Trigger words Thyroid P2 Flashcards
1
Q
women >60 who smoke
A
MC demographic for hyper/hypothyroidism
2
Q
autoantibodies binding to TSH receptorss
A
Graves Disease
3
Q
positive Thyroid stimulating Ig, Anti-TPO, Anti-Tg
A
graves disease
4
Q
amiodarone can cause
A
excessive iodine leading to thyrotoxicosis
5
Q
kelp can cause
A
excessive iodine leading to thyrotoxicosis
6
Q
nori is known for
A
excessive iodine leading to thyrotoxicosis
7
Q
polyuria, diarrhea, muscle cramps
A
unexpected symptoms of thyrotoxicosis
8
Q
lid lag/lid retraction
A
signs of thyrotoxicosis
9
Q
hyperreflexia indicative of
A
signs of thyrotoxicosis
10
Q
osteoporosis and resting tremors indicative of
A
signs of thyrotoxicosis
11
Q
thyroid acropachy seen in
A
graves disease
12
Q
staring appearance/upper eyelid retraction
A
graves ophthalmology
13
Q
periosteal reaction of extremity bones, digital clubbing, swelling of the fingers and toes
A
thyroid acropachy indicative of graves disease
14
Q
erythematous rough plaques and lymphoid infiltration
A
graves dermopathy/pretibial myxedema indicative of graves disease
15
Q
forceful heartbeat, premature atrial contraction, pulmonary HTN, exertional dyspnea, forceful heartbeat
A
cardiopulmonary manifestations of thyrotoxicosis
16
Q
most common in 2nd trimester of pregnancy
A
graves disease
17
Q
hypercalcemia
^ alk phosphate
A
primary hyperthyroidism
also seen: anemia
decreased granulocytes
18
Q
anemia
decreased granulocytes
A
primary hyperthyroidism
also seen:
hypercalcemia
^ alk phosphate
19
Q
elevated ESR
A
subacute thyroiditis
suppurative thyroiditis
20
Q
low serum thyroglobulin levels suggest what manifestation
(there may be multiple of these, check me plz)
A
thyrotoxicosis factitia
21
Q
used to differentiate thyrotoxicosis etiologies
A
RAI
22
Q
increased uptake of iodine in RAI
A
graves disease, toxic solitary nodule, toxic multinodular goiter, T1 amiodarone thyrotoxicosis
23
Q
low uptake of iodine in RAI
A
thyroiditis, iodine induced thyrotoxicosis, T2 amiodarone thyrotoxicosis
24
Q
RAI contraindication
A
pregnancy
25
cannot tell benign from malignant
thyroid US
26
cannot be used to measure metabolic activity
thyroid US
27
treat with steroids.
treat with radiation/surgery if severe
graves disease with severe ophthalmologic manifestations
28
symmetric flaccid paralysis
common after IV dextrose, oral carbs or vigorous exercise
this is called hypokalemic periodic paralysis and it presents in thyrotoxicosis
29
high fever, tachycardia, delirium, vomiting/diarrhea, dehydration
thyroid storm
(severe life threatening thyrotoxicosis)
30
treatment for thyroid storm
Thiourea drug: methimazole or PTU (inhibits iodine oxidation, preventing formation of thyroid hormone.)
Iodinated contrast agent: ipodate sodium or iopanoic acid (Inhibits peripheral conversion of T4 to T3)
BB: propranolol or atenolol (symptomatic relief)
Hydrocortisone
AVOID ASA
definitive: Radioactive iodine and/or surgery
31
normal serum FT4 and T3 but low TSH
subclinical hyperthyroidism
32
BB
Iodinated contrast agents
thiourea drugs
graves disease treatment
33
teratogenicity, passed through breast milk
methiomazole
34
Inhibits organification of iodine, preventing formation of thyroid hormone.
Decreases peripheral conversion of T4 to T3.
