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Clin Med-Endocrine > thyroid disorders > Flashcards

thyroid disorders Flashcards

1
Q

what is the function of the thyroid gland

A

produced thyroid hormones that control the rates of metabolic processes throughout the body

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2
Q

what is the sole purpose of iodine

A

to maintain euthyroid

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3
Q

what are some of the function of T3&T4

A 
regulated catabolism
metabolic rate
heat production
GH secretion and skeletal maturation
CNS development
muscle tone
GI secretions 
respiration
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4
Q

what are anti thyroid peroxidase

A

these are circulating antibodies against thyroid peroxidase

used to detect thyroid disorders

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5
Q

what is a goiter

A

an increase in the size of the thyroid gland
can occur in hyer/hypo or euthyroid
can be diffuse or nodular
due to hypertrophy of tissue from thyroid hormone

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6
Q

what is the pembertons sign

A

large substernal goiters can cause superior vena cava syndrome
facial erythema and cyanosis when both arms are raised over the head

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7
Q

What is congenital hypothyroidism

A

very rare and preventable
usually a child born without or half of a thyroid
Can also be due to lack of producing function thyroid

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8
Q

what are the signs and symptoms of congenital hypothyroidism

A

mental retardation
growth impairment
poor psychomotor development

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9
Q

that is the treatment for congenital hypothyroidism

A

screening at birth with hormone supplement

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10
Q

what are types of autoimmune hypothyroidism

A

hasimotos thyroiditis, atrophic thyroiditis

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11
Q

what are types of drug induced hypothyroidism

A

iodine excess, amiodarone, iodine contrast media, lithium, antithyroid drugs

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12
Q

what are the most common causes of hypothyroidism world wide

A

iodine deficiency

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13
Q

what is the most common cause of hypothyroidism in the US

A

autoimmune

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14
Q

what are some infiltrative and surgical processes that can cause hypothyroidism

A

amyloidosis, sarcoidosis, hemochromatosis

thyroidectomy

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15
Q

what are causes of transient hypothyroidism

A

sub acute thyroiditis

withdrawal of thyroxine Tx in individuals with an intact thyroid

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16
Q

what are secondary causes of hypothyroidism

A

hypopituitarism

hypothalamic disease

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17
Q

what is the most common form of thyroiditis and most common cause of thyroid disease in the US

A

hashimotos thyroiditis

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18
Q

what symptoms of hypothyroidism

A 
weight gain
fatigue/lethargy
depression
constipation
dry skin
cold interolerance
weakness
DOE
muscle cramps
heavey/light or no period
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19
Q

what are signs of hypothyroidism

A 
bradycardia
thin brittle nails
thinning hair
puffy face/eyelids
pale skin
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20
Q

what are signs and symptoms that are unique to hashimotos

A

initially present with transient hypoerthyroidism due to destruction of thyroid
many present b/c of non-tender goiter initially and then later in the disease they will present with the common signs/symptoms of hypothyroidism

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21
Q

what will the serum TSH and FT4 be like for primary hypothyroidism

A

will be elevated
FT4 will be normal or low
if hashimotos antibodies against thyroperoxidase are high

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22
Q

what are TSH and FT4 values like with secondary hypothyroidism

A

low or normal

low or normal

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23
Q

what are the other lab abnormalities like with hypothyroidism

A

increased serum LDL, cholesterol, triglycerides, lipoprotein, liver enzymes, and creatine kinase, hyponatermia, hypoglycemia and anemia

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24
Q

what is subclinical hypothyroidism

A

patients w/ normal FT4 and mildly elevates TSH
maybe benefit thyroid replacement
if they are asymptomatic then there is no need to replace just monitor for symptoms

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25
Q

when should you use imaging

A

usually not necessary
If a goiter is present and asymmetric the ultra-sound should be indicated to show if there is solitary lesion or multinodular goiter
if a solitary lesion/focal nodule is present fine needle aspiration is recommended

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26
Q

what are some complications of hypothyroidism

A 
myxedema
infertility
miscarriage
cardiac complications
megacolon
increased risk of bacterial pneumonia
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27
Q

what is the mainstay treatment for hypothyroidism

A

levothyroxine

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28
Q

when started on levothyroxine treatments are started when should TSH levels be monitored

A

6-8weeks after initiation

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29
Q

how long will it take for the replacement take to be effective

A

3-6 months

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30
Q

how should the dosages be adjusted for treatment with levothyroxine

A

small increments of 12.5-25ug/day

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31
Q

what should you do with your patient once normal levels are maintained and stable for 1 year

A

follow up with TSH on annual basis

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32
Q

what should you start pt<60 yo with heart disease

A

50-100ug

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33
Q

what is the starting dose for elderly patients?

