Thyrotoxicosis

Question 1

Sx of thrytoxicosis

Answer 1

hyper, but tired

• lose weight
• agitatetd, insomnia
• sweating and heat intolerance
• diarrhea
• muscle weakness

Question 2

tests for hyper

Answer 2

1. TSH, T3-4
2. serum K - eating disorders
3. ECG
4. B-HcG
5. CBC - underlying disease?

Question 3

what will be seen in hyper

Answer 3

low TSH and high T3-4

Question 4

2 things when find hyper

Answer 4

1. B-blocker

2. urgent referral to endo

Question 5

Sx on exam for hypoer

Answer 5

• silky warm sweaty skin
• tremor, hyperrelfexic
• thyroid large and non-tender, no nodules
• proptosis in graves
• ## arryhtmias

Question 6

DDx for hyper (6)

Answer 6

1. graves
2. toxic multinoduclar goiter
3. subacute thyroiditis
4. ingested iodine
5. exogneous thyroid
6. other rare

Question 7

3 ways TSH-r may be stimulated

Answer 7

1. TSH autoimmune antibodies - graves
2. beta-HCG related TSH-r activation
3. activatine TSH-r genes

Question 8

what is seen on histo of graves thyroid

Answer 8

no colloid

Question 9

what is multinodular goiter and follicular nodular disease

Answer 9

• impaired synthesis of thyroid hormone
• usually euthyroid
• hyperplastic vs. neoplastic
• mech is activation of cAMP pathway in thyroid

Question 10

what is mech of subacute thyroididits

Answer 10

destruction of colloid containing follicle - releases t34

- may be inflam or mechanical

Question 11

what is mech of increaed iodine load

Answer 11

intake leads to increased uptake and production of hormones

Question 12

how to diagnose the type of hyper thyroid

Answer 12

radioactive iodine uptake

Question 13

common and high RAI types (3)

Answer 13

1. graves
2. MNG
3. toxic adenoma

Question 14

common and low RAI (2)

Answer 14

1. subacute thyroiditis

2. exogenous

Question 15

uncommon and high RAI types (2)

Answer 15

1. TSHoma

2. b-HCG stimulated

Question 16

uncommon and low RAI types (1)

Answer 16

struma ovarii

Question 17

what is pathophysio of graves

Answer 17

thryoirid stimulatin immunoglobulin

Question 18

4 actions of TSI

Answer 18

1. causes goiter
2. hyperthyroid
3. can be blocking - hypo
4. interaction with fibroblasts behind eye causes orbitopathy

Question 19

treatment of graves (3)

Answer 19

b-blokc until normal

1. thriouracil meds - methimazole - 1st line
2. redioavtice iodine
3. surgery

Question 20

** 5 types of hyper pathologies

Answer 20

1. inappropriate secretion of TRH/TSH
2. activatiokn of TSH-r
3. activation of cAMP in thyroid cells
4. destuction of colloid containing cells
5. iodine load