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Internal Medicine > Thyroid > Flashcards

Thyroid Flashcards

1
Q

Jod-Boseman phenomenon?

A

Iodine-induced Hyperthyroidism

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2
Q

Cardiac Complications of Hyperthyroidism?

A
  • Increased heart rate, contractility, cardiac output
  • Cardiomegaly
  • Hypercalcemia-induced ECG changes (d/t bone turnover)
  • Arrhythmia
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3
Q

Nervous System Complications of Hyperthyroidism?

A
  • Fine tremor (hands)
  • Anxiety
  • Insomnia
  • Emotional lability
  • Inability to concentrate
  • Brisk deep tendon reflexes
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4
Q

GI Complications of Hyperthyroidism?

A
  • Malabsorption

- Diarrhea

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5
Q

Endocrine Complications of Hyperthyroidism?

A
  • Increased bone turnover -> Osteoporosis

- Oligomenorrhea

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6
Q

Clinical Presentation of Hyperthyroidism?

A
  • Increased Basal Metabolic Rate, Tachypnea
  • Weight loss
  • Myopathy (muscle weakness)
  • Heat Intolerance
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7
Q

Diagnostic tests for Hyperthyroidism?

A

TSH, T3, T4

  • Primary Hyperthyroidism: Decreased TSH
  • Secondary Hyperthyroidism: Increased TSH
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8
Q

Treatment for Hyperthyroidism?

A
  • β-blockers
  • Thioamides
  • High-dose iodide
  • Radioactive iodine (131I)
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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
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10
Q

Neurologic Complications in Hypothyroidism?

A
  • Slow deep tendon reflexes,with a prolonged relaxation phase
  • Fatigue and lethargy
  • Mental slowness
  • Perinatal intellectual disability
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11
Q

Cardiac Complications in Hypothyroidism?

A
  • Bradycardia
  • Decreased Contractility, Stroke Volume, Cardiac Output
  • Increased LDL levels
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12
Q

Dermatologic Complications in Hypothyroidism?

A
  • Coarse, brittle hair andnails
  • Dry, sometimes yellow skin
  • Facial & periorbital myxedema
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13
Q

Endocrine Complications of Hypothyroidism?

A

Hyperprolactinemia

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14
Q

GI Complications of Hypothyroidism?

A

Constipation (d/t decreased gut motility)

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15
Q

Only serious complication of Hypothyroidism?

A

Myxedema Coma

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16
Q

Clinical Presentation of Myxedema Coma?

A
  • Hypothermic stupor/coma
  • Hypoventilation with CO2 retention
  • Hypotension
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17
Q

Treatment of Myxedema Coma?

A
  • Respiratory support
  • Intravenous levothyroxine
  • Cortisol
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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)
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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
Q

Clinical Presentation of Subacute Lymphocytic Thyroiditis?

A

Non-tender thyroid in postpartum women

26
Q

What is Riedel Thyroiditis?

A

When Fibrous tissue replaces thyroid paremchyma-> Hypothyroidism

27
Q

Physical Exam Findings in Riedel thyroidiits?

A
  • Rock hard, fixed thyroid

- Painless

28
Q

Etiologies of Primary Adrenal Insufficiency?

A
  • Adrenal atrophy orautoimmune 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
Q

Manifestations of decreased aldosterone and cortisol in Primary Adrenal Insufficiency?

A
  • Hyponatremia (volume contraction →HYPOtension)
  • Hyperkalemia
  • Hypoglycemia
  • Increased skin pigmentation*
30
Q

Causes of Secondary Adrenal Insufficiency?

A

Insufficient ACTH secretion from pituitary

31
Q

Manifestations of decreased cortisol (aldosterone is normal) in Secondary Adrenal Insufficiency?

A
  • Hypoglycemia

- Low testosterone

32
Q

Diagnostic Testing for Adrenal Insufficiency?

A
  • 8 AM serum cortisol
  • Plasma ACTH levels
  • ACTH (cosyntropin) stimulation test
33
Q

What is indicated if a ACTH analog is given and there is no increase in cortisol levels?

A

Primary Adrenal Insufficiency

34
Q

ACTH, Aldosterone, Renin levels in Primary Adrenal Insufficiency?

A
  • Elevated ACTH
  • Low aldosterone
  • Elevated renin
35
Q

ACTH, Aldosterone and Renin levels in Secondary Adrenal Insufficiency?

A
  • Decreased ACTH
  • Normal aldosterone
  • Normal renin
36
Q

Most severe complication of adrenal insufficiency?

A

Shock (Adrenal Crisis)

37
Q

What is the next best step for a thyroid nodule with Normal/Elevated serum TSH levels? Low TSH levels?

A
  • Normal/Elevated: Fine Needle Biospy

- Low: Thyroid Scintigraphy (Contraindicated in pregnancy)

38
Q

Ultrasound Findings of a thyroid nodule that are suggestive of a malignancy?

A
  • Hypoechoic nodule
  • Microcalcifications
  • Progressive growth
  • Extrathyroidal extension
  • Irregular margins(infiltrative,microlobulated)
39
Q

Hypocalcemia caused the release of what hormone?

A

Parathyroid Hormone (PTH)

40
Q

Functions of Parathyroid Hormone (3)?

A

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
Q

Diagnostic Workup for Thyroid Cancer?

A

1) Serum TSH
2) Ultrasound
3) Fine needle biopsy
4) Radionucleotide Scan

42
Q

Factors that are indicative of Thyroid Cancer?

A
  • Solid nodule palpated or seen on US
  • Age (20-60) and increases with age
  • Male
  • Cold nodule on scintigram
  • History of neck irradiation
43
Q

The following histopathological findings are present in which thyroid carcinoma?

  • Intranuclear cytoplasmic inclusions (“Orphan Annie eyes”)
  • Psammoma bodies (concentric calcium collections)
  • Nuclear grooves
A

Papillary Carcinoma

  • Lymphatic Spread*
  • Excellent Prognosis*
44
Q

MEN2A and MEN2B are associated with which thyroid carcinoma?

A

Medullary Carcinoma

45
Q

Clinical Manifestations of Medullary Carcinoma?

A
  • Malignant Parafollicular Cells

- Cells stain positive for Amyloid

46
Q

Surgical Invention in the presence of Thyroid Carcinomas?

A
  • Surgical removal plus radioactive iodine ablation
  • Lobectomy if nodule <1cm
  • Total thyroidectomy if >1cm

Patient placed on Levothyroxine

Internal Medicine (15 decks)

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