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27 Cards in this Set
- Front
- Back
- 3rd side (hint)
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What does the thyroglobulin do? When is the thyroglobulin elevated |
It’s stores thyroid hormone, elevated in the hyperthyroidism and destructive thyroiditis It is mostly helpful and someone who is following a patient with thyroid cancer |
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When we do use a thyroid stimulating immunoglobulin levels, also called TSIG |
Helpful in patient w Graves esp pregnancy |
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What else should you be concerned about in a patient who is hypothyroid |
Look for other autoimmune diseases such as diabetes or adrenal insufficiency |
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Name a couple of medications that mess with thyroid levels |
Lithium, amiodarone |
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What are the laboratory findings in secondary hypothyroidism |
Low free T4, low TSH or normal TSH Monitor only free T4 for these patients |
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What medications can impair thyroid hormone absorption |
Calcium, iron, fibrates , sucralfate |
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If a patient is on combination therapy for hypothyroidism, with armour thyroid Or another combo of T4 & T3, What testing should be used for monitoring |
TSH only!!! |
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MS chgs hyponatremia Extreme hypothyroidism, maybe precipitated by stroke or infection |
Myxedema coma Treat with IV levothyroxine & IV glucocorticoid (adrenals May be stressed) |
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Key point why |
Back (Definition) |
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What Antibody test is specific for graves |
TSIG thyroid stimulating immunoglobulin |
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Findings for hyperfunctioning or toxic thyroid nodule |
Usually large, easily palpable, symptoms are same as in Graves’ disease, there is increased RAI uptake in the nodule, The rest of the gland is suppressed |
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Which type of hyperthyroidism is more common in the elderly |
Toxic nodular goiter, irregular nodular features on palpation. |
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For symptoms of hyperthyroidism, with duration of one or two months, what would usually be the diagnosis |
Subacute thyroiditis, although gland is usually tender. Graves’ disease takes much longer to present |
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How can you tell the difference between Graves’ disease and subacute thyroiditis? |
Labs are both the same with low free T4’s And high TSH. But the graves thyroid continues to make thyroid hormone, the thyroiditis fibroid does not make hormone, it is inflamed so gland usu tender. Also it takes a long time to develop graves |
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Pearl subacute thyroiditis on PE Also lab |
Ear & gland pain Elevated ESR |
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What test would you use to figure out if someone is taking thyroid hormone surreptitiously |
Thyroglobulin Level would be low. The thuroglobulin stores the patient’s own thyroid hormone. So if she is taking levothyroxin, her own gland has gone to sleep and the thyroglobulin level will be low |
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When would you avoid radioactive iodine treatment a Graves patient? |
Severe Graves ophthal & pregnancy |
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If a patient has had radioactive treatment for graves, when Can she attempt pregnancy? Does a single dose work? |
Six months 90% |
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Which agent can you use during the first trimester of pregnancy |
PTU also in thyroid storm Use methimazole after 1st trimester |
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What is the treatment course of thyroid storm |
First block T4 synthesis with PTU, then block T4 release with non-radioactive iodine, then continue anti-thyroid agent, PTU. Also add glucocorticoids to treat relative adrenal insufficiency |
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What is the definition of subclinical hyperthyroidism |
Low TSH with normal free T4 and T3, most common cause is over replacement with thyroid hormone |
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Patients with subclinical hyperthyroidism, what are they at risk for |
Atrial fib , low bone density |
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What size thyroid nodule should you consider doing a fine needle aspiration on |
1cm Or if microcalcifications |
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Name 4 types of thyroid cancer |
Papillary and follicular have an indolent course, recommend surgery and or RAI Medullary cancer think of MEN, Calcitonin biomarker, surgery Anaplastic, poor prognosis |
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What is the next test on a hyper thyroid Patient with a thyroid nodule |
Technicium scan to see if it is a hot nodule FNA not Needed, hot nodules are not malignant |
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If TSH is low, and free T4 is normal in an elderly patient, what is the next step |
Get T3, May have T3 elevated, rare but happens in the elderly which can cause subclinical hyperthyroidism |
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Elderly, tsh low free T4 low T3 low Long illness |
Euthyroid sick syndrome Levels normalize after recovery |
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