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medicine > Thyroid Disorders - Cryar > Flashcards

Thyroid Disorders - Cryar Flashcards

1
Q

What are examples of thyroid disorders based on abnormal function?

A

thyrotoxicosis

hypothyroidism

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2
Q

What are examples of thyroid disorders based on abnormal structure?

A

diffuse goiter
nodular goiter (solitary nodule or multi)
atrophy

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3
Q

What are the most important and valid thyroid tests?

A 
TSH
Free Thyroxine (FT4)
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4
Q

What are the thyroid antibody tests testing for and for which diseases?

A

1) anitmicrosmal and antithyroglobulin - highly positive in chronic lymphocytic thyroiditis
2) thyroid stimulating Ig (TSIG) - marker for graves disease

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5
Q

When is thyroglobulin test high and when is it low?

A

low - exogenous thyroid ingestion

high - thyrotoxicosis

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6
Q

What is the main marker for recurrent thyroid cancer?

A

thyroglobulin tests

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7
Q

Which nuclear thyroid tests are there?

A

1) radioactive iodine (I131) - scan for configuration or uptake for function
2) technetium scan - for configuration

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8
Q

Why is an ultrasound good for seeing the thyroid?

A

it can see nodules < 1mm

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9
Q

Why do we test TSH and not actual thyroid hormone levels for function?

A

bc a patient can be hyperthyroid or hypothyroid and have “normal” thyroid hormone levels - T3/T4 are very sensitive to proteins and thyroid binding globulin (pregnancy, oral contraceptives, low albumin)
TSH is not affected by TBG or proteins

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10
Q

Why is TSH a sensitive test?

A

1) changes log rhythmically in response to change in thyroid hormone
2) can be supressed or elevated while the hormone is still in the normal range

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11
Q

What is subclinical thyroid disease?

A

patients with normal thyroid hormone levels and abnormal TSH - subclinical referring to the fact that the symptoms are not evident to the doctor

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12
Q

What can subclinical thyroid disease result in?

A

atrial fibrilation

osteoperosis

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13
Q

What are the etiologies of thryotoxicosis?

A 
Graves Disease
Toxic nodular goiter
toxic nodule
thyroiditis
exogenous
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14
Q

What are the signs and symptoms of thyrotoxicosis?

A 
nervousness
heat intolerance
palpitations
tremulousness
weight loss
weakness
diarrhea
enlarged thyroid
ophthalmopathy
warm, smooth skin
fine tremor
brisk reflexes
proximal weakness
tachycardia
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15
Q

What is Graves disease?

A

Hyperthyroidism - due to immunoglobulin stimulation of the TSH receptor and produces a diffuse goiter

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16
Q

What are some complications of graves disease?

A

1) ophthalopathy - an inflammatory condition of the periorbital tissue
2) pretibial myxedema

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17
Q

How do you diagnos Graves disease?

A

1) clinical features - goiter, ophthalmopathy, Symptoms
2) thyrotoxicosis on lab data - undetectable TSH and elevated T4
3) diffuse, elevated I131 uptake
4) positive TSIG

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18
Q

What are the consequences of thyroid associated ophthalmopathy?

A

1) due to thyrotoxicosis of any etiology - lid lag and widened palpebral fissure
2) inflammatory- conjuctival and periorbital edema and red eye
3) infiltrative - proptosis (double vision), lid retraction, compromise vascular supple to optic nerve

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19
Q

What nerves are affected in Graves disease ophthalmopathy?

A

medial and inferior rectus - problems looking up/out and laterally

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20
Q

What are the 3 treatment options for Graves disease?

A

1) radioactive Iodine (I131)
2) surgery
3) antithyroid medications

21
Q

How does I131 treat Graves?

A

the thyroid slowly stops working. Its painless and you get gradual development of hypothyroid

There is a temporary risk or rise in T4

22
Q

What is the benefit to using surgery to treat Graves and who should get it?

A

this option is for really sick and frail patients. It is good for QUICK resolution. You get hypothyroidism right away. (risk of hypoparathyroidism or recurrent laryngeal nerve damage)

23
Q

When toxic nodular goiter usually occur?

