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Clin Med II FINAL (Annie & Lauren) (the answer is always lifestyle modifications) > Thyroid And Parathyroid 🦋 > Flashcards

Thyroid And Parathyroid 🦋 Flashcards

1
Q

How will someone with hypothyroidism present?

A

Fatigue, weakness

Cold intolerance

Weight gain

Cognitive dysfunction (“fog”)

Constipation

Pubertal delay

Menstrual changes

Myalgia, arthralgia

Decreased hearing

Depression

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2
Q

How will hypothyroidism affect blood pressure?

A

Diastolic BP increases

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3
Q

How does hypothyroidism affect your skin, hair and nails?

A

Dry skin

Thinning hair

Brittle nails

Eyebrows fall out

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4
Q

How will hypothyroidism affect the face and neck?

A

Puffy facies

Periorbital edema

Tongue enlargement

Goiter**

Loss of eyebrows

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5
Q

How will hypothyroidism affect DTRs?

A

Delayed

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6
Q

Primary hypothyroidism (aka the gland itself is messed up):

TSH:

Free T4/T3:

A

TSH: high

Free T4/T3: low

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7
Q

Central hypothyroidism:

TSH:

Free T4/T3:

A

TSH: low or normal

Free T4/T3: low or normal

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8
Q

Subclinical hypothyroidism

TSH:

Free T4/T3:

A

TSH: high

Free T4/T3: normal

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9
Q

What is primary hypothyroidism?

A

There is something wrong with the thyroid gland itself

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10
Q

What is central hypothyroidism?

A

Something is wrong with the pituitary or hypothalamus and they’re not making TSH or TRH

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11
Q

What 2 antibodies would you expect to see high levels of in Hashimoto’s Thyroiditis?

A

Anti Thyroid Peroxidase antibody (TPO Ab)

Antithyroglobulin Antibody (TgAb)

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12
Q

In what two conditions may Anti Thyroid Peroxidase antibody (TPO Ab) be elevated?

A

Hashimotos Thyroiditis***

Grave’s disease

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13
Q

What antibody is used to monitor thyroid cancer?

A

Antithruglobulin Antibody (TgAb)

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14
Q

In what two conditions may Antithyroglobulin Antibody (TgAb) be high?

A

Hashimoto’s thyroiditis ***

Graves’ disease

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15
Q

Is TSH Receptor Antibody (TRAb) seen in Underactive or Overactive thyroid?

A

Overactive

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16
Q

Will TSH Receptor Antibody (TRAb) be positive in Hashimotos?

A

May or may not be

Have nooo idea what this slide meant

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17
Q

Will TSH Receptor Antibody (TRAb) be positive in Graves’ disease

A

Yes

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18
Q

What is the main cause of primary hypothyroidism

A

Hashimotos

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19
Q

What is the most common cause of hypothyroidism?

A

Hashimotos

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20
Q

What causes HAshimotos?

A

Autoimmune attack on thyroid that causes a gradual loss of thyroid function.

Caused by a combo of genetic and environmental factors

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21
Q

What two syndromes are associated with a higher risk for hashimotos?

A

Down syndrome

Turner’s syndrome

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22
Q

What is Hashitoxicosis?

A

It is transient HYPERthyroidism that happens at the beginning inflammation of Hashimoto’s.

(Thyroid dumps out a ton of thyroid hormones before becoming hypo)

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23
Q

What are some precipitating factors that may cause hashimotos to develop?

A

Stress

Pregnancy*

Infection

Iodine intake

Radiation exposure

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24
Q

Do women or men get hashimotos more?

A

Women 7x more

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25
Q

How do you treat hypothyroidism?

A

Synthetic Thyroxine (T4)

=Levothyroxine (Synthroid, Levothroid, Levoxyl)

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26
Q

What is the goal of synthetic T4 replacement therapy?

A

Maintain a euthyroid state (0.5-5.0), relieve sx, and decrease goiter size

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27
Q

How do you dose Levothyroxine?

