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05 Endo > Thyroid Gland Disorders > Flashcards

Thyroid Gland Disorders Flashcards

1
Q

most common cause of hypothyroidism world wide

A

iodine deficiency

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2
Q

most common cause of hypothyroidism in iodine sufficient areas

A

autoimmune disease and iatrogenic causes

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3
Q

common complaint for hypothyroidism

A

weight change

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4
Q

first line test performed if thyroid disorder is highly suspected

A

tsh

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5
Q

most useful physiologic marker of thyroid hormone action

A

tsh

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6
Q

when is thyroid hormone requested

A

tsh is abnormal

suspected or known pituitary disease (measure both tsh and ft4)

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7
Q

diagnostic hallmark for autoimmune thyroid disorders

A

thyroid autoantibodies

can contribute to its development and chronicity

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8
Q

normal values to thyroid ab

A

Tg-Ab 5-20
TPO-Ab 8-27
TSHR-Ab 0

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9
Q

modality that can confirm presence of a nodule

A

uts

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10
Q

uses of uts

A 
confirm nodule
size
benign or suspicious features
cervical lymphadenopathy
>50% cystic (anechoic, usually benign)
posterior location
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11
Q

what is subclinical hypothyroidism

A

biochemical evidence of hormone deficiency in patients who have few or no apparent clinical features of hypothyroidism

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12
Q

biochem of subclinical hypothyroid

A

elevated serum tsh and normal ft4

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13
Q

indications for treatment of subclinical hypothyroidism

A

woman who wishes to concieve or is pregnant
tsh >10 mlU/l
tsh <10 mlU/l with symptoms of hypothyroidism, positive tpo-ab, or evidence of heart disease

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14
Q

treatment for subclinical hypothyroidism

A

starting treatment: low dose levothyroxine (25-50 ug/d), target normal tsh
not starting treatment: monitor annually

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15
Q

queen anne’s sign

A

thinning of outer third eyebrows

NOT A SPECIFIC SIGN OF HYPOTHYROIDISM

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16
Q

classification of autoimmune hypothyroidism

A

hashimoto’s or goitrous thyroiditis: early stage

atrophic thyroiditis: late stage

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17
Q

pathogenesis of autoimmune hypothyroidism

A

lymphocyte infiltration and fibrosis

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18
Q

risk factors for autoimmune hypothyroidism

A

hla-dr polymorphisms
female preponderance
environmental factors (5)

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19
Q

clinical manifestations of autoimmune hypothyroidism

A

initial stages: goiter > hypothyroid
hashimoto’s thyroiditis: irregular, firm consistency, small goiter with mild symptoms
autoimmune thyroiditis: overt symptoms with atrophic thyroid

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20
Q

treatment for hypothyroidism

A

levothyroxine
no residual thyroid fn: 1.6-1.7 ug/kg or 100-150 ug/d
<60 yo without cvd: 50-100 ug/d
after treatment of graves’: 75-125 ug/day

