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MEDICAL SURGICAL > THYROID DISORDERS > Flashcards

THYROID DISORDERS Flashcards

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USMLE® Step 1 flashcards
1
Q

These hormones are synthesized and stored bound to proteins in the cells of the thyroid gland until needed for release into the bloodstream.

A

THYROID HORMONES
T3 + T4

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2
Q

secretion of T3 and T4 by the thyroid gland is controlled by

A

TSH
THYROID STIMULATING HORMONE (THYROTROPIN)

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3
Q

is essential to the thyroid gland for synthesis of its hormones.

A

IODINE

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4
Q

INCREASES OF DECREASES?
If the thyroid hormone concentration in the blood decreases, the release of TSH

A

INCREASES

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4
Q

TSH controls the rate of thyroid hormone release through a

A

NEGATIVE FEEDBACK MECHANISM

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5
Q

secreted by the hypothalamus and exerts a modulating influence on the release of TSH from the pituitary.

A

TRH
THYROTROPIN RELEASING HORMONE

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6
Q

What are the by-products of cellular metabolism

A

ATP
HEAT
ENERGY

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7
Q

The main function of thyroid hormone is

A

CONTROL CELLULAR METABOLIC ACTIVITY

OR

CONTROL BMR

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8
Q

a relatively weak thyroid hormone, maintains body metabolism in a steady state

A

T4 or THYROSINE

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9
Q

is another important hormone secreted by the thyroid gland. The hormone is secreted in response to high plasma levels of calcium, and it reduces the plasma level of calcium by increasing its deposition in bone.

A

CALCITONIN

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9
Q

is about five times as potent as T4 and has a more rapid metabolic action

A

T3 OR TRIIODOTHYRONINE

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10
Q

occurs when there is inadequate secretion of thyroid hormone during fetal and neonatal development, results in intellectual disability and stunted physical growth because of general
depression of metabolic activity

A

CONGENITAL HYPOTHYROIDISM

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11
Q

Enlargement of thyroid gland that commonly occurs due to deficiency in iodine.

A

GOITER

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11
Q

When palpated, isthmus should be

A

FIRM
RUBBER BAND CONSITENCY

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12
Q

Separates the 2 lobes of thyroid gland

A

ISTHMUS

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13
Q

TRUE OR FALSE
isthmus is the only portion of the thyroid that is normally palpable.

A

TRUE

For patient has a very thin neck, two thin, smooth, nontender lobes may also be palpable

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14
Q

If palpation of thyroid gland reveals enlargement, it should be auscultated for

A

BRUIT

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15
Q

Soft texture of thyroid gland upon palpation is an indication of

A

GRAVE’S DISEASE

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15
Q

upon auscultation, it is indicative of increased blood flow through the thyroid gland associated with hyperthyroidism.

A

BRUIT

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16
Q

Firmness of thyroid gland upon palpation is an indication of

A

HASHIMOTO DISEASE

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17
Q

Tenderness of thyroid gland upon palpation is an indication of

A

THYROIDITIS

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18
Q

used for monitoring thyroid hormone replacement therapy and for differentiating between disorders of the thyroid gland itself and disorders of the pituitary or hypothalamus.

A

SERUM TSH

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19
Q

is the primary screening test of
thyroid function.

A

SERUM TSH CONCENTRATION

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20
Q

a direct measurement of free (unbound) thyroxine, the only
metabolically active fraction of T4

A

FREE T4

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21
Q

measures the rate of iodine uptake by the thyroid gland.

A

RADIOACTIVE IODINE UPTAKE

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22
Q

The patient is given a tracer dose of iodine 123 or another radionuclide, and a count is made over the thyroid gland with a scintillation counter, which detects and counts the gamma rays released from the breakdown of 123I in the thyroid.

A

RADIOACTIVE IODINE UPTAKE

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23
Q

used to detect persistence or recurrence of thyroid carcinoma.

A

SERUM THYROGLOBULIN

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24
Q

results from suboptimal levels of thyroid hormone.

A

HYPOTHYROIDISM

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25
Q

most common cause of hypothyroidism in adults is

A

HASHIMOTO DISEASE

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26
Q

refers to a condition in which the immune system attacks the thyroid gland leading to hypo function of the gland.

A

HASHIMOTO DISEASE

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27
Q

Refers to the cause of the hypothyroidism that is associated to dysfunction of the thyroid gland itself.

A

PRIMARY OR THYROIDAL HYPOTHYROIDISM

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28
Q

Refers to the the cause of the thyroid dysfunction that is failure of the pituitary gland, the hypothalamus, or both

A

CENTRAL HYPOTHYROIDISM

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29
Q

If the cause of hypothyroidism is entirely a pituitary disorder, it may be referred to as

A

PITUITARY OF SECONDARY HYPOTHYROIDISM

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30
Q

If the cause of hypothyroidism is a disorder of the hypothalamus resulting in inadequate secretion of TSH due to decreased stimulation of TRH, it is referred to as

A

HYPOTHALAMIC OR TERTIARY HYPOTHYROIDISM

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30
Q

refers to the accumulation of
mucopolysaccharides in subcutaneous and other interstitial tissues.