A

Start at 1.6 mcg/kg/day and then titrate up or down at the 6 week follow up

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28
Q

Who needs a lower dose of Levothyroxine ?

A

Elderly

Patients with heart problems

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29
Q

What time of day do patients need to take their Levothyroxine?

A

Empty stomach one hour before breakfast**

Need to absorb ALL of it

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30
Q

Do we need to monitor TSH and free T4 while a patient is on Levothyroxine ?

A

Yes of course you do

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31
Q

What is subclinical hypothyroidism?

A

Elevated TSH with normal T4

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32
Q

How will a patient with subclinical hypothyroidism present?

A

Non-specific symptoms like “Fatigue”

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33
Q

WHat can happen if you don’t treat subclinical hypothyroidism?

A

CV disease

Fatty liver

Miscarriage and Low birth weight babies**

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34
Q

WHat should you do if your patient looks like they have subclinical hypothyroidism (i.e., high TSH, normal T4)?

A

Repeat TSH and T4 in 1-3 months to confirm the diagnosis

BUT if they are pregnant or on fertility treatment, you need to repeat it IMMEDIATELY

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35
Q

When do you need to give treatment for subclinical hypothyroidism?

A

If TSH is 10 or more, definitely treat

If TSH is 4.5-9.9, treatment is controversial based on age and symptoms

And of course, if they are pregnant or doing fertility treatment

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36
Q

What is the biggest complication of hypothyroidism?

A

Myxedma Coma

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37
Q

What is Myxedema coma?

A

Hypothermia, bradycardia, severe hypotension, seizures, coma.

Brought on by cold weather or illness.

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38
Q

Who usually gets myxedema coma?

A

Old patients who have had long-standing profound hypothyroidism

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39
Q

How do you treat myedema coma?

A

IV bolus T4

IV Hydrocortisone

Hypertonic saline

Supportive

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40
Q

Is hyperthyroidism more comon in women or men

A

Women 5x more

Especially older women and smokers

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41
Q

What usually causes hyperthyroidism in younger women?

A

Graves’ disease

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42
Q

What usually causes hyperthyroidism in older women?

A

Toxic nodular goiter

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43
Q

How will someone with hyperthyroidism present?

A

They will look like they’re on speed:
Fast HR

AFib**

Weight loss

Sweating

Stare and lid lag**

Exopthalmos**

Diarrhea*

Insomnia, restlessness

Tremor

Peeing a lot

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44
Q

Hyperthyroidism

TSH:

Free T4/T3:

A

TSH: low

Free T4/T3: high

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45
Q

Subclinical hyperthyroidism:

TSH:

Free T4/T3:

A

TSH: low

Free T4/T3: normal

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46
Q

When you suspect something might be wrong with your patient’s thyroid, what lab test do you order?

A

“TSH with Reflux Free T4”

Which means: check TSH first, and if that is abnormal, then check free T4

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47
Q

Why do we check “Free” T4

A

Because T4 is 99% protein bound

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48
Q

When would you order a “total” T4

A

Never, there is no use

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49
Q

What immunoglobulins will be positive in Grave’s disease?

A

Thyroid-Stimulating Immunoglobulins (TSI)**

Thyroid-binding Inhibitory Immunoglobulin (TBII)

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50
Q

Will TSH Receptor Antibody (TRAb) be positive in Graves’ disease?

A

Yes

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51
Q

Will Anti Thyroid Peroxidase antibody (TPO Ab) be elevated in BOTH Hashimotos and Graves?

A

Yes, but it will be much higher in Hashimotos

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52
Q

Will Anti Thyroglobulin Antibody (TgAb) be elevated in BOTH Hashimotos and Graves?

A

Yes, but it will be much higher in hashimotos

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53
Q

What will cause normal-high radioiodine uptake test results?

A

Anything that causes increased de novo synthesis of thyroid hormone:

Graves’ disease

Hashitoxicosis

Toxic adenoma or toxic nodular goiter

Autonomous nodules (HOT)🔥🔥**

Iodine deficiency

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54
Q

What will cause a nearly-absent radioiodine uptake scan?

