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Foundations III > Thyroid and Parathyroid (Feirstein) > Flashcards

Thyroid and Parathyroid (Feirstein) Flashcards

1
Q

What does the thyroid secrete? (3)

A
  • T3
  • T4
  • Calcitonin
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2
Q

Differentiate Thyroglobulin and Thyroxine binding globulin (TBG)

A

Thyroglobulin is the protein that synthesizes and stores T3 and T4

TBG - T4 binds to this

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3
Q

What cardiovascular symptom can be seen in both hypo and hyperthyroid? What specifically in hypothyroidism?

A

HTN

Hypothryoid =diastolic hypertension

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4
Q

3 of the following 5 diagnostic criteria are needed to diagnose metabolic syndrome. What are they?

A
  1. HDL (<40 men, <50 women)
  2. HTN (>135/85)
  3. Fasting Triglycerides (>150)
  4. Fasting blood sugar (>100)
  5. Abdominal obesity (>40 men, >35 women)
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5
Q

Lab abnormalities in Hypothyroidism

A
  • Hypercholesterolemia
  • Hyponatremia
  • Hypoglycemia
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6
Q

Most common etiology of hypothyroidism

A
  1. Autoimmune thyroiditis (Hashimoto’s)
  2. Iatrogenic (ex. radiation)
  3. Iodine deficiency
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7
Q

Hypothyroidism: screening

A

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)

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8
Q

What is the average dose for synthetic thyroxine (T4) replacement in hypothyroid patient

A

1.6 mcg/kg/day

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9
Q

What is the dose for an elderly patient needing thyroid replacement?

A

25 mcg/day

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10
Q

What is the starting dose for a patient with coronary heart disease and hypothyroidism?

A

25 mcg/day

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11
Q

How often must you monitor thyroid levels in a hypothyroid patient?

A

every 6 weeks

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12
Q

What are some key clinical presentation findings in a patient with hyperthyroidism?

A
  • Exopthalmos*
  • Limited EOMs*
  • Loosing weight with increased appetite*
  • anemia
  • sweaty
  • lid lag
  • Low Total cholesterol and HDL
  • Increased blood pressure
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13
Q

For whom is a 24 hour radioiodine uptake and scan contraindicated?

A

pregnant or breastfeeding women

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14
Q

In a radioiodine uptake scan what does high uptake and low uptake signify?

A

High uptake in Graves/Hyperthyroidism

Low uptake in hypothyroidism

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15
Q

Which of the two Thionaides is safe in pregnancy?

A

Propylthiouracil (PTU)

methimazole is not safe in pregnancy

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16
Q

Tx for subacute Thyroiditis (de Quervain’s, giant cells thyroiditis)

A
  • viral illness association
  • painful glandular enlargement with dysphagia*

Tx: ASA, or NSAIDs, or Prednisone

17
Q

What will be shown on RAI (radioactive iodine) uptake in thyroiditis?

A

absent

18
Q

Thyroid storm: management

A
  1. Beta blocker
  2. Propylthiouracil or Methimazole IV
  3. Oral Iodine solution (blocks release of thyroid hormone from gland)
  4. IV glucocorticoids
  5. Bile acid sequestrants
19
Q

Things that you should be concerned about in a patient with a thyroid nodule

A
  1. Children
  2. Men
  3. Age <30 or >60
  4. Head/neck raditation
  5. Hematopoeitic stem cell transplant
  6. Family history of thyroid cancer
20
Q

What lab value correlates with malignancy in regards to thyroid nodules?

A

TSH

21
Q

FNA indications

A

Perform when:

  1. High risk history
  2. Abnormal cervical lymph nodes
  3. Micro-calcifications
  4. Solid
22
Q

Thyroid carcinoma risk factors

A
  1. history of childhood head or neck irraditation
  2. Thyroid cancer in 1st degree relative
  3. Large nodule >4cm
23
Q

Thyroid cancer types and prevalance

A
  1. Papillary (85%)
  2. Follicular (12%)
  3. Anaplastic (<3%) [this one is the worst!]
24
Q

How do you monitor for thyroid carcinoma post treatment?

A
  • Serum thyroglobulin level
  • Anti-thyroglobulin antibodies
  • Neck US
  • TSH
25
Q

Hypoparathyroidism: clinical presentation

A

Hypocalcemia!

  • carpopedal spasms
  • Chvotek’s and Trousseau’s signs
  • Increased DTRs!
  • Loss of eyebrows
26
Q

In hypoparathyroidism, what woud you expect the labs to look like?

A
  • Low calcium
  • HIGH phosphate
  • Low PTH
  • Mg++ may be low
27
Q

Hypoparathyroidism: treatment

A

IV calcium gluconate + oral calcitriol

Maintenance: oral calcium + vitamin D

28
Q

What are the most common causes for hyperparathyroidism and hypoparathyroidism?

A

Hypo - acquired, damaged or removed with surgery

Hyper -
PRIMARY
1. parathyroid adenoma (MC primary)*
2. Hyperplasia

SECONDARY
Chronic renal failure with elevated phosphate

29
Q

What is the conservative hyperparathyroidism treatment?

A
  • drink fluids
  • Avoid lithium and HCTZ
  • restrict calcium to 1000mg
  • Vitamin D 400-600 IU daily
30
Q

What medical treatment can help lower the calcium blood level in primary hyperparathyroidism

A

IV bisphosphonates (ex. Zoledronic acid

Foundations III (34 decks)

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