1
Q
What is the most common cause of hyperthyroidism?
A
Graves’ disease.
2
Q
Which two problems are unique to Graves’ disease and not directly related to high serum thyroid hormone concentrations?
A
Thyroid eye disease and infiltrative dermopathy (pretibial myxedema).
3
Q
List four classic symptoms of hyperthyroidism.
A
Any four of: heat intolerance, tremor, palpitations, anxiety, weight loss, increased bowel movements, or shortness of breath.
4
Q
What is a common finding on physical examination for a patient with overt hyperthyroidism?
A
Goiter.
5
Q
How does the skin of a hyperthyroid patient typically feel and why?
A
It is warm and smooth due to increased blood flow and a decrease in the keratin layer.
6
Q
Increased calorigenesis in hyperthyroidism leads to what two common skin-related symptoms?
A
Increased sweating and heat intolerance.
7
Q
What is the medical term for the loosening of nails from the nail bed, sometimes seen in hyperthyroidism?
A
Onycholysis (Plummer’s nails).
8
Q
Hyperpigmentation in severe hyperthyroidism is mediated by accelerated cortisol metabolism, leading to increased secretion of what hormone?
A
Corticotropin (ACTH).
9
Q
Infiltrative dermopathy, a unique feature of Graves’ hyperthyroidism, most commonly presents on which part of the body?
A
The skin overlying the shins.
10
Q
What is the characteristic appearance of infiltrative dermopathy in Graves’ disease?
A
Raised, hyperpigmented, violaceous, orange-peel-textured papules.
11
Q
The stare and lid lag seen in all patients with hyperthyroidism are due to _____, possibly mediated by increased alpha-adrenergic receptors.
A
sympathetic overactivity
12
Q
How is lid lag evaluated on physical exam?
A
The patient has lid lag if sclera can be seen above the iris as they follow the examiner’s finger downward.
13
Q
What is the underlying pathology of thyroid eye disease in patients with Graves’ disease?
A
Inflammation of the extraocular muscles and orbital fat and connective tissue.
14
Q
List three major clinical signs of thyroid eye disease.
A
Proptosis (exophthalmos),
impairment of eye muscle function,
and periorbital/conjunctival edema.
15
Q
What are three identified risk factors for developing thyroid eye disease?
A
Cigarette smoking, advancing age, and male sex.
16
Q
Severe proptosis in thyroid eye disease can lead to what two serious complications?
A
Corneal ulceration and optic neuropathy (potentially blindness).
17
Q
What are four cardiovascular signs or symptoms associated with hyperthyroidism?
A
Any four of: palpitations, exertional dyspnea, tachycardia, hyperdynamic precordium, or systolic hypertension with widened pulse pressure.
18
Q
Hyperthyroidism is associated with an increased risk of what serious cardiac arrhythmia?
A
Atrial fibrillation.
19
Q
How does thyroid hormone affect bone metabolism?
A
It stimulates bone resorption, leading to increased porosity of cortical bone and reduced volume of trabecular bone.
20
Q
In hyperthyroidism-induced bone disease, which type of bone (cortical or trabecular) experiences a greater loss in density?
A
Cortical bone.
21
Q
The increased bone resorption in hyperthyroidism can lead to an increase in serum _____ concentrations, which in turn inhibits PTH secretion.
A
calcium
22
Q
What is the net effect of chronic hyperthyroidism on the skeletal system?
A
Osteoporosis and an increased fracture risk.
23
Q
Thyroid acropachy, a finding in Graves’ disease, is characterized by clubbing and periosteal new bone formation in which bones?
A
The metacarpal bones or phalanges.
24
Q
What is the typical effect of hyperthyroidism on serum total and HDL cholesterol concentrations?
A
They tend to be low.
25
Hyperthyroidism interferes with glucose metabolism by antagonizing the peripheral action of _____, which usually predominates and leads to impaired glucose tolerance.
insulin
26
Why might an ACTH stimulation test be misleading in a hyperthyroid patient?
Corticosteroid-binding globulin (CBG) levels decrease, resulting in lower total serum cortisol concentrations that may not reflect true adrenal function.