A

Exogenous Thyroid hormone aka taking Levothyroxine

Nonfunctioning nodules- COLD❄️❄️***

Thyroiditis (subacute, painless, radiation, iodine-induced)

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55
Q

If you see a non functioning COLD ❄️ nodule on a thyroid uptake and scan, what do you need to consider?

A

You should think that it is cancerous and do a Fine Needle Aspiration

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56
Q

What increases the risk of developing Graves’ disease?

A

Genetics

Stress

Smoking

Thyroid injury

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57
Q

What is the most common feature of Graves’ disease?

A

hyperthyroidism

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58
Q

How will a patient with Graves’ disease present?

A

Graves ophthalmopathy**: lid retraction, lid lag, stare, proposes, periorbital edema

Pretibial Myxedema** skin on shins is weird

Non-nodular goiter

Other sx of hyperthyroidism

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59
Q

If someone has Low TSH and Elevated Free T4/T3, as well as TRAb antibodies, and Orbitopathy, what is the next test you need to do?

A

Thyroid uptake and scan

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60
Q

What is a Toxic Multinodular Goiter?

A

A goiter with multiple nodules that is caused by hyperplasia of follicular cells.

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61
Q

What is the 2nd most common cause of hyperthyroidism?

A

Toxic Multinodular Goiter (MNG)

“Toxic” means overactive

62
Q

What is a toxic adenoma?

A

A nodule with increased radioiodine uptake

63
Q

What are some concerning symptoms when someone has toxic adenoma or toxic MNG?

A

Cough

Dyspnea

Dysphagia

OBSTRUCTIVE SYMPTOMS* needs IMEMDIATE TREATMENT

64
Q

If you look at a thyroid uptake and scan and you see Focal areas of increased radioiodine +/- “cold spots,” what do you have

A

Toxic adenoma or toxic MNG

??????

65
Q

If you are unable to differentiate a toxic adenoma or toxic MNG from Grave’s disease, what should you look at?

A

Antibodies

66
Q

How do you treat hyperthyroidism (other than surgery/ablation)?

A

Atenolol 25-50mg daily****

Aspirin*** to prevent clots from AFib

Thionamides for severe sx: (Methimazole or PTU)

Avoid strenuous activity (HR and BP are already too high)

67
Q

What are the two thinoamides?

A

Methimazole

Propylthiouracil (PTU)- preferred in pregnancy🤰🏻

68
Q

What are thionamides taken for?

A

hyperthyroidism

69
Q

What is the first line definitive treatment for hyperthyroidism?

A

Radioiodine ablation

70
Q

How is radioiodine ablation done?

A

Patient takes a thinoamide (PTU/Methimazole) for awhile

Takes a single dose of I131 (radioactive iodine)

=thyroid dead

71
Q

If you get a a radioiodine ablation, who do you need to avoid for 3 weeks

A

Childern

Pregnant women

72
Q

Radioiodine ablation is contraindicated for:

A

Pregnant women

Women who want to get pregnant in the next few years and active ophthalmopathy (???)

73
Q

When would we do surgery for hyperthyroidism (instead of radioiodine ablation)

A

Toxic adenoma/MNG***

Large goiter with obstructive sx

Pts with moderate-severe ophthalmopathy

74
Q

What are the complications of hyperthyroidism?

A

Permanent exopthalmos

Osteoporosis

Stroke, AFib, CHF

Thyroid storm**

75
Q

Is a thyroid storm an emergency?

A

Yes

76
Q

What can cause thyroid storm?

A

Major stress*

Surgery

Radioiodine ablation**

Iodine contrast

Inadequate treatment

77
Q

What are the symptoms of a thyroid storm?

A

Vomiting/diarrhea

Confusion/delirium

Tachyarrythimas

Dehydration

Fever

Coma

78
Q

How do you treat thyroid storm?

