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Endocrinology > Thyroid Disorders > Flashcards

Thyroid Disorders Flashcards

1
Q

Hypothyroidism TSH, T3 and T4 levels

A

High TSH

Low T3 and T4

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2
Q

Hyperthyroidism TSH, T3 and T4 levels

A

Low TSH

High T3 and T4

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3
Q

Goiter

A

Occurs when the thyroid gland is unable to secrete enough thyroid hormone to meet metabolic needs, so it becomes larger.

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4
Q

Endemic Goiter

A

Caused by lack of iodine in the diet.

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5
Q

Sporadic Goiter

A

Related to ingestion of large amounts of certain drugs and foods.

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6
Q

Goiter Sequela

A

Monotone voice
Dysphagia
Tracheal compression

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7
Q

Goiter Labs

A

T3, 4 and TSH are usually normal

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8
Q

Goiter Tx

A

reduce hyperplasia and correct underlying dysfxn.
Fine needle aspiration for fast growing goiters
Surgery for large goiters

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9
Q

Hypothyroidism epidemiology

A

3-5% of population has some form
Women > men
Increases with age
Most common cause = hashimotos thyroiditis

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10
Q

Primary hypothyroidism

A 
Iodine deficiency
Autoimmune:  Hashimotos
Post partom thyroiditis
Drug induced
Normal aging
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11
Q

Secondary Hypothyroidism

A 
Neoplasm
Surgery
Post partom necrosis
Cushings
Radiation
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12
Q

Tertiary Hypothyroidism

A

Hypothalamus dysfxn
Hemochromatosis
Sarcoidosis

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13
Q

Hypothyroidism History

A

fatigue, weakness, lethargy
Cold intolerance
Myalgias, arthralgias
Hair loss, menstrual irregularities

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14
Q

Hypothyroidism physical findings

A 
Dry, course skin and brittle nails
Hoarse voice
Periorbital edema
Delayed reflexes
Bradycardia
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15
Q

Hypothyroidism Tx

A

> 50 + CVD = Levothyroxine .025 - .05 mg/day

>50 NO CVD = .075 mg/day

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16
Q

Hypothyroidism monitoring

A

If hypothalamic-pituitary axis intact: TSH measurements

W/ Pituitary insufficiency: T3 and T4 up to 1.4 and .5 ng/dl

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17
Q

Hashimotos Thyroiditis

A

Most ommon
AKA chronic lymphocytic thyroiditis
Associated with non-hodgkins lymphoma

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18
Q

Hashimotos epidemiology

A

Autoimmune and genetic
5-10x more common in women
Usually occurs between 30 and 60

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19
Q

Hashimotos Dx

A

Anti-thyroid peroxidase antibodies

Goiter, low hormone levels

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20
Q

Hashimotos S/S

A

Painless goiter
Fatigue, weakness, weight gain
Fullness in throat, neck pain
Low grade fever

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21
Q

Hashimotos Tx

A

Thyroid hormone replacement
Levothyroxine (synthroid)
Monitor TSH

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22
Q

When to treat subclinical hypothyroidism?

A

If TSH is >10 mU/L

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23
Q

Myxedema

A 
Tissue proliferation in rxn to increased TSH levels
Usually a hx of hypothyroid dz
Older adults
Droopy eyelids, decreased reflexes
**Facial puffiness**
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24
Q

Myxedema Tx

A

Levothyroxine

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25
Q

Myxedema Coma

A

True life-threatening emergency
End-stage expression of hypothyroidism
Most frequently seen in elderly women

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26
Q

Myxedema Coma S/S

A

Coma, hypothermia, CV collapse

Metabolic disorders

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27
Q

Myxedema Coma Tx

A

Supportive measures
Correct CV and hemodynamic abnormalities
Prevention!

28
Q

Certinism

A

Severely stunted mental and physical growth
Usually due to maternal hypothyroidism
Severely delayed puberty
Infertility

29
Q

Cretinism Tx

A

Thyroid replacement

30
Q

Hyperthyroidism

A

AKA Thyrotoxicosis
102 cases in 1,000 each year
Most common cause is Grave’s
Most common in women 20-40

31
Q

Hyperthyroidism Symptoms

A

Nervousness, diaphoresis
heat intolerance
Palpitations, fatigue, weight loss
Frequent bowel movements

32
Q

Hyperthyroidism Signs

A 
Tachycardia
Goiter, skin changes
Pretibial myxedema
Tremor
Exopthalmos
Lid Lag
Osteoporosis
33
Q

Hyperthyroidism Lab Findings

A

Low TSH

Increased T3 and T4

34
Q

Tx for grave’s or toxic goiter

A 
Methimazole (Tapazole) 5-15 mg/day
Propylthiouracil (PTU) 100-150 mg/day
radioactive iodine Tx
Surgical Tx
Propranolol (For less severe hyperT)
35
Q

Radioactive iodine treatment

A

Permanent cure for hyperthyroidism

36
Q

Hyperthyroid Surgery can result in?