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21
Q

treatment for hypothyroidism for elderly

A

20% less levothyroxine

with cad: 12.5-25 ug/d

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22
Q

monitoring of hypothyroidism

A

check tsh levels, 2 mos after start of treatment

target tsh: lower half of reference range

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23
Q

expected results for hypothy treatment

A

until 3-6 mos

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24
Q

t/f patients can double the dose after a skipped dose in hypothyroidism

A

true

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25
other causes of hypothyroidism
amiodarone-induced hypothyroidism secondary hypothyroidism sick euthyroid syndrome
26
confirmation of secondary hypothyroidism
low ft4 level | tsh can be low, normal, or slightly increased
27
treatment for secondary hypothyroidism
elevated tsh, normal ft4 = subclinical hypothyroidism (+) tpo-ab or symptomatic = t4 treatment (-) tpo-ab or asymptomatic = annual follow up
28
major cause of sick euthyroid syndrome
release of cytokines (ex. il-6)
29
patterns of ses
``` *low t3, normal t4 and tsh low t4 (decreased tissue perfusion) ```
30
thyrotoxicosis vs hyperthyroidism
thyrotoxicosis: classic physiologic manifestations of excessive quantities of thyroid hormones hyperthyroidism: disorders that result from sustained overproduction and release of hormone by the thyroid
31
causes of thyrotoxicosis
primary hyperthyroidism thyrotoxicosis without hyperthyroidism secondary hyperthyroidism
32
common symptoms of thyrotoxicosis
hyperactivity, irritability, dysphoria, heat intolerance and sweating, palpitations, fatigue and weakness, weight loss with increased appetite, diarrhea, polyuria, oligomenorrhea
33
signs of thyrotoxicosis
tachycardia, tremor, goiter, warm moist skin, muscle weakness, proximal myopathy, lid lag, gynecomastia
34
t/f only tsh will suffice to check for thyrotoxicosis
false, also request t3 and t4
35
t/f grave's disease accounts for 40-60% of thyrotoxicosis
false, 60-80%
36
pathophysiology of grave's disease
thyroid stimulating immunoglobulins leading to thyroid hormone synthesis and gland growth
37
PE for grave's disease
symmetric enlargement of thyroid up to 2-3x soft to firm and rubbery smooth or lobular severe: thrill/bruit
38
what is a true bruit
auscultated bruit should be louder over the thyroid than upper left sternal area
39
signs and symptoms of grave's disease
graves' opthalmopathy thyroid dermopathy thyroid acropachy
40
natural history of graves' opthalmopathy
rapid onset and deterioration (worsens in initial 3-6 mos) and then gradual improvement (plateau in next 12-18 mos)
41
most frequent lesion in thyroid dermopathy
pre-tibial myxedema
42
associated with long-standing thyrotoxicosis
clubbing
43
clinical manifestations of graves disease
apathetic thyrotoxicosis (elderly) hypokalemic periodic paralysis (asian males) sinus tachy*/a fib
44
diagnostic test for graves disease
radioactive iodine uptake and scan (discriminates high uptake of gd vs low/no uptake of thyroiditis)
45
factors that increase uptake in rai
``` hyperthyroidism response to glandular hormone depletion excessive hormone loss normal hormone synthesis with deficiencies hormone biosynthetic defect ```
46
factors that decrease uptake in rai
``` primary hypofunction secondary hypofunction exogenous thyroid hormones increase availability of iodine increased hormone release (rare) ```
47
treatment for gd
antithyroid drugs: thioamides carbimazole or methimazole | propylthiouracil
48
monitoring for gd
every 4-6 weeks, based on thyroid function tests and clinical manifestations euthyroidism is achieved in 6-8 weeks
49
other drugs for gd
propanolol for adrenergic symptoms | anticoagulation for a fib
50
t/f older patients, females, non-smokers and patients with allergy, severe hypothyroid or large goiters are most likely to relapse
false, should be younger patients, males, and smokers. [sic]
51
____ can be initial treatment for gd in relapses after trial of anti-thyroid drugs
radioiodine
52
t/f if first dose of rai fails, give second dose
true, can be done after 6 months
53
indications for surgery
relapse after antithyroid drugs | very large goiter
54
t/f clinical features of gd worsen without treatment and lead to death
true
55
what is the diagnosis? tsh low, unbound t4 normal, unbound t3 high
t3 toxicosis
56
possible diagnosis/differentials for primary thyrotoxicosis without features of graves disease
toxic adenoma | multinodular toxic goiter
57
pathogenesis of multinodular toxic goiter
similar to non-toxic multinodular goiter but difference is presence of functional autonomy