A

MYXEDEMA

31
Q

a rare life-threatening condition and a decompensated state of severe hypothyroidism in which the patient is hypothermic and unconscious.

A

MYXEDEMA COMA

32
Q

Classic to hypothyroidism is

A

COLD INTOLERANCE

33
Q

Goiter when becomes so large that it compresses the neck and chest, it can cause

A

RESPIRATORY SYMPTOMS
DYSPHAGIA

34
Q

Decrease level of thyroid hormones leads to

A

SLOWIG OF BMR

35
Q

Refers to the decreased acid production in the stomach due to hypothyroidism

A

ACHLORHYDRIA

36
Q

The most important change caused by decreased level of thyroid hormones

A

LIPID METABOLISM

37
Q

Refers to the bulging of the eyes

A

EXOPTHALMUS

37
Q

Decreased consumption of oxygen due to decrease metabolism can lead to

A

ANEMIA

the decreased in oxygen consumption stimulates the bone marrow to stop producing RBC (carry O2) thus there will be ANEMIA

37
Q

drug of choice for the treatment of
hypothyroidism

A

LEVOTHYROXINE (SYNTHROID)

37
Q

Thyroid extract or gland that is dried and powdered for medical use

A

DESICCATED THYROID

38
Q

Most commonly used for treatment of hypothyroidism

A

LEVOTHYROXINE (SYNTHROID)

39
Q

Desiccated thyroid takes up how many weeks to take effect?

A

3 weeks

40
Q

Pharmacologic management for hypothyroidism

A

LIOTHYRONINE (CYTOMEL)
LEVOTHYROXINE
DESICCATED THYROID

41
Q

Dietary management for hypothyrodisim

A

IODINE
IODIZED SALT
SEAFOODS
DAIRY PRODUCTS

42
Q

After thyroidectomy, one should watch out for signs and symptoms of

A

HYPOPARATHYROIDISM

43
Q

A complication of hypothyroidism

A

MYXEDEMA COMA

44
Q

Characterized by progressive stupor ending in comatose state

A

MYXEDEMA COMA

45
Q

Myxedema coma is triggered by

A

AWACS

ACUTE ILLNESS
WITHDRAWAL OF THYROID MEDS
ANESTHESIA AND SURGERY
COLD TEMPERATURE
SEDATIVES AND OPOIDS ANALGESI

ACUTE ILLNESS Increases the demand for energy leading to sudden decreased in thyroid hormone

WITHDRAWAL OF THYROID MEDICATION causes sudden drop in thyroid hormones

ANESTHESIA AND SURGERY increases demand for bmr

SEDATIVES AND OPOIDS ANALGESIC can lead to respiratory and neurologic depression

46
Q

The use of these medication in hypothyroidism or myxedema coma can lead to respiratory and neurologic depression

A

SEDATIVES
OPOIDS

46
Q

Thickened, non-pitting edema of the skin

A

MYXEDEMA

46
Q

Priority in managing myxedema coma

A

AIRWAY (MECHANICAL VENTILATOR)

47
Q

Pharmacologic management for myxedema coma

A

SODIUM LEVOTHYROXINE WITH GLUCOSE AND CORTICOSTEROID

Levothyroxine increases thyroid hormones and thus BMR which can also increases glucose metabolism. A sudden increase in glucose metabolism can cause decrease blood glucose level

Glucose is administered to provide immediate energy substrate for cells and tissues

Corticosteroid is hormone associated with stress response. Patient in myxedema coma undergoes such stress thus with the administration of corticosteroid it help maintain blood pressure, metabolic stability, and counteract the stress response associated with myxedema coma.

Corticosteroid also prevent adrenal insufficiency.

48
Q

Electrolyte imbalance seen in patient with myxedema coma

A

HYPONATREMIA

Bradycardia seen in patient with myxedema can lead to decreased cardiac output and perfusion to the renal system causing renal failure and inability to secrete fluids thereby, fluid retention. Fluid retention causes hemodilution and thus hyponatremia.

49
Q

Metabolic disorder or problem seen in patient with myxedema coma

A

HYPOGLYCEMIA

Severe hypothyroidism can lead to very low thyroid hormones that is important in metabolism. Thyroid hormones stimulate gluconeogenesis and glycogenolysis. Decreased with these hormones can inhibit such process leading to hypoglycemia.