A

Hypothyroidism

Severed recurrent laryngeal nerve

37
Q

Grave’s Disease

A

Organ-specific autoimmune disorder

Body produces anti-TPO, anti-TG and TSI

38
Q

TSI

A

Thyroid Stimulating Immunoglobulin

Acts as a TSH agonist

39
Q

Graves epedemiology

A

Females 4:1
Age 20-50
Spontaneous remission in 1/4 of pts

40
Q

Graves Tetrad of symptoms

A

Nontender, smooth symmetric thyroid enlargement
Hyperthyroid state
Exopthalmos
Pretibial Myxedema

41
Q

Other Graves S/S

A

Extremely thin digits
Excess sweating
Flat affect, weakness, Afib

42
Q

Graves Dx

A

Most specific = ELISA for TSHR-Ab
Evelates TSI
Radioactive iodine uptake

43
Q

Graves Tx

A 
Methimazole (Tapazole)
Propylthiouracil (PTU)
Beta Blockers
Radioactive Iodine and Steroids
Surgery
44
Q

Multinodular Goiter

A

“Plummers Disease”
Characterized by functionally autonomous nodules
Older people, iodine insufficiency

45
Q

Multinodular Goiter Dx

A

Decreased TSH
Elevated T3, T4
Thyroid scan shows multiple functioning nodules

46
Q

Factitous Hyperthyroidism

A

Ingestion of levothyroxine by eithyroid individuals
Health care workers, dieters, body builders….
Attempt to lose weight
T3 and 4 are elevated, Decreased TSH

47
Q

Thyroid Storm

A

Life-threatening crisis
Hyperthyroidism
Stress, infxn, DKA, Trauma

48
Q

Thyroid Storm S/S

A

Very febrile
Cardiovascular Effects
CNS effect
N/V

49
Q

Thyroid Storm Tx

A 
Peripheral cooling
Replace fluids, glucose, electrolytes
Propranolol
Glucocorticoids
Propylthiouracil and Methimazole
50
Q

Thyroiditis

A

Similar to hyperthyroidism
Leakage of thyroid hormone
RAIU is Low

51
Q

What differentiates thyroiditis from Hyperthyroidism?

A

RAIU is Low

52
Q

Acute Thyroiditis

A 
Rare complication of septicemia
Fever, skin redness
**Tender Thyroid**
Treat with IV Abx
I&D of gland may be required
53
Q

Subacute Thyroiditis

A

Secondary to viral infxn
Fever, anterior neck pain
Exquisitely tender thyroid
NO RAIU

54
Q

Postpartum Thyroiditis

A

Occurs in 5-10% of women post-partum
3-12 months post-delivery
Eventually resolves
25-30% will develop hypothyroid within 5 yrs

55
Q

Postpartum Thyroiditis S/S

A

Thyroid gland is NONtender

Low uptake of RAI

56
Q

Postpartum Thyroiditis Tx

A

Propranolol

Levothyroxine if hypothyroidism develops

57
Q

Iodine Induced thyroiditis

A

Jod-Basedow

Contrast agents for angiography or CT

58
Q

Amiodarone Induced Thyroiditis

A

Amio is iodinated

Can occur in normal pt’s or pt’s w/ thyroid dz.

59
Q

Riedel’s Struma

A

Chronic Thyroiditis
Rare
Thyroid gland is stony hard and adheres to surrounding tissue.
Tx with steroids, tamoxifen

60
Q

Thyroid Nodules

A

Most often a benign neoplasm
Usually solitary
Often painless
Appear cold on thyroid scan

61
Q

Solitary Thyroid Nodule

A

Usually benign and occurs in most everyone by death.
Hard, fixed nodule
Lymphadenopathy
Cold nodule on scan

62
Q

T of F: A hot nodule is suspicious for Cancer.

A

False. A cold nodule is suspicious for cancer.

Hot nodules are very low risk for cancer

63
Q

Thyroid Cancer

A

1% of malignant neoplasias
Painless swelling of thyroid
Normal thyroid fxn test
Scan usually shows cold lesions

64
Q

Papillary Carcinoma

A 
Most common
Slow growing
Generally asymptomatic
Painless neck mass
Elevated thyroglobulin levels
Good prognosis
65
Q

Follicular Carcinoma

A

Slow growing
Regional nodes
Spread to lung or bone

66
Q

Medullary Carcinoma

A

Familial affiliation
C-cells of thyroid
Nodule in upper half of thyroid
Calcitonin is tumor marker

Endocrinology (16 decks)

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