Thyroid Disorders

Question 1

What will TSH look like in primary hypothyroidism?

Answer 1

elevated

Question 2

What will TSH look like in secondary hypothyroidism?

Answer 2

depressed

Question 3

What are the lab values for TSH, T3, and I123 in hyperthyroidism?

Answer 3

depressed TSH, elevated T3, increased uptake - “hot” foci

Question 4

Gold standard for diagnosing thyroid nodule

Answer 4

FNA bx. - US guided

Question 5

How will thyroid nodule look with I123?

Answer 5

“cold” foci

Question 6

Symptoms of hyperthyroidism

Answer 6

sweating, weight loss or gain, anxiety, palpitations, loose stool, heat intolerance, irritable, fatigue, weakness, menstural irrgularities, stare, tremor

Question 7

Cardiac issues seen with hyperthyroidism

Answer 7

tachycardia

Question 8

describe the skin of a hyperthyroid patient

Answer 8

warm and moist

Question 9

Most common cause of thyrotoxicosis

Answer 9

Graves Disease

Question 10

How does Graves Disease cause thyrotoxicosis?

Answer 10

increase in synthesis of thyroid hormone - autoantibodies [thyroid-stimulating immunoglobulins or TSH receptor antibodies] bind to TSH receptor in thyroid cell membranes and result in hyperfunction

Question 11

two symptoms often seen in Graves Disease

Answer 11

ophthalmopathy pretibial myxedema

Question 12

What can trigger Graves Disease?

Answer 12

Dietary Iodine Supplements

Question 13

What are patients with Graves Disease at increased risk for?

Answer 13

other systemic autoimmune disorders

Question 14

Autonomous hyperfunctioning thyroid nodules that produce hyperthyroidism - more prevalent among older adults and in iodine-deficient regions

Answer 14

Plummer Disease

Question 15

Autoimmune thyroiditis that occurs in the first 12 months postpartum and occasionally after miscarriage

Answer 15

postpartum thyroiditis

Question 16

Postpartum thyroiditis has increased incidence in women with

Answer 16

preexistent type 1 DM and other autoimmune disorders

Question 17

Thyroiditis typically caused by viral infection - MC is URI that results in enlarged and painful thyroid

Answer 17

Subacute thyroiditis

Question 18

thyroiditis that occurs spontaneously or due to chemotherapeutic agnts or drugs such as lithium, amiodarone

Answer 18

Silent thyroiditis

Question 19

What must be supressed to diagnose amiodarone-induced thyrotoxicosis?

Answer 19

TSH

Question 20

What can cause hyperthyroidism in pregnancy?

Answer 20

high levels of serum hCG binding to TSH receptors

Question 21

Symptoms of thyrotoxic crisis or “storm”

Answer 21

marker agitation or delirium, very high fever, severe tachycardia, vomiting, diarrhea, dehydration

Question 22

Causes of thyrotoxic crisis or “storm”

Answer 22

trigger - stressful illness, thyroid surgery, or RAI administration

Question 23

Term for asymptomatic individuals with low serum TSH but normal FT4 and FT3

Answer 23

Subclinical Hyperthyroidism

Question 24

Hyperthyroidism can cause what other abnormal lab values

Answer 24

hypercalcemia, increased liver enzymes, increased alkaline phosphatase, anemia, decreased neutrophils

Question 25

When is radioisotope testing contraindicated?

Answer 25

pregnancy or breast feeding

Question 26

Primary treatment for symptomatic relief in Graves Disease

Answer 26

propranolol

Question 27

initial treatment of choice for thyrotoxic crisis

Answer 27

propranolol

Question 28

Two most common Thiourea drugs

Answer 28

methimazole propylthiouricil

Question 29

What type of patients do thiourea drugs show best results?

Answer 29

small goiter, mild hyperthyroidism, those requiring smaller doses

Question 30

What two symptoms must patient on thiourea be on the lookout for?

Answer 30

agranulocytosis pancytopenia

Question 31

What would cause a patient to stop their thiourea?

