Thyroid Guidelines

Question 1

How to administer MMI during RAI treatment

Answer 1

Discontinue 2-3 days prior yo therapy and resume 3-7 d after RAI and taper

Question 2

RAI dose for graves

Answer 2

10-15 mCi

370-555 MBq

Question 3

When to follow up RAI therapg

Answer 3

1-2 mos
Ft4
Tital t3
Tsh

Question 4

When to consider readmi nistratoon of RAI

Answer 4

Hyperthyroudidm persistent after 6 mongths

Question 5

Recommended dose of MMI

Answer 5

If FT4 > ULN

1-1.5 5-10
1.5-2 10-20
2-3 30-40

Question 6

Recommended initial and maintenance dose of MMI

Answer 6

Initial 10-30daily

Maintenance 5-10 daily

Question 7

In calculating dose for RAI what should gland weight be multiplied to

Answer 7

50-200 over 24 h % amdinistered activity

Question 8

Higher doses of ATD armin combindwd with L thyroxine

Answer 8

Block and repalce therapy

Question 9

KI and ATD dose

Answer 9

38 mg KI wifh 15 mg MMI

Question 10

Vasculitis in ATDs

Answer 10

Anca positive vasculitus

Question 11

When to treat subclinical hyperthyroidism

Answer 11

TSH <0.1 
Individuals > 65 y age 
(+) cardiac risk factos 
Heart diaease or osteoporosis
Post menopausal women not on estrogen

Question 12

Elecations in transaminases 3x above upper limit of normal occur ___ % jn px taking ptu

Answer 12

4%

Question 13

Duration of MMI as primary therapy for GD

Answer 13

12-18 mos

Then discontinued if TSH and TRAB are normal at that time

Question 14

Remission in gaves

Answer 14

1 yr after Dc thyroid therapy N tsh ft4 total t3

Question 15

Discsharging post op grgave spx with Lt4

Answer 15

0.8-1.6 ug/kg

Remeasure 6-8 weeks post op

Question 16

Burch wartofsky score to start treatment

Answer 16

> 45

Question 17

ATA high risk histopath

Answer 17

Macroscopic invasion of tumor
Kncomplete resection of the tumor
Distant meta 
Post op Tg distant mets 
Pathologic N1 wuth LN > 3 cn 
Follicular thyroid Ca with extensive vascular invasion >4 foci

Question 18

Define biochemical incomplete respinse to theraoy

Answer 18

Nonstimulated Tg values of > 1 ng/mL

TSH stumulates valuze > 10 biochemical i complete response to therapy

Question 19

Intermediate risk TSH goal

Answer 19

0.1-0.5 mU/L

Question 20

Low risk tsh goal

Answer 20

If nonstimulated Tg <0.2 ex response
Tsh 0.5-2

If nonsti Tg >0.2
Tab 0.1-0.5

Question 21

Type 1 AIT

Answer 21

ipdine induxed form of hyperthyroidism

Due to 37% I of amiodarone

Question 22

AIT 2

Answer 22

Destruxtive thyroiditis

Question 23

Suggested dose of corticosteeoida in AIT 2

Answer 23

Prednisone 40 mg OD

Question 24

Target in pregnancy treatment of hypertheoidism

Answer 24

Maintajn maternal TT4/ FT4 just aboce the upper limit of normal

Question 25

Biochemical goal in treating hypothyroidism in pregnant women

Answer 25

TSH in the lower half of the trimester specific range | When not available TSH less than 2.5

Question 26

UTZ features of Ln predictive of malignant involvement

Answer 26

``` Microcalcifications Cystic aspect Peripheral vasculRity Huperechogwnicity Round shape ```

Question 27

High suspicion thyroid nodule % malignancy

Answer 27

70-90%

Question 28

Intermediate risk nodule

Answer 28

10-20% malignancy

Question 29

Cancer risk low suspicion nodule

Answer 29

5-10%

Question 30

Cancer risk | Very low suspicion nodule

Answer 30

<5%

Question 31

Size to do biopsy high and int risk

Answer 31

> 1 cm

Question 32

Size to do hiopsy low suspicion

Answer 32

1.5 cm

Question 33

Size to do biopsy | Vey low suspicion

Answer 33

2 cm or more

Question 34

FNAB risk for malignancy | Benign

Answer 34

0-3

Question 35

FNAB risk for malignancy | Follicular neoplasm

Answer 35

15-30%

Question 36

ATA low risk | Post op

Answer 36

``` PTC WITH: - no mets - all macroscopic tumor resected - no tumor invasion - tumor does not have aggressive histology - ```

Question 37

High suspicion thyroid nodule % malignancy

Answer 37

70-90%

Question 38

Intermediate risk nodule

Answer 38

10-20% malignancy

Question 39

Cancer risk low suspicion nodule

Answer 39

5-10%

Question 40

Cancer risk | Very low suspicion nodule

Answer 40

<5%

Question 41

Size to do biopsy high and int risk

Answer 41

> 1 cm

Question 42

Size to do hiopsy low suspicion

Answer 42

1.5 cm

Question 43

Size to do biopsy | Vey low suspicion

Answer 43

2 cm or more

Question 44

FNAB risk for malignancy | Benign

Answer 44

0-3

Question 45

FNAB risk for malignancy | Follicular neoplasm

Answer 45

15-30%

Question 46

ATA low risk | Post op

Answer 46

``` PTC WITH: - no mets - all macroscopic tumor resected - no tumor invasion - tumor does not have aggressive histology - ```