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69 Cards in this Set
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(3) causes of Macroglossia
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Acromegaly;
Myxedema; Amyloidosis |
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Definition:
Increased synthesis and secretion of free thyroid hormones resulting in hypermetabolism |
Hyperthyroidism
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Etiology of Hyperthyroidism
(4) |
Grave's Dz;
Toxic Nodular Goiter; Plummer's Dz (toxic adenoma); Subacute thyroiditis |
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Dx:
heat intolerance, sweating, palpitations, weight loss, tremor, nervousness, weakness, hyperdefication |
Hyperthyroidism
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When is the only time TSH is increased and TRH is decreased?
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Pituitary tumor (secretes TSH)
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When is the only time TSH and TRH are both increased (w/ T3 and T4 decreased)?
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Primary Hypothyroidism
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Definition:
A medical emergency consisting of an exaggerated manifestation of hyperthyroidism |
Thyroid Storm
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Etiology of a Thyroid Storm
(4) |
1. Trauma, infection;
2. DKA; 3. MI, CVA, PE; 4. Withdrawl from anti-hyperthyroid meds |
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Dx:
fever, tachycardia, high-output CHF and volume depletion, exhaustion, diarrhea, abdominal pain, agitation and confusion, possible jaundice |
Thyroid Storm
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What is the BP change w/ hyperthyroidism?
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Isolated systolic HTN
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(4) Primary stabilization Tx for a Thyroid Storm
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Airway protection;
Oxygenation; Assess circulation and BP; IV hydration |
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Aside from primary stabilization, how is a Thyroid Storm treated?
(4 together) |
1. Beta-blocker - block adrenergic effects;
2. Acetaminophen - fever; 3. PTU - block new thyroid hormones 4. Iodine - 1.5 hrs after PTU to decrease release of preformed thyroid hormones |
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Definition:
Autoimmune Dz causing hyperthyroidism due to Ab, which stimulates TSH receptor |
Graves Dz
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Dx:
diffusely enlarged thyroid, exopthalamos, pretibial myxedema, tachycardia |
Graves Dz
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Dx tests for Graves Dz
(4) |
1. High radioactive iodine uptake
(if present but low, then Dx is thyroiditis) 2. high Free thyroid hormones; 3. Undetectable TSH levels; 4. High thyroglobulin levels |
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what is the Long-term anti-thyroid therapy?
complication? |
PTU
complication: Leukopenia |
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what is the preferred Tx for Graves Dz?
AE? |
Radioactive Iodine Ablation Therapy
AE: can result in Hypothyroidism over time |
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what should be used as adjunctive therapy for Graves Dz?
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Adrenergic Antagonist:
Propranolol |
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Definition:
TSH levels are more then twice the upper limit of normal |
Hypothyroidism
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Etiology of Primary Hypothyroidism
(5) |
Hashimoto's thyroiditis;
Radiation to neck; Subacute thyroiditis; Iodine deficiency (or excess); Medications: Lithium |
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Etiology of Secondary Hypothyroidism
(3) |
Secondary = Pituitary problem:
Sheehan's syndrome; Pituitary neoplasm; Infiltrating Dz (TB) causing TSH deficiency |
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Etiology of Tertiary Hypothyroidism
(3) |
Tertiary = Hypothalamic problem:
Granuloma; Neoplasm; Radiation |
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Dx:
fatigue, lethargy, weakness, weight gain, constipation, cold intolerance, slow speech, dry skin, brittle hair, delayed deep tendon reflexes |
Hypothyroidism
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Because muscle weakness and cramps are associated w/ both hyper and hypothyroidism, how can you tell the difference w/ CPK level?
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Hyper: CPK is normal
Hypo: CPK is elevated |
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what additional lab tests may be elevated or decreased w/ hypothyroidism?
(4 categories) |
Increased:
1. Cholesterol and TG 2. LFTs: LDH, AST, ALT, MM of CPK Decreased: 3. Hct and Hb 4. serum sodium |
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If a patient presents w/ high cholesterol, what should you consider testing?