A

Fluid replacement

Anti-arrhythmia meds

IV PTU

Electrolyte stabilization

79
Q

What are the other names for subacute thyroiditis?

A

Granulomatous

De Quervain’s

Giant cell thyroiditis

80
Q

What happens before subacute thyroiditis?

A

Viral Illness or URI**!!!!!!!!!!*!!!**!

81
Q

Who usually gets subacute thyroiditis?

A

Young to middle-age women

82
Q

How will a pt with subacute thyroiditis present?

A

Acute, SEVERELY painful glandular enlargement (goiter)đź’Ąđź’Ąđź’Ą***

Radiating pain to jaw, chest, etc

Fever, fatigue, malaise, anorexia, myalgia

83
Q

True or false:

Subacute thyroiditis is an inflammatory process

A

True

~~~~INFLAMMATORY~~~~~~

84
Q

What is the progression of subacute thyroiditis?

A

Hyperthyroid

Euthyroid

Hypothyroid

Recovery (Euthyroid)

This is a PREDICTABLE progression of phases

**THIS WAS CIRCLED IN BLUE**

85
Q

How do you treat subacute thyroiditis?

A

NSAIDs/Aspirin

Prednisone

We DON’T block the thyroid or give levothyroxine: all we do is try to bring down inflammation

86
Q

Who needs to be screened for thyroid disorders?

A

EVERYONE over 60***

Goiter

Hx of autoimmune disease

Prior radioactive iodine therapy

Family hx of thyroid disease

Certain meds: lithium**, amiodarone*, aminoglutethimind, interferon a, thalidomide, betaroxine, stavudine

(Probably only need to know lithium and amiodarone)

87
Q

What are the 4 types of thyroid cancer in order of most common to least common***

A

Papillary 76%

Follicular 16%

Medullary 4%

Anaplastic 1% (VERY aggressive)

88
Q

So you find a thyroid nodule. Now what do you need to know/

A

Is it cancer?

Is it causing thyroid dysfunction?

89
Q

A thyroid nodule in what groups of people should make you very concerned about cacner?

A

Kids

Men**

Younger than 30

Older than 60

Head/neck radiation

Stem cell transplant

Family hx of thyroid cancer

90
Q

When is a thyroid nodule more concerning: in a man or in a woman?

A

Man

Women get benign nodules alll the time so we are less concerned

91
Q

How do you work up a thyroid nodule?

A
  1. History and exam to determine high or low risk
  2. Measure TSH
  3. Thyroid ultrasound (if concerning, ~then~ do FNA) ???
  4. Thyroid uptake and scan
  5. If nodule is COLD- do fine needle aspiration
  6. If nodule is HOT- DO NOT stick a needle in it!!

(This slide was sort of unclear!! I’m sorry!)

92
Q

(Hot/Cold) nodules are NOT cancer

A

Hot

93
Q

What happens if you stick a needle in a Hot nodule?

A

You will cause thyroid storm**

94
Q

As TSH levels go up, the likelihood of cancer (increases/decreases)

A

Increases

95
Q

What findings on a thyroid ultrasound are more likely to be malignant?

A

Hypoechoic**

Microcalcifications**

> 1cm and solid/hypoechoic

Irregular margins

Tall>wide

Extracapsular growth

Associated cervical nodes

96
Q

What findings on a thyroid ultrasound are more likely to be benign?

A

“Purely cystic” *****

Colloid

<1 cm without other suspicious characteristics

97
Q

Hypoechoic and Microcalcifications on a thyroid ultrasound should make you think (malignant/benign)

A

Malignant

98
Q

“Purely cystic” and “Colloid” on a thyroid ultrasound should make you think (Malignant/Benign)

A

Benign

99
Q

What is the procedure of choice to evaluate nodules and to select surgical candidates?

A

Fine Needle Aspiration Biopsy

100
Q

What is the most common result of a FNA biopsy?

A

