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IM > Thyroid Disorders > Flashcards

Thyroid Disorders Flashcards

1
Q

the state of thyroid hormone excess

A

thyrotoxicosis

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2
Q

the result of excessive thyroid function

A

hyperthyroidism

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3
Q

Primary Hyperthyroidism

A 
Graves Disease
Toxic Multinodular Goiter
Toxic Adenoma
functioning thyroid carcinoma metastases
Activating mutation of TSH receptor
McCune-Albright syndrome
Struma ovarii
Drugs: iodine excess (Jod-Basedow phenomenon)
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4
Q

Thyrotoxicosis without Hyperthyroidism

A

Subacute thyroiditis
Silent thyroiditis
Other causes of thyroid destruction: amiodarone, radiation, infarction of adenoma

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5
Q

Secondary Hyperthyroidism

A

TSH-secreting pituitary adenoma
Thyroid Hormone Resistance Syndrome: some patients may have symptoms of thyrotoxicosis
Gestational thyrotoxicosis

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6
Q

MINOR risk factor for Graves’ disease

A

smoking

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7
Q

MAJOR risk factor for the development of ophthalmopathy

A

ophthalmopathy

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8
Q

Antibodies that (+) TSH receptor

A

thyroid stimulating immunoglobulin (TSI)

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9
Q

Play a major role in thyroid-associated ophthalmopathy

A

cytokines

the release of cytokines such as interferon γ (IFN-γ), tumor necrosis factor (TNF), and interleukin-1 (IL-1) –> fibroblast activation and ↑ synthesis of glycosaminoglycans that trap water –> muscle swelling

LATER - there is irreversible fibrosis of the muscles

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10
Q

Features of thyrotoxicosis may be subtle or masked

A

apathetic thyrotoxicosis

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11
Q

Symptoms of Thyrotoxicosis

A
  1. hyperactivity, irritability, dysphoria
  2. heat intolerance and sweating
  3. palpitations
  4. fatigue and weakness
  5. weight loss w/ increased 6. appetite
  6. diarrhea
  7. polyuria
  8. oligomenorrhea, loss of libido
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12
Q

Signs of Thyrotoxicosis

A
  1. tachycardia
  2. afib in elderly
  3. tremor
  4. goiter
  5. warm, moist skin
  6. muscle weakness, proximal myopathy
  7. lid retraction or lag
  8. gynecomastia
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13
Q

MC cardiovascular manifestation

A

sinus tachycardia

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14
Q

Thyroid gland in patients w/ Grave’s disease

A

usually diffusely enlarged to 2 to 3x its normal size

consistency - firm, but NOT nodular

thrill or bruit

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15
Q

Earliest manifestations of Graves’ ophthalmopathy

A

sensation of grittiness
eye discomfort
excess tearing

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16
Q

Most serious manifestation of Graves’ ophthalmopathy

A

compression of the optic nerve at the apex of the orbit –> PAPILLEDEMA; peripheral field defects; permanent loss of vision (if left untreated)

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17
Q

NO SPECS

A

0 No signs or symptoms

1 Only signs (lid retraction or lag), no symptoms

2 Soft tissue involvement (periorbital edema)

3 Proptosis (> 22mm)

4 Extraocular muscle involvement (diplopia)

5 Corneal involvement

6 Sight loss

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18
Q

Most frequent over the anterior and lateral aspects of the lower leg (pretibial myxedema)

A

Thyroid dermopathy

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19
Q

Refers to a form of clubbing found in <1% of patients with Graves’ disease

A

Thyroid acropachy

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20
Q

Lab result of hyperthyroidism

A

↓ TSH level

↑ total and unbound thyroid hormone levels

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21
Q

May be useful if the diagnosis is unclear clinically but is not needed routinely

A

Measurement of TPO antibodies or TBII

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22
Q

Diagnosis of Graves Disease

A

biochemically confirmed
thyrotoxicosis

diffuse goiter on palpation

ophthalmopathy

dermopathy

often a personal or family history of autoimmune disorders

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23
Q

Distinguish the diffuse, high uptake of Graves’ disease from destructive thyroiditis, ectopic thyroid tissue, and factitious thyrotoxicosis, as well as diagnosing a toxic adenoma or toxic MNG

A

radionuclide (99mTc, 123I, or 131I) scan and uptake of the thyroid

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24
Q

Thyrotoxicosis w/ ELEVATED RAI uptake

A

Graves disease
Toxic adenoma
Toxic MNG

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25
Q

Thyrotoxicosis w/ LOW RAI uptake

A

Painless (silent) thyroiditis
Amiodarone-induced thyroiditis
Subacute thyroiditis (granulomatous, de Quervain’s)
Others: thyrotoxicosis factitia, struma ovarii

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26
Q

Frequent finding in patients with hyperthyroidism

A

fine tremor

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27
Q

Drugs that DECREASE serum T4 and T3

A 
glucocorticoids
androgens
L-asparaginase
salicylates
mefenamic acid
antiseizure medications - phenytoin, carbamazepine
furosemide
28
Q

Conditions that DECREASE serum T4 and T3

A

genetic factors

acute and chronic illnesses

29
Q

Low TSH, Low FT4

A

secondary/central hypothyroidism

sick euthyroid syndrome

30
Q

Low TSH, Normal FT4

A

subclinical hyperthyroidism (if normal FT3)

