Thyroid Disorder

Question 1

Graves Patients- Who to refer to?

Answer 1

ALL need ophthalmologist

Question 2

S and S of Hyperthyroidism

Answer 2

Bruit, nodules, ANS hyperactivity, new A.Fib, dermopathy, skin, hair (velvet), exopthalamos, lid lag, pretrial myxedema, adenopathy, quick DTR, pelvic exam (pregnancy)

Question 3

Medications that Cause Hyperthryoidism

Answer 3

Lithium, steroids, pregnancy, HCG, estrogens, amiodarone, phenytoin

Question 4

Plummer’s Disease

Answer 4

Toxic Multinodular Goiter

Question 5

Labs- Increased TSH, T4, and Uptake on radio iodine test

Answer 5

Pituitary tumor

Question 6

Labs- Decreased TSH, increased T4, Increased uptake of I

Answer 6

Graves, Plummers, Adenoma

Question 7

Labs- Normal T4, undetectable TSH

Answer 7

Subclinical Hyperthyroidism

Question 8

Labs- Decreased TSH, Increased T4, decreased uptake of I

Answer 8

Thryoiditis- pregnancy, postpartum, silent, and viral

Question 9

Treatment for Ssmptoms of hyperthyroidism

Answer 9

Propranolol- 160 mg/day, CCB for those with Asthma, COPD

Question 10

What does U/S of thyroid show?

Answer 10

Differentiates cyst from nodule, cancer?

Question 11

What is Antithyroid Perioxidase Antibodies?

Answer 11

Lab- tests for antibodies that attack thyroid. In Graves and Hashimoto’s

Question 12

What is antithryoglobulin?

Answer 12

Lab- tests for antibodies that attack thyroid. In Graves and Hashimotos

Question 13

PTU Treatment

Answer 13

For pregnancy. Risks of agranulocytosis, skin rash, and fever. Check CBC and LFT

Question 14

Radioactive Iodine

Answer 14

Can worsen opthalmopathy. No pregnancy or children, or breastfeeding

Question 15

Tx for Opthalmopathy

Answer 15

ALWAYS referral to ophthalmologist. Also steroids, eye lubricant for dry eyes.

Question 16

Treatment for subclinical Thyroiditis

Answer 16

Watch and wait unless: A.Fib, presence of antibodies, menopausal women with osteoporosis.

Question 17

Drugs that cause hypothyroidism?

Answer 17

Amiodarone and lithium

Question 18

What can an elevated anti-TPO antibody suggest?

Answer 18

Hashimoto’s or Graves, depending on the T4 and TSH

Question 19

S and S of hypothyroidism

Answer 19

Dry skin, weight gain, loss of lateral eyebrows, bradycardia, heart hypertrophy, prolonged DTR relaxation

Question 20

Normal TSH Value

Answer 20

.35-2.5. Up to 3 in Elderly

Question 21

Treatment of elevated hypothyroidism based on TSH

Answer 21

> 10 should be treated
15 in presence of illness, check again
5-10, depends on judgement

Question 22

Therapy for hashimoto’s disease

Answer 22

1.6 mcg/kg/day-50-100

>60 or CAD, start at half the dose

Question 23

Nodules and Cancer: Red Flags

Answer 23

Only one nodule. Firm, nontender, fixed, irregular. Men. >60, or