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thyroid function tests
(since high cholesterol is a sign of hypothyroidism) |
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what test is useful from distinguishing secondary from tertiary hypothyroidism?
what are the results of each? |
TRH stimulation test:
Secondary: Low Tertiary: normal |
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Tx for Hypothyroidism
How often do you check meds? How is therapy monitored (b/t primary and secondary hypothyroidism)? |
Low-dose Levothyroxine
(increase dose every 6 to 8 weeks, depending on patient's response) Primary: measure TSH levels Secondary: measure T-4 levels |
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Definition:
elevated TSH w/ normal thyroid hormone levels in the absence of overt clinical symptoms what are the (2) possible prognosis? |
Subclinical Hypothyroidism
1. can become Primary Hypothyroidism 2. become Euthyroid |
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Tx parameters for replacement therapy for Subacute Hypothyroidism
(3) |
1. All patients w/ TSH > 10
2. Patients w/ TSH > 5 and Goiter or Anti-thyroid Ab 3. All patients w/ Hx of Iodine therapy |
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(2) Antibody tests that are positive in Hashimoto's thyroiditis
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Anti-thyroglobulin
Anti-microsomal |
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Definition:
Life-threatening complication of Hypothyroidism w/ profound lethargy or worse, usually assoc. w/ hypothermia |
Myxedema Coma
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Etiology of Myxedema coma
(4) |
Sepsis;
Prolonged exposure to cold weather; CNS depressants; Trauma/surgery |
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Dx:
hypothermia w/ rectal temp < 95; bradycardia or circulatory collapse; severe lethargy; delayed relaxation of DTR or Areflexia |
Myxedema Coma
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Tx for Myxedema coma (in order)
(5) |
1. Airway management
2. Prevent further heat loss 3. Glucocorticoids 4. IV Levothyroxine 5. IV hydration (D5 1/2 NS) |
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Why are glucocorticoids given before levothyroxine in the Myxedema patient?
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due to the concern that the patient may have associated Addison's Dz. Giving only thyroxine could initiate an Addisonian crisis
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In Hashimoto's Thyroiditis, what destroys the thyroid?
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CD-4 lymphocytes
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What PE finding distinguishes Hashimoto's from other forms of Thyroiditis?
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Thyroid is not tender
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Etiology of Thyroiditis types:
1. Subacute 2. Silent 3. Suppurative 4. Riedel's |
1. Subacute: Post-viral (usu a UTI)
2. Silent: Postpartum (autoimmune) 3. Suppurative: Bacterial or fungal (commonly seen w/ PCP in HIV pt) 4. Riedel's: Fibrous infiltration of unknown etiology |
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Dx:
35-yo female w/ Hx of hyperthyroidism and recent flu presents w/ neck pain and elevated ESR |
Subacute Thyroiditis
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Dx:
tender, enlarged thyroid, fever and signs of hyperthyroidism; jaw or tooth pain; hypothyroidism may develop what other Dx is similar to this w/o tenderness? |
Subacute Thyroiditis
other: Silent thyroiditis |
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Dx:
fever w/ severe neck pain, focal tenderness of involved portion of thyroid |
Suppurative Thyroiditis
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Dx:
slowly enlarging rock hard mass in anterior neck, tight and stiff neck, fibrosis of mediastinum |
Riedel's Thyroiditis
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what labs allow you to distinguish b/t Subacute, Silent and suppurative thyroiditis?
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Silent:
high serum Thyroglobulin levels only (and possible Antimicrosomal Ab) Subacute: high serum Thyroglobulin levels and WBC left shift Suppurative: WBC w/ left shift only |
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What is Tx for:
1. Pain from Subacute thyroiditis 2. Suppurative thyroiditis what should never be given to any thyroiditis patient? |
1. NSAIDs (or steroids)
2. IV Abx and drainage of abscess Never give PTU to thyroiditis |
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*Best test to evaluate a thyroid nodule
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Fine-needle aspiration
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If thyroglobulin levels return to normal after a thyroidectomy, what does that suggest?
