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Internal medicine > Thyroid disorders > Flashcards

Thyroid disorders Flashcards

1
Q

Lab findings of RTH (resistance to thyroid hormones

A

Elevated T3,T4 and normal/elevated TSH (unsuppressed)

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2
Q

Characteristic clinical feature of RTH (resistance to thyroid hormone)

A

Goiter without symptoms

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3
Q

Treatment of RTH (resistance to thyroid hormone)

A

No specific treatment

If hypothyroidism exists then treat with levothryoxine

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4
Q

List the causes of elevated total T4 with non suppressed TSH

A 
1-resistance to thyroid hormone 
2- familial dysalbuminemic hyperthyroxinaemia 
3- neonatal period
4- iatrogenic (amiodarone, heparin)
5- TSH secreting pituitary tumor
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5
Q

Whats the diagnostic approach in suspected RTH (resistance to thyroid hormone)

A

1- Measure T4,T3,TSH (they are elevated with a non suppressed TSH)

2- measure T3,T4 in relatives
3-exclude TH transport defects
4- sequence for TRbeta mutation
5-exclude TSHoma by measuring serum alpha-SU
6- demonstrate a blunted TSH with the administration of extraneous TH

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6
Q

Why is there hyperlipidemia in hypothyroidism

A

T3 upragulates LDL receptor gene. Low T3 causes lower numbers of LDL receptors so that LDL stays in the plasma longer

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7
Q

Definition and cause fo thyroid dermopathy

A

Hypothyroid causes deposition of hyaluronic acid in the dermis which attracts water and causes non-pitting edema

(Pretibial myxedema is an exception seen in Graves’ disease)

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8
Q

Treatment of hypothyroidism

A

Levó-thyroxine (synthetic T4)

Monitor TSH until its normal to manage the dose

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9
Q

Whats The best initial test for a thyroid disorder

A

TSH because it provides more detailed info on the status of T3,T4. If they are elevated then TSH decreases in response. Plus its levels can raise and fall before T3, T4 fall or raise can be evident in the blood

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10
Q

Whats thyroid storm

A

When someone had a previous thyroid problem (adenomas, graves..etc) then an acute stressor (surgery, trauma, infection) happen, this triggers a surge of catecholeamines (epinephrine, norepinephrine, dopamine) which are dangerous.

Symptoms include, tachycardia, hyperglycemia, fever, delirium.

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11
Q

Central hypo/hyper thyroid lab findings

A

T4,T3 levels follow TSH levels.

which means LOW TSH causes LOW T4,T3
and High TSH causes High T4,T3

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12
Q

Definition an diagnosis of euthyroid sick syndrome (ESS)

A

Patients who are critically ill can have low TSH and T4,T3 (related to their critical illness). This is similar presentation to central hypothyroidism, so to differentiate between Euthyroid sick syndrome and central hypothyroidism we check reverse-T3. If its high then its ESS. If its low then its central hypothyroidism

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13
Q

Causes of hypothyroidism

A

PRIMARY:Iodine deficiency, iatrogenic (surgical), Hashimoto’s thyroiditis (and other thyroiditis), wolf-chaikoff effect (in response to a load of iodine), lithium, congenital, infiltrative disorders, overexperssion of type 3 deiodinase

Secondary(central): hypopituitarim , hypothalamic disease, cancers (mass effect, craniopharengioma)

Extra thyroidal: resistance to TH

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14
Q

When do you measure free T3, total T3 for diagnosis

A

Following and diagnosing thyrotoxicosis

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15
Q

What are anti-thyroid antibodies and anti-thyroid peroxidase antibodies used for

A

Anti thyroid antibody is used as a marker for CHRONIC thyroiditis

Anti thyroid peroxidase antibody correlates with hypothyroidism

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16
Q

What do we use to monitor Graves’ disease

A

TSI thyroid stimulating immunoglobulin

TBII TSH binding inhibitory immunoglobulins

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17
Q

Whats the HLA associated with increased risk of thyroiditis

A

HLA-DR polymorphism (DR3,DR4,DR5)

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18
Q

Signs and symptoms of hypothyroidism

A 
Symptoms
Weakness
Dry skin
Bradycardia
Constipation
Weight gain
Confusion (hyponatremia caused be increased ADH caused by hypothyroidism)
Hoarse voice 
Parasthesia 
Signs 
Cool, dry skin
Puffy face, hands and feet (myxedema)
Alopecia
Peripheral edema (secondary to myxedema) 
Delayed tendon reflexes 
Carpal tunnel s
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19
Q

Whats myxedema coma

A

Coma caused by severe hypothyroidism, treat with levo thyroxine, and supportive therapy

20
Q

Treatment of graves diseas

A

BB and thionamides as an inicial management. Thionamides are [PTU and methimazole] they inhibit TPO thyroidperoxidase. In pregnant woman with graves use only PTU.

Radioiodine ablation of the thyroid (contra in pregnancy)

Surgery thyroidectomy

21
Q

Graves’ disease pathophysiology

A

antibodies that bind to TSH receptors on the thyroid and stimulate them

22
Q

Most specific symptoms of graves disease

A

Exophthalmus

pretibial edema

23
Q

Pathophysiology and treatment of graves ophthalmopathy

A

Autoimmune, TSH activates lymphocytes which induce inflammation and collagen deposition this is why its treated with steroids

24
Q

Pathophysiology of graves pretibial edema

A

Inflammation induces fibrosis and collagen deposition plus glycosaminoglycans deposition in muscle which sucks water in and causes myxedema

25
Q

Graves eye sings

A 
Staring gaze
Lid retraction
Lid lag
Potsis 
Exophthalmus
Conjunctivitis 
Opthalmoplegia
26
Q

Whats the “NO SPECS” scoring system

A

System to evaluate ophthalmopathy

0= No symptoms or signs 
1= Only signs (lid retraction or lag) no symptoms 
2= Soft tissue involvement (peri orbital edema)
3= Ptosis (>22mm)
4= Extraocular muscle involvement (diploid)
5= Corneal involvement
6= Sight loss
27
Q

Subclinical hyperthyroidism, definition and do you treat it?