PTU
35
BBW hepatotoxicity
PTU
36
BB + PTU or methimazole can be used to treat which conditions
toxic solitary nodules
amiodarone induced thyrotoxicosis
Toxic multinodular goiter
37
Thioureas are ineffective
thyroiditis
38
avoid aspirin
thyroid storm
39
use BB for treatment. iodinated contrast agents if severe.
thyroiditis
40
radioactive iodine interferes with
TSI labs
41
hepatitis C
iodine deficiency
family Hx
head/neck radiation
risk factors for hashimotos
42
diffusely enlarged, firm, finely nodular thyroid
presents with no pain/tenderness
hashimotos typical presentation
43
more prone to depression even if labs are w/i normal limits
hashimotos
44
enlarged thyroid w/ transient hyperthyroid for 1-6 mo, then transient hypothyroid for 1-2 mo
painless postpartum thyroiditis
45
50% w/small nontender goiter. transient hyper for 1-2 mo then hypo
painless sporadic thyroiditis (subacute form of hashimoto)
46
subacute form of hashimoto
painless sporadic thyroiditis
47
acute enlargement of thyroid w pain radiating to ear/jaw
subacute thyroiditis
presents w/
Acute enlargement of thyroid gland.
Pain and dysphagia, usually referred to ear or jaw.
Malaise and fever
Hx of recent URI
Short-term thyrotoxicosis followed by long hypothyroidism
48
due to viral infection
subacute thyroiditis
49
low grade fever, malaise, and painful dysphagia
subacute thyroiditis
Acute enlargement of thyroid gland.
Pain and dysphagia, usually referred to ear or jaw.
Malaise and fever
Hx of recent URI
Short-term thyrotoxicosis followed by long hypothyroidism
50
Short-term thyrotoxicosis followed by long hypothyroidism
subacute thyroiditis
51
Severe pain, tenderness, redness, fluctuance
presents w fever
suppurative thyroiditis
52
Hx of immunosuppression common with
suppurative thyroiditis
strongly correlated w hashimotos as well
53
Assymetric, stony, adherent thyroid gland
ridel thyroiditis
associated dysphagia, dyspnea, pain, hoarseness also present
54
positive Anti-TPO or Anti-Tg antibodies.
TSI not necessarily important.
sometimes have labs consistent w celiac disease
hashimotos
55
low antithyroid antibodies
subacute thyroiditis
56
elevated Leukocytes
suppurative thyroiditis
57
elevated ESR w NORMAL thyroid antibody labs
suppurative thyroiditis
58
elevated ESR w LOW thyroid antibody labs
Subacute thyroiditis
59
Fever
thyroid storm
subacute thyroiditis
suppurative thyroiditis
60
diffuse, heterogeneous texture on ultrasound
hashimotos
61
increased vascularity on US
graves disease
62
normal or decreased vascularity on US
thyroiditis
63
FNA biopsy w gram stain and culture
suppurative thyroiditis
64
1st trimester miscarriage risk
hashimotos
65
abscess or chronic sinus tract formation
suppurative
66
can use levothyroxine for hypothyroid
may try levo suppression for hyperthyroid
hashimotos treatment
67
High dose ASA or NSAIDS
subacute thyroiditis
use BB for s/s
severe = iodinated contrast agents
68
antibiotics and surgical drainage of abscess
suppurative thyroiditis
69
tamoxifen and/or steroid therapy
riedel thyroiditis
70
due to systemic fibrosis
common cause of riedel thyroiditis
71
for viewing vascularity
thyroid US
72
HPT axis dysfunction
sick euthyroid syndrome
73
abnormal thyroid function with nonthyroid illness
sick euthyroid syndrome
74
impaired deiodination of T4 to T3 and decreased clearance of reverse T3
sick euthyroid syndrome
75
cytokine based inhibition of thyroid hormone production
sick euthyroid syndrome
76
specifically due to IL-6 cytokine
sick euthyroid syndrome
77
Observation unless s/s or previous hx.
Correcting the underlying disease is typically sufficient.
sick euthyroid syndrome
78
MC in asian and american indian men
Hypokalemic periodic paralysis
79
vocal cord paralysis
LAN
adherence to local structures
large size
cancerous thyroid nodule characteristics.
80
Retrosternal: dyspnea, facial erythema, JVD
large multinodular goiter characteristics
81
Cold RAI uptake
higher cancer risk
82
hot RAI uptake
lower cancer risk
83
warm RAI uptake
normal thyroid cells
84
FNA biopsy
evaluates for malignancy in nodules
85
Biopsy or no?
nodule >1cm w suspicious appearance.
yes
86
Biopsy or no?
nodule <1cm w LAD
yes
87
Biopsy or no ?
1.5 cm w/o suspicious appearance
no
88
Biopsy or no?