T3 toxicosis (high FT3)

early phase of treatment of thyrotoxicosis w/ antithyroid medications

31
Q

Low TSH, High FT4

A

Primary Thyrotoxicosis: Graves’ disease, MNG, toxic adenoma

Destructive thyroiditis, excess iodine intake, excess thyroid hormone

32
Q

Reduces thyroid hormone synthesis

A

antithyroid drug

33
Q

Reduces the amount of thyroid tissue

A

radioiodine treatment or thyroidectomy

34
Q

Antithyroid drug indicated in EARLY gestation (1st trimester), THYROID STORM and those experiencing adverse reactions to methimazole

A

Propylthiouracil

35
Q

MOA of propylthiouracil

A

(-) thyroid peroxidase (TPO), reducing oxidation and organification of iodide

36
Q

Thioamide that inhibits peripheral deiodinization of T4 to T3

A

Propylthiouracil

37
Q

Most DANGEROUS complication of thioamide use

A

AGRANULOCYTOSIS- severe reduction in the number of white blood cells (granulocytes) in the circulating blood

38
Q

MOST COMMON adverse effect of thioamide use

A

MACULOPAPULAR PRUTITIC RASH

39
Q

Antithyroid drug of choice in adults and children

A

Methimazole

40
Q

Inhibits hormone release through inhibition of thyroglobulin proteolysis and is often used to decrease the size and vascularity of the hyperplastic gland (used in preoperative preparation for surgery)

A

Iodide

41
Q

PTU dosage

A

100-200 mg PO q6-8h (initiation)

50-100 mg PO/day (maintenance)

42
Q

Methimazole dosage

A

10-20 mg PO q8-12 h (initiation)

2.5 - 10 mg PO/day (maintenance)

43
Q

Common minor side effects of antithyroid drugs

A

rash
urticaria
fever
arthralgia (1-5% patients)

44
Q

Rare but major side effects of antithyroid drugs

A

hepatitis (propylthiouracil)
cholestasis
vasculitis
AGRANULOCYTOSIS – most important

45
Q

Selective β1 receptor blocker without sympathomimetic activity which is indicated for THYROID STORM and THYROTOXICOSIS

A

Propanolol

46
Q

Used in the early stages before antithyroid drugs take effect

A

Propanolol

47
Q

Inhibit the peripheral conversion of T4 to T3 and is used in thyroid storm and Graves ophthalmopathy

A

Steroids (Dexamethasone, Hydrocortisone, Prednisone)

48
Q

Used to control TACHYCARDIA in patients with hyperthyroidism whom beta blockers are C.I. (asthma)

A

Diltiazem

49
Q

Accelerates T4 breakdown by hepatic enzyme induction

A

Barbiturates

50
Q

Lower T4 levels by increasing the fetal excretion of T4

A

Cholestyramine

51
Q

Maximum effect of thyroid preparations will be achieved after how many weeks of therapy

A

6-8 weeks

52
Q

Methimazole/carbimazole embryopathy

A

APLASIA CUTIS
CHOANAL ATRESIA
TRACHEOESOPHAGEAL FISTULA

53
Q

Thyroid Storm

A

Rare and life-threatening exacerbation of hyperthyroidism

fever, delirium, seizures, coma, vomiting, diarrhea and jaundice

54
Q

Burch and Wartofsky’s Criteria

A

> 45 - HIGHLY suggestive of thyroid storm

55
Q

Precipitants of Thyroid Storm

A

pre-existing thyrotoxicosis, untreated or partially treated

surgery (poorly prepared patient w/ diffuse toxic goiter for thyroidectomy)

withdrawal of anti-thyroid drug therapy
radioiodine therapy
vigorous thyroid palpation
iodinated contrast dyes
salicylates
56
Q

Laboratory Findings (Thyroid Storm)

A 
Increased FT4 and FT3
Decreased TSH
Leukocytosis
Mild hypercalcemia (increased bone turnover)
Liver function test abnormalities
Mild-moderate hyperglycemia
57
Q

Antithyroid DOC for thyroid storm

A

PTU - 500 - 1000 mg LD and 250 mg q4h PO or per rectum /per NGT

58
Q

Primary Hypothyroidism

A

Iodine deficiency
Autoimmune thyroiditis (Hashimoto’s thyroiditis)
Iatrogenic Hypothyroidism
Subacute Lymphocytic Thyroiditis

59
Q

Secondary Hypothyroidism

A

Lesions compressing the pituitary (adenoma, craniopharyngioma, meningioma, empty sella)
Sheehan syndrome
Autoimmune diseases (polyglandular disorders)
Infectious (TB, syphilis)

60
Q

Symptoms of Hypothyroidism

A 
tiredness, weakness
dry skin
cold tolerance
hair loss
difficulty concentrating and poor memory
constipation
weight gain w/ poor appetite
dyspnea
hoarse voice
menorrhagia
paresthesia
impaired hearing
61
Q

Signs of Hypothyroidism

A 
Dry coarse skin
Cool Peripheral Extremities
Puffy face, hands and feet (myxedema)
Diffuse alopecia
Bradycardia
Peripheral Edema
Delayed tendon reflex relaxation
Carpal Tunnel Syndrome
Serous Cavity Effusions
62
Q

High TSH, Low FT4

A

Primary (overt) Hypothyroidism

Autoimmune Hypothyroidism

63
Q

High TSH, Normal FT4

A

Mild (subclinical) Hypothyroidism

Early phase treatment of primary hypothyroidism w/ levothyroxine

64
Q

High TSH, High FT4

A

TSH producing adenoma

Generalized resistance to thyroid hormone

65
Q

Preparation of choice for treatment of hypothyroidism

A

Levothyroxine (LT4)

IM (66 decks)

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