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Clin Lab Med > Thyroid and Parathyroid > Flashcards

Thyroid and Parathyroid Flashcards

1
Q

T4 is converted to T3 primarily where?

A

Liver

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2
Q

What is the best initial test to check thyroid function?

A

TSH levels

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3
Q

TSH levels are tightly regulated by levels of what?

A

Serum levels of T4 and T3

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4
Q

FT4 is more diagnostically relevant than TT4 and is used to evaluted what hormone?

A

TSH levels

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5
Q

Thyroid peroxidase antibodies (TPO Ab) is most often found in?

A

Hypothyroidism (Hashimoto’s)

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6
Q

Thyroglobin antibodies (TgAb) is most often found in?

A

Hypothyroidism (Hashimoto’s)

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7
Q

Thyrotropin receptor antibody (TRAb) is most often found in?

A

Hyperthyroidism (Grave’s)

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8
Q

What functional study is used to evaluted suppressed TSH?

A

Radioactive Iodine/thyroid uptake scan

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9
Q

What imaging study is used to assess structure of the thyroid gland tissue and nodules?

A

US

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10
Q

What is the single most accurate, reliable, cost effective test to DX thyroid CA?

A

Fine needle aspiration

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11
Q

Endogenous hyperthyroidsm is due to what?

A

Overproduction of thyroid hormone

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12
Q

What are the 4 most common causes of endogenous hyperthyroidism?

A

Graves’ disease, toxic multinodular goiter (MNG), toxic adenoma, thyroiditis

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13
Q

What are the most common causes of exogenous (iatrogenic) hyperthyroidism? (2)

A

Over-replacement in hypothyroidism, suppressive therapy (intentional for thyroid cancer)

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14
Q

What lab values would you expect to see with primary hyperthyroidism?

A

Low TSH, high FT4, high T3

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15
Q

What is the most common cause of primary hyperthyroidism?

A

Grave’s disease

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16
Q

What lab values would you expect to see with subclinical hyperthyroidism?

A

Low TSH, normal FT4, normal T3

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17
Q

What lab values would you expect to see with T3 toxicosis?

A

Low TSH, normal FT4, high T3

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18
Q

Opthalmopathy (exophthalmos, proptosis) is a common sign of what?

A

Graves’ disease

19
Q

Radioactive iodine uptake and scan is used to evaluate what?

A

Hyperthyroidism

20
Q

What uptake % is normal on radioactive iodine uptake and scan?

A

15% uptake after 6 hrs

21
Q

Diffuse high/ elevated uptake on radioactive iodine uptake and scan indicates what?

A

De novo synthesis of hormone

22
Q

Diffuse low/decreased uptake after a radioactive iodine and uptake sckin can indicate what? (2)

A

Inflammation/destruction of thyroid tissues (thyroiditis) or extrathyroidal source of thyroid hormone (factitious thyrotoxicosis)

23
Q

What will Graves’ show on a radioactive iodine and uptake scan?

A

Diffuse uptake

24
Q

What will a nodule or toxin MNG show on a radioactive iodine and uptake scan?

A

Irregular uptake

25
Q

What is indicated by a hyperfunctioning “hot” nodule? (2)

A

Increased irregular uptake, rarely malignant

26
Q

What is indicated by a hypofunctioning “cold” nodule? (2)

A

Decreased irregular uptake, more likely to be malignant

27
Q

If you identify a cold nodule on radioactive iodine scan, what additional test should you consider?

A

FNA

28
Q

What are the treatment options for Graves’? (4)

A

Beta blockers (sx control), antithyroid drugs (Methimazole, PTU), radioactive iodine ablation, surgery

29
Q

What is the most common cause of primary hypothyroidism?

A

Hashimoto’s thyroiditis (autoimmune)

30
Q

What are the 2 different types of central hypothyroidism?

A

Pituitary (secondary) or hypothalamic (tertiary)

31
Q

What will TSH and FT4 levels show with central hypothyroidism?

A

Both low (T3 also low)

32
Q

If TSH and FT4 levels are low and you suspect central hypothyroidism, what should the next step be?

A

Pituitary MRI

33
Q

What is the treatment for iatrogenic hypothyroidism?

A

Radioactive Iodine

34
Q

What medications can cause iatrogenic hypothyroidism? (4)

A

Lithium, amiodarone, other iodine-containing drugs, contrast agents

35
Q

What labs would you expect to see w/ primary hypothyroidism?

A

High TSH, low FT4, normal or low T3

36
Q

What labs would you expect to see w/ subclinical hypothyroidism?

A

High TSH, normal FT4, normal T3

37
Q

In primary hypothyroidism, the serum TSH is increased in a reflex effort to stimulate what?

A

The failing gland (represented by low serum FT4)

38
Q

What are the most important considerations when treating hypothyroidism with levothyroxine replacement? (4)

A

Weight based, take on empty stomach, mindful of meds that interfere w absorption, goal = acheive euthyroid state and alleviate sxs

39
Q

Pt presents for a routine PE when you note a thyroid nodule. How do you proceed?

A

TSH and US first

40
Q

What % of nodules are benign vs cancerous?

A

95% benign, 5% cancerous

41
Q

Most cancerous thyroid nodules are what?

A

Papillary

42
Q

When evaluating a thyroid nodule, if TSH is N or elevated, what should be ordered next?

A

Check for TPO antibodies

43
Q

If low TSH and low FT4 what is the most likely cause of hypothyroidism?

A

Central (secondary or tertiary)

Clin Lab Med (4 decks)

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