27
In women with hyperthyroidism, high serum sex hormone-binding globulin (SHBG) results in what change to total and free estradiol levels?
High serum total estradiol and low-normal serum free (unbound) estradiol.
28
What are two common gynecologic manifestations of hyperthyroidism in women?
Oligomenorrhea and anovulatory infertility (amenorrhea in severe cases).
29
In men with hyperthyroidism, increased SHBG concentrations lead to what change in total and free testosterone levels?
High serum total testosterone concentrations, but normal or low serum free (unbound) testosterone.
30
Men with hyperthyroidism have increased extragonadal conversion of testosterone to _____, leading to high serum concentrations of this hormone.
estradiol
31
What are three potential reproductive or sexual side effects of hyperthyroidism in men?
Gynecomastia, reduced libido, and erectile dysfunction.
32
One important cause of dyspnea and reduced exercise capacity in hyperthyroidism is weakness of the _____ muscles.
respiratory
33
What is the primary reason for weight loss in most patients with hyperthyroidism?
Increased metabolic rate (hypermetabolism).
34
While most hyperthyroid patients experience hyperphagia and weight loss, what paradoxical symptom may occur in younger patients?
Weight gain, due to sufficient appetite stimulation.
35
While younger patients with hyperthyroidism are often hyperphagic, older patients may prominently display what contrasting appetite-related symptom?
Anorexia.
36
What liver function test is most commonly elevated in patients with hyperthyroidism, found in 44% of patients in a meta-analysis?
Alkaline phosphatase (ALP).
37
Thymic enlargement due to hyperplasia is a reported feature of which specific cause of hyperthyroidism?
Graves' disease.
38
What is the recommended management step after discovering thymic hyperplasia in a patient with Graves' disease and initiating therapy?
Repeat imaging three to four months after initiation of therapy is warranted to ensure regression.
39
What type of anemia can be seen in hyperthyroidism, resulting from a greater increase in plasma volume than red blood cell mass?
A normochromic, normocytic anemia.
40
Graves' hyperthyroidism may be associated with which two autoimmune hematologic disorders?
Immune thrombocytopenia (ITP) and pernicious anemia.
41
Hyperthyroidism can induce a prothrombotic state by increasing levels of which coagulation factors?
Factors VIII, IX, fibrinogen, von Willebrand factor, and plasminogen activator inhibitor-1.
42
What are two common genitourinary symptoms in hyperthyroidism?
Urinary frequency and nocturia.
43
List three common neuropsychiatric manifestations of thyrotoxicosis.
Anxiety, restlessness, irritability, and/or emotional lability.
44
What are two cognitive impairments that can accompany the behavioral changes of hyperthyroidism?
Impaired concentration and poor immediate recall.
45
What is thyrotoxic periodic paralysis?
A rare presentation of thyrotoxicosis marked by muscle weakness associated with hypokalemia.
46
Thyrotoxic periodic paralysis is most frequently seen in what demographic group?
East Asian males.
47
List two factors that can precipitate an episode of thyrotoxic periodic paralysis.
Exercise, fasting, or a high carbohydrate meal.
48
What term is used to describe the presentation of hyperthyroidism in older patients who may lack hyperactivity and other classic symptoms?
Apathetic hyperthyroidism.
49
Compared to younger patients, older patients with hyperthyroidism have a reduced prevalence of which three classic symptoms?
Heat intolerance, tremor, and nervousness.
50
Older patients with hyperthyroidism have a higher prevalence of which two symptoms compared to younger patients?
Weight loss and shortness of breath.
51
While Graves' disease is the most common cause of hyperthyroidism at any age, which cause is relatively more common in older patients?
Toxic multinodular goiter.
52
What is a reason that tachycardia might be absent in up to 40 percent of older hyperthyroid patients?
Coexistent conduction system disease.
53
A patient with Graves' disease presents with asymptomatic clubbing, severe thyroid eye disease, and dermopathy. What is this constellation of findings called?
Thyroid acropachy.
54
Dyspnea on exertion in hyperthyroidism can be caused by increased oxygen consumption and increased production of what gas?
Carbon dioxide.
