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Clinical Medicine II > Thyroid & Parathyroid > Flashcards

Thyroid & Parathyroid Flashcards

1
Q

Three functions of T3/T4

A

metabolism
HR & Contractility
Development

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2
Q

+ TPO Abs…

A

hashimotos

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3
Q

MC Cause of primary hypothyroidism…

A

hashimoto thyroiditis

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4
Q

Increased TSH
Decreased FT4
Decreased FT3

A

Primary hypothyroid

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5
Q

Increased TSH

Normal FT4/FT3

A

Subclinical hypothyroid

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6
Q

Normal/low TSH
Low-Normal/low FT4
Normal/low FT3

A

Central Hypothyroid

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7
Q

Transient hyperthyroid common with early Hashimoto’s Thyroiditis

A

hashitoxicosis

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8
Q

This is autoimmune mediated destruction of thyroid gland

Gradual loss of fxn w/ inflamation

A

Hashimoto Thyroiditis

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9
Q

2 factors that cause hashimoto thyroiditis?

A

genetic susceptibility, environmental factors

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10
Q

The below are precipitating factors for…

Viral infx
Stress
Pregnancy
Iiodine intake
Radiation
A

Hashimoto thyroiditis

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11
Q

What Abs are (+) in hashimoto thyroiditis?

A 
TPO Ab (MC)
TgAb

+/-TRAb

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12
Q

Tx for hashimoto thyroiditis

A

levothyroxine 1.6 mcg/kg/day

*weight based dosing

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13
Q

Who should receive a lower synthroid dose initially?

A

> 60, cardiac concerns

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14
Q

Describe the dosing regimen for synthroid?

A

empty stomach 1 hr before breakfast

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15
Q

The below can have what effect on hashimoto thyroiditis tx?

ferrous sulfate
calcium carbonate
PPIs
Bile acid resins

A

interfere w/ synthroid absorption

take them 4 hours after T4

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16
Q

When should hashimoto thyroiditis sxs begin resolving after starting synthroid?

A

2-4 weeks

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17
Q

When should a repeat TSH after starting synthroid for Hashimotos occur?

A

6 weeks after tx

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18
Q

How long is therapy with synthroid for hashimotos over the life-cycle?

A

life-long tx

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19
Q

Patient presents with…

mild or vague sxs of constipation, fatigue, depression

Normal T4, elevated TSH

A

Subclinical hypothyroidism

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20
Q

The below are consequences of…

NAFLD
Neuropsych sxs
Infertility
Miscarriage
CV disease
A

subclinical hypothyroidism

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21
Q

How do you confirm a dx of subclinical hypothyroidism?

A

Repeat TSH/T4 after 1-3 mo

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22
Q

Tx for subclinical hypothyroidism should occur if TSH is _____ or higher

A

10

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23
Q

Increased TSH and Decreased T4

Presents w/

AMS, hypothermia, hypoventilation

hyponatremia, hypotension, fatal arrhythmia

A

Myxedema coma

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24
Q

What 4 things can precipitate myxedema coma?

A

stroke, HF, infx, Trauma

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25
Q

Tx for myxedema coma?

A

IV thyroxine & triiodothyronine (T3)

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26
Q

Pt. presents w.

weight gain, fatigue, constipation…

hypo or hyper

A

hypothyroid

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27
Q

3 causes of hyperthyroid

A

Graves (MC)
Toxic Adenoma
Toxic Multinodular Goiter

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28
Q

Pt. presents w.

Weight loss, exopthalmos, periorbital edema, increased appetite, tachy, palpitations

hyper or hypothyroid?

A

Hyperthyroid

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29
Q

TSH decreased

FT4/T3 Increased

A

Primary hyperthyroidism

graves

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30
Q

TSH Decreased

FT4/T3 Normal

A

Subclinical hyperthyroidism

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31
Q

TSH Decreased
Normal FT4
T3 Increased

A

T3 toxicosis (early graves)

32
Q

RAIU Scan is contraindicated for (2)

A

pregnancy

breast feeding

33
Q

RAIU result for Graves…

A

diffuse elevated

34
Q

RAIU Result…

Diffuse decreased/absent uptake

A

thyroiditis/exogenous hormone

35
Q

RAIU Result

Focal Elevated uptake

A

hot nodule

36
Q

RAIU Result

Focal decreased uptake

A

cold nodule

37
Q

This is an autoimmune mediated stimulation of the thyrotropin receptor. It is the MC cause of hyperthyroidism

38
Q

What two conditions are the 2nd most common cause of hyperthyroidism?

