Thyroid Disoders

Question 1

Evaluate for thyroid nodule

Answer 1

Screen family history, red flags (hoarseness, weight loss), adenopathy

Labs: TSH, T4 and T3 if TSH is abnormal

Imaging: US

Question 2

US findings suspicious for thyroid malignancy

Answer 2

microcalficicaitons
partially cystic
peripheral vascularity
hyperechogencitiy

Question 3

When to do radioisotopic scan

Answer 3

Hyperthyroidism (check for hyperfunctioning nodule)

Question 4

When to do FNA (under US guidance)

Answer 4

Do when nodule diameter >1cm. This will include cytology

Question 5

Benign thyroid nodules surveillance

Answer 5

1-2 years US

Question 6

Malignant thyroid nodule tx

Answer 6

Lobectomy/thryoidectomy

Question 7

Causes of hypothyroid

Answer 7

Hashimotos, thyroidectomy, RI therapy, iodine xx or deficiency, infiltrative disase, congenital

Question 8

Subclinical hypothyroid

Answer 8

Elevated TSH, normal T4

Question 9

Central (secondary) hypothyroid

Answer 9

low TSH, low T4
Pituitary of hypothalamic disease
Pituitary hormone abnormalitiy

Question 10

Diagnosis of hypothyroid

Answer 10

TSH
T4
TPO Abs
Thyroglobulin Ab

Question 11

Dosing of synthroid

Answer 11

1.6ug/kg

Question 12

Hypothyroid f/u

Answer 12

4-6 weeks after starting synthroid due to long 1/2 life

Question 13

Hyperthyroid

Answer 13

Primary: low TSH, high T3
Subclinical: low TSH, normal T4
Secondary (central): high TSH, high T4

Question 14

Causes of hyperthyroid

Answer 14

graves, autoimmune, thyroiditis, toxic nodular goiter, xx thyroid hormone, medication induced (amiodarone)

Question 15

Grave’s disease

Answer 15

Hyperthyroid. Ophtalmopathy, lid retraction, proptosis, pretibial myxedema, acropachy,

Question 16

Hyperthyroid diagnosis

Answer 16

TSH
T4
RAI
Thyroglboulin Ab

Question 17

Tx hyperthyroid

Answer 17

B1-selective blocker (propanolol)
Methimazole, PTU (blocks TPO and thryroid syntheiss)
RAI (second line tx for hyperfuncitioning nodule)
Thyroidectomy

Question 18

Tx subclinical hyperthyroidism:

Answer 18

Age >65, TSH <0.1 and coexisting conditions (CV, osteopenia/porosis)

Question 19

Thyroidiitis

Answer 19

acute: rare
Chronic: autoimmune (hashimotos)
Silent: painless
Subacute: aka dequervain, due to virus. Painful. Systemic system.
Low RAI

Question 20

SIck euthyroid

Answer 20

due to cytokines that are proinfammatory.

rT3 can tell non-thyroidal inllness