Thyroid Glands - Sheet1 Flashcards
↑ PTH and ↑ CA+
Hyperparathyroidism
↓ PTH and ↓ CA+
Hypoparathyroidism
A 62-year-old woman presents complaining of joint pain, polyuria, polydipsia, and generalized fatigue. The woman reports a history of recurrent kidney stones and depression. Radiographs show osteopenia and subperiosteal resorption on the phalanges.
Hyperparathyroidism
Tingling, tetany, trousseau’s
Hypoparathyroidism
↓ TSH and ↑ Free T4
Hyperthyroidism
Weight gain, fatigue, edema
Hypothyroidism
↑ TSH and ↓ Free T4
Hypothyroidism
Weight loss, anxiety, tachycardia
Hyperthyroidism
Hoarse voice, cold nodule on thyroid uptake scan
Thyroid neoplastic disease
Neck tenderness preceded by a viral illness (will likely be a URI) a few weeks earlier.
Thyroiditis
↑ PTH usually caused by a PTH secreting parathyroid ADENOMA
Primary hyperparathyroidism
Secondary hyperparathyroidism - Chronic kidney disease is the most common cause of secondary hyperparathyroidism.
↑ PTH by a physiologic response to hypocalcemia or vitamin D deficiency.
Thyroid nodules larger than _____ cm should be biopsied?
Lesions larger than 1 cm should be biopsied. Lesions with features suggestive of malignancy (Microcalcifications, hypoechogenicity, a solid nodule, irregular nodule margins, chaotic intranodular vasculature, and a nodule that is more tall than wide) and those in patients with risk factors for thyroid cancer should be biopsied, regardless of size. Smaller lesions and those with benign histology can be followed and reevaluated if they grow.
Initial hyperthyroidism which may occur with Hashimoto’s thyroiditis?
Hashitoxicosis
Which disorder causes osteoporosis, bone pain, renal calculi GI symptoms and psychosis?
Hyperparathyroidism
Which type of thyroiditis has fever pain redness and neck mass?
Suppurative Thyroiditis - Most common cause staph or strep
What is the preferred test to set initial dosing of thyroid replacement?
TSH
What is the treatment for Hashimoto’s thyroiditis?
Lifetime replacement of thyroxine (T4) (levothyroxine or liothyronine)
What is the drug of choice to treat a pregnant/breast feeding patient with hyperthyroidism?
PTU in the first trimester then methimazole for rest of pregnancy (both are OK for nursing)
What does a cold nodule on thyroid uptake scan likely represent?
Malignancy
What is the most common treatment for primary hyperparathyroidism?
Surgical removal
Are renal calculi are more common with hypo or hyperparathyroidism?
Hyperparathyroidism due to increased urinary excretion of calcium from the high serum calcium levels
List the five hallmark signs and symptoms of hyperparathyroid disease.
Osteoporosis - Renal calculi - Bone pain - GI symptoms - Depression/psychosis
What happens to serum and urinary calcium in hyperparathyroidism?
Increased PTH = increased Serum Ca++ and decreased Urine Ca++ initially but increased Urine Ca++ chronically
Prolonged hypoparathyroidism can produce symptoms which mimic which neurological disorder?
Parkinson’s
Prolonged hypoparathyroidism can result in what acute neurological event?
Seizure
What is the treatment for hypoparathyroidism?
Oral calcium and vitamin D to keep serum calcium > 8
What happens to serum and urinary calcium in hypoparathyroidism?
Decreased PTH = Decreased Serum Ca++ and increased Urine Ca++
What are the three systems which parathyroid hormone affects to change calcium levels?
Intestinal absorption - Bone resorption - Renal reabsorption
What is the sign? Ipsilateral facial contraction with tapping anterior to ear.
Chvostek’s sign
What is the sign? Carpopedal spasm with inflation of BP cuff > systolic pressure for > 3 minutes.
Trousseau’s sign
List two signs which can occur with hypoparathyroidism.
Trousseau’s sign - Chvostek’s sign
Hypoparathyroidism may be caused by chronic depletion of which electrolyte?
Magnesium
What is the most common cause of hypoparathyroidism?
Surgical removal
In a patient with a cold thyroid nodule what procedure should be performed for definitive diagnosis?
Fine needle aspiration (FNA) biopsy
List three genetic risk factors for thyroid cancer.
Familial medullary thyroid CA - MEN - Familial adenomatous polyposis
What is the most common risk factor for thyroid cancer?
Radiation exposure
List four etiologies for painless thyroiditis.
Postpartum - Drug induced - Chronic lymphocytic - Fibrous
List four etiologies for painful thyroiditis.
Subacute thyroiditis - Radiation induced - Traumatic - Infectious
What instructions regarding food should be given to a patient taking levothyroxine?
Take on an empty stomach many foods decrease absorption.
Which medications can cause hyper or hypothyroidism?
Amiodarone and lithium
List three medications which can cause hyperthyroidism.
Levothyroxine - Amiodarone - Lithium
A hypothyroid patient has an increased TSH and an decreased Free T4. Is this primary or secondary disease?
Primary
List three non-autoimmune causes of hyperthyroidism.
Toxic adenoma or multinodular goiter - Thyroiditis - Iatrogenic
A hypothyroid patient has an decreased TSH and an decreased Free T4. Is this primary or secondary disease?
Secondary
What is the most common cause of secondary hyperparathyroidism?
End stage renal failure
Which antibodies are positive in both Hashimoto’s and Grave’s?
Anti-Thyroglobulin antibody and Antithyroid Peroxidase antibody
What hyperthyroid condition can cause weight gain?
Heart failure due to high cardiac output
List three non-autoimmune causes of hypothyroidism.
Thyroidectomy - Radioactive iodine - Medication (e.g. lithium amiodarone)
Treatment of acute thyroid storm?
Beta blockers first then: Oral iodine compounds - Thioamides (methimazole, carbimazole, PTU)
End stage kidney failure leads to what parathyroid problem?
Secondary hyperparathyroidism
What do lithium and hyperparathyroidism have in common?
Calcium kidney stones
What is the disorder? Anti- Thyroid Peroxidase antibody and + TSH receptor antibody
Grave’s disease
Which thyroid problem most commonly causes weight gain?
Hypothyroidism
Most common cause of hypothyroidism?
Autoimmune Hashimoto’s Thyroiditis
Chronic low serum levels of which electrolyte can lead to hypoparathyroidism?
Chronic hypomagnesemia can lead to hypoparathyroidism
What three organ systems affect calcium levels in response to parathyroid hormone levels?
Intestinal absorption - Bone resorption - Renal excretion
Which parathyroid disorder is Trousseau’s and Chvostek’s sign indicative of?
Hypoparathyroidism
What findings on thyroid uptake scan would support the possibility of malignancy and warrant a fine needle aspiration of the nodule?
Cold nodule
A patient presents with radiation induced thyroiditis. Do you expect to find a tender or non-tender thyroid on exam?
Tender
A 34 year old female presents in thyroid storm with a BP of 210/110 mmHg and a heart rate of 124 bpm. What medication should be used first line?
Beta blockers are first line to deal with the emergent symptoms
What is the preferred laboratory test to establish initial dosing in hypothyroidism?
TSH
What term describes the initial hyperthyroidism that may occur prior to subsequent hypothyroidism in the beginning stages of Hashimoto’s thyroiditis?
Hashitoxicosis
List two medications which may cause either hypothyroidism or hyperthyroidism.
Amiodarone and lithium
A patient has weight gain, fatigue and brittle, dry hair. Her general screening labs find a TSH of 0.28. What is the most likely disorder?
Secondary hypothyroidism