A 
Toxic MNG (hyperplasia)
Toxic adenoma (nodules)
39
Q

Patient presents with:

lid retraction
lid lag
ptosis
goiter
proptosis
40
Q

(+) TRAb indicates…

41
Q

TRAb result for toxic adenoma and toxic mng…

A

negative TRAb

42
Q

RAIU results for toxic adenoma/toxic mng…

A

focal uptake

43
Q

A patient presents with the following labs and S/S.

Decreased TSH, Increased T4/T3

Agitation, delirium, fever, tachy, vomiting, dehydration

A

Thyroid storm

44
Q

What is symptomatic treatment for hyperthyroidism?

A

Atenolol/Propranolol

45
Q

What medications decrease thyroid hormone synthesis?

A

Methimazole (DOC)

PTU (pregnancy)

46
Q

What are two definitive txs for hyperthyroid?

A 
radioiodine ablation (1st line)
surgery (obstructive sxs/severe dz)
47
Q

This thioamide has the below characteistics

QD dosing
Rapid efficacy
low sfx

A

methimazole

48
Q

Three C/I for radioiodine ablation…

A

active ophthalmopathy
pregnancy
lactation

49
Q

What is the progression of thyroid levels with subacute thyroiditis?

A

Hyperthyroid, Euthyroid, Hypothyroid, Euthyroid

50
Q

What are you concerned for?

Preceding viral illness

painful gland enlargement
radiating pain to jaw/neck

fever, fatigue, anorexia

A

subacute thyroiditis

51
Q

How is subacute thyroiditis diagnosed?

52
Q

Management for subacute thyroiditis

A

aspirin/NSAIDs +/- prednisone

monitor TSH

53
Q

MC malignant thyroid nodule…

A

papillary carcinoma

54
Q

Thyroid nodules are associated with FHx of…

A

thyroid CA, MEN-2

55
Q

Benign or malignant US results?

colloid
< 1 cm
cystic

56
Q

Benign or malignant US results?

taller than wide
solid
irregular margins
microcalcification
> 1 cm
57
Q

What is the most aggressive form of thyroid cancer?

A

anaplastic

58
Q

which type of thyroid cancer mets to bone, brain, lung, liver

A

follicular

59
Q

What is the diagnostic workup for thyroid cancer?

4

A

US
RAIU
FNA
CT/MRI/PET

60
Q

What does tx of thyroid Ca look like?

A 
thyroid lobectomy/total thyroidecomy
\+
iodine ablation
\+
Levothyroxine
61
Q

surgery on thyroid ca can result in what two complications?

A

injury to left recurrent laryngeal

hypoPTH

62
Q

Patient presents with…

Prolonged QT
chvostek
Trousseau
tetany
carpopedal spasm
63
Q

The following labs indicate…

Low PTH
Low Ca

Normal/low Vit. D
Normal/low Mg

High PO4

64
Q

mild hypoPTH can be treated with…

A

calcitriol (1,25) and calcium carbonate

65
Q

If hypoPTH with tetany or prolonged QT, tx with

A

emergent IV calcium gluconate

66
Q

If hyperphosphatemia with hypoPTH, add…

A

phosphate binders

67
Q

If hypomagnesemia with hypoPTH, add..

68
Q

MC cause of primary hyperPTH…

A

parathyroid adenoma

69
Q

Secondary hyperparathyroidism is often caused by…

A

CKD (decreased vit. D production)

70
Q

What is the common presentation of hyperPTH?

A

bones, stones, abdominal moans, psychiatric groans

71
Q

High PTH
High Ca
Low PO4

A

primary hyperPTH

72
Q

High PTH
Low Ca
High PO4

A

secondary hyperPTH

73
Q

What additional imaging modality should be used to evaluate for osteopenia/porosis with PTH disorders?

74
Q

What drugs must be avoided for fear of aggrevated hypercalcemia with hyperPTH?

75
Q

What is definitive tx for hyperPTH?

A

parathyroidectomy

76
Q

Primary hyperPTH with parathyroid ademona PTH/Ca…

77
Q

Secondary HyperPTH with renal disease PTH/Ca…

A

High PTH

Low Ca

Clinical Medicine II (31 decks)

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