55
The autoimmune-mediated mechanism for thymic hyperplasia in Graves' disease involves TSH immunoglobulins binding to TSH receptors in the thymus, causing proliferation of what cell type?
Thymocytes.
56
Though red blood cell mass increases in hyperthyroidism, anemia occurs because _____ increases to a greater extent.
plasma volume
57
In a patient with Graves' disease, the finding of vitiligo or alopecia areata is related to the underlying _____ nature of the disease.
autoimmune
58
What is the effect of hyperthyroidism on the metabolic clearance rate of calcitriol (1,25-dihydroxyvitamin D)?
It is increased, contributing to impaired calcium absorption.
59
What happens to serum levels of total cholesterol, LDL, and HDL in overt hyperthyroidism?
They are typically lowered.
60
A patient with severe hyperthyroidism may develop amenorrhea due to a reduced midcycle surge in which hormone?
Luteinizing hormone (LH).
61
The increased serum estradiol in men with hyperthyroidism results from increased extragonadal conversion of ____.
testosterone
62
A hyperthyroid patient complains of difficulty swallowing. This dysphagia is most likely due to what physical finding?
A large goiter causing tracheal or esophageal compression.
63
What effect can hyperthyroidism have on a patient's pre-existing asthma?
It may exacerbate the asthma.
64
According to a meta-analysis, what percentage of patients presenting with Graves' hyperthyroidism had neutropenia?
10 percent.
65
Enuresis is a common genitourinary symptom of hyperthyroidism in which patient population?
Children.
66
Infiltrative dermopathy and _____ are two clinical manifestations unique to Graves' disease.
thyroid eye disease
67
A patient with hyperthyroidism has a normal total T4 but an elevated free T4. A decrease in what binding protein could explain this finding?
Corticosteroid-binding globulin (CBG) is mentioned, but thyroid-binding globulin (TBG) is the primary one (though not in the text, the principle of decreased binding globulins applies).
68
In geriatric hyperthyroidism, what gastrointestinal symptom may persist, contrary to the hyperdefecation seen in younger patients?
Constipation.
69
Hyperthyroidism can lead to impaired glucose tolerance because antagonism to the peripheral action of insulin _____ the effect of increased insulin secretion.
predominates over
70
What is the consequence of decreased corticosteroid-binding globulin (CBG) on the interpretation of cortisol levels in hyperthyroidism?
It may result in misleadingly low basal or ACTH-stimulated total cortisol levels.
71
How does hyperthyroidism affect spermatogenesis in males?
It is often decreased or abnormal, with more nonmotile or abnormal spermatozoa.
72
What is the defining characteristic of thyroid storm?
It is a life-threatening condition characterized by severe clinical manifestations of thyrotoxicosis.
73
What is the approximate incidence of thyroid storm in the United States per 100,000 persons per year?
The incidence is 0.36 per 100,000 persons per year.
74
What is the approximate mortality rate associated with thyroid storm?
The mortality rate is substantial, ranging from 10 to 30 percent.
75
List two common precipitating events for thyroid storm in a patient with untreated hyperthyroidism.
Common precipitants include surgery (thyroid or nonthyroidal), infection, trauma, an acute iodine load, or parturition.
76
What action regarding antithyroid drugs is a common precipitant of thyroid storm?
The irregular use or abrupt discontinuation of antithyroid drugs.
77
Thyroid hormone levels (T4 and T3) in thyroid storm are typically _____ compared to those in uncomplicated thyrotoxicosis.
not more profound
78
One study found that while total T4 and T3 levels were similar, the concentrations of which thyroid hormones were higher in patients with thyroid storm versus uncomplicated thyrotoxicosis?
The free T4 and free T3 concentrations were higher.
79
What category of central nervous system symptoms is considered essential to the diagnosis of thyroid storm by many clinicians?
Altered mentation, such as agitation, delirium, psychosis, stupor, or coma.
80
What is a common cardiovascular finding in thyroid storm, often with rates exceeding 140 beats/minute?
Tachycardia is a common finding.
81
What degree of hyperpyrexia is commonly seen in patients with thyroid storm?
