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clin med II, exam 4 > Thyroid and parathyroid disease > Flashcards

Thyroid and parathyroid disease Flashcards

1
Q

clinical presentation

  • generalized metabolic slowing
  • fatigue, weakness
  • cold intolerance
  • weight gain
  • decreased hearing
  • depression
  • menstrual changes, pubertal delay
  • bradycardia
A

Hypothyroidism

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2
Q

what would present with

  • high TSH
  • low T4
  • normal or low T3
A

primary hypothyroidism

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3
Q

what would present with

  • high TSH
  • normal T4
  • normal T3
A

subclinical hypothyroidism

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4
Q

what would present with

  • normal or low TSH
  • normal or low T4
  • normal or low T3
A

central hypothyroidism (pituitary and hypothalamic disorders)

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5
Q

What antibody tests do you expect to be elevated in Hashimotos thyroiditis

A
  • anti thyroid peroxidase (TPO) antibody
  • Anti thyroglobulin (Tg) antibody
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6
Q

What antibody tests do you expect to be elevated in Graves disease

A

TSH receptor antibody (TRAb)

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7
Q

What is the most common cause of hypothyroidism

A

hashimoto’s thyroiditis (chronic autoimmune thyroiditis)

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8
Q

is hashimoto’s thyroiditis more common in males or females

A

F>M 7:1

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9
Q

increase risk of hashimoto’s thyroiditis associated with

A
  • down syndrome
  • turners syndrome
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10
Q

hashitoxicosis

A

transient hyperthyroidism related to early inflammation

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11
Q

precipitating factors to getting hashimoto’s thyroiditis

A
  • stress
  • infection
  • pregnancy
  • iodine intake
  • radiation exposure
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12
Q

management of hypothyroid

A
  • synthetic thyroxine (T4) replacement
    • leveothyroxine 1.6 mcg/kg/day
  • monitoring is important: 6 week f/u to evaluate dosage
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13
Q

definition of subclinical hypothyroidism

A
  • elevated TSH with normal T4
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14
Q

what risks are associated with subclinical hypothyroidism

A
  • CV disease
  • nonalcoholic fatty liver
  • neuropsychiatric
  • miscarriage and low birth weight babies
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15
Q

managment of subclinical hypothyroidism

A
  • repeat TSH and T4 after 1-3 months to confirm dx
    • TSH > 10: tx recommended
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16
Q

Hyperthyroidism most commonly affects what patient population

A
  • W > M 5:1
  • smokers
  • graves: younger women
  • toxic nodular goiter: older women
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17
Q

clinical presentation

  • exophthalmos, goiter
  • weight loss
  • tachycardia
  • osteoporosis
A

Hyperthyroidism

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18
Q

what presents with

  • Low TSH
  • High Free T4 and T3
A

Hyperthyroidism

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19
Q

what presents with

  • Low TSH
  • normal Free T4 and T3
A

subclinical Hyperthyroidism

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20
Q

Hyperthyroidism has what effect on glucose tolerance

A
  • impairs glucose tolerance
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21
Q

What does high uptake and low uptake mean on a 24 hour radioiodine uptake and scan

A
  • high uptake: de novo synthesis of hormone
  • low uptake: inflammation/destruction of thyroid gland or extrathyroidal source of thyroid hormone
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22
Q

contraindications to 24 hour radioiodine uptake and scan

A
  • pregnancy
  • breast feeding
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23
Q

24 hour radioiodine uptake and scan: HOT -> normal to high radioiodine uptake is consistent with what conditions

A
  • Graves
  • hashitoxicosis
  • toxic nodular goiter
  • iodine induced
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24
Q

24 hour radioiodine uptake and scan: COLD -> near absent radioiodine uptake is consistent with what conditions

A
  • exogenous ingestion of hormone
  • thyroiditis
  • CA? FNA?
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25
Q

clinical presentation

  • lid retraction, stare, Exophthalmos, periorbital edema
  • pretibial myxedema
  • non nodular goiter
  • hyperthyroidism symptoms
A

graves disease

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26
Q

graves disease is caused by

A

autoantibodies to thyrotropin receptor (TRAb)

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27
Q

What causes Toxic Multinodular goiter/Toxic adenoma

A
  • diffuse or focal hyperplasia of follicular cells
    • likelihood increases with age and iodine deficiency
28
Q

what is a toxic adenoma

A

nodule with increased radioiodine uptake

29
Q

what is a Toxic Multinodular goiter

A

palpable or defined goiter with multiple nodules

  • focal area of increased radioiodine +/- cold spots
  • concerning symptoms: cough, dysphagia, dyspnea
30
Q

medication management of hyperthyroidism

A
  • beta blocker: atenolol
  • thionamides: added to BB for severe dx
    • Methimazonle: daily dosing
    • Propylthiouracil: preferred in pregnancy
31
Q

first line treatment for hyperthyroidism

A
  • radioiodine ablation
    • typically provided following thionamide
32
Q

tx of toxic adenoma/MNG

A

surgery

33
Q

What are some other names of Subacute thyroiditis

A
  • granulomatous
  • de Quervain’s
  • gaint cell thyroiditis
34
Q

Subacute thyroiditis is most common in what patient population

A

middle aged females

35
Q

Subacute thyroiditis is associated with what

A
  • URI
36
Q

clinical presentation

  • acute severely painful glandular enlargement (goiter)
  • fever, fatigue
  • can persist weeks to months
A

Subacute thyroiditis

37
Q

how is Subacute thyroiditis diagnosed?

