Thyroid nodules/cancer 178

Question 1

What are the major signs of hyperthyroidism?

Answer 1

hyperactivity, tachycardia,hyperthermia, increased perspiration, hyperreflexia, muscle weakness, tremor, weight loss, eyelid retraction, exophthalmos (Graves’ disease), diffuse or nodular goiter

Question 2

What are the major signs of hypothyroidism?

Answer 2

lethargy, bradycardia, cold intolerance, dry skin, hyporeflexia, myxedema, hoarseness, weight gain

Question 3

What are the symptoms of intrauterine/neonatal hyperthyroidism?

Answer 3

mental retardation

advanced bone age

Question 4

What are the symptoms of intrauterine/neonatal hypothyroidism?

Answer 4

mental retardation, neurologic deficits, retarded bone age/growth

Question 5

What are the symptoms of hyperthyroidism?

Answer 5

nervousness, weakness, palpitation, increased appetite, irregular menses

Question 6

What are the symptoms of hypothyroidism?

Answer 6

fatigue, sleepiness, depression, constipation, decreased appetite, irregular menses

Question 7

What are the lab findings (TSH, T4, T3) of primary hyperthyroidism? Central/secondary?

Answer 7

primary: high T4, high T3, low TSH

central/secondary: high T4, high T3, high TSH

Question 8

What are the lab findings (TSH, T4, T3) of primary hypothyroidism? Central/secondary?

Answer 8

primary: low T4, low T3, high TSH

central/secondary: low T4, low T3, low TSH

Question 9

What are the lab findings (T4, T3, TSH) of primary thyrotoxicosis?

Answer 9

low TSH, high T4, high T3

Question 10

What are the signs of endocrine ophthalmopathy?

Answer 10

soft tissue involvement, proptosis, extraocular muscle involvement, corneal lesions, lagophthalmos, compressed optic nerve

Question 11

How can pregnancy lead to hyperthyroidism?

Answer 11

hCG crossreacts with the TSH receptors, resulting in mildly elevated free thyroid hormones

Question 12

What is the mechanism of thionamides?

Answer 12

they inhibit the organification of iodide and the coupling reaction by blocking thyroid peroxidase

also decreases conversion of T4 into T3

Question 13

What medications can be used to treat hyperthyroidism?

Answer 13

thionamides (propylthiouracil and methimazole)

Question 14

What are the side effects of thionamides?

Answer 14

thionamide-induced agranulocytosis

PTU associated with hepatotoxicity

methimazole associated with teratogenecity in early pregnancy

Question 15

What is the mechanism of iodine radiotherapy for hyperthyroidism?

Answer 15

the iodine delivers beta-irradiation to the thyroid tissue

Question 16

What is the major complication associated with surgical thyroidectomy?

Answer 16

hypoparathyroidism

Question 17

What is the treatment for hypothyroidism?

Answer 17

levothyroxine and regular monitoring

Question 18

What is subacute/DeQuervain’s thyroiditis?

Answer 18

a form of thyroiditis that is often preceded by a URI that presents with fever, malaise, and tenderness to palpation

starts with thyrotoxicosis followed by a hypothyroid phase that may eventually normalize

Question 19

What is the mechanism of postpartum thyroiditis?

Answer 19

pregnancy leads to generalized immunosuppression, which can cause a rebound of thyroid antibodies after delivery

can cause transient hyper- or hypothyroidism

Question 20

What are the risk factors for development of thyroid nodules?

Answer 20

iodine deficiency and radiation, older age

Question 21

What are the major associations with MEN2A?

Answer 21

medullary thyroid carcinoma, parathyroid adenomas, pheochromocytoma

Question 22

What are the major associations with MEN2B?

Answer 22

mucocutaneous ganglioneuromas, marfanoid habitus

Question 23

What are the etiologies of thyroiditis? How are they treated?

Answer 23

etiologies: autoimmune, subacute, postpartum
treatment: betablockers during the hyperthyroid phase, levothyroxine during the hypothyroid phase (may be needed long term)

Question 24

How do you evaluate patients presenting with thyroid nodules?

Answer 24

TSH followed by radioiodine scan if hyperthyroid; ultrasound

Question 25

What are the key steps in treating patients with thyroid cancer?

Answer 25

surgery with appropriate lymph node dissection, selected use radioiodine for differentiated thyroid cancers, levothyroxine replacement with TSH suppression for differentiated thyroid cancers

Question 27

What tumor markers are used in the follow-up fo patients with thyroid cancer?

Answer 27

thyroglobulin –> differentiated thyroid cancers

calcitonin –> medullary thyroid cancer