Temperatures of 104 to 106°F (40 to 41.1°C) are common.
82
Besides nausea and vomiting, what severe gastrointestinal or hepatic manifestation can occur in thyroid storm?
Hepatic failure with jaundice may occur.
83
According to the Burch-Wartofsky scoring system, a score of what value is highly suggestive of thyroid storm?
A score of 45 or more is highly suggestive of thyroid storm.
84
In the Burch-Wartofsky scoring system, a score below what value makes thyroid storm unlikely?
A score below 25 makes thyroid storm unlikely.
85
A Burch-Wartofsky score between 25 and 44 is suggestive of what condition?
It is suggestive of an impending storm.
86
What is the typical pattern of TSH, free T4, and T3 found in a patient with thyroid storm due to primary hyperthyroidism?
TSH is low (suppressed), while free T4 and/or T3 concentrations are high.
87
What is the most common underlying etiology of hyperthyroidism in patients who develop thyroid storm?
Graves' disease is the most common cause.
88
What is the first-line class of medication used to control the adrenergic symptoms of thyroid storm?
Beta blockers are the first-line medication class for adrenergic symptom control.
89
Which specific beta blocker is preferred in thyroid storm due to its additional effect on T4 to T3 conversion?
Propranolol is preferred.
90
What is the mechanism by which thionamides (like PTU and methimazole) work in thyroid storm?
They block de novo synthesis of thyroid hormone.
91
What is the primary role of an iodine solution (e.g., SSKI, Lugol's) in the acute management of thyroid storm?
It blocks the release of preformed thyroid hormone from the gland.
92
What is the triple mechanism of action of glucocorticoids in the treatment of thyroid storm?
They reduce T4-to-T3 conversion, promote vasomotor stability, and may treat relative adrenal insufficiency or reduce the autoimmune process in Graves' disease.
93
Why should aspirin be avoided for fever control in thyroid storm?
Aspirin can increase serum free T4 and T3 concentrations by interfering with their protein binding.
94
What is the recommended analgesic and antipyretic for managing hyperpyrexia in thyroid storm?
Acetaminophen should be used.
95
In which clinical scenario involving cardiovascular function are beta blockers contraindicated in thyroid storm?
Beta blockers are contraindicated in patients with acute decompensated heart failure with systolic dysfunction.
96
What is the typical oral starting dose of propranolol for an adult in thyroid storm?
The dose is typically 60 to 80 mg orally every four to six hours.
97
Which short-acting intravenous beta blocker may be a reasonable option if it is uncertain that a beta blocker will be tolerated?
Esmolol may be a reasonable option due to its very short duration of action.
98
For life-threatening thyroid storm in an ICU setting, which thionamide is suggested and why?
Propylthiouracil (PTU) is suggested because it decreases T4-to-T3 conversion more rapidly than methimazole.
99
What is the typical oral dose of propylthiouracil (PTU) for an adult in thyroid storm?
The dose is 200 to 250 mg every four hours.
100
What is the typical oral dose of methimazole for an adult in thyroid storm?
The dose is 20 mg orally every four to six hours.
101
Why should iodine administration be delayed for at least one hour after a thionamide is given?
To prevent the iodine from being used as a substrate for new hormone synthesis before the thionamide has taken effect.
102
What is the recommended oral dose for SSKI (saturated solution of potassium iodide) in thyroid storm?
The dose is 5 drops (approximately 250 mg iodide) orally every six hours.
103
What is the recommended intravenous loading dose of hydrocortisone for a patient with thyroid storm?
A loading dose of 300 mg of hydrocortisone is recommended.
104
Following the loading dose, what is the typical intravenous maintenance dose of hydrocortisone in thyroid storm?
The maintenance dose is 100 mg intravenously every eight hours.
105
How does cholestyramine act as an adjunctive therapy in severe thyrotoxicosis?
It reduces thyroid hormone levels by interfering with the enterohepatic circulation and recycling of thyroid hormones.
106
What is the typical oral dose of cholestyramine when used as an adjunctive therapy for thyroid storm?
The dose is 4 grams orally four times daily.
