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ENDOCRINE > Thyroid h > Flashcards

Thyroid h Flashcards

1
Q

Thyroid

A 
Micro L
Cystic 
Peripheral vascularutt
Round shape
—-
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2
Q

Type 1 deiodinase

A

Outer and inner Rung

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3
Q

Deiodinase

Subcellular location in endoplasmic reticulim

A

Type 2

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4
Q

Deiodinase

Outer ri g

A

Type 2

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5
Q

Deiodinase

High susceptibility to PTU

A

Type 1

Inner and outer

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6
Q

Deiodinase

Decreased response to increased T4 (the rest increases)

A

Type 2

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7
Q

Deiodinase

Source of plasma t3 in thyroyoxic patients

A

Type 3

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8
Q

Deiodinase

Found in liver kidney thyroid pituitary

A

Type 1

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9
Q

Effects of thyrotoxicosis in CV system

A

> decreased peripheral vasc resistance to dissipate heat

> inc CO inc HR inc SV

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10
Q

Mechanism of increased cardiac contractility in thyrotoxicosis

A

Increase in ratio of alpha to B myosin chain

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11
Q

Mearns Lerman scratch

A

Scratchy systolic sound in left sternal border resembling a oleuripericardialnfriction rub found in thyrotoxicosis

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12
Q

% of px with unexplained atrial fibrillation who are thyrotoxic

A

15%

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13
Q

Percent of px with thyroxtoxicosis who have atrial fibrillation

A

2-20%

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14
Q

Most common thyroid neoplasm

A

Folliculae adenoma

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15
Q

Dose of rTSh

A

0.01 to 0.03 mg

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16
Q

TNM scoring

T4

A 
T0 no evidence of prary tumor
T1 <1 
T2 2-3
T3 4 cm limited to thyroid
T4 extending beyond the thyroid
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17
Q

Most impt cytologic variant of thyroid CA whicb composed predominantly entirely of large cells with granular eosinophilic cytoplasm

A

Oxyphilic / oncocytic/ hurthle cell adenoma

alignant

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18
Q

PTC variant with poor progmostic finding

A

Hobnail variant with micropapillary pattern

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19
Q

PTC variant cells twice as tall as they are wide

A

Tall cell variant

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20
Q

PTC variant prominent nuclear stratification of elongated cells

A

Columnar cell variant

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21
Q

Aggrassive variants

A

Tall cell

Columnar cell variant

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22
Q

Nuclear changes in FNA

A

Nuclei are larger than N folloculae cells and overlap
Fissured like coffee beans
Ground glass nuclei (Chromatin hypodense)
Contain an inclusion corresponding to cytoplasmic invagination

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23
Q

Protooncogene whose activation is found only in PTC

A

RET

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24
Q

Where is RET found

A

Chr 10q11-2

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25
Q

% of thyroid malignancies that are medullar

A

5%

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26
Q

Mutation found in tall cell bariant of PtC

A

BRAF

Associated with higher risk of recurrence

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27
Q

Age papillary thyroid CA

A

30- 50 yrs

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28
Q

Female predominance of ptca

A

80

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29
Q

FTC

A

Invasion of capsule blood vessel or adjacent thyroid

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30
Q

CA more common in areas with iosine deficiency

A

Folliculae CA

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31
Q

Oncogene in FTCs

A

RAS oncogene

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32
Q

Cytogenetic abnormality limited to FTC

A

P arm chromosome 3

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33
Q

Age anaplastic thyroid CA

A

After 60 yrs

FTC- 50 yrs ave

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34
Q

Hypothyroidism without a goiter

A

Atrophoc thyroiditis

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35
Q

Commoneat cause of goiter in iodine sufficient regions

A

Hasimotos

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36
Q

Presence of this may be a favorable prognostic factor in patients with papillaryy CA

A

Hasimoto

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37
Q

Suspected in hashimoto px witb painful enlargement of the thyroid gland
Occurs almost exclusively in hasimoto patients

