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Step 2 > Thyroid Disease > Flashcards

Thyroid Disease Flashcards

1
Q

Pt presents with headache, visual disturbances, palpitations, tremor, and enlarged thyroid.
↑/– TSH
↑ T3/T4

Diagnosis?

A

TSH-secreting pituitary adenoma

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2
Q

Fine-needle aspiration thyroid biopsy reveals large cells with ground glass cytoplasm, and pale nuclei containing inclusion bodies and central grooving consistent with ___. NBSIM?

A

papillary thyroid cancer
Thyroidectomy

(if high recurrence risk)
± radioiodine ablation + Levothyroxine

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3
Q

Pt presents with history of 1st Trimester miscarriages and non-tender thyroidmegaly.

↑ TSH
T4 wnl

Diagnosis? Treatment?

A

chronic lymphocytic/autoimmune thyroiditis
(Hashimoto thyroiditis)
(Subclinical)

–anti-TPO antibodies
–antithyroglobulin antibodies

Levothyroxine (even if subclinical) in pts with elevated anti-TPO antibodies.

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4
Q

Hypothyroidism can cause elevated levels of ____.

A

total cholesterol, LDL, & triglycerides
(↑ risk of CAD)

Levothyroxine can improve lipid levels, although normalization may take several months

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5
Q

Pt presents with anxiety, weight-loss, palpitations, tremor, and enlarged, non-tender thyroid.
↓ TSH
↑ T3/T4

↑ Radioactive iodine uptake at 24 hours and homogenously distributed.

Diagnosis? Treatment?

A

Graves disease

Propranolol
+
Propylthiouracil or Methimazole

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6
Q

Patients with mild Graves disease, small goiters, and low TSH receptor antibody titers can be managed with ___.

A

Propylthiouracil or Methimazole
alone with 50% of remission.

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7
Q

In patients with Graves disease who have significant symptoms and T3/T4 level >2-3x normal

Definitive treatment is ___.

A

Propranolol
+
Propylthiouracil or Methimazole

to stabilize the patient before
definitive treatment with RAI (adioactive iodine) or thyroidectomy.

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8
Q

Common post-surgical thyroidectomy complication

A

hypoparathyroidism → hypocalcemia

(presents with fatigue, anxiety, or depression; tetany of lips, face, and extremities; seizures)

ECG → QT-interval prolongation

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9
Q

Fever and sore throat in any patient taking antithyroid drugs (PTU or MMZ) suggests ____.

A

agranulocytosis

(d/c medication and get a CBC)

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10
Q

Pt presents with anxiety, palpitations, weight-loss, and enlarged, non-tender thyroid gland
↓ TSH
↑ T4
Radioactive iodine uptake is <5% (low)
+ anti-thyroid peroxidase antibodies (high titers)

Diagnosis & NBSIM?

A

painless (silent) thyroiditis

Tx: Propanolol

RAIU scan (normal: 8%-25%)

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11
Q

Pt presents with Hyperthyroid sxs
↓ TSH
↑ T4
+ Anti-TPO titers
+ Low RAIU

Diagnosis?

A

painless (silent) thyroiditis

(self-limited; can give propranolol for sxs)

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12
Q

This thyroiditis presents the same as postpartum thyroiditis but by definition excludes patients within a year of pregnancy.

A

painless (silent) thyroiditis

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13
Q

Primary hyperthyroidism can result from
↓ TSH
↑ T4

Overproduction of thyroid hormone (2)

Release of preformed hormone (2)

A

Overproduction → Graves disease, toxic nodular goiter

Preformed Released → painless thyroiditis, subacute (deQuervains) thyroiditis

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14
Q

Thyrotoxicosis (↑T4) with normal or ↑ RAIU
(3)

A

Graves disease
Toxic multinodular goiter
Toxic nodule

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15
Q

Thyrotoxicosis (↑T4) with ↓ RAIU
(3)

A

Painless (silent) thyroiditis
Subacute (de Quervain) thyroiditis
Excessive dose (or surreptitious intake) of levothyroxine

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16
Q

This thyroiditis is characterized by fever, neck pain, and a tender goiter following an upper respiratory illness.
Patients have a self-limited thyrotoxic phase followed by hypothyroidism and eventual recovery of thyroid function.
Diagnosis and Treatment?

A

Subacute (de Quervain) thyroiditis

Beta blockers (for sxs)

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17
Q

Levothyroxine requirements ____ during pregnancy.

A

increase

(Pts should increase their levothyroxine dose at the time pregnancy is detected)

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18
Q

Radioiodine therapy for Graves disease can acutely worsen Graves ____ due to increased titers of thyroid-stimulating autoantibodies.