A

12.5-25ug much lower than younger patients

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34
Q

what happens if you do not treat a pregnant women with hypothyroidism

A

may affect fetal neural development and cause preterm labor

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35
Q

when should you check thyroid for pregnant women

A

2nd and 3rd trimesters

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36
Q

what should you do with women who have known hypothyroidism

A

increase their levothyroxine by 50% during pregnancy

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37
Q

what is myxedema crisis

A

severe life threatening hypothyroidism

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38
Q

what are the symptoms of myxedems crisis

A

impaired cognition
convulsions and abnormal CNS signs
severe hypothermia, hypoventilation, hyponatremia, hypoglycemia, and hypotension and kidney injury

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39
Q

who is myxedema crisis most common in

A

women who have had a stroke or stopped thyroid meds

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40
Q

what is the treatment for myxedema crisis

A

rapid thyroid hormone replacement and supportive therapy

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41
Q

what is hyperthyroidism

A

a condition in which the thyroid gland is overactive, making too much thyroid hormone

42
Q

what are types of primary hyperthyroidism

A

graves, toxic multinodular goiter
struma ovarii
drugs

43
Q

what are causes of transient hyperthryoidism

A

subacute thyroiditis
thyroid destruction
thyrotoxicosis factitia

44
Q

what are causes of secondary hyperthyroidism

A

TSH pituitary adenoma
thyroid hormone resistance
molar pregnancy
gestational thyrotocixcosis

45
Q

what is the most common cause of hyperthyroidism

A

graves disease

46
Q

when is graves disease

A

autoimmune disease affecting the thyroid gland characterized y an increase in synthesis and release of thyroid hormones

47
Q

what increases the risk factors for hyperthyroidism

A

high iodine intake as well as medication use (potassium iodide, amiodarone-contain iodine)
genetics

48
Q

what is the pathogenisis of graves disease

A

caused by production of antibodies to the thyroid glands TSH receptors
Ab stimulate the receptor and are called thyroid stimulating immunoglobulins which leads to increased thyroid gland hormone production

49
Q

what age group is graves disease most common age

A

20-50years old

more common in women

50
Q

what is toxic single/multinodular goiter

A

autonomouslt secreting nodules produced thyroid hormone w/o the need for TSH receptor stimulation

51
Q

what is single toxic nodule hyperthyroidism

A

plummers disease

52
Q

what is granulomatous thyroiditis (dequervain thyroiditis)

A

initially inflammation causes thyroid follicle destruction with release of thyroid hormones, followed by period of hypothyroidism while glands are recovering and then euthyroid returns

53
Q

what is lymphocytic thyroiditis

A

causes brief thyrotoxic state followed by hypothyroidism then resolution
common in postpartum women

54
Q

what are other causes of hyperthyroidism

A 
ovarian teratoma
metastatic thyroid cancer
pituitary tumor 
Iodine-induced 
amiodarone
55
Q

what is the jod baselow effect

A

occurs in patients with an endemic goiter who relocated to an iodine abundant geographical area

56
Q

what are symptoms of thyrotoxicosis/hyperthyroidism

A 
hyperactivity
heat intolerance and sweating
palpitations
weight loss despite increased appetite 
diarrhea
polyuria
57
Q

what are signs of hyperthyroidism

A 
tachycardia
tremor
goiter
warm moist skin
palmar erythema
lid retraction or lag
fever
58
Q

what are signs specific to graves disease

A

enlarged thyroid with a bruit due to vascularity of gland
lid retraction, periorbital edema, conjunctival injection proptosis, visual disturbance
pretibial brawny thickening of skin

59
Q

what are the lab values like for hyperthyroidism (TSH,FT4,T3)

A

TSH-low
FT4-elevated
T3-norm or elevated

60
Q

what is elevated erythrocyte or ESR indicative of

A

subacute thyroiditis

61
Q

what is ultra sounds useful for with thyroid disorders

A

helpful for patients with palpable thyroid

62
Q

what is a thyroid scan used for

A

used to evaluate uptake radioactive iodine in the thyroid scan

63
Q

how to treat graves disease

A 
symptomatic treatment
reduce T4 production
radioactive iodine
ant-thyroid drugs
iodinated contrast agents
surgery
64
Q

what are you going to want to use for symptomatic treatments for graves disease

A

beta blocker to relieves tachycardia, tremor
propanolol
atenolol

65
Q

How does radioactive iodine work to treat graves disease

A

destroys thyroid gland so lifelong replacement of thyroid hormone
In adenoma/toxic nodules- the adenomas take up the iodine, destroying it and leaving the normal gland tissue intact

66
Q

when is the use of radioactive iodine contraindicated

A

pregnant women because of risk of fetus developing hypothyroidism

67
Q

how do antithyroid drugs work

A

interferes with the production of T4
does not permanently damage thyroid
lower chance of post treatment