A

THYROID LYMPHOMA

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38
Q

Impairment of intrathyroidL Nd peripheral deiodinatjon of iodotyrosines

A

Ipdotyrosine dehydrofenSe defect

DEHAL1B gene

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39
Q

Unusual cause of hypothyroidism that has been identified in infants with viceral hemangiomas

A

Consumptive hypothyroidism

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40
Q

Contained in cassava

A

Linamarin

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41
Q

Tsh goal of treafment in Hashimoto

A

Tsh in the lower half of the reference interval

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42
Q

Action of lithium and why it causes hypothyroidism

A

Inhibirs thyroid hormone release

In high concentrations can inhibit organic binding reactions

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43
Q

Pendred syndrome

A

Defect in iodine organificatkon and sensory nerve deafness

44
Q

Difference in finding:

Painful versus painless subacute thyroiditis

A

Painful- small and atrophic

Painless- enlarged and dfirm infiltraion

45
Q

% of thyroid independent of pituitary

Why central is leas severe than primary hypothyroidism

A

10-15%

46
Q

Expressed by visceral hemangiomas

A

D3

47
Q

Defects in this gene causes hereditary hypothyroidism

A

POUf1 Nd prop 1

48
Q

More common type of mutation in RTH (resistance to thyroid hormone)

A

Mutation in thyroid hormone receptor B

Interferes capacity of receptor to respond normally to T3

49
Q

Presentation of patients witb RTH

A

Mix of hyper and hypo

Palpitations and tachy
Growth retardation

50
Q

Profile of RTH patient

A

inc ft4
N or alightly increased tsh
Tachy
Goiter

51
Q

Treatment of RTH

A

TRIAC

52
Q

Time required for conplete equilibriation of FT4

A

6 weeks

53
Q

% of levothyroxine absorbed in stomach

A

80%

54
Q

Px with impaired gastric acid secretion require higher dose levothyroxine
How higher

A

22-34% higher

55
Q

Dose adjustment thyroid hormone in Elderly because thyroid hormone clearance is decreased

A

20-30% less

56
Q

Increase thyroid hormone requirement in elederly

A

First trimester

57
Q

Reasons dor the increase req of thyroid hormone in the fieat trimester of pregnancy

A
  • increased T4 binding
  • increased colume of distribution of T4
  • increase in D3 in placemta
58
Q