107
For a patient with thyroid storm who cannot tolerate thionamides and is too unstable for surgery, what therapeutic procedure can be used to remove thyroid hormones from plasma?
Plasmapheresis can be used.
108
After a patient with thyroid storm shows clinical improvement, what should be done with the iodine therapy?
Iodine therapy can be discontinued unless a thyroidectomy is planned in the next 10 to 14 days.
109
When is it appropriate to switch a patient from PTU to methimazole during recovery from thyroid storm?
The switch should occur once the serum T3 is declining and hospital discharge is anticipated.
110
Why is methimazole preferred over PTU for long-term management after the acute phase of thyroid storm?
Methimazole has a better safety profile (lower risk of severe hepatotoxicity) and better compliance rates due to its longer half-life.
111
A patient with longstanding Graves' disease presents with a fever of 104.5°F, heart rate of 150 bpm, and severe agitation. These findings are classic for ____ ____.
thyroid storm
112
What is the primary reason that appropriate preoperative preparation of hyperthyroid patients has dramatically reduced surgically induced thyroid storm?
It ensures patients are as close to euthyroid as possible before the stress of surgery, minimizing the risk of a hyperadrenergic crisis.
113
In a patient with thyroid storm due to Graves' disease, physical examination may reveal goiter and what specific eye finding?
Ophthalmopathy (such as proptosis or periorbital edema) may be present.
114
What mild metabolic abnormality related to glucose is often seen in thyrotoxicosis due to catecholamine-induced inhibition of insulin release?
Mild hyperglycemia is often seen.
115
What electrolyte abnormality, related to hemoconcentration and enhanced bone resorption, can be found in patients with thyrotoxicosis?
Mild hypercalcemia can be found.
116
In a patient with suspected thyroid storm and a history of amiodarone use, what is a likely precipitating factor?
An acute iodine load from the amiodarone is a likely precipitating factor.
117
Besides an ICU, full supportive care for thyroid storm includes recognition and treatment of any _____ factors, such as infection.
precipitating
118
In patients with severe asthma where beta blockers are contraindicated, what class of medication can be used for rate control?
Calcium channel blockers, such as diltiazem, can be used.
119
If a patient cannot take oral or nasogastric medications, how can thionamides be administered?
They can be compounded for rectal administration as a suppository or retention enema.
120
For a patient with thionamide intolerance requiring urgent surgery, how long is the optimal preoperative treatment with iodine?
The optimal duration of preoperative iodine treatment is approximately 10 days.
121
What phenomenon occurs if iodine is given for too long preoperatively, potentially exacerbating thyrotoxicosis?
Escape from the Wolff-Chaikoff effect occurs.
122
What is the definitive therapy that is important to consider after recovery from thyroid storm to prevent recurrence?
Definitive therapy with either radioiodine or thyroidectomy is important to prevent recurrence.
123
A mildly hyperthyroid patient with influenza, a fever, and nausea could score high enough on the Burch-Wartofsky scale to meet criteria for storm, illustrating the system's lack of _____.
specificity
124
What is the mechanism by which iodinated radiocontrast agents (if available) treat hyperthyroidism?
They are potent inhibitors of T4-to-T3 conversion and block thyroid hormone release due to their iodine content.
125
The effects of plasmapheresis in treating thyroid storm are _____, lasting only 24 to 48 hours.
transient
126
What is the rationale for tapering glucocorticoids slowly in a patient who had a prolonged ICU stay for thyroid storm?
A prolonged course of glucocorticoids can cause adrenal suppression, necessitating a slow taper to allow for recovery of adrenal function.
127
In a French multicenter study, what was identified as the most common precipitating factor for thyroid storm?
Amiodarone use was the most common precipitating factor.
128
What hematologic complication was observed in 23% of patients in one Japanese series on thyroid storm?
Disseminated intravascular coagulation (DIC) was observed.
129
What is the therapeutic goal for heart rate when titrating propranolol in a patient with thyroid storm?
The dose is titrated to achieve adequate control of heart rate, though a specific target is not given in the text beyond appropriate adjustment.
130
Why might medication requirements, such as for beta blockers or digoxin, be unusually high in patients with thyroid storm?
