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05 Endo > Thyroid Pedia > Flashcards

Thyroid Pedia Flashcards

1
Q

features of permanent hypothyroidism

A

anatomical problem

  • aplasia/athyreosis
  • hypoplasia
  • ectopic thyroid
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2
Q

only form of congenital hypothyroidism that presents with goiter

A

thyroid dyshormogenesis

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3
Q

causes of thyroid dyshormogenesis

A 
tsh unresponsiveness (receptor abnormality)
abnormal iodide uptake
peroxidase or organification defect (cannot convert iodide to iodine)
tg defect
deiodinase defect
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4
Q

features of pendred syndrome

A

organification defect
congenital deafness
goiter

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5
Q

pathophysio of transient hypothyroid

A

excessive maternal ingestion of goitrogens, drugs, and tsh receptor blocking antibodies

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6
Q

trab is suspected in babies where ___

A

there is history of maternal autoimmune diesease

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7
Q

trab can go into remission in ___ (time)

A

3-6 mos

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8
Q

drugs that can cause fetal hypothy

A

anti-thyroid drugs. lithium, iodine, amiodarone

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9
Q

central hypothy is deficiency of __

A

tsh associated with pituitary/hypothalamus disorder

also presents with multiple pituitary deficiencies (hypogly, jaundice, micropenis)

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10
Q

clinical features of central hypothy at birth

A

hypotonia, shrill cry, rough, dry, pale, hypothermic skin, wide open fontanelles, prolonged jaundice, abdominal distention and constipation, umbilical hernia, coarse facial features, feeding problems, goiter*

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11
Q

hypoplasia of cortical neurons and retarded myelination causes

A

mental retardation, psychomotor delay, speech delay

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12
Q

decreased peristalsis of alimentary system and delayed maturation of glucuronide conjugation causes

A

constipation, abnormal distension, and prolonged jaundice

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13
Q

loss of inotropic and chronotropic effects of thyroid hormone causes

A

bradycardia

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14
Q

impaired protein synthesis and dec igf1, decreased bone maturation causes

A

growth failure, wide anterior fontanelles, delayed dentition and bone age

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15
Q

decreased lipid degradation causes

A

inc cholesterol/ldl

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16
Q

dec energy met causes

A

low bmr, decreased appetite, cold intolerance, low basal body temp

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17
Q

accumulation of hyaluronic acid mucinous edema causes

A

puffy appreance, macroglossia, thickening of laryngeal and pharyngeal mucous membranes = poor feeding and hoarse cry

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18
Q

dec secretions of sweat and seb glands

A

dry and coarse skin

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19
Q

dec o2 reqs and dec epo

A

anemia

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20
Q

myxedema of 8th nerve

A

hearing loss

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21
Q

late presentations of central hypothy

A

mental retardation, growth retardation, delayed skeletal maturation, delayed dental dev, delayed puberty

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22
Q

nbs to detect thyroid problem

A

heel prick sample

tsh > 15 iu/l = (+) congenital hypothyroid

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23
Q

confirmatory test for hypothy

A

decreased serum thyroid, elevated tsh

24
Q

other tests to document etiology of congenital hypothy

A

thyroid scan
uts
lateral radiograph of the knee

25
Q

when should l-thyroxine be started for congenital hypothy

A

immediately after positive confirmatory test, within 2 weeks of age

26
Q

how often to test thyroid function for cong hypothy

A

monthly in the first 6 mos, every 2-3 mos between 6 mos to 2 years, every 4-6 mos after that

27
Q

t/f l-thyroxine should be given after meals

A

false, it should be given on an empty stomach. 30 mins before eating in older children

28
Q

treatment goals for cong hypothy

A

normalize serum thyroxine level within 2 weeks, tsh within 1 week

29
Q

cause of neonatal thyrotoxicosis

A

maternal graves disease causes transplacental passage of tsh-r stimulating and blocking ab

30
Q

pathophysio for neonatal thyrotoxicosis

A

neonates can present with both hypothyroid and hyperthyroid

31
Q

treatment for neonatal thyrotoxicosis

A

antithyroid drugs, b adrenergic blocker, 10% potassium iodide 1 drop every 8 hrs, steroids

32
Q

most common cause of acquired hypothyroidism and goiter in children living in iodine sufficient areas

A

acquired hypothyroid: autoimmune thyroiditis or hashimoto’s thyroiditis

33
Q

pathophysio of autoimmune thyroiditis

A

high concentrations of anti thyroid peroxidase and anti-tg -> ab that destroy the thyroid gland

34
Q

clinical course of AT

A

gradual loss of thyroid function

can be overetly hypothyroid, subclinical hypothy (no symptoms + positive abs), initial hashitoxicosis

35
Q

first clinical manifestation of hashimoto’s thyroiditis

A

growth retardation

36
Q

PE findings in hashimoto

A

symmetric or asymmetric, non-tender, firm, can be granular or nodular

37
Q

most cases of acute thyroiditis are in the __ lobe

A

left lobe

38
Q

features of acute thyroiditis

A

acute onset of pain in thyroid area
preceded by urti
normal thyroid function test
fungal or bacterial infection!!

39
Q

which thyroiditis has clinical response to glucocorticoid treatment

A

subacute thyroiditis

40
Q

thyroiditis that benefits from incision and drainage

A

acute thyroiditis

41
Q

piriform fistula is discovered in __ thyroiditis

A

acute thyroiditis

42
Q

clinical hallmark of subacute thyroiditis

A

painful swelling after VIRAL infection

43
Q

possible mechanisms for childhood thyrotoxicosis

A

thyroid gland hyperfunction
thyrotoxic phase of thyroiditis
acute or chronic ingestion of thyroid hormone

44
Q

diseases under thyroid gland hyperfunction

A 
HIGH RAI UPTAKE:
graves' disease
toxic multinodular goiter
thyroid ademona / autonomous thyroid nodule
tsh producing pituitary adenoma
pituitary resistance to thyroid hormone
45
Q

diseases under thyrotoxic phase of thyroiditis

A

INHOMOGENOUS/LOW RAI UPTAKE
autoimmune thyroiditis
subacute autoimmune thyroiditis (painless sporadic)
subacute granulomatous thyroiditis (painful subacute)

46
Q

most common cause of hyperthyroidism in children

A

graves disease

47
Q

pathophysiology of proptosis and eom dysfunction in graves disease

A

activation of retroorbital fibroblasts and t cells produce inflammatory cytokines -> increase in gags and retroorbital fat -> inflammation, proliferation, and increased growth of eom

48
Q

lab exams in graves

A 
total t4 elevated
free t4 elevated
tsh suppressed
tsi/trab elevated
raiu increased homogenous uptake
49
Q

t/f long term remission is likely in high levels of trab

A

false, less likely

50
Q

recommended initial treatment for pedia graves

A

carbimazole and methimazole minimum first 2 years, 3-6 years continuously

ptu - NOT FIRST LINE

51
Q

effects of propanolol treatment

A

controls adrenergic symptoms

decreases conversion of t4 to 3

52
Q

indications for ablative radioiodine therapy

A

toxic reactions with drugs
poor surgical candidates
children > 5 yo (avoided in very young children <5 yo)

53
Q

indications for total thyroidectomy

A

child is too young for rai therapy

very large goiter

54
Q

monitoring for graves

A

remission: long term surveillance

recur, severe side effects, noncompliance: rai therapy or thyroidectomy -> treat hypothyroid

55
Q

diagnosis for thyroid cancer

A

fna, mostly papillary

56
Q

treatment for thyroid cancer

A

surgery + rai treatment

elevated serum tg = recurrence

05 Endo (16 decks)

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