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Foundations-Endocrine > Thyroid/Parathyroid > Flashcards

Thyroid/Parathyroid Flashcards

1
Q

What is the function of the thyroid gland?

A
  1. Secrete T3 & T4 (metabolism)

2. Secrete Calcitonin: Decreases calcium

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2
Q

What protein synthesizes and stores T3 and T4?

A

Thyroglobulin

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3
Q

What thyroid hormone do we measure?

A

T4 (thyroxine)*

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4
Q

Hypothyroidism Si/Sx’s

A
  1. Fatigue/weakness
  2. Cold intolerance
  3. Bradycardia
  4. Delayed relaxation of DTR’s
  5. Cognitive dysfunction
  6. Constipation
  7. WEIGHT GAIN
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5
Q

Vital signs in hypothyroidism

A
  1. Bradycardia

2. HTN

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6
Q

Hypothyroidism Skin findings

A
  1. Dry skin
  2. Coarse skin
  3. Hair loss
  4. Brittle nails
  5. Signs of vitiligo and alopecia
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7
Q

Hypothyroidism Respiratory findings

A

Dyspnea

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8
Q

Hypothyroidism cardiac findings

A

Decreased CO

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9
Q

Hypothyroidism Abdominal findings

A
  1. Hypoactive bowel sounds

2. Constipation

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10
Q

Hypothyroidism extremity findings

A
  1. Edema

2. CTS-Initial sx*

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11
Q

Hypothyroidism lab findings

A

High TSH

Low T4

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12
Q

What conditions will anti TPO antibodies be elevated in?

A
  1. Hashimoto’s thyroiditis

2. Grave’s disease

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13
Q

What conditions will anti thyroglobulin antibodies be elevated in?

A
  1. Hashimoto’s thyroiditis

2. Grave’s disease

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14
Q

What condition will TSH receptor antibody be elevated in?

A

Grave’s disease (65%)*

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15
Q

What is the MC etiology of hypothyroidism?

A
  1. Autoimmune thyroiditis

2. Hashimoto’s

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16
Q

Iatrogenic causes for hypothyroidism?

A
  1. Radiation Tx for HYPERthyroidism

2. Surgical intervention of thyroid gland

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17
Q

Who should we consider screening for hypothyroidism?

A
  1. Goiter
  2. H/o autoimmune disease
  3. Previous radioactive iodine therapy
  4. Hx head/neck irradiation
  5. Family hx thyroid disease
  6. Meds that impair thyroid function
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18
Q

Hypothyroidism treatment

A

Synthetic thyroxine (T4) replacement: Levothroid, Levoxyl, Synthroid

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19
Q

Levothyroxine dosing for elderly patients

A

25-50 mcg/day

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20
Q

Levothyroxine dosing for patients with h/o coronary heart disease

A

Max=25 mcg/day

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21
Q

How often are you going to check/monitor TSH levels?

A

Every 6 weeks

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22
Q

At what TSH level would you start a patient on thyroid hormone with subclinical hypothyroidism?

A
  1. TSH>10

2. TSH ULN-10 with si/sx’s

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23
Q

What is the MC etiology of Hyperthyroidism?

A

Grave’s disease

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24
Q

Hyperthyroidism clinical presentation

A
  1. Skin: Sweating, warm skin
  2. Eyes: Stare and lid lag, Exophthalmos, pain w/ EOM
  3. Cardiac: Tachycardia, Arryhthmias, HTN
  4. Respiratory: Dyspnea
  5. GI: increased urinary frequency
  6. Weight LOSS
  7. Neuro: Irritable, agitated
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25
Q

What imaging would you order to determine etiology of Hyperthyroidism?

A

24 hour radioiodine uptake and scan:
High uptake = increased hormone synthesis
Low uptake = inflammation/destruction of thyroid gland or extrathyroidal source of thyroid hormone

26
Q

24 hour radioiodine uptake and scan CI?

A

Pregnancy

Breastfeeding

27
Q

Symptomatic hyperthyroidism treatment

A

Beta Blockers

28
Q

Treatment to prevent further thyroid secretion?

A

Thionamides

29
Q

Definitive Tx in hyperthyroidism

A

Radioiodine ablation

30
Q

Hyperthyroidism Tx in pregnancy

A

Propylthiouracil (PTU)*

31
Q

What is Subacute Thyroiditis associated with?