Because of increased drug metabolism as a result of the hyperthyroid state.
131
What is the most common feature of Graves' disease, affecting nearly all patients?
Hyperthyroidism.
132
What is the underlying cause of hyperthyroidism and goiter in Graves' disease?
Thyroid-stimulating hormone (TSH)-receptor antibodies (TRAb) that activate the receptor.
133
The therapeutic approach to Graves' hyperthyroidism consists of rapid symptom amelioration and measures aimed at decreasing _____ _____ _____.
thyroid hormone synthesis
134
Which class of medication should be started in most patients as soon as the diagnosis of hyperthyroidism is made, assuming no contraindications?
A beta blocker.
135
What is the typical starting dose of atenolol for symptom control in hyperthyroidism?
25 to 50 mg daily.
136
What is the target pulse rate when titrating beta blockers for hyperthyroid symptom control?
60 to 90 beats per minute.
137
What are the two main advantages of atenolol over other beta blockers for hyperthyroidism?
Single daily dosing and beta-1 selectivity.
138
List four symptoms of hyperthyroidism caused by increased beta-adrenergic tone that are ameliorated by beta blockers.
Palpitations, tachycardia, tremulousness, and anxiety (also heat intolerance).
139
What are the three primary treatment options aimed at decreasing thyroid hormone synthesis in Graves' disease?
Antithyroid drugs (thionamides), radioiodine, or surgery.
140
In the only randomized trial comparing thionamides, radioiodine, and surgery, what was the risk of relapse in the thionamide group?
The risk of relapse was 37 percent.
141
According to a Mayo Clinic study, what was the success rate of radioiodine for Graves' hyperthyroidism?
92 percent.
142
According to a Mayo Clinic study, what was the success rate of surgery for Graves' hyperthyroidism?
100 percent.
143
A Swedish study found that half of patients initially treated with thionamides eventually required what type of therapy?
Ablative therapy (radioiodine or surgery).
144
What is the current trend regarding the use of radioiodine for Graves' disease in the United States?
Its use is decreasing.
145
According to a 2023 global survey, what percentage of endocrinologists preferred antithyroid drugs as initial therapy for Graves' disease?
91.5 percent.
146
What are two cited reasons for the declining popularity of radioiodine therapy?
Its association with worsening thyroid eye disease and patient fears regarding radiation exposure.
147
According to ATA guidelines, for a patient with mild hyperthyroidism (free T4 1-1.5x ULN), what treatment is associated with above-average remission rates?
A one- to two-year course of thionamides.
148
For a patient with severe hyperthyroidism (free T4 2-3x ULN), what initial medication is suggested in addition to a beta blocker?
A thionamide, to achieve euthyroidism quickly.
149
For patients with moderate to severe thyroid eye disease who require definitive therapy, what treatment is preferred over radioiodine?
Surgery (thyroidectomy).
150
Why may radioiodine therapy lead to worsening of Graves' orbitopathy?
It is associated with an increase in TSH-receptor antibodies (TRAb).
151
For a Graves' patient with a very large, obstructive goiter, what is the suggested treatment?
Surgery.
152
Surgery for Graves' disease is also indicated if a patient has a coexisting suspicious thyroid nodule or concomitant _____.
hyperparathyroidism
153
Radioiodine is contraindicated during _____ and lactation.
pregnancy
154
In which two situations are antithyroid drugs contraindicated?
Prior adverse reactions of agranulocytosis or hepatitis.
155
What is the goal timeframe to attain a euthyroid state after starting thionamide therapy?
Within three to eight weeks.
156
Remission with thionamides is more likely in patients with mild hyperthyroidism and _____ goiters.
small
157
A change in which lab value over time during thionamide therapy can predict remission?
TSH-receptor antibody (TRAb) levels.
158
What two baseline blood tests should be obtained before initiating thionamides?
A complete blood count (with differential) and a liver profile (bilirubin and transaminases).
159
Thionamides should not be used in patients with a baseline absolute neutrophil count less than _____ cells/microL.
1000
160
Which thionamide is the primary drug used to treat Graves' hyperthyroidism due to its longer duration of action and lower incidence of side effects?
