Thyroid and Parathyroid (Feirstein) Flashcards
What does the thyroid secrete? (3)
- T3
- T4
- Calcitonin
Differentiate Thyroglobulin and Thyroxine binding globulin (TBG)
Thyroglobulin is the protein that synthesizes and stores T3 and T4
TBG - T4 binds to this
What cardiovascular symptom can be seen in both hypo and hyperthyroid? What specifically in hypothyroidism?
HTN
Hypothryoid =diastolic hypertension
3 of the following 5 diagnostic criteria are needed to diagnose metabolic syndrome. What are they?
- HDL (<40 men, <50 women)
- HTN (>135/85)
- Fasting Triglycerides (>150)
- Fasting blood sugar (>100)
- Abdominal obesity (>40 men, >35 women)
Lab abnormalities in Hypothyroidism
- Hypercholesterolemia
- Hyponatremia
- Hypoglycemia
Most common etiology of hypothyroidism
- Autoimmune thyroiditis (Hashimoto’s)
- Iatrogenic (ex. radiation)
- Iodine deficiency
Hypothyroidism: screening
USPSTF: no evidence to recommend screening
-consider if risk factors (goiter, hx of autoimmunity, head/neck irradation, family history of thyroid disease, medication (ex. amiodorone, lithium)
What is the average dose for synthetic thyroxine (T4) replacement in hypothyroid patient
1.6 mcg/kg/day
What is the dose for an elderly patient needing thyroid replacement?
25 mcg/day
What is the starting dose for a patient with coronary heart disease and hypothyroidism?
25 mcg/day
How often must you monitor thyroid levels in a hypothyroid patient?
every 6 weeks
What are some key clinical presentation findings in a patient with hyperthyroidism?
- Exopthalmos*
- Limited EOMs*
- Loosing weight with increased appetite*
- anemia
- sweaty
- lid lag
- Low Total cholesterol and HDL
- Increased blood pressure
For whom is a 24 hour radioiodine uptake and scan contraindicated?
pregnant or breastfeeding women
In a radioiodine uptake scan what does high uptake and low uptake signify?
High uptake in Graves/Hyperthyroidism
Low uptake in hypothyroidism
Which of the two Thionaides is safe in pregnancy?
Propylthiouracil (PTU)
methimazole is not safe in pregnancy
Tx for subacute Thyroiditis (de Quervain’s, giant cells thyroiditis)
- viral illness association
- painful glandular enlargement with dysphagia*
Tx: ASA, or NSAIDs, or Prednisone
What will be shown on RAI (radioactive iodine) uptake in thyroiditis?
absent
Thyroid storm: management
- Beta blocker
- Propylthiouracil or Methimazole IV
- Oral Iodine solution (blocks release of thyroid hormone from gland)
- IV glucocorticoids
- Bile acid sequestrants
Things that you should be concerned about in a patient with a thyroid nodule
- Children
- Men
- Age <30 or >60
- Head/neck raditation
- Hematopoeitic stem cell transplant
- Family history of thyroid cancer
What lab value correlates with malignancy in regards to thyroid nodules?
TSH
FNA indications
Perform when:
- High risk history
- Abnormal cervical lymph nodes
- Micro-calcifications
- Solid
Thyroid carcinoma risk factors
- history of childhood head or neck irraditation
- Thyroid cancer in 1st degree relative
- Large nodule >4cm
Thyroid cancer types and prevalance
- Papillary (85%)
- Follicular (12%)
- Anaplastic (<3%) [this one is the worst!]
How do you monitor for thyroid carcinoma post treatment?
- Serum thyroglobulin level
- Anti-thyroglobulin antibodies
- Neck US
- TSH
