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F3 E4 Shea > Thyroid/Parathyroid 1 > Flashcards

Thyroid/Parathyroid 1 Flashcards

1
Q

Thyroglobulin

A

–Protein that synthesizes and stores T3 and T4

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2
Q

another name for T3

A

–T3 (3,5,3’-triiodothyronine)

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3
Q

–Fatigue, weakness

–Cold intolerance

–Weight gain

–Cognitive dysfunction

–Constipation

–Slow movement/speech

–Delayed relaxation DTRs

–Bradycardia

s/sx of what dz?

A

Hypothyroidism (generalized metabolic slowing)

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4
Q

–Dry, coarse skin

–Hoarseness

–Edema

–Puffy facies

–Loss of eyebrows

–Periorbital edema

–Tongue enlargement

S/sx of what dz?

A

hypothyroidism (Accumulation of extracellular matrix substances)

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5
Q

what labs would you see for primary hypothyroidism?

A

high TSH: (4-5)

low T4

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6
Q

what would you see on labs of subclinical hypothyroidism?

A

normal T4

High TSH

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7
Q

what other labs should you look at when dx hypothyroidism?

A

BMP (Na, Cr)

Lipids

Drug levels

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8
Q

What conditions will you see elevated Anti-TPO antibodies?

A

Hashimoto’s thyroiditis

Grave’s disease

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9
Q

what conditions will you see elevated anti-thyroglobulin antibodies in? (anti-TGB)

A

Hasimoto’s thyroiditis

Grave’s dz

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10
Q

what antibody will be elevated in 65% of pts w/graves dz?

A

Thyroid Stimulating Immunoglobulin (aka TSH Receptor Antibody)

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11
Q

MCC of hypothyroidism

A

autoimmune thyroiditis (hashimotos)

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12
Q

OTHER causes of hypothyroidism

A
  • Iatrogenic
  • Iodine deficiency or excess
  • Medications
  • Transient
  • Infiltrative (rare)
  • Congenital
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13
Q

hypothyroidism tx

A

Synthetic thyroxine (T4) replacement to achieve and maintain euthyroid state (Levothyroid)

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14
Q

PK of T4 (Levothyroxine)

A

high abs, long 1//2 life

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15
Q

what is the avg dose of T4 (levothyroxine)?

A

1.6 mcg/kg/day

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16
Q

T4 dosage for elderly

A

start on low dose

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17
Q

T4 dose for pts with hx of coronary hrt dz

A

no higher than 25mcg

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18
Q

goals of tx for hypothyroidism

A

–Symptom relief

–Normalization of TSH secretion

–If applicable, decrease in goiter size

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19
Q

What are other tx options for hypothyroidism?

A

T3 (Cytomel)/T4 combo therapy

Dessicated thyroid extract (Armour Thyroid, Nature Throid)

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20
Q

About 1/3 to ½ progress to overt hypothyroidism

A

subclinical hypothyroidism

21
Q

possible conditions associated with subclinical hypothyroidism?

A

–CV disease

–NAFLD

–Neuropsychiatric

–Reproductive

22
Q

when should you initiate tx for subclinical hypothyroidism?

A

–TSH > 10

23
Q

MCC of hyperthyroidism

A

grave’s dz

24
Q

Other etiologies of hyperthyroidism

A

—Hashimoto’s thyroiditis

—Autonomous thyroid tissue: Toxic adenoma, Toxic multinodular goiter

—TSH-mediated hyperthyroidism: TSH-producing pituitary adenoma, Non-neoplastic TSH-mediated hyperthyroidism

—Human chorionic gonadotropin-mediated hyperthyroidism

25
Q

which condition has normal or high RAI uptake?

A

hyperthyroidism

26
Q

•Skin changes

•Stare and lid lag

•Graves’ ophthalmopathy

•Cardiovascular

•Low total and HDL cholesterol

•Impaired glucose tolerance

Clinical px of what?

A

Hyperthyroidism

27
Q

•Dyspnea and DOE

•Weight loss

•Normochromic, normocytic anemia

  • Genitourinary
  • Bone changes
  • Neuropsychiatric changes

Clinical px of what?

A

hyperthyroidism

28
Q

what labs will you see on hyperthyroidism?

A

low TSH

high T3/T4

+ TSH receptot a-bodies

29
Q

What diagnostic test should you order for Hyperthyroidism?

A

24 hr radioiodine uptake & scan

30
Q

what does a high uptake vx. low uptake on a 24-hr radioiodine uptake scan mean?

A

–High uptake = increased hormone synthesis

–Low uptake = inflammation/destruction of thyroid gland or extrathyroidal source of thyroid hormone

31
Q

CI for 24-hr radioiodine uptake and scan

A

preggos

breastfeeding

32
Q

hyperthyroidism tx

A

–Beta-blockers

–Thionamides: Methimazole, Propylthiouracil (PTU)

–Radioiodine ablation

–Surgery

33
Q

MCC of thyroiditis

A

subacute granulomatous thyroiditis (de Quervain’s)

34
Q

–Can present with acute symptoms or silently

–Common in young or middle-aged females

–Associated with viral illnesses

–Acutely painful glandular enlargement with dysphagia

–Can last from weeks to months

clinical px of what?

A

thyroiditis (de Quervain’s)

35
Q

dx of thyroiditis

A

clinical dx w/labs

36
Q

thyroiditis may be followed by what?

A

hypothyroidism

37
Q

thyroiditis tx

A

anti-inflammatories (ASA, NSAIDS, prednisone)

sx mgmt

38
Q

Rare, endocrine emergency

High mortality

Usually results from an acute event

Which dz?

A

thyroid storm

39
Q

thyroid storm RF

A

–Surgery

–Trauma

–Infection

–Iodine administration

–Childbirth

–Withdrawal of antithyroid meds

–MI, CVA, PE

40
Q

Main Clinical signs of thyroid storm

A

Cardiac: tachy, CHF, hypotension

Fever

aditation, anxiety

stupor, coma

N/V/D

Hepatic failure

warm, moist skin

lig lag

41
Q

Thyroid storm dx

A

Clinical presentation of severe, life-threatening symptoms

PLUS

Low TSH, high free T4/T3 (same as hyperthyroidism)

42
Q

thyroid storm tx

A

ICU

Beta-blocker – sx control

Thionamide – block new hormone synthesis

Iodine solution – blocks release of thyroid hormone from gland

Glucocorticoids – reduces T4 to T3 conversion, promotes vasomotor stability, treat associated related adrenal insufficiency

Bile acid sequestrants – decrease enterohepatic recycling of thyroid hormones

43
Q

definitive tx for thyroid storm

A

radioablation of gland

44
Q

how does beta blocker tx thyroid storm?

A

sx control

45
Q

how does thionamide tx thyroid storm?

A

blocks new hormone synthesis

46
Q

how does iodine solution tx thyroid storm?

A

blocks release of thyroid hormone from gland

47
Q

how do glucocorticoids tx thyroid storm?

A

reduces T4 to T3 conversion, promotes vasomotor stability, treat associated related adrenal insufficiency

48
Q

how do bile acid sequestrants tx thyroid storm?

A

decrease enterohepatic recycling of thyroid hormones

49
Q
A

F3 E4 Shea (12 decks)

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