clinical thyroid

Question 1

what is HP-T axis

Answer 1

hypo(TRH)>pit(TSH)> thyroid T3/4

Question 2

4 thyroid presentations

Answer 2

1. hyper
2. hypo
3. mass effect
4. associated issues

Question 3

hormones in primary hyper

Answer 3

TSH down, TH up

Question 4

hormones in secondary hyper

Answer 4

TSH up, TH up

Question 5

hormones in primary hypo

Answer 5

TSH down, TH up

Question 6

hormones in secondary hypo

Answer 6

TSH down, TH down

Question 7

presentation of hyper-thyroid

Answer 7

1. hypermatabolism
2. overactiv adrenergic system - anxiety etc
3. may have orbiopathy if graves

Question 8

physical appearance in hyper

Answer 8

1. general: warm, anxious, silky skin
2. vitals: increased HR, syst. hypertension
3. Eyes: stare, lid lag
4. thyroid: enlarged, bruit
5. neuro: tremor, proximal muscle weakness

Question 9

4 common causes of primary hyperthyroid

Answer 9

1. graves disease
2. multinodule goiter - benign
3. toxic adenoma - benign
4. subacute thyroidisitis

Question 10

how to identify hyper

Answer 10

increased radioactive iodone uptake

Question 11

what if uptake is low

Answer 11

1. PT taking thyroid drugs

2. subacute thyroiditis - leaking

Question 12

treatment if uptake high

Answer 12

thionamide and B-bloacker

Question 13

treatment if uptake is low

Answer 13

B-blocker only

Question 14

4 treatment options for graves

Answer 14

1. Thionamide drugs - block t3/4 production
2. B-blocker - reduce symp symptoms
3. radioactive iodine - kills cells
4. surg

Question 15

hypo presentation

Answer 15

1. everything slowed down
2. constipation
3. dry skin and hair
4. swelling around eyes, heart and lung

Question 16

4 possible causes of primary hypo

Answer 16

1. congential
2. hashimotos - autoimmune destruction
3. subacute thyroiditis
4. drug/radiation

Question 17

treatment for hypothy

Answer 17

l-thyroxine

Question 18

what is DDx for thyroid mass

Answer 18

1. solitary - benign or thyroid cancer

2. multiple - multinodular goiter

Question 19

approach to thyroid nodule

Answer 19

1. asses risk for cancer (fam, growth speed)
2. check TSH
   - if okay go to 3, if supress radio scan - if hot not cancer
3. utrasound and fine needle biopsy

Question 20

best imaging for thyroid

Answer 20

ultrasound

Question 21

2 types of nodules

Answer 21

1. hot - take up isotope - zero cancer risk

2. cold - looks blank - 5% cancer risk

Question 22

2 structures at risk in thyroid surgery

Answer 22

1. parathyroid -PTH

2. recurrent laryngeal nerve - voice

Question 23

treatment of thyroid cancer (4)

Answer 23

1. total thyroidectomy
2. RAI to ablate remaining thyroid
3. thyroid replacment homrones
4. follow levels and neck US