Answer 31

onset of any infection

Question 32

Common side effects of thiourea drugs

Answer 32

pruritis, allergic dermitits, nausea, dyspepsia

Question 33

In a non-pregnant patient what is the preferred oral therapy for hyperthyroidism?

Answer 33

Methimazole

Question 34

Why is propylthiouracil considered second line therapy?

Answer 34

acutte liver failure

Question 35

Who is propylthiourcil reseverd for?

Answer 35

pregnancy and breast feeding - not known to cause fetal anomalies

Question 36

Effective in temporary treating thyrotoxicosis

Answer 36

iodinated contrast agents

Question 37

MOA of iopanoic acid and ipodate sodium

Answer 37

inhibit coversion of T4 to T3 in periphery

Question 38

Who are iodinated contrast agents particularly useful for?

Answer 38

those who are symptomatically very thyrotoxic

Question 39

How does Radioactive Iodine work?

Answer 39

destroys overactive thyroid tissue

Question 40

Can you used RAI in pregnancy or lactation?

Answer 40

No

Question 41

After RAI therapy when can men and women safely conceive?

Answer 41

women - 4 months men - 6 months

Question 42

While patients are on RAI therapy, what can they take to treat symptoms?

Answer 42

propranolol

Question 43

What is a contraindication of 121I therapy?

Answer 43

Graves ophthalmopathy

Question 44

Patients with Graves ophthalmopathy who are being treated with radioiodine should also be prophylactically given

Answer 44

prednisone

Question 45

After radioiodine therapy, a patients FT4 level drops then rises to toxic levels, should you be concerned?

Answer 45

no - does NOT indicated treatment failure. Release of sored thyroid hormone fomr injured thyroid cells

Question 46

Symptoms of hypothyroidism

Answer 46

fatigue, cold intolerance, constiptation, weight change, depression, menorrhagia, hoarseness, dry skin, bradycardia, delayed return of deep tendon reflexes, anemia, hyponatremia, hyperlipidemia

Question 47

what will FT4 and TSH be in hypothyroidism?

Answer 47

TSH will be elevated T4 will be depressed

Question 48

Most common cause of hypothyroidism

Answer 48

Hashimoto thyroiditis

Question 49

what drug causes clinically significant hypothyroidism?

Answer 49

amiodarone

Question 50

Liver disease associated with increased risk of autoimmune thyroiditis

Answer 50

chronic hepatitis C

Question 51

what is a goiter?

Answer 51

enlarged thyroid due to elevated serum TSH levels

Question 52

what is the best screening test for hypothyroidism?

Answer 52

serum TSH levels

Question 53

lab values for hypothyroidism

Answer 53

elevated serum TSH low serum FT4 hyponatremia hypoglycemia anemia

Question 54

Patient has normal serum FT4 and elevated serum TSH, diagnosis?

Answer 54

subclinical hypothyroidism

Question 55

two antibodies that will be elevated in Hashimoto thyroiditis

Answer 55

antithyroglobulin and antithyroperoxidase

Question 56

prefered medical therapy for hypothyroidism

Answer 56

levothyroxine

Question 57

is levothyroxine safe in pregnancy?

Answer 57

yes

Question 58

what is the goal of medical therapy in hypothyroid patient?

Answer 58

normalize TSH

Question 59

Most common and most benign type of thyroid cancer

Answer 59

papillary carcinoma

Question 60

rarest and most deadly type of thyroid cancer

Answer 60

anaplastic carcinoma

Question 61

Classification system for Thyroid nodules

Answer 61

Bethesda Classification System

Question 62

Hot nodule has \_\_\_% chance of being malignant What type of nodule is malignant?

Answer 62

0% cold nodule

Question 63

Thyroid cancer most commonly associated with ionizing radiation

Answer 63

papillary thyroid cancer

Question 64

Rank the following in terms of malignancy: anaplastic, papillary, follicular, medullary

Answer 64

papillary → follicular → medullary → anaplastic

Question 65

How does Plummers differ from Graves?

Answer 65

plummers has no antibodies → no exophthalmos

Question 66

name of operation to fix thyroglossal duct cyst

Answer 66

sistrunk operation