68
Q

When is methimazole preferred

A

second line therapy for pregnant/ breastfeeding women

69
Q

when to use PTU

A

in pregnancy and breastfeeding

70
Q

how do iodinated contrast agents like iopnanoic acid or ipondate sodium work

A

temprorary tx for thyrotoxicosis
bloack conversion of T4 to T3
NOT USED FOR DEFINITIVE LONG TERM TX

71
Q

when should surgery be used to treat hyperthyroidism

A

pts who fail medication and RAI with large goiters compromising airway
pts are treated with antithyroid drug prior to surgery to obtain euthyroid state

72
Q

what are complications of thyroid surgery

A

recurrent laryngeal nerve paralysis or hypoparathyroidism

73
Q

what is the treatment of choice for single toxic adeoma

A

RAI

surgical resection

74
Q

what is the treatment for toxic multinodular goiter

A

medical tx for symptomatic tx to normalize thyroid function

followed by surgery which is the definitive treatment

75
Q

how do you treat lymphocytic thyroiditis

A

improves over weeks on own

symptomatic treatment with beta blocker

76
Q

what is the treatment for De Quervain thyroiditis

A

will subside spontaneously with in week to months
short course of NSAID of steriods
ANTI THYROID medis ineffective

77
Q

what triggers thyroid storm

A

stressfull illness, thyroid surgery or RAI

78
Q

what are signs and symptoms of thyroid storm

A

marked delirium

severe tachycardia, vomiting, diarrhea, dehydration and very high fever

79
Q

what is the goal of treatment for thyroid storm

A

induce a euthyroid state
anti-thyroid drugs, ipodate sodium, iodine tx, propanolol, hydrocortisone then followed by radioactive iodine ablation or surgery

80
Q

the risk of malignancy of non-toxic thyroid adenomas and multinodular goiters are higher in which of the following patients?

A 
hx of head and neck radiation
total body radiation for bone marrow transplant
FH of thyroid cancer
hoarsness
vocal cord paralysis
thyroid nodule
81
Q

what are signs and symptoms of non-toxic thyroid adenomas mutinodular goiters

A

cosmetically embarrassing
cause discomfort and dyphagia
cause dyspnea d/t tracheal compression

82
Q

what is the labs you want to order for a patient with a thyroid nodule

A

serum TSH

antithyroperoxidase Ab and antithyroglobulin Ab

83
Q

what imaging is the initial test of choice for nodules

A

ultrasound- this measures the size and if there is multinodular goiter present

84
Q

what increases the risk of the nodule being malignant

A

irregular or indistinct margins, greater than 1cm

85
Q

what is the best method to determine if a nodule id benign or malignant

A

fine needle aspiration or biopsy done with US guidance

86
Q

what is done to nodules including benign

A

monitoring with regular periodic palpation and US 6 months and re-biopsied if growth occurs

87
Q

when is levothyroxine use for non-toxic thyroid adenomas

A

for larger benign nodules >2cm

88
Q

when is the use of levothyroxine contraindicated

A

pts with cardiac disease

89
Q

surgery is required for all types of what kind of nodules

A

malignant

90
Q

what is the most common malignancy of endocrine system

A

thyroid cancer

91
Q

Who is most at risk for thyroid cancer

A

increased incidence with age

more likely in females than males but males have a worse prognosis

92
Q

what are risk factors for thyroid cancer

A 
head and neck radiation
bilateral disease
nodule>4cm
iodine deficiency
FH of thyroid cancer
hoarse voice
nodule fixed to other structures
lymph involvement
93
Q

what is the most common type of thyroid cancer

A 
papillary
presents with single nodule
related to childhood history of radiation
genetics
lest agressive
94
Q

what is the second most common type of thyroid cancer

A

follicular
more aggressive than papillary
due to gene mutations or translocation

95
Q

what makes up about 3% of thyroid cancers

A

medullary
1/3 sporadic
1/3 familial
1/3 associated with MEN type2

96
Q

what makes up 2% of thyroid cancer

A

anaplastic
present in older pts
most aggressive
due to gene mutations

97
Q

what are signs and symptoms of thyroid cancer

A

palpable firm non-tender nodule

most are asymptomatic some can cause neck discomfort

98
Q

how would a thyroid cancer be diagnosed

A

FNA biopsy with cytology testing

99
Q

what is usually high in metastatic disease

A

high serum thyroglobulin

100
Q

what is elevated with medullary carcinoma

A

serum calcitonin

carcinoembryonic antigen

101
Q

What can you use for imaging

A

U/S help localize and measure
RAI scan-post
thyroidectomy
CT/MRI-located metastasis

102
Q

what is the first line treatment for thyroid cancer

A

surgery
RAI therapy
radiation therapy
thyroid hormone supplementation

Clin Med-Endocrine (8 decks)

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