A

with known long-standing nodular goiter

24
Q

What is seen with I131 uptake on patients with toxic nodular goiter?

A

patchy uptake of I131

25
Q

How is toxic nodular goiter treated?

A

1) surgery

2) I131 - less responsive to this than Graves disease

26
Q

What is toxic nodule?

A

solitary autonomous nodule suppressing the remaining thyroid tissue

27
Q

How is toxic nodule treated?

A

1) I131

2) surgery

28
Q

When is thyrotoxicosis usually seen and how is it treated?

A

It is secondary to thyroiditis

self-limited illness requiring symptomatic treatment

29
Q

What can thyrotoxicosis be indistinguishable from clinically?

A

Graves disease

30
Q

How can laboratory tests distinguish throtoxicosis from Graves disease?

A

on lab work thyrotoxicosis shows low I131 uptake and TSH = 0

31
Q

What are the 3 types of thyroiditis?

A

1) acute (bacterial, fungal)
2) subacute granulomatous (de Quervain’s)
3) chronic lymphocytic (hashimoto’s)

32
Q

What is the three phase response of chronic throiditis?

A

1) thyrotoxicosis
2) hypothyroidism
3) recovery or permanent hypothyroidism

33
Q

What is post-partum thyroiditis?

A

a variant of Hashimoto’s

34
Q

What is the clinical course of post-partum thyroiditis?

A

1) hyperthyroidism (1-4 months after delivery lasting 2-8 weeks)
2) hypothyroidism (lasts 2-8 weeks)
3) recovery

35
Q

What are the clinical findings in subacute granulomatous thyroiditis or de Quervain’s?

A

1) PAINFUL
2) preceded or associated with fever
3) elevated ESR
4) may have thyrotoxicosis with low I131 uptake

36
Q

How do you treat subacute granulomatous thyroiditis or de Quervain’s?

A

Symptomatic

1) asprin or NSAIDs
2) propanolol
3) maybe steroids

37
Q

What is the typical outcome of de Quervain’s?

A

usually self limited

8-12 weeks

38
Q

What is another name for chronic lymphocytic thyroditis?

A

Hashimotos

39
Q

What are complications of Hashimotos?

A

1) hypothyroidism

2) thyrotoxicosis

40
Q

What is seen clinically in exogenous thyrotoxicosis?

A

1) suppressed TSH and elevated FTI (free thyroid index)
2) normal or small thyroid
3) low thyroglobulin
4) low I131 uptake

41
Q

What are the types of euthyroid goiter?

A

1) endemic (areas of iodine deficiency)
2) sporadic (hereditary)
3) nodular
4) diffuse

42
Q

What are some clinical features of hypothyroidism?

A

1) lethargy and fatigue, bradycardia, thin hair
2) dementia, irregular menses
3) cold intolerance, dry coarse skin, pallor
4) weight gain, thick tongue
5) hoarseness, paresthesis
6) delayed relaxation of reflexes

43
Q

How is primary hypothyroidism diagnosed?

A

with elevated TSH

44
Q

How is secondary hypothyroidism diagnosed?

A

1) low T3/T4

2) inappropriately low TSH (normally the TSH should be elevated if the FTI is low)

45
Q

How do you treat hypothyroidism?

A

initiation of thyroxine

46
Q

what are some cautions to be aware of with initiation of thyroxine for hypothyroidism?

A

1) caution in elderly or those who have compensated heart disease
2) does the patient have schmidt syndrome? (autoimmune polyendocrine disorder)

47
Q

Why do we replace with T4 and not T3?

A

the body converts T4 to T3 in the exact amount the body needs

48
Q

Why is a thyroid scan usually not helpful for cancer?

A

thyroid cancer is usually a “cold nodule”

49
Q

What are the types of thyroid carcinomas?

A

1) papillary - most common and most indolent
2) follicular - less common and more aggressive
3) anaplastic - most aggressive of all cancers
4) medullary - sporadic or familial (MEN II)

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