A

TSH decreased but normal T3,T4
And no signs nor symptoms.

Only treat younger patient or older patients that have persistent lower than normal TSH/patients with cardiac disease, osteoporosis, or patients with symptoms

28
Q

What are the most common causes of subclinical hyperthyroidism

A

Excessive thyroid hormone replacement

Thyroid gland autonomy: adenomas , goiter , graves

29
Q

Jod-basedaw phenomenon

A

Hyperthyroidism in patients who commonly live in areas with low iodine. If you give those individuals iodine they will develop hyperthyroidism

Also happens with patients with a thyroid adenoma, if you give them an idodine load, it will cause the adenoma to reales more TH and cause thyrotoxicosis

30
Q

Amiodarone effect on the thyroid

A

Type 1: those who have a previous thyroid disease (graves, adenomas) it will cause hyperthyroidism

Type 2: in those who dont have previous thyroid siseasen,, the direct toxic effect of amiodaron on thyroid cells causes destructive thyroiditis (thyroiditis usually presents initially as hyperthyroidism then euthyroid state then hypothyroidism

It can cause hypothyroidism by two mechanisms:

1- wolf chaikoff effect
2-similar to T4 which inhibits 5’deiodinase that causes the peripheral conversion of T4 to T3 (the more potent form)

31
Q

Symptoms of acute thyroiditis

A 
Thyroid pain
Erythema in the thyroid area
Fever
Systemic fever symptoms 
Small, tender goiter
Dysphasia
32
Q

Diagnosis of acute thyroiditis

A 
Erythrocytes sedimentation rate
Fine needle aspiration 
Polymorphonuclear lymphocyte infiltrates 
White blood cell count 
Culture of the sample
33
Q

Whats subacute de Quervains granulomatous thyroiditis and how do you diagnose it

A

Subclinical thyroiditis with granulomas that’s normally self limited. Presents with painful and enlarged thyroid, with the pain radiating to the jaw, malaise, and symptoms of Upper respiratory tract infection. important feature that its TENDER

Diagnosis with :
Measuring erythrocytes sedimentation rate
Low uptake of iodine
FNA biopsy shows granulomas

Treat with NSAIDs and manage symptoms if present (thyrotoxicosis) [its SELF LIMITED]

34
Q

Whats silent thyroiditis

A

Usually subclinical, it happens after pregnancy, and is associated with TPO antibodies with more prevalence in patients with type 1 diabetes

35
Q

What are the features of Hashimoto’s thyroiditis and its treatment

A

Non tender, asymmetric, fixed goiter (Nasty As Fuck)
Treated with TH replacement therapy (levothyroxine) (presentation says tamoxifen which is an estrogen receptor modifier??? (dafuq))

36
Q

Whats sick euthyroid syndrome

A

Decreased in thyroid hormones due to their critical illness (ICU patient) (not related to central nor primary hypothyroidism)

37
Q

Factors that alter thyroid function in pregnancy

A

Exacerbation of underlying autoimmune disease
Increased TH demand by placenta(woman in low iodine areas are at risk of developing goiter)
HCG increased which stimulates TSH-Receptor
Estrogen induced raise in blood glucose levels
increase idodine urine excretion

38
Q

Whats the definition of goiter

A

Increased in thyroid size caused by deficiency of iodine (most common), biosynthetic defect, autoimmune disease/nodular disease

It can be single or multiple, functional or nonfunctional

39
Q

Whats diffuse nontoxic goiter

A

Goiter with no nodules that happens with iodine deficiency. Treat with iodine

40
Q

Indication for thyroid surgery

A

Malignancy
Aesthetic
Compressive symptoms
Repeated non diagnostic FNA

41
Q

whats Hyper functioning solitary nodule, how do you treat it?

A

A solitary nodule that is mutated with over functioning TSH-r receptor so that it keeps synthesizing TH while the pituitary senses this and lowers TSH, the rest of the thyroid becomes hypofunctioning while the adenoma keeps overproducing TH

Since its the only one taking iodine, treat with radioiodine that will spare the rest of the thyroid

42
Q

Thyroid ultrasound exam suspicious signs include..

A 
Larger than 1cm 
Hyper vascularization
Hypoechoic
Rapidly growing 
More tall than it is wide
Micro calcification

These are the criteria for FNA (not every goiter/nodule gets a FNA)

43
Q

What are Bethesda classification for thyroid cytology diagnostic category risk of malignancy

A

No diagnostic or unsatisfactory (repeat FNA) 1-5%
Benign. 2-4%
Atypia or follicular lesion of unknown significance 15-20%
Follicular neoplasm. 20-30%
Suspicious malignancy. 60-75%
Malignant. 90-100%

44
Q

What are the risk factors of thyroid carcinoma

A 
Radiation exposure
Vocal cord paralysis 
Male gender
Size >4
Age <20, >65
Family history of MEN2
Lateral cervical adenoma they
Nodule extension to adnusent structures
45
Q

Whats the most common thyroid cancer

A

Papillary carcinoma (derived from follicular cells)

46
Q

Who is most likely to develop anaplastic thyroid cancer

A

Females more often, age older than 65

47
Q

EU-TIRADS indication for high risk features of a neoplasm

A

Irregular shape
Irregular margins
Microcalcification
Hypoechogenicity

Internal medicine (3 decks)

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