Thyroid Disease Flashcards

1
Q

Presenting symptoms of hyperthyroidism

A

progressive nervousness, palpitations, weight loss, irritability, fine resting tremor, dyspnea on exertion, concentration difficulties

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2
Q

Physical exam findings of hyperthyroidism

A

fine resting tremor, rapid pulse, elevated BP (more in systolic so greater pulse pressure), atrial fib

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3
Q

acute hypermetabolic state associated with sudden release of large amounts of thyroid hormone into circulation

A

thyroid storm

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4
Q

Symptoms of thyroid storm

A

autonomic instability, confusion, psychosis, restlessness, dysrhythmias,

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5
Q

pathophysiology of Graves dx

A

autoimmuno disorder caused by immunoglobulins (IgG) antibodies that bind to TSH receptors initiating the production and release of thyroid hormone

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6
Q

common, distinct feature of Graves dx

A

exophthalmos

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7
Q

second most common cause of hyperthyroidism

A

autonomous thyroid nodule that secretes thyroxine (ignores TSH)

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8
Q

other causes of hyperthyroidism besides Graves and autonomous thyroid nodule

A

iatrogenic hyperthyroidism (overuse of thyroxine supplement), thyroditis (acute stages)

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9
Q

Lab values in hyperthyroidism

A

elevated thyroxine (free T4) and low TSH

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10
Q

Once hyperthyroidism is established with lab values, what test to do next?

A

radionucleotide imaging (direct scan of gland) with tech99 or iodine123

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11
Q

How to Graves appear on radionucleotide scan

A

diffuse hyperactivity with large amounts of uptake

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12
Q

How does thyroiditis appear on radionucleotide scan

A

patchy uptake with overall reduced activity (reflects release of hormone rather than overproduction of it)

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13
Q

How to treat Graves

A

radioactive iodine

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14
Q

Who shouldn’t get radioactive iodine

A

pregnant mothers and children

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15
Q

What are alternatives to radioactive iodine?

A

anti-thyroid meds like PTU, methimazole, carbimazole (inhibit organification of iodine and prevents conversion of T4 into T3; the more active form)

ESP EFFECTIVE IN ADOLESCENTS WITH GRAVES

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16
Q

Harmful side effects of antithyroid drugs

A

hepatotoxicity (PTU; blackbox warning), agranulocytosis

17
Q

If iodine/antithyroid meds aren’t working for Graves?

A

SURGERY; can also do this if huge goiter is compressing nearby structures

18
Q

Symptoms of hypothyroidism

A

weight gain, cold intolerance, hair loss, lethargy, dry skin, slowed mentation, constipation, depressed

19
Q

What can hypothyroidism be confused with in elderly patients?

A

Alzheimers

20
Q

Most common cause of noniatrogenic hypothyroidism in the US

A

hashimoto’s thyroiditis

21
Q

Iatrogenic/other causes of hypothyroidism

A

post-Graves disease thyroid ablation and surgical removal of thyroid gland, secondary to hypothalamus/pituitary dysfunction (i.e. intracranial radiation or removal of pituitary adenoma)

22
Q

Primary hypothyroidism vs secondary hypothyroidism on lab values

A

Primary - elevated TSH, low T4 (dysfunction with gland)

Secondary - low TSH, low T4 (dysfunction in HPA axis)

23
Q

Once primary hypothyroidism is diagnosed, what workup is needed next?

A

NOTHING! esp if thyroid gland is normal on physical….just start supplementing with thyroid

24
Q

Once secondary hypothyroidism is diagnosed, what workup is needed next?

A

need to determine if hypothalamus or pituitary is the problem

IV TRH test! stimulates pituitary to release TSH. If pituitary releases TSH, then hypothalamus done fucked up. If there is no increase in TSH, the pituitary done fucked up

25
Q

Starting dose for thyroid replacement

A

25-50 ug daily then increase to 25 every 3-4 weeks until optimal dose is reached

26
Q

How to determine is thyroid replacement dose is appropriate?

A

Serial TSH checks! Check 4-6 weeks after adjustment has been made

Check for TSH between 0.3 (too much thyroid) and 5 (too little thyroid/ bad med adherence)

27
Q

Incidence of malignancy in incidental finding of thyroid nodule

A

5-6% SO WORK THESE UP

28
Q

Risk factors for thyroid cancer

A

family history, dysphagia, SOB, cervical lymphadenopathy, new onset hoarse voice

29
Q

How to evaluate a thyroid nodule

A

Ultrasound for size, character (cystic v solid), presence of other nodules
thyroid function tests (measure TSH)

30
Q

Prognosis of functional adenoma

A

rarely malignant

31
Q

When to biopsy a nodule

A

when nodule measure greater than 1cm in person with elevated or normal TSH

do this with FNA

32
Q

Types of thyroid carcinomas and how to diagnose

A

papillary, medullary, anaplastic thyroid carcinomas

dx by FNA

33
Q

Treatment for thyroid cancer

A

thyroidectomy followed by radioactive ablation

34
Q

In pregnant patient, when to use PTU vs methimazole

A

if they aren’t pregnant and can’t do radioactive iodine METHIMAZOLE IS FIRST LINE

but if they are preggo
PTU 1st trimester
methimazole 2nd and 3rd