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ENDO 2 > thyroid (SOME) > Flashcards

thyroid (SOME) Flashcards

1
Q

sx of hypothyroidism

A

hypoactivity: fatigue, depression, cognitive impairment,
cold intolerance
wt gain
dry skin, coarse hair, dry brittle nails
lateral eyebrow thinning
constipation, menorrhagia,
exertional dyspnea,
delayed DTR

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2
Q

sx of hyperthyroidism

A
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3
Q

medications that can cause hypothyroidism

A

lithium
amiodarone
methimazole
PTU
interferon
rifampin

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4
Q

how can amiodarone cause hypothyroidism?

A

via antithyroid action of iodine- blocking T4,3 secretion, stop TH from entering peripheral tissue

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5
Q

intentional etiologies of hypothyroidism

A

surgery
ablative (I-131)
radiation therapy

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6
Q

how does lithium cause hypothyroidism

A

impairs T4,T3 release

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7
Q

how does interferon cause hypothyroidism

A

causes sx that look like hashimotos and goes away after med is stopped

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8
Q

how does rifampin cause hypothyroidism

A

it increases levothyroxine metabolism- concern for compromised fx at baseline

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9
Q

which conditions would have low iodine uptake on radioactive uptake scan?

A

thyroiditis
drug induced (iodine, amiodarone, TH)

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10
Q

how can amiodarone cause hyperthyroidism? (two types)

A

type 1: excess hormone synthesis
type 2: damage thyroid cells causing T3,T4 release

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11
Q

how does iodine excess cause hyperthyroidism

A

via Jod-Basedow phenomenon

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12
Q

Free T4 levels in T3 thyrotoxicosis

A

normal or low

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13
Q

thyrotoxicosis vs hyperthyroidism

A

they are used interchangeably BUT
thyrotoxicosis is when theres too much thyroid hormone in body in general while hyperthyroidism is excess from the thyroid gland

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14
Q

how estrogen affects “total” labs

A

increases total T4 and T3 bc of increased TBG
even tho thyroid function is actually ok

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15
Q

how illness affects “total” labs

A

decrease total T3 and T3 d/t decreased protein levels
even tho thyroid function is actually ok

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16
Q

4 types of thyroid cancer

A

papillary thyroid cancer
follicular carcinoma
medullary carcinoma
anaplastic carcinoma

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17
Q

what is the most common type of thyroid cancer?

A

papillary thyroid cancer

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18
Q

which thyroid cancer has the best prognosis?

A

papillary thyroid cancer

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19
Q

which thyroid cancer has the worst prognosis?

A

anaplastic carcinoma– 100% mortality!!

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20
Q

which two thyroid cancers are treated with thyroidectomy, RAI w/ I-131 and TSH suppression?

A

papillary thyroid cancer
follicular carcinoma

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21
Q

how does papillary thyroid cancer metastasize?

A

lymphatics

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22
Q

how do you monitor papillary thyroid cancer

A

neck US
thyroglobulin levels
I-131 metastatic surveys
PET scans

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23
Q

what does the prognosis of follicular carcinoma depend on?

A

extent of extrathyroidal extension and vascular invasion
in general it has a good prognosis

24
Q

how does follicular carcinoma metastasize?

A

hematogenously

25
Q

which variant of follicular carcinoma may be more aggressive?

A

hurthle cell variant

26
Q

what are the two types of medullary carcinoma?

A

sporadic and familial

27
Q

which type of medullary carcinoma is more common?

A

sporadic

28
Q

which of the medullary carcinomas has C cell hyperplasia?

A

familial medullary carcinoma

29
Q

what procedure improves prognosis for familial medullary carcinoma?

A

prophylactic thyroidectomy

30
Q

what genetic screening can be done for both types of medullary carcinoma?

A

germ line mutation of RET oncogene

31
Q

how does medullary carcinoma metastasize?

A

early before tumor is palpable

32
Q

why dont we use R-131 to treat medullary carcinomas?

A

bc the rumors are not iodine avid

33
Q

tx for medullary carcinomas

A

thyroidectomy
neck dissection

34
Q

what is the serum marker for medullary carcinoma? how can you diagnose it?

A

calcitonin
diagnosed with FNA

35
Q

which type of thyroid cancer is rare and more common in elderly?

A

anaplastic carcinoma

36
Q

tx for anaplastic carcinoma

A

palliative care

37
Q

how does anaplastic carcinoma tend to present

A

rapidly expanding, fixed, hard thyroid mass

38
Q

which cancer can be seen as a late de-differentiation of papillary thyroid carcinoma?

A

anaplastic carcinoma

39
Q

what supplement should be held before getting TSH levels? for how long?

A

Biotin for 2-3 days

40
Q

abbreviation for TSH receptor antibodies

A

Anti-TSHR
TRab

41
Q

abbreviation for thyroid peroxidase antibody

A

TPO Ab

42
Q

what is the gold standard for evaluating thyroid nodules?

A

fine needle aspiration (FNA)

43
Q

which type of nodule should you never stick a needle in?

A

hot nodules

44
Q

which type of nodule should undergo FNA biopsy? why?

A

cold nodules
they are more likely to be cancerous

45
Q

what is a hot nodule?

A

hyperfunctioning nodules that take up more of the isotope compared to normal thyroid tissue

46
Q

which type of nodule is more likely to be cancerous?

A

cold nodules

47
Q

what are cold nodules?

A

non-functioning nodule
they take up less isotope

48
Q

in general, thyroid US are useful for..

A

finding out the size and texture of the gland and nodules

49
Q

how big must a nodule be to biopsy it?

A

1cm

50
Q

which screening procedure cannot differentiate follicular adenoma from follicular carcinoma?

A

fine needle aspiration

51
Q

what is the initial diagnostic study in euthyroid nodular disease?

A

fine needle aspiration

52
Q

when can you get a thyroid scan Tc99?

A

if TSH is low or FNA shows evidence of follicular neoplasia

53
Q

what is a warm nodule?

A

functioning with similar risk of malignancy as cold nodule

54
Q

what can cause a falsely low uptake with I-131?

A

iodine exposure

55
Q

if theres a nodule, you check TSH and its high or low, whats the next step in evaluation?

A

I-131 uptake and scan

ENDO 2 (6 decks)

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