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Clin Med 2 > Thyroid and PTH > Flashcards

Thyroid and PTH Flashcards

1
Q

T3

A

3,5,3’-triiodothyronine

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2
Q

T4

A

thyroxine

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3
Q

What are some signs of accumulation of matrix substances that accompany hypothyroidism?

A

Puffy facies
Loss of eyebrows
Periorbital edema
Tongue enlargement

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4
Q

What are some less common sx of hypothyroidism?

A 
–Decreased hearing
–Myalgias/arthralgias/paresthesias
–Depression
–Menstrual changes
–Pubertal delay
–Diastolic HTN
–Pleural and pericardial effusions
–Ascites
–Galactorrhea
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5
Q

What labs should you check with hypothyroidism?

A

TSH, Free T4, T3, BMP (for decreased Na+ and elevated creatinine), lipids and DRUG LEVELS

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6
Q

What two antibodies should be elevated in Hashimotos?

A

anti-TPO and anti-thyroglobulin

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7
Q

What patients should you screen for hypothyroidism?

A 
Goiter
Hx of autoimmune dz
hx of head/neck radiation
family hx thyroid dz
pt on meds that impair thyroid function
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8
Q

What meds impair thyroid function?

A 
lithium
amiodarone
aminogluthimide
interferon alpha
thalidomide
betaroxine
stavudine
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9
Q

What labs do you expect to see in subclinical hypothyroidism?

A

High TSH and normal T4

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10
Q

What labs do you expect to see with secondary hypothyroidism?

A

TSH normal (not appropriately elevated) and low T3

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11
Q

What are three T4 replacement drugs?

A

Levothroid, Levoxyl, Synthroid

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12
Q

Who should you replace T4 in slowly?

A

elderly and people with cardiac abnormalities

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13
Q

What are two important things to note about replacement of T4 (pt ed)?

A

Missing a dose should not change levels too drastically

Take on an empty stomach

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14
Q

How fq should you monitor T4?

A

every 6 weeks initially

eventually yearly

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15
Q

What will bind up T4 and lower therapeutic levels?

A

estrogen

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16
Q

What should you remember about armour thyroid?

A

Monitor it more frequently

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17
Q

What are symptoms of subclinical hypothyroidism?

A

CVD
Nonalcoholic fatty liver disease
Neuropsychiatric symptoms
Miscarriage and low birth weight babies

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18
Q

What lab is unique to Grave’s disease?

A

Thyroid Stimulating Immunoglobulin (TSH Receptor Antibody)

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19
Q

What are common causes of hyperthyroidism?

A 
Graves
early Hashimoto's
Autonomous thyroid tissue (adenoma or multinodular goiter)
TSH-mediated hyperthyroidism 
hCG mediated
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20
Q

What are some common causes of thyroiditis?

A 
subacute granulomatous
painless
postpartum
amiodarone induced
radiation
palpation
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21
Q

What are some common sx of hyperthyroidism?

A 
Skin changes (sweating)
Stare and lid lag
Graves’ ophthalmopathy
Cardiovascular
LOW TOTAL AND HDL
Impaired glucose tolerance
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22
Q

Signs of hyperthyroidism

A

normochromic normocytic anemia
bone changes
irritability

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23
Q

What is Grave’s ophthalmopathy?

A

decreased ocular muscle movement
periorbital edema
conjunctival edema

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24
Q

In addition to Thyroid stimulating immunoglobulin, what other labs are elevated in Graves disease?

A

Anti-thyroid and anti TPO

ANA and Anti-ds DNA may also be elevated

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25
Q

What test confirms hyperthyroidism?

A

24 hour radioiodine uptake scan
high uptake=endogenous hormone synthesis
low uptake=inflammation or destruction of gland
CI in PGN/Breastfeeding

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26
Q

Tx options for Graves (hyperthyroidism)

A 
–Beta-blockers
–Thionamides
•Methimazole
•Propylthiouracil (PTU)
–Radioiodine ablation
–Surgery (last resort)
27
Q

What signs/symptoms are a/w subacute thyroiditis? How do you treat?

A

Painful glandular enlargement leads to DYSPHAGIA, sometimes associated with VIRUS
Tx with aspirin

28
Q

What are the causes of benign thyroid nodules?

A

multinodular goiter
Hashimoto’s
cysts
Follicular adenoma

29
Q

What are some causes of malignant adenomas?

A

CARCINOMAS: Papillary, follicular, medullary, anaplastic
Primary T lymphoma
metastatic carcinoma

30
Q

What is the most common type of thyroid cancer?

A

Papillary, best prognosis until stage 4

31
Q

What is the most aggressive form of thyroid cancer?

A

anaplastic, highly aggressive

32
Q

What two questions do you ask when treating a nodule?

