Thyroiditis

Question 1

non-viral infection of the thyroid gland

Answer 1

suppurative thyroiditis

Question 2

in which patients is suppurative thyroiditis often found in?

Answer 2

immunosuppressed patients

Question 3

why is the thyroid usually highly resistant to infection?

Answer 3

has high iodine concentration

Question 4

a patient presents with a fever and painful, erythematous, fluctuant thyroid. they appear to be very sick. what are they likely experiencing?

Answer 4

suppurative thyroiditis

Question 5

what labs would we get for a patient with suspicious suppurative thyroiditis? what will those labs look like?

Answer 5

ESR - elevated
WBCs - elevated
TSH - normal
T3/T4 - normal

Question 6

in a patient with suppurative thyroiditis, why would TSH, T3, and T4 be normal?

Answer 6

it is not a thyroid cell problem, the thyroid itself is sick

Question 7

what are 2 diagnostics to order for a patient with suspicious suppurative thyroiditis?

Answer 7

ultrasound
FNA biopsy + gram stain/culture

Question 8

why would we want to order an ultrasound for a patient suspicious for suppurative thyroiditis?

Answer 8

look for swelling vs abscess

Question 9

what is the treatment for suppurative thyroiditis?

Answer 9

empiric IV broad spectrum antibiotics
clindamycin
amoxicillin/clauvanate (augmentin)

Question 10

what is an additional treatment for suppurative thyroiditis is the patient has an abscess?

Answer 10

surgical drainage

Question 11

viral infection or a post-viral inflammatory process of the thyroid

Answer 11

subacute thyroiditis

Question 12

a patient presents with an acutely tender, moderately large thyroid, pain that radiates to head and chest and is worse when coughing/moving. They also have a fever, fatigue, anorexia, and symptoms of hyperthyroidism. what are they likely experiencing?

Answer 12

subacute thyroiditis

Question 13

a patient that is suspicious for subacute thyroiditis gets labs done. what should we expect to see if our suspicion is correct? (3)

Answer 13

varied TSH/T3, T4
elevated ESR
elevated CRP

Question 14

if we got a histology on a patient with subacute thyroiditis, what would we expect to see? (4)

Answer 14

neutrophils
lymphocytes
histocytes
giant cells

Question 15

what is the treatment for subacute thyroiditis? (3)

Answer 15

aspirin/NSAID for pain
beta blocker for thyrotoxicosis
levothyroxine for hypothyroidism

Question 16

a patient with subacute thyroiditis is in severe pain. what medication should we give for pain control?

Answer 16

prednisone

Question 17

what is the most common cause of hypothyroidism?

Answer 17

hashimoto thyroiditis

Question 18

autoimmune disorder in which antibodies and antigen-specific T cells are directed against major thyroid antigens: thyroglobulin (Tg) and thyroid peroxidase (TPO)

Answer 18

hashimoto thyroiditis

Question 19

what are 4 risk factors for hashimoto thyroiditis? (IAGE)

Answer 19

Iodine supplementation
Amiodarone
Genetics
Exposure to radiation

Question 20

which medical condition may start as transient hyperthyroidism and then transitions into mild or subclinical hypothyroidism?

Answer 20

hashimoto thyroiditis

Question 21

a patient presents with depression, chronic fatigue, xerostomia, keratoconjuntiva, and a diffusely large/firm thyroid. what are they likely experiencing?

Answer 21

hashimoto thyroiditis

Question 22

what labs would we get for a patient that is suspicious for hashimoto thyroiditis? what will the results be? (4)

Answer 22

TSH - varies
T3/T4 - varies
anti-TPO - elevated
anti-TG - elevated

Question 23

if a patient has had hashimoto thyroiditis for a while, what will their TSH, T3/T4 likely be?

Answer 23

TSH elevated
T3/T4 low

Question 24

what diagnostic will help distinguish between multinodular goiter / Graves and hashimoto thyroiditis?

Answer 24

ultrasound

Question 25

what is the treatment for hashimoto thyroiditis?

Answer 25

levothyroxine