A

ophthalmopathy

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19
Q

The initial evaluation of thyroid nodules includes (2).

A

serum TSH levels
thyroid ultrasound

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20
Q

Thyroid Nodule + ↓TSH →

A

radionuclide thyroid scan (scintigraphy)

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21
Q

Thyroid Nodule + ↑/– TSH →

A

Fine Needle Aspiration

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22
Q

A small, hyperfunctioning (“hot”) nodule (increased isotope uptake in the nodule with decreased surrounding uptake) → NBSIM?

A

No FNA
(associated with a low cancer risk)

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23
Q

A hypofunctioning (“cold”) nodule (decreased isotope uptake compared to surrounding tissue) → NBSIM?

A

FNA
(associated with a high risk of cancer)

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24
Q

Systolic hypertension in thyrotoxicosis is caused by hyperdynamic circulation resulting from increased ____ and heart rate.

A

myocardial contractility

25
Q

Antithyroid Drugs adverse effects:
_____: 1st-trimester teratogen, cholestasis, agranulocytosis
______: Hepatic failure, agranulocytosis

A

Methimazole
Propylthiouracil

26
Q

Postpartum woman with:
↓ TSH ↑ T3/T4
Thyroid peroxidase antibody positive
Thyrotropin receptor antibody negative

Diagnosis and NBSIM?

A

Post-Partum Thyroiditis

Tx:
Propanolol (hyperthyroid phase)
Levothyroxine (Hypothyroid phase)

27
Q

___ is characterized by myalgias, proximal muscle weakness, and an ↑ creatine kinase level.

A

Hypothyroid myopathy

Pts have additional features of hypothyroidism (fatigue, delayed reflexes).
NBSIM: TSH and free T4 levels

28
Q

Prominent fever & hyperthyroid features
hx of recent viral infection
Painful/tender goiter
↓ TSH ↑ T3/ T4
↓ radioiodine uptake (<5%)
↑ ESR & CRP

A

Subacute Granulomatous thyroiditis
(de Quervain’s thyroiditis)

Tx: Propanolol

Features of hyperthyroidism followed by features of hypothyroidism

29
Q

Predominant hypothyroid features
Diffuse, non-tender goiter
↑ TSH ↓/– T3/T4
Radioiodine uptake (decreased, patchy, irregular)
(+) Anti- thyroglobulin
(+) Anti-TPO antibody
(+) anti-microsomal antibodies

A

Chronic autoimmune thyroiditis
(Hashimoto thyroiditis)

Tx: Levothyroxine

30
Q

Predominant hyperthyroid features
hx of auto-immune disorder
Diffuse, non-tender goiter
↓ TSH ↑ T3/ T4
↓ radioiodine uptake (<5%)
(+) Anti-TPO antibody

A

Subacute lymphocytic thyroiditis
(Painless/Silent thyroiditis)

Tx: Propanolol

Features of hyperthyroidism followed by features of hypothyroidism

31
Q

critically ill or post-op patient

↓ T3 TSH & T4 (wnl)
or
↓ TSH ↓ T4 ↓ T3

Diagnosis and Tx?

A

Euthyroid sick syndrome (low T3 syndrome)
No treatment indicated

s/t ↓ peripheral conversion of T4 to T3
(can be seen in pts on high dose IV glucocorticoids)

32
Q

Reverse T3 is elevated in

A

Euthyroid sick syndrome (low T3 syndrome)

33
Q

A high RAIU suggests de novo hormone synthesis due to Graves’ disease (diffusely increased uptake) or toxic nodular disease (nodular uptake). In contrast, a low RAIU suggests either release of preformed thyroid hormone (ie, thyroiditis) or exogenous thyroid hormone intake. In such cases, the serum thyroglobulin level can make the distinction: elevated thyroglobulin is consistent with endogenous thyroid hormone release whereas decreased thyroglobulin suggests exogenous or factitious thyrotoxicosis.

A

EDit

34
Q

Secondary Hyperthyroidism
__ TSH
__ T3/T4

NBSIM?

A

↑ TSH
↑ T3/T4

MRI of Pituitary

35
Q

Primary Hyperthyroidism
__ TSH
__ T3/T4

A

↓ TSH
↑ T3/T4

36
Q

Primary Hyperthyroidism but not classic Graves Disease presentation.
NBSIM?

A

RAIU scintigraphy

37
Q

↓ TSH
↑ T3/T4
(+) TSH receptor Antibodies
↑ RAIU scan (normal: 8%-25%)
Diffuse pattern
Diagnosis?