Methimazole.
161
In which two clinical scenarios is propylthiouracil (PTU) preferred over methimazole?
During the first trimester of pregnancy and in patients with minor reactions to methimazole who refuse definitive therapy.
162
Carbimazole, available in some countries, is metabolized to methimazole; a 10 mg dose of carbimazole yields roughly how much methimazole?
6 mg of methimazole.
163
What is the recommended starting dose of methimazole for a patient with mild hyperthyroidism (free T4 1-1.5x ULN)?
5 to 10 mg once daily.
164
What is the recommended starting dose of methimazole for a patient with moderate hyperthyroidism (free T4 1.5-2x ULN)?
10 to 20 mg daily.
165
What is the recommended starting dose of methimazole for a patient with severe hyperthyroidism (free T4 2-3x ULN) and a large goiter?
20 to 40 mg daily.
166
What is the typical maintenance dose range for methimazole once a euthyroid state is achieved?
5 to 10 mg once daily.
167
For patients with significant symptoms, older age, or heart disease, what should be done before administering radioiodine?
They should be treated with a thionamide to restore euthyroidism first.
168
Radioiodine therapy can cause the development or worsening of _____ _____ _____ more often than antithyroid drugs or surgery.
thyroid eye disease
169
If radioiodine is given to a patient with mild thyroid eye disease, what concomitant medication may be used for coverage?
Glucocorticoids.
170
How is radioiodine administered for the treatment of Graves' disease?
As an oral capsule or solution of sodium iodine-131 (I-131).
171
What is the approximate timeframe for radioiodine to induce thyroid ablation?
Within 6 to 18 weeks.
172
What percentage of patients fail the first radioiodine treatment and require a second dose?
Approximately 10 to 20 percent.
173
Surgery is being used more frequently in women desiring definitive therapy prior to a _____.
pregnancy
174
What advice should be given to women with Graves' disease desiring to become pregnant in the near future?
Consider radioiodine or surgery 6 to 12 months in advance of a planned pregnancy.
175
If a woman with Graves' disease planning pregnancy does not want definitive therapy, which antithyroid drug is preferred during the first trimester?
Propylthiouracil (PTU).
176
What medication is used perioperatively for 7-10 days to reduce thyroid gland vascularity before a thyroidectomy for Graves' disease?
A saturated solution of potassium iodide (SSKI).
177
Besides inhibiting T4 to T3 conversion, glucocorticoids also reduce thyroid _____ in patients with Graves' hyperthyroidism.
secretion
178
Which medication, given at 4 g four times daily with methimazole, can more rapidly lower serum T4 and T3 concentrations?
Cholestyramine.
179
Overt hyperthyroidism is associated with accelerated bone remodeling, reduced bone density, and an increase in _____ rate.
fracture
180
Unless they have hypercalcemia, hyperthyroid patients should be advised to ingest how much elemental calcium daily?
1200 to 1500 mg.
181
Why should serum TSH concentrations be interpreted with caution in the initial weeks after starting treatment for hyperthyroidism?
They may remain low for several weeks even after the patient becomes euthyroid.
182
How often should thyroid function be assessed in a patient starting on thionamides, until they are stabilized on a maintenance dose?
At four- to six-week intervals.
183
Once a patient is on a stable maintenance dose of a thionamide, how often should thyroid tests be performed?
Every six months.
184
Persistently high levels of _____ after one or more years of thionamide treatment suggest a patient is unlikely to remain euthyroid if the drug is discontinued.
TSH-receptor antibodies (TRAb)
185
After radioiodine treatment, how often should free T4 and TSH be measured for the first six months?
At four- to six-week intervals.
186
For a patient who undergoes total thyroidectomy for Graves' disease, when should serum TSH be measured post-operatively to adjust the levothyroxine dose?
Six to eight weeks later.
187
What common side effect should patients be advised about after successful treatment for hyperthyroidism?
Significant weight gain.
188
In a study of hyperthyroid patients, those treated with _____ who developed hypothyroidism gained more weight than those treated with thionamides.
radioiodine
189
What is one proposed mechanism for excessive weight gain after hyperthyroidism treatment?