Benign (60-75%)

101
Q

Is thyroid cancer more common in men or women

A

Women

102
Q

What ages have a worse prognosis for thyroid cancer?>

A

Younger than 20

Older than 45

103
Q

Do men or women have a worse prognosis of thyroid cacner

A

Men

104
Q

What are the 2 types of “Differentiated” thyroid cancer?

A

Papillary

Follicular
*******

105
Q

Which kind of thyroid cancer is “Undifferentiaed”?

A

Anaplastic

106
Q

Which has the highest cure rates:

Differentiated or Undifferentiated Thyroid Cancer

A

Differentiated

107
Q

What is the prognosis like for Anaplastic thyroid cacner

A

Poor

*****

108
Q

Which type of thyroid cancer is “Familial”?

A

Medullary

***

109
Q

Medullary Thyroid cancer is “Familial.” Can it also occur spontaneously?

A

Yes

**

110
Q

What genetic marker should you test for when you discover medullary thyroid cancer?

A

RET mutations

111
Q

What is the treatment for Thyroid cancer?

A

Surgery- total thyroidectomy

Radioiodine Ablation after surgery

Thyroid hormone suppression to prevent further growth- levothyroxine at lower therapeutic thresholds*****

Radiation/chemotherapy

112
Q

Hyper or Hypo thyroidism:

Brittle nails

A

Hypothyroidism

113
Q

Hyper or Hypothyroidism:

Cold intolerance

A

Hypothyroidism

114
Q

Hyper or Hypothyroidism:

Depression

A

Hypothyroidism

115
Q

Hyper or Hypothyroidism:

Increased Appetite

A

Hyperthyroidism

116
Q

Hyper or Hypothyroidism:

Hand tremors

A

Hyper

117
Q

Hyper or Hypothyroidism:

Frequent bowel movements

A

Hyper

🧻

118
Q

Hyper or Hypothyroidism:

Sleeplessness

A

Hyper

119
Q

What causes PTH to be released?

A

Low serum calcium

120
Q

What is the MOT common cause of hypoparathyroidism?

A

Damage after a thyroidectomy🔪

*****

121
Q

What are 2 other causes of Acquired hypoparathyroidism, other than damage during surgery?

A

Neck irradiation

Alcoholism

122
Q

Which the most common cause of hypoparathyroidism:
Acquired

Autoimmune

Congenital

A

Acquired (Due to damage during surgery)

123
Q

If you have hypoparathyroidism, what will your levels be:

Calcium:

PO4:

A

Calcium: Low

PO4: HIGH**

(Even though there’s less resorption of phosphate from the bone and gut, there’s a lot more phosphate reabsorption in the kidney, and the kidney always wins)

124
Q

What are the neuromuscular symptoms of hypoparathyroidism?

A

Tetany

Muscle twitching

Carpopedal spasms

Seizures

Weakness

Laryngospasm

Paresthesia

All due to hypocalcemia

125
Q

What are the cardiac symptoms of hypoparathyroidism?

A

Heart failure

Hypotension

Arrhythmia

Prolonged QT

126
Q

Chvostek’s Sign and Trousseau’s sign will be positive in what condition?

A

Hypocalcemia****

127
Q

Will Chvostek’s and Trousseau’s sign be positive in Hyper or hypoparathyroidism

A

Hypoparathyroidism (causes low calcium)

128
Q

What is Chvostek’s sign?

A

Spasm of the facial muscles following facial nerve tapping

129
Q

What is Trousseau’s sign?

A

Muscle spasm of the hand and wrist when you inflate a BP cuff around the upper arm

130
Q

What do you think this person has:

Ectopic calcification

Parkinsonism (jerky, spasms)

Dementia

Cataracts

Shitty teeth

Dry coarse skin

Brittle nails

Hair loss

Renal stones

A

Hypoparathyroidism

131
Q

Expected lab results for hypoparathyroidism:

PTH

Calcium

Magensium

Vit D

Phosphate

A

PTH: Low

Calcium: Low

Magnesium: Low

Vitamin D: normal/low