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Absence of metastatic thyroid tissue
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what test distinguishes b/t Hot and Cold thyroid nodules?
what is the difference b/t them? which is more likely malignant? |
Thyroid Scan w/ t-99
Hot: Hyperfunctioning thyroid; less likely malignancy Cold: Hypofunctioning thyroid; more likely malignant |
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(4) Types of thyroid Cancer
which is most common? has best prognosis? worst prognosis (0% survival in 5 yrs)? Seen in MEN II and III? |
1. Papillary - MC; best prognosis
2. Follicular 3. Anaplastic - worst prognosis 4. Parafollicular (Medullary) - in MEN II and III |
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Thyroid CA:
ground-glass "Orphan Annie" nuclei and psammoma bodies |
Papillary
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Thyroid CA:
good prognosis but commonly bloodborne mets to bone and lungs |
Follicular
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Thyroid CA:
cancer of the "C" cells, derived from branchial pouch 5 and secretes Calcitonin (2 names) |
Parafollicular
(Medullary thyroid CA) |
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Tx for any thyroid CA
(2) |
Thyroidectomy
Oral thyroxine supplements after surgery |
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Definition:
hypersecretion of PTH by the parathyroid gland |
Primary Hyperparathyroidism
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Definition:
Glandular hyperplasia and elevated PTH in an inappropriate response to hypocalcemia |
Secondary Hyperparathyroidism
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Definition:
continued elevation of PTH after the disturbance causing secondary hyperparathyroidism has been corrected |
Tertiary Hyperparathyroidism
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Etiology of Hyperparathyroidism
(3) |
Hyperplasia of all 4 glands;
Adenoma/carcinoma; MEN II and III |
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Pathophysiology of the parathyroid gland
(4 ways to increase Calcium) |
PTH increases serum Ca levels:
1. stimulates renal hydroxylation of Vit-D (needed for GI to absorb Ca) 2. Increases renal resorption of Ca 3. Decreases renal resorption of phosphorus; 4. Increases Osteoclastic resorption of bone (via osteoblast receptors) |
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what do lab tests show to Dx Hyperparathyroidism?
(3) |
high serum calcium (low phos);
high serum PTH; hypercalciuria |
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what are the indications for surgery w/ Dx of hyperparathyroidism?
(2) |
Adenomas should be removed;
Hyperplasia of all four glands: remove and reinsert a small portion of one on the SCM so that it is accessable if problems arise |
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Emergent measures taken (PRN) w/ hyperparathyroidism
(3) |
1. Hydration w/ Lasix
2. Bisphosphonates to block bone resorption 3. Calcitonin |
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When is Mg deficiency seen?
(3) |
SAP:
SIADH; Alcoholism; Pancreatitis |
SAP |
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Etiology of Hypoparathyroidism
(3)* |
HID Parathyroids:
Hypomagnesium; Infiltrative CA / Irradiation; DiGeorge Syndrome; Post-surgical |
HID Parathyroids |
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Dx:
30-yo woman presents w/ perioral paresthesia and long QT interval. She recently had surgery on her goiter. |
Hypoparathyroidism
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Dx:
seizures, perioral paresthesia, tetany, fasciculations, muscle weakness, CNS depression, faint heart sounds, bronchospasm |
Hypoparathyroidism
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What is seen in hypoparathyroidism on the EKG?
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QT prolongation
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Tx for hypoparathyroidism
(life-threatening versus maintenance) |
Life-threatening:
IV Calcium Maintenance: Calcitriol and oral calcium |
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Dx:
Similar characteristics to Hypoparathyroidism, but tissue is resistant to PTH, causing an INCREASE in serum PTH |
Pseudohypoparathyroidism
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What is pseudohypoparathyroidism assoc with?
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Albright's hereditary osteodystrophy
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