Subnormal energy expenditure without a concomitant reduction in appetite or food intake.
190
For a patient with severe hyperthyroidism or thyroid storm, what adjunctive therapy can be used with thionamides to more quickly normalize thyroid function?
Iodine (e.g., SSKI).
191
Rituximab, a monoclonal antibody that causes peripheral B cell depletion, may induce remission in Graves' patients with low levels of what antibody?
TSH-receptor antibodies (TRAb).
192
In a trial, what medication added to methimazole was found to increase the percentage of patients who could be withdrawn from therapy at 18 months?
Methotrexate (10 mg weekly).
193
What minimally invasive technique has been used to treat recurrent Graves' disease in patients with small gland size?
Radiofrequency ablation (RFA).
194
In the context of Graves' disease, what does the acronym TRAb stand for?
TSH-receptor antibodies.
195
What is the term for the thyroid eye disease associated with Graves' disease?
Orbitopathy.
196
In a randomized trial comparing the three main treatments for Graves' disease, which therapy had the lowest risk of relapse (6%)?
Surgery.
197
What is the term for the skin condition occasionally seen in Graves' disease?
Dermopathy (pretibial or localized myxedema).
198
Patients with Graves' disease who are treated with radioiodine or surgery will most likely require long-term treatment with what medication?
Levothyroxine (for permanent hypothyroidism).
199
In a 2011 survey, what was the preferred treatment for Graves' disease among clinicians in Europe and Asia?
Antithyroid drugs (chosen by over 80%).
200
What is a key patient-centered reason for the increased popularity of antithyroid drugs?
The desire to avoid permanent hypothyroidism.
201
For patients taking $\ge$20 mg of methimazole daily, why might initial therapy be given in divided doses for a week or two?
To normalize thyroid function more quickly and to minimize gastrointestinal side effects.
202
Which adjunctive therapy for severe hyperthyroidism is not currently available in the United States and most of the world?
Oral radiocontrast agents (sodium ipodate and iopanoic acid).
203
What is a potential adverse effect of using lithium to block thyroid hormone release?
Its use is limited by its toxicity.
204
Even if euthyroid with low TRAb levels after thionamide treatment, patients still have a relapse risk of what percentage?
20 percent.
205
According to one study, what was the average weight gain for men during treatment for hyperthyroidism?
8 kg.
206
According to one study, what was the average weight gain for women during treatment for hyperthyroidism?
5.5 kg.
endo boards
flashcards
Decks in class (40)
# Cards
-
male reproductive- SB notes91
-
ESAP 2022158
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thyroid cancer- SB notes42
-
pituitary-SB70
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lipid 2025 guidelines AACE46
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vasomotor postmen txt uptodate62
-
ATA thyroid cancer guidelines 202594
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Diagnosis of primary aldosteronism up to date60
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Utd- Classic CAH 21-hydroxylase def Peds - diagnosis60
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Treatment of classic CAH due to 21-hydroxylase deficiency in adults up to date60
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DKS HHS consensus ADA 202473
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cushings- SB notes71
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lipids+TAG- SB notes138
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obesity- SB notes73
-
ESAP 202477
-
2023 meet the professor71
-
2024 meet the professor91
-
2025 meet the professor76
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thyroid -SB94
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MEN-SB62
-
calcium-SB78
-
male hypogonadism-SB57
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hyperaldosteronism- SB50
-
bariatric-SB55
-
adrenal insufficiency-SB60
-
hypoglycemia-SB55
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osteoporosis107
-
transgender-SB81
-
hypoaldo RTA 4 - UTD55
-
EBR 20236
-
female reproductive endo guidelines78
-
acromegaly-utd/pit soc/2025 consensus177
-
ADA- DM guidelines436
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endo - DM in elderly, hyper/hypo - glycemia, dm in preg284
-
UTD-thyroid storm/ hyperthyroidism206
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UTD-Toxic MNG management56
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ATA hyperthyoidism guidelines49
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utd- AVP def118
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GH def- UTD, guideline update150
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UTD- osteomalacia80