Dose levothyroxine myxedema coma

A

Levothyroxine 500-800 IV
Then 100 IV thereafter

Hypertonic Saline!!!
IV liothyrosine 25 ug q12

59
Q

Rx reidel thyroiditis

A

Tamoxifen

60
Q

Acute thyroiditis VS Subacute thyroiditis

Preceding upper respiratory infection
Fever
Soretbroat

A

Acute

61
Q

Acute thyroiditis VS Subacute thyroiditis

Paiful thyroid swelling

A

100- acute

77- subacute

62
Q

Acute thyroiditis VS Subacute thyroiditis

Left side affectes

A

Acute

63
Q

Acute thyroiditis VS Subacute thyroiditis

Migratory thyroid tenderness

A

Sibacute

64
Q

Acute thyroiditis VS Subacute thyroiditis

Abnormal thyroid hormone levels
Elevated or depressed

A

Subacute

65
Q

Acute thyroiditis VS Subacute thyroiditis

FNAB
Purule t bacteria fungi

A

Acute

In subacute - lymphocytes macriphage giant cells

66
Q

Acute thyroiditis VS Subacute thyroiditis

Response to GC treatment

A

Acute transient

Subacute 100%

67
Q

Acute thyroiditis VS Subacute thyroiditis

Gallium scan positive

A

Both

68
Q

Thyroid fibrosis in middle aged women

A

Riedel chronic sclerosing thyroiditis

69
Q

Tissue location of type 1 deiodinase

A

Liver
Kidney
Thyroud
Pituitary

Type 2
Cns brown adipose tissue heart skeletal muscle placenta

Tupe 3 placenta cns hemangiomas

70
Q

Half life of T 3

A

0.75 days

71
Q

The most impt thyroid hormone inactivating emzyme

A

D3

72
Q

Recommended iodine dose pregnant

A

200 ug

Adults 150 ug
Childreb 90-120 ug

73
Q

Naturally occuring I

A

I 127

74
Q

Suggested starting dose of MMI in the setting of AIT

Ata guidelines

A

40 mg OD

75
Q

How are T3 and T4 transportes across cellular membranes

A

MCT8

MCT10

76
Q

Proteins facilitating transport of T4 and T3 across cell membranes

A

Mct8 and mct10

77
Q

Transport of T4 across blood brain barrier

A

OAYP1C1

78
Q

Mutation in the MCT8 gene

Mental retardation
Increased T3
Dysarthria
Athetoid movements

A

Allan Herndon Dudley Syndrome

79
Q

Rx for mct8 gene mutation

A 
PTU with LT4
Diiosithyropropionic acid (DITPA)
80
Q

Most impt pathywat for T4 metabolism

A

Outer ring
D1 and D2

And is 80% of the source of T3 for humans

81
Q

Diff of D1 Nd d2

A

D1 hugher Km
Prefers T3 Nd T3so4
Inhibited by PTU
Increased by thyroid hormone (D2 decreased)

82
Q

To convert T4 nmol to ug/dl

A

Divide by 12.87

83
Q

Half lfe of TBG

A

5 days

84
Q

% of T3 bound by TBG

A

T3 80%

T4 64 %

85
Q

Blocka aynthesis of TBG

A

L asparahinase

86
Q

Major thyroid hormone binding protein in the csf

A

Transthyretin (TTR)

Found in choroid plexus

87
Q

Moa if iopanoic and iopodipie acid

A

Inhibit deiodinases

88
Q

Iodine per drop of sski

A

38 mg/drop

Lugols 6 mg/drop

89
Q

Quantity of iodine required to supress tadioactive iodine to <2

A

> 30 mg/day

90
Q

Iodine content per iodized salt

A

760/10 g

91
Q

Iodine content angiographic and CT dyes

A

400-4000 mg/dose

92
Q

How growth hormone affects thyroud

A

Decrease D3 activity outer ring deoidination

93
Q

Biochemical markers of thyroid status

Decreased during thyrotoxicosis

A

Low low

LDL
Lipoproteins

94
Q

Biochemical markers of thyroid status

Increased during thyrotoxicosis

A 
Vw
Osteocalcin
Urine pyridium
Ferritin 
ALP
Sex hormone BG
ANP
95
Q

Decreased during hypothyroidiam

A

Vassopressin

96
Q

Spared graves ophthalmoplegia

A

Muscle tendons spared

With lateral rectua least commonly affected

97
Q

10 mg carbimaxole is metabolized to ___

A

6 mg methimazole

98
Q

Multinodular toxic goiter

A

12-14 mci

99
Q

Transient thyrotoxicosis where thyroid tenderness is the most prominent symptom and thyrotoxicosis is rare

A

Viral thyroiditia
Subacute
De quercain
Ganulomatous

100
Q

Histopath subacute thyroiditis/

Giant cell thyroiditis

A

Well developed follicular lesion that consists of cebtral core of colloid surrounded by multinucleated giant cells

101
Q

(+) sudden appearance of paun in region of thyroid gland wuth or without fever
Aggravated by turning head or swallowing radiates to ear and occiput

A

Subacute thyroiditis
De quercain
Granulomayous
Giant cell

102
Q

Viral infection of thyroid gland preceesed by URt

A

Subacute thyroiditis

103
Q

Differentiate acute exacerbation if hasgimito thyroiditis and de quervain/ subacute thyroiditus

A

Lack of elecation if ESR in hasimotis

104
Q

Rx compromised Cv function hypothyroid

A

DITPA

105
Q

Acute thyroiditis commonly affeects

A

Left lobe

106
Q

1 mCi= __ MBq

A

37

ENDOCRINE (12 decks)

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