 retention
- Hypotension
17
Q
Treatment of Myxedema Coma?
A
- Respiratory support
- Intravenous levothyroxine
- Cortisol
18
Q
Causes of Primary Hypothyroidism?
A
- Iodine deficiency
- Hashimoto thyroiditis (chronic autoimmune thyroiditis)
- Surgical thyroid removal or thyroid ablation (surgical orI-131 radiation)
- Drugs(notably lithium, amiodarone or sulfonamides)
- Other types of thyroiditis (subacute lymphocytic, subacute granulomatous,Riedel’s etc)
19
Q
Clinical Presentation of Congenital Hypothyroidism?
A
- Poor brain development
- Pot-bellied
- Pale
- Puffy-faced
- Protruding umbilicus
- Protuberant tongue
20
Q
Serum TSH levels seen in primary, secondary, and tertiatry hypothyroidism?
A
-Primary hypothyroidism (caused by thyroid hypofunction),TSH levels will be increased.
- ## Secondary hypothyroidism (caused by pituitary hypofunction), TSH levels will be decreased.Tertiary hypothyroidism: (caused by hypothalamic hypofunction),TSH levels will benormal/low-normal,
21
Q
Clinical Presentation of Acute Thyrioditis?
A
- Fever
- Painful thyroid
- Painful cervical lymphadenopathy
22
Q
Cause of Subacute Granulomatous Thyroiditis (DeQuervian)?
A
- Mumps
- Coxsackie virus
23
Q
Clinical Presentation of Subacute Granulomatous Thyroiditis?
A
- Sore throat and fever
- Jaw pain
- Tender thyroid
- Elevated ESR
- No lymphadenopathy
24
Q
Treatment for Subacute Granulomatous Thyroiditis?
A
- Aspirin
Usually Self-limiting within weeks
25
Clinical Presentation of Subacute Lymphocytic Thyroiditis?
Non-tender thyroid in postpartum women
26
What is Riedel Thyroiditis?
When Fibrous tissue replaces thyroid paremchyma-> Hypothyroidism
27
Physical Exam Findings in Riedel thyroidiits?
- Rock hard, fixed thyroid
| - Painless
28
Etiologies of Primary Adrenal Insufficiency?
- Adrenal atrophy or autoimmune destruction
- Granulomatous infection (eg, tuberculosis)
- Metastasis to adrenal glands (Lung, breast cancers)
- HIV
- Infarction of the adrenal gland
- Waterhouse-Friderichsen syndrome
- Disseminated intravascular coagulation
29
Manifestations of decreased aldosterone and cortisol in Primary Adrenal Insufficiency?
- Hyponatremia (volume contraction → HYPOtension)
- Hyperkalemia
- Hypoglycemia
- Increased skin pigmentation*
30
Causes of Secondary Adrenal Insufficiency?
Insufficient ACTH secretion from pituitary
31
Manifestations of decreased cortisol (aldosterone is normal) in Secondary Adrenal Insufficiency?
- Hypoglycemia
| - Low testosterone
32
Diagnostic Testing for Adrenal Insufficiency?
- 8 AM serum cortisol
- Plasma ACTH levels
- ACTH (cosyntropin) stimulation test
33
What is indicated if a ACTH analog is given and there is no increase in cortisol levels?
Primary Adrenal Insufficiency
34
ACTH, Aldosterone, Renin levels in Primary Adrenal Insufficiency?
- Elevated ACTH
- Low aldosterone
- Elevated renin
35
ACTH, Aldosterone and Renin levels in Secondary Adrenal Insufficiency?
- Decreased ACTH
- Normal aldosterone
- Normal renin
36
Most severe complication of adrenal insufficiency?
Shock (Adrenal Crisis)
37
What is the next best step for a thyroid nodule with Normal/Elevated serum TSH levels? Low TSH levels?
- Normal/Elevated: Fine Needle Biospy
| - Low: Thyroid Scintigraphy (Contraindicated in pregnancy)
38
Ultrasound Findings of a thyroid nodule that are suggestive of a malignancy?
- Hypoechoic nodule
- Microcalcifications
- Progressive growth
- Extrathyroidal extension
- Irregular margins (infiltrative, microlobulated)
39
Hypocalcemia caused the release of what hormone?
Parathyroid Hormone (PTH)
40
Functions of Parathyroid Hormone (3)?
Aim to increase Serum Calcium:
- Increase Calcium reabsorption in Distal Convoluted Tubule
- Increase Calcium absorption in Intestines (by conversion of 25-OH Vit D to active 1,25 (OH)2 Vit. D)
- Decrease Phosphate Reabsorption
- Increase bone resorption (->Osteoclast Proliferation)
41
Diagnostic Workup for Thyroid Cancer?
1) Serum TSH
2) Ultrasound
3) Fine needle biopsy
4) Radionucleotide Scan
42
Factors that are indicative of Thyroid Cancer?
- Solid nodule palpated or seen on US
- Age (20-60) and increases with age
- Male
- Cold nodule on scintigram
- History of neck irradiation
43
The following histopathological findings are present in which thyroid carcinoma?
- Intranuclear cytoplasmic inclusions ("Orphan Annie eyes")
- Psammoma bodies (concentric calcium collections)
- Nuclear grooves
Papillary Carcinoma
* Lymphatic Spread*
* Excellent Prognosis*
44
MEN2A and MEN2B are associated with which thyroid carcinoma?
Medullary Carcinoma
45
Clinical Manifestations of Medullary Carcinoma?
- Malignant Parafollicular Cells
| - Cells stain positive for Amyloid
46
Surgical Invention in the presence of Thyroid Carcinomas?
- Surgical removal plus radioactive iodine ablation
- Lobectomy if nodule <1cm
- Total thyroidectomy if >1cm
*Patient placed on Levothyroxine*