58
diagnosis/test for mtg
thyroid scan showing areas of increased uptake with decreased uptake in surrounding areas uts can assess "cold nodules" fine needle aspiration
59
pathogenesis of toxic adenoma/ hyperfunctioning solitary nodule
most have acquired somatic, activating mutations in tsh-receptor subnormal tsh, thyroid nodule, absence of clinical features of gd or other toxicoses
60
diagnostic test for toxic adenoma
thyroid scan showing focal uptake in the hyperfunctioning nodule and diminished uptake in the remainder of thyroid gland
61
management for toxic adenoma
rai, thyroid drugs, surgery
62
preferred therapy for toxic mng/ta in pregnancy
anti thyroid drugs
63
when is rai preferred therapy for toxic mng/ta
elderly px previously operated or externally irradiated necks no access to thyroid surgeon
64
when is surgery preferred therapy for toxic mng/ta
- symptoms/signs of neck compression - thyroid malignancy confirmed or suspected - large goiter/nodule - goiter/nodule with substernal or retrosternal extension - coexisting hyperparathyroidism requiring surgery
65
labs for subclinical hyperthyroidism
subnormal tsh, normal free t3/t4
66
t/f tpo-ab can be used to predict risk of autoimmunity in px with subclinical hyperthyroidism
true
67
management for subclinical hyperthyroidism
rai > 65 yo / < 65 yo with comorbidities + TSH <0.1 mU/L = TREAT <65 yo asymptomatic = consider treating or observe
68
other diseases associated with thyrotoxicosis
``` multinodular toxic goiter hyperfunctioning solitary nodule subclinical hyperthyroid thyroiditis amiodarone-induced thyrotoxicosis ```
69
subacute thyroiditis is thought to be caused by ___
viral infection of thyroid gland (mumps, influenza, adenovirus)
70
pathogenesis of subacute thyroiditis
apoptosis -> release of t3 and t4 = 1. thyrotoxicosis and suppression of tsh -> (6wks) t3 and t4 run out = 2. hypothyroidism + elevated tsh -> 3. recovery
71
_____ is the usual outcome of subacute thyroiditis
complete resolution
72
management for subacute thyroiditis
``` antithyroid drugs aspirin/nsaids prednisone tsh and ft4, monitor every 2-4 wks levothyroxine ```
73
pathophysiology of acute thyroiditis
suppurative infection of the thyroid children and ya: presence of piriform sinus
74
clinical presentation of acute thyroiditis
abrupt, thyroid pain that radiated to throat or ears, small tender asymmetric goiter fever, dysphagia, erythema over thyroid
75
diagnosis of acute thyroiditis
esr and wbc increased normal thyroid fn fna biopsy infiltrated by pmns
76
management of acute thyroiditis
antibiotics | surgery to drain abscess
77
pathophysiology of silent thyroiditis
underlying autoimmune thyroid disease
78
phases of postpartum thyroiditis
2-4 wks: thyrotoxicosis 4-12 wks: hypothyroidism resolution
79
diagnosis of silent thyroiditis
normal esr with tpo-ab
80
management for silent thyroiditis
propanolol to relieve adrenergic symptoms levothyroxine annual follow up
81
types of chronic thyroiditis
hashimoto's thyroiditis* | riedel's thyroiditis
82
type 1 vs type 2 amiodarone induced thyrotoxicosis
table 8
83
t/f in general thyroid nodules are malignant, however there is a 5-15% benign rate
false, generally benign, 5-15% chance malignant
84
evaluation of thyroid nodules
tsh -> uts -> fna
85
features that are bad in uts for thyroid nodules
``` microcalcifications hypoechogenicity irregular margins taller than wide presence of lateral lymph nodes ```
86
thyroid biopsy indications
solid, >1 cm cyst >2 cm <1 cm with high suspicious features
87
management for patients with benign thyroid neoplasms
tsh suppression therapy
88
most common malignancy in the endocrine system
thyroid cancer
89
method of spreading well differentiated follicular epithelial cell thyroid cancers
papillary (ptc) = lymphatics | follicular (ftc) = hematogenous
90
most common type of thyroid cancer
well differentiated papillary tc
91
indicators for poor prognosis of ftc
``` distant metastases >50 yo primary tumor >4 cm hurthle cell histology marked vascular invasion ```
92
treatment for well differentiated tcs
surgery, radioiodine (more beneficial in more severe), levothyroxine-tsh suppression therapy (MAINSTAY)
93
monitoring for well differentiated tcs
``` serum tg (normal: < 1 ng/ml) whole body scan for px with known iodine-avid metastases or elevated tg + (-) imaging ```
94
t/f anaplastic (undifferentiated) carcinoma has poor prognosis
true
95
t/f all patients with medullary thyroid ca should be tested for ret mutations
true
96
treatment for medullary thyroid carcinoma
mainstay: surgery monitoring: serum calcitonin

05 Endo (16 decks)

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