Thyroid DX

Question 1

What gland regulates the thyroid and where is it made

Answer 1

anterior pituitary gland where TSH madeand the hypothalmus regulates it

Question 2

What does the parathyroid regulate

Answer 2

calcium blood levels

Question 3

what is primary hyerparathyroidism

Answer 3

asympotomatic, increased serum CA + levels then follow up by testing the PTH

Question 4

what is hypothyroidism? What is the most common cause? What is the screening test?

Answer 4

Elevated TSH

Auto-immune dx called Hashtmoto’s

TSH

Question 5

What are the risk factors for hypothyroidism?

Answer 5

Fam hx, post-partum, females > 50 , other autoimmune dx

Question 6

Hypothyroidism Presentation ? Mnuemonic

Answer 6

MOM's SO TIRED 
Memory loss
Obesity
Menorhhage
Slowness ( mental and physcial )
Skin and hair dryness (hair loss)
Onset Gradual
Tiredness
Intolerance to cold
Raised BP
Energy level falls
Depression/delayed reflexes
Achilles rupture and alopecia

Question 7

What would you see on hypo-T labs

Answer 7

increased TSH

Low t4 and low t3

Question 8

when would you order a anti-tpo test

Answer 8

when r/o hashimotos dx ( would be elevated if it was autoimmune related)

Question 9

what labs would you see in sub-clinical hypothyroidism?

Answer 9

elevated TSH normal T4 … check every 6-12 months

Question 10

What is the tx for hypothyriodism? when should you check it?

Answer 10

levothyroxine (can take while preg) should be 1.6 mcg/kg body weight per day

should recheck levels 6-8 weeks

Question 11

what is armour thyroid?

Answer 11

dessicated porine thyroid ( it can not be given to jews or muslums due to the fact that it has pork in it)

Question 12

When should you re-evalute dosing?

Answer 12

symptomatic, losing more than 10% body weight, or pregnancy ( will need higher dose)

Question 13

What drugs can cause hypo-T

Answer 13

Lithium and Amiodarone (both), interferon

Question 14

What labs would you see on HYPER-T

Answer 14

Low TSH

increased T4 and T3

Question 15

What is the most common cause of HYper-T

Answer 15

graves (autoimmune) #2 toxic multi-nodular goiter

Question 16

What test should you order with HyperT

Answer 16

Screening: TSH

TSH - antibody test = (anti-TPO) will be elevated if they have Graves or Hashimoto’s

Question 17

If they have a goiter or nodules what should you order ?

Answer 17

thyroid US with a thyroid function panel

Question 18

What is the classic presentation for HYPER-T

Answer 18

SWEATING
Sweating 
Weight loss
Emotional mind racing
Appetitie increased 
Tremor/ tachy
Intolerance of heat, irritability, irregular menstration
Nervousness 
Goiter, Gi problems

eye lid lag

Question 19

What is a common feature in Graves’ dx

Answer 19

Exopthalmus and goiter , eye lid lag

Question 20

What medication can cause HYPER-T

Answer 20

amiodarone

Question 21

What are the complications with HYPER-T

Answer 21

arrythmias (afibb, PVC’s) angina, CHF, thyroid storm , osteoporosis

refer asap

Question 22

What is radioiodine ablation? what does it result in

Answer 22

People with HYPER -T get this ablation which results in destroying the thyroid and HYPO-T will need synthroid for rest of life

Question 23

What medications can you take for HYper-T

Answer 23

Methimazole once a day

PTU- preffered for preg woman

INderal ( propanolol ) to control tremors

Question 24

What are the clinical findings concerning for a maligant thyroid nodule?

Answer 24

history of neck radiation
larger than 4 cm
Firmness, nontender on palpation
Nonmobile
Dysphonia
Lymphadenopathy
hemotysis

Question 25

What is the process for once you find a mass

Answer 25

1. TSH level
2. Low - thyroid scan - HOT ( good news) Not Hot - get a fine needle aspiration biopsy
3. HIGH - good news