A
  • clinical presentation
    • predictable phases: hyperthyroid, euthyroid, hypothyroid, recovery (euthyroid)
    • ESR and CRP elevated
38
Q

treatment of Subacute thyroiditis

A
  • ASA or NSAID
  • prednisone if no improvement in several days
39
Q

thyroid screening is recommended

A
  • not in favor of routine screening
40
Q

What factors put someone at a higher concern for cancerous thyroid nodules

A
  • kids, men, adults < 30 or > 60
  • hx head/neck radiation
  • hx hematopoietic stem cell transplant
  • fam h/o thyroid ca
41
Q

Thyroid nodules 3 step approach

A
  1. history and physical
  2. TSH
  3. thyroid US
42
Q

high risk patients should have thyroid biopsy if nodule is

A
  • 5-10 mm
  • all solid nodules: 5 mm
43
Q

low risk patients should have thyroid biopsy if nodule is

A
  • solid nodule: 10-15 mm (Hypoechoic: 10 mm)
  • mixed cystic and solid: 15-20 mm
44
Q

when is FNA/biopsy indicated for all patients

A
  • all patients with cervical lymphadenopathy
45
Q

is FNA/biopsy indicated if nodule is purely cystic

A

no

46
Q

Thyroid carcinoma is more common in what patient population? What worsens the prognosis?

A
  • more common in females
  • worse prognosis
    • < 20 yo
    • > 45 yo
    • male
47
Q

Causes of differentiated thyroid CA

A
  • papillary: most common
  • follicular
48
Q

Causes of undifferentiated thyroid CA

A
  • anaplastic
    • poor prognosis
49
Q

Causes of familial thyroid CA

A
  • medullary
    • test for RET mutations as a genetic marker
50
Q

Management of thyroid ca

A
  1. surgery
  2. radioiodine ablation (follows surgery)
  3. thyroid hormone suppression
    • levothyroxine
51
Q

Hypoparathyroidism causes

A
  • acquired
    • ​usually occurs post-thyroidectomy
    • rarely, neck irradation
  • autoimmune
  • congenital
52
Q

clinical presentation

  • tetany
  • sz
  • weakness
  • heart failure, hypotension, arrhythmia, prolonged QT interval
  • papilledemia
A

acute Hypoparathyroidism

53
Q

what specialized tests should you do when assessing for Hypoparathyroidism

A
  • Trousseau’s sign
  • Chvostek’s sign
54
Q

clinical presentation

  • ectopic calcifications
  • parkinsonism
  • dementia
  • cataracts
  • dry, coarse skin
  • impaired dentition
  • brittle nails
  • hair loss
  • renal stones, renal failure
A

chronic Hypoparathyroidism

55
Q

what lab results would you expect in Hypoparathyroidism

  • serum Ca2+
  • serum phosphate
  • urinary Ca2+
  • alk phos
  • PTH
  • magnesium
A
  • serum Ca2+: Low
  • serum phosphate: High
  • urinary Ca2+: Low
  • alk phos: Nml
  • PTH: Low
  • magnesium: often elevated
56
Q

tx for acute, emergent hypoparathyroidism

A
  • IV calcium gluconate
57
Q

treatment for chronic hypoparathyroidism

A
  • calcium and vit D supplementation
58
Q

most common cause of primary hyperparathyroidism

A

parathyroid adenoma

59
Q

causes of secondary hyperparathyroidism

A
  • chronic renal failure
  • vit D deficiency
  • renal osteodystrophy
60
Q

clinical presentation

  • asymptomatic hypercalcemia
  • bones, stones, abdominal moans, psychiatric groans”
    • ​fragile bones
    • kidney stones, DI
    • abd pain, N/V
    • psychosis, depression
A

hyperparathyroidism

61
Q

what lab results would you expect in secondary hyperparathyroidism

  • serum calcium
  • serum phosphate
  • PTH
A
  • serum calcium: low
  • serum phosphate
    • high (renal)
    • low (Vit D)
  • PTH: high
62
Q

what diagnostics would you get to assess for hyperparathyroidism

A
  • DEXA scan
  • kidney function
    • 24 hr urine
  • parathyroid US
  • sestabibi parahyroid scan (radioactive) with CT scan
63
Q

definitive tx of hyperparathyroidism

A
  • surgery: parathyroidectomy
    • may be hypocalcemic post-op
64
Q

conservative tx of hyperparathyroidism

A
  • physical activity
  • fluids
  • avoid lithium and HCTZ
  • restrict Ca2+ intake
65
Q

medical management of primary hyperparathyroidism

A
  • IV bisphosphonates
    • can temporarily decrease hypercalcemia and treat bone pain
      • pamidronate
      • zoledronic acid
66
Q

medical management of secondary or tertiary hyperparathyroidism

A
  • phosphate binders: calcium carbonate or calcium acetate
  • calcimimetics
  • vitamin D

clin med II, exam 4 (6 decks)

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