50
Q

is a form of thyrotoxicosis resulting from an excessive synthesis and secretion of endogenous or exogenous thyroid hormones by the thyroid

A

HYPERTHYROIDISM

51
Q

is an autoimmune disorder that results from an excessive output of thyroid hormones caused by abnormal stimulation of the thyroid gland by circulating immunoglobulins

A

GRAVES DISEASE

Immune cells mistakenly identify thyroid cells as antigen or foreign thus it produces thyroid antibodies which mimic the action of TSH leading to hyperthyroidism

The antibodies produced mimic the action of TSH because they bind on the same receptor site and thus increase production that produces thyroid hormones

52
Q

Most common cause of hyperthyroidism

A

GRAVES DISEASE

53
Q

most common form of
treatment for Graves disease.

A

RADIOACTIVE IODINE (IODINE 131)

53
Q

3 principal hallmarks of graves disease

A

HYPERTHYROIDISM
GOITER
EXOPTHALMUS

53
Q

One of the cause of hyperthyroidism that is generally seen in in people over 50 years old with long standing goiter and is characterized by multiple thyroid nodules

A

TOXIC MULTINODULAR GOITER

54
Q

Hyperthyroidism that is caused by excessive use of thyroid replacement hormone and overdosage of medication

A

EXOGENOUS HYPERTHYROIDISM

55
Q

Hallmark of hyperthyroidism

A

HEAT INTOLERANCE

56
Q

Classic sign of hyperthyroidism

A

EXOPTHALMUS

57
Q

Common complication of hyperthyroidism

A

HEART DISEASE

58
Q

Cells in the thyroid that is responsible for production of thyroid hormones

A

FOLLICULAR CELLS

59
Q

What are the three major forms of hyperthyroidism medications

A

ANTITHYROID
ADRENERGIC BLOCKING AGENTS
RADIOACTIVE THERAPY

60
Q

Antithyroid medications are

A

PROPYLTHIOURACIL
METHIMAZOLE
IODINE THERAPY (SSKI + LUGOL’S SOL)

61
Q

SSKI stands for

A

SATURATED SOLUTION OF POTASSIUM IODIDE

62
Q

Prior to surgery (thyroidectomy), the patient is given with this solution to decrease size and vascularity thus easy manipulation during surgery and prevent excessive bleeding

A

LUGOL’S SOLUTION

When Lugol’s solution is ingested, it saturates the thyroid gland with iodine. This excess iodine temporarily suppresses the synthesis and release of thyroid hormones from the thyroid gland.

63
Q

refers to a phenomenon in which high levels of iodine temporarily suppress thyroid hormone synthesis and release

A

WOLFF-CHAIKOFF EFFECT

64
Q

block the utilization of iodine leading to decrease synthesis and release

A

ANTITHYROID

65
Q

This antithyroid drug is mix with juice or milks and is given by straw to prevent staining of the teeth.

A

SATURATED SOLUTION OF POTASSIUM IODIDE (SSKI)

66
Q

indicated to decrease the cardiovascular signs and symptoms of thyrotoxicosis

A

ADRENERGIC BLOCKING AGENTS

67
Q

Diet for patient with hyperthyroidism.

A

4000-5000 KCAL

This is because the patient has hyperactivity due to increase BMR. To support the needs for energy, one must have high caloric diet

67
Q

Refers to sustained contraction of muscle as a result of hypocalcemia

A

TETANY

68
Q

Pharmacologic management for patient experiencing tetany after thyroidectomy

A

CALCIUM GLUCONATE

69
Q

After thyroidectomy, what are the things that must be readily prepared at bedside

A

CALCIUM GLUCONATE
TRACHEOSTOMY CARE

70
Q

Management for thyroid storm

A

ENSURE PATENT AIRWAY
ANTIPYRETIC
PNSS FOR HYDRATION
PTU - 300 TO 900 mgs
METHIMAZOLE - up to 60 mgs
SSKI - 2g IV
BETA BLOCKERS 1 to 3 mgs IV
HYDOROCORTISONE - 100 to 50 mgs IV

70
Q

What must be assess after thyroidectomy?

A

RNT

RESPIRATORY DISTRESS
NERVE DAMAGE
TETANY

RESPIRATORY DISTRESS related to hemorrhaged, edema, or laryngeal spasm

NERVE DAMAGE nerve damage is common in thyroidectomy because of the location of the thyroid gland *Check for ability to speak, tone, and quality of the voice

TETANY as s/s of hypocalcemia related to accidental removal of parathyroid gland

70
Q

To prevent Addisonian crisis in patient with thyroid storm, what is given?

A

HYDROCORTISONE 100-150 mgs IV

71
Q

TRUE OR FALSE
patient who has thyroid storm should not palpate the thyroid gland

A

TRUE

Palpation could stimulate the production of thyroid hormones

72
Q

Severe form of hyperthyroidism

A

THYROID STORM

MEDICAL SURGICAL (14 decks)

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