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HPIM 19th Endo > Thyroid Diseases > Flashcards

Thyroid Diseases Flashcards

1
Q

Most physiologic marker of thyroid hormone action

A

TSH

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2
Q

Major POSITIVE regulator of TSH

A

Thyrotropin Releasing Hormone (TRH)

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3
Q

May artificially SUPPRESS TSH

A

Thyrotoxicosis
hCG secretion in early pregnancy
High dose GC therapy
Treatment with dopamine

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4
Q

Critical first step in the synthesis of thyroid hormone

A

Uptake of iodide

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5
Q

Mental and growth retardation in children due to severe iodine deficiency

A

Cretinism

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6
Q

Autosomal recessive disorder characterized by goiter and sensorineural deafness caused by DEFECTIVE ORGANIFICATION of iodine

A

Pendred Syndrome

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7
Q

May raise serum Total T4 and T3 levels by causing elevation of serum thyroxine binding globulin (TBG)

A

Estrogen

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8
Q

Characteristic distinguishing T4 from T3

A

100% produced directly from the thyroid

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9
Q

Transient inhibition of thyroid iodide organification in response to excess iodide

A

Wolff-Chaikoff phenomenon

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10
Q

Venous distention over the neck and difficulty breathing upon raising the arms caused by large retrosternal goiters

A

Pemberton sign

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11
Q

Lid lag that occurs with exophthalmos in thyrotoxicosis

A

Von Graffe sign

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12
Q

Condition in which finding a bruit over the thyroid gland indicates increased vascularity

A

Hyperthyroidism

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13
Q

Thyrotoxic states characterized by a LOW or ABSENT radioactive iodine uptake

A

Thyrotoxicosis factitia

Subacute thyroiditis

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14
Q

MC cause of hypothyroidism worldwide

A

Iodine Deficiency

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15
Q

Associated with Hashimoto’s Thyroiditis

A

Autoimmune Hypothyroidism

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16
Q

Associated with Autoimmune Hypothyroidism

A 
Vitiligo
Type 1 DM
Pernicious Anemia
Addison’s Disease
Alopecia areata
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17
Q

Cause of myxedema with typical non-pitting skin thickening

A

Increased dermal glycosaminoglycan content

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18
Q

Can establish autoimmune etiology for clinical or subclinical hypothyroidism

A

Presence of thyroid peroxidase (TPO) antibodies

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19
Q

Low or normal TSH + Low unbound T4 + Clinical signs of hypothyroidism

A

Hypopituitarism

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20
Q

Masked thyrotoxic features in the elderly, with patients presenting mainly with fatigue, depression and weight loss

A

Apathetic thyrotoxicosis

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21
Q

MC cardiovascular manifestation of Grave’s disease

A

Sinus Tachycardia

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22
Q

Indurated plaque-like lesions with an “orange skin” appearance on the anterior or lateral aspects of the lower legs seen in thyrotoxicosis

A

Pretibial myxedema

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23
Q

“Thyroid acropachy”

A

Clubbing

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24
Q

Pt with Normal FT4 + very low TSH and with suspected thyrotoxicosis, what should be the next diagnostic test?

A

FT3 determination

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25
Q

Clinical SSx of thyrotoxicosis + Normal or increased TSH + Increased FT4

A

Pituitary Adenoma

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26
Q

Anthithyroid of choice for Grave’s disease during pregnancy

A

PTU

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27
Q

Drug given prior to subtotal thyroidectomy as treatment for thyrotoxicosis to reduce the vascularity if the thyroid gland

A

Potassium iodide

28
Q

MOA of PTU in thyroid storm

A

Inhibits conversion of T4 to T3; Inhibit thyroid peroxidase reducing oxidation and organification of iodide

29
Q

Rationale why stable iodide is given an hour after the first dose of PTU in thyroid crisis

A

To block thyroid hormone synthesis via the Wolff-Chaikoff effect

30
Q

Drug causing painless thyroiditis

A

Interferon alfa

31
Q

MC clinically apparent cause of chronic thyroiditis

A

Hashimoto’s thyroiditis

32
Q

Rare thyroid disorder characterized by dense fibrosis of the gland presents in middle aged women with a hard, non-tender, fixed goiter with local compression symptoms

