Thyroid Disorders

Question 1

Describe the etiology of goiter

Answer 1

Question 2

Describe the presentation of goiter

Answer 2

Question 3

Describe the diagnostics for goiter

Answer 3

Question 4

Describe the treatment of goiter

Answer 4

Question 5

What are the actions of T3 & T4

Answer 5

• increase basal metabolic rate & metabolism
• stimulate bone maturation & growth
• ensure proper fetal growth & development (esp CNS)
• increase cardiac output

Question 6

What meds can suppress TSH

Answer 6

high dose steroids, dopamine

Question 7

What meds can increase TSH

Answer 7

metoclopramide & amiodarone

Question 8

Describe when to do thyroid screening

Answer 8

• newborn (screen for congenital hypothyroidism ( cretinism, intellectual disability))
• sometimes in pregnancy
• high index of suspicion in elderly pts
• if symptomatic
• when titrating certain meds (or when using amiodarone, Li, metoclopramide)

Question 9

Describe the screening for thyroid conditions

Answer 9

TSH first (if normal, no further testing)
- if high: free T4, maybe T3 (if sus for hyperthyroidism)
- if low: free T4 & T3

Question 10

Describe the difference between total vs free T3 & T4

Answer 10

Total: highly protein bound, many factors influence binding

Free: corresponds to biologically available hormone pool, unpound

Question 11

Describe the consideration for biotin (Vit H, B7) in thyroid testing

Answer 11

• can impact TSH results
• stop at least 18 hrs prior to blood draw

Question 12

Dx for high TSH & low Free T4

Answer 12

primary hypothyroidism (thyroid failure)

Question 13

Dx if TSH is high but FT4 is normal

Answer 13

subclinical hypothyroidism

Question 14

Dx if TSH is low & FT3/FT4 are high

Answer 14

primary hyperthyroidism (thyroid overproducing)

Question 15

Dx if TSH is low and FT3/FT4 are normal

Answer 15

subclinical hyperthyroidism

Question 16

Dx if TSH is low and FT4 is low

Answer 16

Central/Secondary hypothyroidism (pituitary failure)

Question 17

Dx if TSH is high and FT3/FT4 are high

Answer 17

Central/Secondary hyperthyroidism (TSH producing tumor)

Question 18

Which labs test for Hashimoto’s

Answer 18

• Anti-Tg
• Anti-TPO (also Graves
• TSH receptor antibody (blocking in hashimoto’s)

Question 19

Which labs test for Grave’s disease

Answer 19

• Anti-TPO (also hashimoto’s)
• Antimicrosomal antibody
• TSH receptor antibody (stimulating in Grave’s)

Question 20

Describe radioactive iodine uptake scans

Answer 20

• done in hyperthyroidism or nodule workup
• iodine collects in thyroid gland
• overactive/nodule takes up more iodine

Question 21

Describe the appearance of the thyroid in a radioactive iodine uptake scan in Grave’s

Answer 21

symmetrical high uptake

Question 22

Describe the appearance of the thyroid in a radioactive iodine uptake scan in thyroiditis

Answer 22

symmetrical low uptake (underfunctioning, usually not ordered for this)

Question 23

Describe the appearance of the thyroid in a radioactive iodine uptake scan in Toxic MNG or Toxic adenoma

Answer 23

irregular/uneven increased uptake

Question 24

Describe thyrotoxicosis

Answer 24

state of excess thyroid hormone (from gland, meds, etc?)

Question 25

When is it important to include a T3 in workup of the thyroid?

Answer 25

when HYPERthyroidism is suspected

Question 26

Describe the course of postpartum thyroid conditions

Answer 26

- hyper or hypo - 2-4 weeks of thyrotoxicosis - 4-12 weeks of hypothyroidism - spontaneously resolves - can treat symptomatically or with short term levo when in hypothyroid phase

Question 27

Describe the thyroid considerations prior to surgery

Answer 27

- if hyperthyroidism: achieve euthyroid prior - if hypothyroidism: proceed if taking meds regularly

Question 28

Describe the etiology of goiter

Answer 28

Question 29

Describe the etiology of hyperthyroidism

Answer 29

Question 30

Describe the presentation of hyperthyroidism

Answer 30

Question 31

Describe the labs for hyperthyroidism

Answer 31

Question 32

Describe the etiology of Grave's disease

Answer 32

Question 33

Describe the triad presentation of hyperthyroidism

Answer 33

Question 34

Describe the diagnostics for grave's

Answer 34

Question 35

What is this a typical presentation of

Answer 35

Graves disease

Question 36

Describe the etiology of a thyroid storm

Answer 36

Question 37

Describe the presentation of a thyroid storm

Answer 37

Question 38

Describe the labs for a thyroid storm

Answer 38

Question 39

Describe the treatment of a thyroid storm

Answer 39

Question 40

Describe the etiology of toxic MNG

Answer 40

Question 41

Describe the presentation of toxic MNG

Answer 41

Question 42

Describe the etiology of toxic adenoma

Answer 42

Question 43

Describe the workup for toxic MNG & toxic adenoma

Answer 43

Question 44

Describe the treatment for toxic MNG

Answer 44

Question 45

Describe the etiology of hypothyroidism

Answer 45

Question 46

Describe the presentation of hypothyroidism

Answer 46

Question 47

Describe the treatment of hypothyroidism

Answer 47

Question 48

Describe the workup of hypothyroidism

Answer 48

Question 49

Describe the etiology of thyroiditis

Answer 49

Question 50

Describe the presentation of viral thyroiditis

Answer 50

Question 51

Describe the labs for viral thyroiditis

Answer 51

Question 52

Describe the treatment for viral thyroiditis

Answer 52

Question 53

Describe the etiology of hashimoto's thyroiditis

Answer 53

Question 54

Describe the labs for hashimoto's thyroiditis

Answer 54

Question 55

Describe the etiology of myxedema coma

Answer 55

Question 56

Describe the presentation of myxedema coma

Answer 56

Question 57

Describe the treatment of myxedema coma

Answer 57

Question 58

Describe the etiology & presentation of euthyroid sick syndrome

Answer 58

Question 59

What is important to check in euthyroid sick syndrome

Answer 59

reverse T3

Question 60

What is the most common endocrine cancer

Answer 60

thyroid cancer

Question 61

What are the worst and chillest thyroid neoplasms

Answer 61

Worst: anaplastic carcinoma Chillest: papillary or follicular carcinoma

Question 62

What is this characteristic of

Answer 62

Hypothyroidism

Question 63

What is this characteristic of

Answer 63

hyperthyroidism

Question 64

Describe the treatment of toxic adenoma

Answer 64

may develop hypothyroidism after tx

Question 65

Describe the treatment for hyperthyroidism

Answer 65

Question 66

Describe the workup of goiter

Answer 66

Question 67

Describe the treatment of goiter

Answer 67