A

Viral illness

32
Q

Subacute Thyroiditis clinical presentation

A
  1. Acutely painful glandular enlargement

2. Dysphagia/hoarseness

33
Q

Subacute Thyroiditis Tx

A

Anti-inflammatories:

  1. ASA
  2. NSAIDs
  3. Prednisone
34
Q

Thyroiditis RAI findings

A

Near absent RAI uptake

35
Q

Etiology of thyroid storm

A 
Acute Event: 
Surgery
Trauma
Infection
Iodine adminsitration
Childbirth
Withdrawal of antithyroid meds
MI, CVA, PE
36
Q

Thyroid Storm clinical presentation

A 
1. Cardiac: Tachycardia, CHF, 
Hypotension, Arrhythmia
2. High Fever (104-106) 
3. Psych: Agitation, anxiety, delirium, psychosis
4. Stupor, coma
37
Q

Thyroid Storm Diagnosis

A

Clinical Presentation + Low TSH, high free T4/T3

38
Q

Benign causes for thyroid nodules

A
  1. Multinodular goiter
  2. Hashimoto’s thyroiditis
  3. Cysts
  4. Follicular adenomas
39
Q

Malignant causes for thyroid nodules

A
  1. Carcinoma: Papillary, follicular, medullary, anapestic
  2. Primary thyroid lymphoma
  3. Metastatic carcinoma
40
Q

List the higher concerns for thyroid nodules

A
  1. Kids, men, adults <30 y/o, >60 y/o
  2. H/o head/neck radiation
  3. H/o hematopoeitic stem cell transplant
  4. Family hx thyroid cancer
  5. Size: Large
41
Q

What lab value in thyroid nodules is highly associated with thyroid cancer?

A

High TSH levels

42
Q

Worrisome findings for CA on a thyroid scan? Treatment?

A

“Cold” nodule

Fine need aspiration with biopsy

43
Q

Findings that would prompt you to get a fine need aspiration with biopsy?

A
  1. Thyroid CA hx
  2. Lymph nodes
  3. Calcifications
  4. Solid masses
  5. Hypoechoic on US
44
Q

Thyroid carcinoma risk factors

A
  1. H/o childhood head or neck irradiation
  2. Thyroid CA in first degree relative
  3. Large nodule size (≥ 4 cm)
45
Q

What is the MC type of thyroid CA? Prognosis?

A

Papillary= 85%

Best Prognosis

46
Q

What type of thyroid CA has the worst prognosis?

A

Anaplastic

47
Q

Thyroid CA treatment

A
  1. Surgery: Near total thyroidectomy
  2. TSH Suppression: Levothyroxine
  3. Radioiodine ablation
  4. Chemotherapy
48
Q

What is the function of the parathyroid gland?

A

Regulate calcium homeostasis

49
Q

Hypoparathyroidism MC etiology

A

Acquired: Post-thyroidectomy

50
Q

Classic Hypoparathyroidism clinical presentation findings

A

Chvostek sign

Trousseau phenomenon

51
Q

Hypoparathyroidism lab findings

A

Low: Calcium (serum and urinary), PTH, Mg
High: Serum phosphate

52
Q

Hypoparathyroidism treatment

A

Emergency treatment for acute tetany:

  1. IV calcium gluconate + oral calcitriol
  2. Airway maintenance
53
Q

MC etiology of Hyperparathyroidism

A

Parathyroid adenoma

54
Q

MC Hyperparathyroidism clinical presentation

A

Asymptomatic hypercalcemia

55
Q

Presentation in Symptomatic Hyperparathyroidism

A

“bones, stones, abdominal groans, and psychiatric moans” + FATIGUE*

  1. Bone pain
  2. Kidney Stones
  3. Abdominal pain
  4. Confusion, fatigue
  5. Fatigue
56
Q

Hyperparathyroidism DDX

A

Malignancy

Familial Hypocalciuric Hypercalcemia (FHH)

57
Q

Definitive Dx in Hyperparathyroidism

A

Surgical resection: Parathyroidectomy

58
Q

What medications do you want to avoid in Hyperparathyroidism

A

Lithium

HCTZ

59
Q

What dose do want to restrict calcium to in Hyperparathyroidism?

A

1000 mg/day

60
Q

What do you want to make sure you supplement with in Hyperparathyroidism?

A

Vitamin D

61
Q

What can temporarily ↓ hypercalcemia and treat bone pain

A

IV bisphosphonates:Zoledronic acid (Reclast)

62
Q

Secondary or tertiary hyperparathyroidism treatment

A
  1. Cinacalcet: Mimics Ca++

2. Paricalcitol: Vitamin D analog

Foundations-Endocrine (4 decks)

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