.7cm w suspicious appearance
no
89
heart disease exacerbation, osteoporosis, hyperthyroidism
risks of LT4 suppression
90
treatment for thyroid goiter with s/s of thyrotoxicosis
thiourea drug +/- BB
91
treatment for thyroid goiter that is cancerous, hyperfunctioning or toxic
surgery
92
ethanol injections
treatment for thyroid goiter w benign nodules to shrink them
93
toxic thyroid adenoma or toxic MNG treatment
RAI therapy.
94
initial labs for a pt w/ thyroid goiter or nodule(s)
TSH +/- FT4 and autoimmune labs
95
MC thyroid cancer
papillary thyroid cancer
96
can occur as autosomal dominant
papillary thyroid carcinomas
97
slow growing, often remains confined to thyroid/regional lymph nodes
papillary thyroid carcinoma.
98
cancer with high RAI uptake
Follicular thyroid carcinoma
99
presents with flushing and diarrhea.
medullary thyroid carcinoma
100
can sometimes appear as cushings syndrome
medullary thyroid carcinoma
101
nodule that is palpable, firm, nontender
indicative of thyroid carcinoma
102
carcinoma w elevated serum Tg
metastatic papillary or follicular carcinomas
103
elevated calcitonin and serum CEA
medullary thyroid carcinoma
104
used to evaluate distant metastases
CT/MRI
105
thyroid mass that is 2cm is found to be cancerous. treatment plan?
total thyroidectomy + cervical lymph node disection
106
thyroid mass is .5 cm and found to be cancerous. Treatmnt plan?
consider lobectomy
107
lesion found that is 6 cm but is undetermined to be cancerous or noncancerous. treatment plan?
total thyroidectomy
108
lesion found to be 2cm but is undetermied to be cancerous or noncancerous. treatment plan?
lobectomy (+/- lacter thyroidectomy)
109
differentiated thyroid cancer treatment
RAI therapy
chemotherapy
thyroxine suppression
110
hypothermia, hypotension, hyponatremia.... finish the symptoms and state diagnosis
hypothermia
hypotension
hyponatremia
hypoventilation
hypoglycemia
cognitive impairment
myxedema crisis
111
IV LT4, may need IV LT3
myxedema crisis. use LT3 if in coma
112
labs show increased lipids and elevated prolactin
hypothyroidism.
113
labs show normal FT4 with TSH above normal range
subclinical hypotyroidism.
114
CI for acute MI, thyrotoxicosis and adrenal insufficiency
levothyroxine (LT4), liothyronine (LT3), dessicated thyroid (LT3/LT4 combo aka armour thyroid)
115
CI for allergy to beef/pork
desiccated thyroid (LT3/LT4 combo aka armour thyroid)
116
not reccomended medication in elderly patients
desiccated thyroid (LT3/LT4 combo aka armour thyroid)
117
Increased risk of megacolon
Hypothyroidism
118
what is the job of deiodinases
convert T4 to T3
119
what converts T4 to T3
deiodinases
120
what enzyme processes iodine for thyroid use
TPO
121
what does increased rT3 indicate other than stress inceased in the body
hypothyroidism because it is metabolically inactive
122
which thyroid hormone binds better to proteins? receptors?
T4 - proteins
T3 - receptors`
123
what alters gene expression, usually causing a target gene to be expressed
T3 receptor complex aka TR-RXR complex
124
what thyroid problem could cause heavy menses
hypothyroidism
125
when are TSH levels highest and lowest
highest at 10pm
lowst at 10am
126
affect of lithium on TSH, T3 and T4
increases TSH
decreases T3 and T4
127
what would cause decreased T3/FT3
Decreased conversion of T4 to T3, aka liver disease or severe illness.
128
what two things could cause increased TBG
high estrogen levels
infectious hepatitis
129
hat 4 things can cause low TBG
Hypoproteinemia
Ovarian failure
Elevated testosterone levels
Major Stress
130
differentiate between primary, secondary and tertiary hypothyroidism
primary - decreased thyroid function
secondary - decreaseed pituitary function
tertiary - decreased hypothalamus function
131
A TRH stimulating test shows no increase in TSH, what is the diagnossi
secondary hypothyroidism. pituiatry problem
132
there is a delayed increase in baseline TSH after a TRH stimulation test, what is the diagnosis
tertiary hypothyroidism
133
MCC hypothyroidism in US
hashimotos
134
what does enlarged thymus suggest
autoimmune thyroiditis
135
CI for levothyroxine
angina (acute MI)
adrenal insufficiency (uncontrolled)
thyrotoxicosis