A

Reidel’s thyroiditis

33
Q

MC hormone pattern in sick euthyroid syndrome

A

Decreased T3

Normal T4 and TSH

34
Q

Enhanced thyroid hormone production by autonomous thyroid nodules due to administration of radiocontrast and other iodine-containing agents

A

Jod-Basedow phenomenon

35
Q

Goiter + mild increased FT4 + low TSH + heterogenous uptake with multiple regions of decreased and increased uptake in scan

A

Toxic Multinodular Goiter

36
Q

Treatment if choice for the hyperfunctioning solitary thyroid nodule

A

Radioiodine ablation

37
Q

Iodine deficiency as a risk factor for which type fo thyroid cancer?

A

Follicular Ca

38
Q

MC type of thyroid Ca

A

Papillary Ca

39
Q

Presence of psammoma bodies and cleaved nuclei with “Orphan Annie” appearance

A

Papillary Ca

40
Q

Thyroid Ca with very poor prognosis

A

Anaplastic Ca

41
Q

Serum marker for recurrent or residual medullary carcinoma of the thyroid

A

Serum calcitonin

42
Q

Indicated for pts with solitary thyroid nodule + Low TSH + presence of “cold” or indeterminate nodule on scan

43
Q

First step in the evaluation of a thyroid nodule in a patient with normal TSH

44
Q

Recommended daily iron intake

A

150-250 ug/d

in pregnant and lactating: 250 ug/d

45
Q

Best documented genetric risk factor for Grave’s disease and autoimmune hypothyroidism in Caucasians

46
Q

Treatment for clinical hypothyroidism

A

Levothyroxine 1.6 ug/kg 30mins before breakfast

47
Q

Treatment for subclinical hypothyroidism

A

Low dose levothyroxine with goal of normalizing TSH

48
Q

Dose adjustment of levothyroxine in pregnant women

A

Increased by >/=50% during pregnancy and returned to previous levels after delivery

49
Q

State of thyroid HORMONE excess

A

Thyrotoxicosis (exogenous or endogenous)

50
Q

Result of excessive thyroid function

A

Hyperthyroidism (endogenous)

51
Q

Accoutnts 60-80% of thyrotoxicosis

A

Grave’s disease

52
Q

Thyroid disease heralded by viral infections

A

Subacute thyroiditis/de Quervain’s

53
Q

3 phases of subacute thyroiditis

A

Thyrotoxic phase
Hypothyroid phase
Recovery phase

54
Q

Treatment for subacute thyroiditis

A

Aspirin 600mg q 4-6 hours

55
Q

Thyroid disease most frequently occuring 3-6 months after pregnancy

A

Silent thyroiditis/painless thyroiditis

56
Q

Major cause of sick euthyroid syndrome

A

Release of cytokines (drug-induced)

57
Q

Urinary iodine levels supporting a diagnosis of iodine deficiency

58
Q

Treatment of choice for toxic multinodular goiter

A

Radioiodine

59
Q

Definitive diagnostic test for Toxic Adenoma

A

Thyroid scan (focal uptake)

60
Q

Treatment of choice for toxic adenoma

A

RAI ablation

61
Q

Neoplasms with increased risk for malignancy

A

Microfollicular
Trabecular
Hurthle cell variants

62
Q

MC thyroid lymphoma

A

Diffuse large cell lymphoma

63
Q

Marker of residual or recurrent disease in medullary thyroid carcinoma

A

Elevated serum calcitonin

64
Q

Solitary or suspicious nodule with Low TSH, what is the next step?

A

Thyroid scan

Hot nodule: Ablate, resect or treat medically

Cold nodule or indeterminate: Biopsy

65
Q

Solitary or suspicious nodule with normal TSH, what is the next step?

A

Biopsy (FNA or UTZ guided depending on size)

66
Q

With RAI low uptake

A

Subacute thyroiditis
Thyrotoxicosis factitia
Toxic MNG

67
Q

With RAI high uptake

A

Grave’s
Toxic Adenoma
Toxic MNG

HPIM 19th Endo (10 decks)

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