Thyroid disease Flashcards
What is the indication of a slow thyroid
High TSH
What is the indication of a fast thyroid
Low TSH
What is goiter
An enlarged thyroid or abnormal growth of thyroid gland
What is the most common cause of goiter
iodine deficiency
What are the types of goiter
diffuse
multinodular
What are the primary causes of goiter
physiological (puberty/preggers)
Iodine deficiency
Goitrogens
Dysmorphogensis
granulomatous disease
What are goitrogen rich foods that can effect thyroid function
broccoli
cauliflwoer
kale
peanuts
red wine
strawberries
peaches
mustard
tea
soy
Which gender is at higher risk for goiter
females
When do sporadic goiter from dysmorphogenesis and endemic goiter generally occur
in childhood
Why does iodine deficiency lead to goiter
It increases the demand of thyroid hormone, causing the pituitary gland to release more TSH
What role does TSH have on the thyroid
stimulates follicular cells and with continuous long term stimulation leads to follicular hyperplasia and thyroid enlargement
What is the biggest concern with goiter
dysphagia
dyspnea
hoarseness
What is Pemberton maneuver
elevating arms may lift goiter into thoracic inlet and cause stridor, dyspnea or enlargement of neck veins
What does it mean if there is non-toxic thyroid or goiter
there is no hyper/hypothyroidism present
What are examples of hyperthyroidism
graves disease
multi nodular goiter
toxic adenoma
What is an example of hypothyroidism
hashimotos
*unless in area with endemic goiter
What is the usual TSH range
.45-4.5
IF there is intervention done for non-toxic goiter, what is the mainstay treatment
thyroidectomy
What is the most common complication postoperatively with a thyroidectomy
hypocalcemia
What is the etiology for hypothyroidism
Autoimmune
previous thyroid surgery
radiation
lithium
PTU
What is the etiology for hyperthyroidism
Graves
toxic adenoma
toxic multi nodular (plummers dz)
Thyroiditis
What is the clinical presentation with hypothyroidism
anorexia
fatigue
anemia
bradycardia
memory impairment
constipation
cold intolerance
Hypo-reflexia
What is the clinical presentation with hyperthyroidism
Nervousness
heat intolerance
sweating
weight loss + increased appetite
tachycardiaa
hyperreflexia
loose stool
What is the most common cause of hyperthyroidism
Graves disease
What is the etiology of graves disease
autoimmune
+FH
HLA association
Female»>Male
What is the patho of graves disease
Caused by Thyroid stimulating immunoglobulin (TSI)
What are some graves disease specific symptoms that may occur
Graves orbitopathy (TED)
Pretibial myxedema
What is an atypical presentation of graves disease in elderly
apathetic thyrotoxicosis
What are signs of extra thyroidal manifestations in Graves disease
Thyroid eye disease
Thyroid dermopathy (thickening of skin, difficult to pinch, peau d’ orange appearance)
Bone involvement (swelling is metacarpals)
onycholysis (Plummers nails)
What is a thyroid storm
sudden onset with severe symptoms of thyrotoxicosis
What is graves ophthalmopathy (thyroid eye disease)
Proptosis
conjunctival irritation
eye dryness
diplopia
What in labs is diagnostic for graves disease
TSI
What will be seen in a CBC with hyperthyroidism
microcytic anemia
thrombocytopenia
What will be seen on CMP with hyperthyroidism
bilirubinemia
high transaminase
hypercalcemia
high alkaline phosphatase
What tests are done to diagnose Graves disease
Blood test
Thyroid radioactive iodine uptake
US to assess blood flow
What are some medications to treat hyperthyroidism
PTU / methimazole
radioactive iodine treatment
+/- propranolol until thyrotoxicosis resolves
What is the recommended first line treatment for graves disease
radioactive iodine
What is the drug of choice for graves disease during pregnancy
PTU
How long can it take to control graves disease with hyperthyroidism
12-24months
What are symptoms of a thyroid storm in graves disease
medical emergency!
