Thyroid Pedia

Question 1

features of permanent hypothyroidism

Answer 1

anatomical problem

• aplasia/athyreosis
• hypoplasia
• ectopic thyroid

Question 2

only form of congenital hypothyroidism that presents with goiter

Answer 2

thyroid dyshormogenesis

Question 3

causes of thyroid dyshormogenesis

Answer 3

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

Question 4

features of pendred syndrome

Answer 4

organification defect
congenital deafness
goiter

Question 5

pathophysio of transient hypothyroid

Answer 5

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

Question 6

trab is suspected in babies where ___

Answer 6

there is history of maternal autoimmune diesease

Question 7

trab can go into remission in ___ (time)

Answer 7

3-6 mos

Question 8

drugs that can cause fetal hypothy

Answer 8

anti-thyroid drugs. lithium, iodine, amiodarone

Question 9

central hypothy is deficiency of __

Answer 9

tsh associated with pituitary/hypothalamus disorder

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

Question 10

clinical features of central hypothy at birth

Answer 10

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*

Question 11

hypoplasia of cortical neurons and retarded myelination causes

Answer 11

mental retardation, psychomotor delay, speech delay

Question 12

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

Answer 12

constipation, abnormal distension, and prolonged jaundice

Question 13

loss of inotropic and chronotropic effects of thyroid hormone causes

Answer 13

bradycardia

Question 14

impaired protein synthesis and dec igf1, decreased bone maturation causes

Answer 14

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

Question 15

decreased lipid degradation causes

Answer 15

inc cholesterol/ldl

Question 16

dec energy met causes

Answer 16

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

Question 17

accumulation of hyaluronic acid mucinous edema causes

Answer 17

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

Question 18

dec secretions of sweat and seb glands

Answer 18

dry and coarse skin

Question 19

dec o2 reqs and dec epo

Answer 19

anemia

Question 20

myxedema of 8th nerve

Answer 20

hearing loss

Question 21

late presentations of central hypothy

Answer 21

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

Question 22

nbs to detect thyroid problem

Answer 22

heel prick sample

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

Question 23

confirmatory test for hypothy

Answer 23

decreased serum thyroid, elevated tsh

Question 24

other tests to document etiology of congenital hypothy

Answer 24

thyroid scan
uts
lateral radiograph of the knee

Question 25

when should l-thyroxine be started for congenital hypothy

Answer 25

immediately after positive confirmatory test, within 2 weeks of age

Question 26

how often to test thyroid function for cong hypothy

Answer 26

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

Question 27

t/f l-thyroxine should be given after meals

Answer 27

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

Question 28

treatment goals for cong hypothy

Answer 28

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

Question 29

cause of neonatal thyrotoxicosis

Answer 29

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

Question 30

pathophysio for neonatal thyrotoxicosis

Answer 30

neonates can present with both hypothyroid and hyperthyroid

Question 31

treatment for neonatal thyrotoxicosis

Answer 31

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

Question 32

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

Answer 32

acquired hypothyroid: autoimmune thyroiditis or hashimoto's thyroiditis

Question 33

pathophysio of autoimmune thyroiditis

Answer 33

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

Question 34

clinical course of AT

Answer 34

gradual loss of thyroid function can be overetly hypothyroid, subclinical hypothy (no symptoms + positive abs), initial hashitoxicosis

Question 35

first clinical manifestation of hashimoto's thyroiditis

Answer 35

growth retardation

Question 36

PE findings in hashimoto

Answer 36

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

Question 37

most cases of acute thyroiditis are in the __ lobe

Answer 37

left lobe

Question 38

features of acute thyroiditis

Answer 38

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

Question 39

which thyroiditis has clinical response to glucocorticoid treatment

Answer 39

subacute thyroiditis

Question 40

thyroiditis that benefits from incision and drainage

Answer 40

acute thyroiditis

Question 41

piriform fistula is discovered in __ thyroiditis

Answer 41

acute thyroiditis

Question 42

clinical hallmark of subacute thyroiditis

Answer 42

painful swelling after VIRAL infection

Question 43

possible mechanisms for childhood thyrotoxicosis

Answer 43

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

Question 44

diseases under thyroid gland hyperfunction

Answer 44

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

Question 45

diseases under thyrotoxic phase of thyroiditis

Answer 45

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

Question 46

most common cause of hyperthyroidism in children

Answer 46

graves disease

Question 47

pathophysiology of proptosis and eom dysfunction in graves disease

Answer 47

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

Question 48

lab exams in graves

Answer 48

``` total t4 elevated free t4 elevated tsh suppressed tsi/trab elevated raiu increased homogenous uptake ```

Question 49

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

Answer 49

false, less likely

Question 50

recommended initial treatment for pedia graves

Answer 50

carbimazole and methimazole minimum first 2 years, 3-6 years continuously ptu - NOT FIRST LINE

Question 51

effects of propanolol treatment

Answer 51

controls adrenergic symptoms | decreases conversion of t4 to 3

Question 52

indications for ablative radioiodine therapy

Answer 52

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

Question 53

indications for total thyroidectomy

Answer 53

child is too young for rai therapy | very large goiter

Question 54

monitoring for graves

Answer 54

remission: long term surveillance | recur, severe side effects, noncompliance: rai therapy or thyroidectomy -> treat hypothyroid

Question 55

diagnosis for thyroid cancer

Answer 55

fna, mostly papillary

Question 56

treatment for thyroid cancer

Answer 56

surgery + rai treatment elevated serum tg = recurrence