A

Graves disease

38
Q

↓ TSH
↑ T3/T4
↑ RAIU scan (normal: 8%-25%)
Nodular pattern
Diagnosis? (2)

A

Multinodular Goiter
Toxic Adenoma

39
Q

↓ TSH
↑ T3/T4
↓ RAIU scan (normal: 8%-25%)
↑ Thyroglobulin
Diagnosis? (2)

A

Thyroiditis

Excess Iodine

40
Q

↓ TSH
↑ T3/T4
↓ RAIU scan (normal: 8%-25%)
↓ Thyroglobulin
Diagnosis?

A

Excessive dose (or surreptitious intake) of thyroid hormone meds

41
Q

Post-partum woman presents with anxiety, fatigue, irritability, constipation, and weight-gain.
Vitals significant for HTN and Bradycardia. What is the NBSIM and why?

A

pt likely has Postpartum thyroiditis → get TSH/T4 labs
(brief hyperthyroid to hypothyroid phase)

we can rule out “psychological” etiology because pt has bradycardia which can’t be explained by depression.

42
Q

Diagnosis:
Infants presents with apathy, weakness, hypotonia, large tongue, sluggish movement, abdominal bloating, and an umbilical hernia.

A

congenital hypothyroidism

43
Q

Untreated hyperthyroidism in pts increases risk for ___ & atrial fibrillation.

A

osteoporosis (fragility fractures)

rapid bone loss s/t ↑ osteoclastic activity

44
Q

Large _____ thyroid nodules carry an increased risk of malignancy and require fine needle aspiration biopsy.

A

hypofunctioning (“cold”)

45
Q

Fetal hyperthyroidism can be seen in patients with active ______.

A

Graves disease
(b/c TSH receptor antibodies can cross the placenta)

(Nodular toxic adenoma pts do not have TSHR antibodies so this isn’t a problem in pregnancy for them)

46
Q

proximal muscle weakness/atrophy in the setting of clinical features of hyperthyroidism. Diagnosis?

A

Chronic hyperthyroid myopathy

47
Q

In evaluating thyroid nodules,
TSH levels and Thyroid Ultrasound need to be obtained 1st.

Thyroid Ultrasound helps determine nodule size and sonographic features.

High risk of Malignancy sonographic features include:
⬩microcalcifications
⬩ irregular borders
⬩internal vascularity

If nodule is >1cm and has the above features or is a _____ nodule
Do a fine-needle aspiration (FNA) biopsy.

A

> 2 cm, noncystic nodule

48
Q

A radionuclide scan is indicated in evaluation of a thyroid nodule only for patients with ___.

A

low TSH

49
Q

Hypothyroid Patient with Irregular menstruation:
__ TSH
__ FSH & LH
__ Prolactin

A

↑ TSH
↓ FSH & LH
↑ Prolactin

( ↓T3 ⇨ ↑TRH ⇨ ↑ TSH & Prolactin)
(↑Prolactin ━┫FSH, LH, & ovulation)

50
Q

___ may represent a mild, transient central hypothyroid state that functions to minimize catabolism in severe illness (adaption to non-thyroidal illness).

A

Euthyroid sick syndrome (ESS)

51
Q

___ stimulates/increases thyroxine-binding globulin (TGB), leading to increased total (but not free) T4.

A

High Estrogen
(Hormone replacement therapy, OCPs, Pregnancy)

52
Q

Patients in a thyroid storm can develop fever, hemodynamic instability, AMS, cardiac arrhythmias, and ____.

A

Congestive heart failure

(Tx: Propanolol → PTU → Potassium → Prednisone to lower peripheral conversion of T4/T3)

53
Q

___ directly stimulates TSH receptors, causing increased production of total T4 and suppressing TSH.

A

hCG
(seen in pregnancy)

(Recall: Estrogen stimulates TGB)

54
Q

Estrogen stimulates/increases thyroxine-binding globulin (TGB), leading to increased ____.

A

total (but not free) T4

(suppresses TSH levels)

55
Q

Neonatal Thyrotoxicosis is caused by ___ which bind to infant’s TSH receptors & cause excessive thyroid hormone release

A

Transplacental passage of maternal anti-TSH receptor antibodies

(Maternal Graves Disease)

56
Q

In neonatal thyrotoxicosis, affected infants are warm/moist, irritable, tachycardic, and gain weight poorly.

___ & ___ are given to symptomatic patients until the condition self-resolves over a few weeks to months.

A

Methimazole + β blocker

57
Q

what is the most common cause of congenital hypothyroidism worldwide?

A

Thyroid dysgenesis

58
Q

Congenital Hypothyroidism presents weeks to months after ___ wanes

A

maternal thyroxine

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