AMS
N/V/D
hypertension
tachyarrhythmias
fever
What is toxic nodular goiter (Plummers disease)
Autonomously functioning thyroid nodules with resulting hyperthyroidism
When does hyperthyroidism generally occur with toxic adenomas
Adenomas >2.5cm diameter
Which populations are at greater risk for TNG
Women, >50y/o
toxicity peaking in 6th-7th decade of life
What is the most common lab finding for TNG
Low TSH with normal free Thyroxine (T4)
What substances are used for nuclear scintigraphy with TNG imagine
Technetium-99
Iodine-123 **(preferred)
How is nuclear scintigraphy useful in determining TNG vs Graves
Graves usually homogenous diffuse uptake where as thyroiditis has low uptake
*TNG have patchy areas of increased and decreased uptake
When is an FNA indicated with TNG
Autonomously functioning thyroid nodule
Dominant cold nodule in multinodular goiter
Clinically sig nodule>1cm
non-palpable nodules
What increases the risk for malignancy with TNG
Head/neck radiation in childhood and as an adult
How do you treat TNG with autonomously functioning nodules
radioactive iodine or surgery
Which patients should you treat vs just observe with subclinical hyperthyroidism
elderly
pregnant
women w/ osteopenia
risk for afib
What is the treatment of choice for TNG
I-131
What Is hashimotos thyroiditis
Autoimmune dx that destroys thyroid cells and antibody mediated immune processes
What are the most common lab findings for hashimotos
elevated TSH
low T4
increased antithyroid peroxidase (TPO)
what is the most common cause of hashimotos
iodine insufficient
What is the conventional treatment for hashimotos
levothyroxine (T4 gets converted to T3)
How do you diagnose hashimotos
Clinical sx
lab results of elevated TSH and normal to low T4
What is myxedema
Edema like skin condition caused by increased glycosaminoglycan deposition
What are common signs of hashimotos
Scaly and dry
alopecia
bradycardia
fatigue
exercise intolerance
muscle weakness/myopathy
What are early symptoms of hashimotos
constipation
fatigue
dry skin
weight gain
What are advanced sx of hasimotos
cold intolerance
goiter
apnea
menorrhagia
joint pain
What findings might be seen on physical exam for hypothyroidism
elevated BP
delayed relaxation of tendon reflexes
brittle nails
bradycardia
ataxia
macroglossia
What are rare but urgent concerns for hasimotos
accumulation of fluid in pleural and pericardial cavities
*myxedema coma is most severe presentation
What confirms diagnosis of primary hypothyroidism
T4, elevated TSH
+ TPO and TGab
What other labs will be elevated within a patient with hashimotos
CK
prolactin
total cholesterol
LDL
TG
What is the TOC for hypothyroidism
titrated levothyroxine sodium
*do not give with iron or calcium and take early am on empty stomach
What is myxedema coma
extreme form of hypothyroidism
-stupor
hypoventilation
hypothermia
hyponatremia
shock&death
How do you treat myxedema coma
icu admission
IV levothyroxine
respiratory supportive care
fluid status
What other disorder is hashimotos associated with
gastric and other autoimmune
What is chronic autoimmune gastritis
partial or complete loss of parietal cells leading to impairment of hydrochloric acid and intrinsic factor production
What is cretinism
Congenital hypothyroidism from a deficiency in thyroid hormone during early fetal development
What are the signs and symptoms of cretinism
intellectual disability
deaf/mute
gait disturbances
short stature
puffy hands&feet
spasticity
What are the diagnostic tests for thyroid nodules
thyroid US
TSH
T4
*if nodule >.6, strongly consider bx
What are the most common types of thyroid cancer
papillary thyroid cancer
follicular thyroid cancer
medullary thyroid cancer
anaplastic thyroid cancer
What forms of thyroid cancer have the best prognosis
Papillary and follicular
*ATC=worst
How does thyroid cancer typically present
as a single nodule
What is diagnosis of thyroid cancer contingent on
cytologic or histologic findings on biopsy
What is the best first step for thyroid cancer dx
biopsy
*if micro calcification, hypo echoic interiors ill defined margins, modularity, chaotic vascular flow = malignant suspicion
What is the mainstay of treatment for thyroid cancer
Surgical resection
*recommended in >1cm lesion
Why can surgery not be preformed of ATC CA
Local invasion into trachea or vasculature generally makes it unresectable
What is the mortality rate for ATC CA
5 years
What is a common surgical complication with thyroid resection
recurrent laryngeal nerve injury