Phosphate: HIGH!!!!!!!**!!!

132
Q

How do you treat emergency hypoparathyroidism?

A

IV Calcium Gluconate

Airway maintenance (often need to be intubated due to all the spasms etc)

133
Q

How do you treat hypoparathyroidism once they are out of the “danger zone?” (No more tetany, seizures, prolonged QT)

A

Oral calcium 1-2 g/day

Vitamin D

Magensium if needed

134
Q

True or False:

We treat hypoparathyroidism with PTH replacement

A

False. We replace calcium

135
Q

What is the MOST common cause of PRIMARY hyperparathyroidism?

A

Parathyroid adenoma**!!! ON TEST

136
Q

What are three possible causes of primary hyperparathyroidism?

A

Parathyroid adenoma **MOST COMMON

Parathyroid hyperplasia

Parathyroid carcinoma (rare)

137
Q

What is the main cause of secondary or teritiary hyperparathyroidism?

A

Chronic renal failure!!**!*

Hyperphosphatemia and low renal Vitamin D production —> low calcium, which stimulates the parathyroid

138
Q

Expected lab values for hyperparathyroidism:

PTH:

Calcium:

Phosphate:

Magnesium:

A

PTH: high

Calcium: High

Phosphate: LOW**

Magensium: high

139
Q

What is the most common presentation of hypercalcemia?

A

Asymptomatic!!!
*****
Was bold, large, and had stars on it**

(Even though we have that little bones stones moans and groans thing for hyperparathyroidism)

140
Q

What does condition does “Bones, Stones, Abdominal Moans, Thrones, and Psychiatric Groans” refer to?

A

Hyperparathyroidism

141
Q

What are the symptoms of hyperparathyroidism that “Bones, Stones, Abdominal Moans, Thrones, and Psychiatric Groans” refers to?

A

Bones: arthralgia, bone pain*** MAIN SYMPTOM

Stones: kidney stones and diabetes insipidus

Abdominal moans: vague GI sx

Psychiatric groans: psychosis, depression delirium

Thrones: constipation and polyuria

142
Q

Lab values for Primary Hyperparathyroidism:

Calcium:

Phosphate:

PTH:

A

\Calcium: high**

Phosphate: low-normal**

PTH: high

143
Q

Lab values for secondary hyperparathyroidism

Calcium:

Phosphate:

PTH:

A

Calcium: LOW**

Phosphate: High if due to renal, and Low if due to vitamin D

PTH: High

144
Q

What diagnostic tests do you need to do if you suspect your patient has hyperparathyroidism?

A

DEXA scan- PTH is chewing up their bones!

Kidney function- 24 hr urine and imaging

Parathyroid ultrasound

Sestamibi parathyroid scan (radioactive) with CT scan- noooooo fuckin clue what this is

145
Q

What is the definitive treatment for hyperparathyroidism?

A

Parathyroidectomy

might need lifelong calcium supplementation after

146
Q

What is the conservative treatment for hyperparathyroidism (aka you’re not doing surgery)

A

Physical activity- keep bones strong

Hydration- no kidney stone

Avoid lithium and HCTZ- cause high calcium

Restrict calcium intake to 1g/day

Vit D

IV BisphosponatesProtects bones from PTH

147
Q

Whenever you measure PTH levels, you must ALWAYS measure ________ as well

A

Calcium levels**

148
Q

Hyperparathyroidism

Calcium:

PTH:

A

Calcium: high

PTH: high

149
Q

Hypoparathyroidism

Calcium:

PTH:

A

Calcium: low

PTH: low

150
Q

Hypercalcemia of malignancy

Calcium:

PTH:

A

Calcium: high

PTH: low

151
Q

Secondary Hyperparathyroidism (renal disease)

Calcium:

PTH:

A

Calcium: low

PTH: High

Clin Med II FINAL (Annie & Lauren) (the answer is always lifestyle modifications) (3 decks)

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