A

Are they cancerous? Think high risk groups

Are they causing dysfunction?

33
Q

What does a very high TSH mean?

A

Higher risk for thyroid cancer

34
Q

You have a suspicious thyroid nodule with normal TSH. What is your first choice for evaluation?

A

Fine needle aspiration

35
Q

You have a suspicious thyroid nodule with low TSH. What is your first choice for eval?

A

Thyroid scan looking for hot nodule or cold nodule

36
Q

What if you have a hot nodule on thyroid scan?

A

DON’T BIOPSY IT!

37
Q

In what high-risk groups are fine needle biopsies recommended for nodules?

A

Anyone with a high risk history and a nodule greater than 5 MM, with or without suspicious sonograph features
anyone with accompanying cervical node enlargement
Anyone with microcalcifications in nodules

38
Q

When is FNB recommended for patients with solid nodules?

A

when HYPOECHOIC and greater than 1 CM

when HYPERECHOIC and less than 1 CM

39
Q

When is FNB recommended for patients with multi-cystic nodules?

A

with suspicious ultrasound features and greater than 1.5-2.0 cm
with no suspicious ultrasound features and greater than 2.0 cm

40
Q

What is FNA not recommended?

A

with a purely cystic nodule

41
Q

What should you do when approaching a nodule that is greater than 4 cm?

A

obtain multiple samples, in general hold off on small samples (less than 1 cm) unless they are high risk

42
Q

Macro or microfollicular thyroid lesion… Which is more benign?

A

Macrofollicular with abundant colloid

43
Q

Pt with irritability, stridor, cataracts, thin/brittle nails, dry/scaly skin, loss of eyebrows, and hyperactive DTRs

A

hypoparathyroidism

44
Q

Labs of hypoparathyroidism

A

Low Ca2+, high phosphate, low urine calcium, normal alk phosphatase
Mg is often elevated

45
Q

Treatment in ER for acute tetany

A

IV calcium gluconate and AIRWAY

46
Q

Treatment for hypoparathyroidism

A

Ca2+ and vitamin D, +/- Mg

47
Q

What do you need to avoid in hypoparathyroidism?

A

Furosemide (loop diuretics)

48
Q

Symptoms of hyperparathyroidism

A

Bones, stones, abdominal moans, psychiatric moans, fatigue overtones, SHORT QT

49
Q

Most likely hyperparathyroidism labs

A

PTH from 60-500, total serum Ca2+ less than 15

50
Q

Most likely malignancy labs (ddx hyperparathyroid)

A

PTH less than 20 with total calcium being less than 15 (mild PTH)

51
Q

What are normal PTH and Ca2+ labs?

A

PTH less than 70 with total serum calcium less than 11 (ish… just focus on hypers)

52
Q

What should you supplement in hyperparathyroidism? Avoid?

A

Supplement Vit D

Avoid lithium and thiazide diuretics

53
Q

What is medical management for hyperpara?

A

IV bisphosphonates (you know the -dronates) or estrogen in post menopausal women

54
Q

In which diseases is thyroglobulin typically elevated? In which is it typically monitored most closely?

A

Acute thyroiditis
Graves’ disease
THYROID CANCER

55
Q

When are TgAb (thyroglobulin antibodies) typically elevated?

A

Hashimotos»Graves

Used to evaluate the likelihood that Graves patient will eventually become hypothyroid with no destruction of the gland

56
Q

When are microsomal TPO antibodies seen?

A

Hashimotos»Graves, also in post-partum thyroiditis

57
Q

What are Thyrotropin Receptor Blocking Antibodies (TBAb or TSBAb)? In what disease are they elevated?

A

Antibodies which prevent TSH from binding to the cell receptor, etiology for HYPOTHYROIDISM since it prevents binding
SEEN ONLY IN HASHIMOTO’S

58
Q

TBI and TBII

A

GRAVEs»Hashimotos

59
Q

Low TSH, what do you evaluate?

A

FT4, FT3, Tg, TPO Ab’s, TgAB’s, TSI

60
Q

High TSH, what do you evaluate?

A

FT4 and AB’s (all)

61
Q

What types of cysts are typically benign?

A

Homogenous (same types of tissues as opposed to degeneration of tissue)

62
Q

What if you encounter a heterogenous cyst?

A

Get T3, T4, antibodies, repeat u/s in 6 months. BIOPSY NODULES GREATER THAN 4MM, wait on smaller than 4 mm (per Roch)

63
Q

You find a follicular nodule on U/S… What do you do next?

A

FINE NEEDLE ASPIRATION (TEST QUESTION)

64
Q

Which PTH test is most indicative of parathyroid disease?

A

intact PTH (as opposed to total)

Clin Med 2 (13 decks)

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