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48 Cards in this Set

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what is contained within a thyrocyte? what enzyme organifies iodide? what does this process do?
thyroglobulin

thyroid peroxidase

active thyroid hormones are synthesized and released
the thyrotropin receptor responds to what? what does it stimulate the production of?
TSH (it is a TSH receptor)

T4/T3
what is the effect on autoantibodies on thyroglobulin, thyroid peroxidase, and TSH receptor respectively
thyroglobulin: hypothyroid

thyroid peroxidase: hypo

TSH receptor: over production of T3/4
Antithyroglobulin causes what?
Hashimotos disease
Anti-TSH receptor causes?
Grave's disease
Amiodarone will cause what problem with the thyroid?
hypothyroid

note: so will Lithium, radioactive iodine, thioamide drugs
flip to read some of the functions of the thyroid
Controls most bodily functions
Controls cellular respiration and total energy expenditure
Plays a critical role in cell differentiation during development
Influences growth and maturation of tissues and organs
Helps maintain thermogenic and metabolic homeostasis in the adult
Plays a crucial role in fetal brain development
two general effects of thyroid disease?
1) Change in size or shape of the gland
2) Change in the secretion of hormones


THINK:
Hypometabolism
or
Hypermetabolism
diagnosis of thyroid disease is based on 3 things?
1) Clinical findings (History and Physical)

2) Palpation of the thyroid
*Size, consistency ,presence of nodules, tenderness, or a thrill

3) Measurement of plasma TSH and thyroid hormones.
a child presents with low growth and development, delayed brain development, and appears to be nutritionally deprived. Assuming we are in a 3rd world country, what would you have expected mom to look like while pregnant?
Pregnant women on a diet that is severely deficient of
iodine can give birth to infants who can present with thyroid hormone deficiency known as congenital hypothyroidism. This kid has Cretinism.
Elevated TSH shows you what problem?
HYPOthyroidism
Decreased TSH shows you what problem?
HYPERthyroidism
actions of TSH?
TSH binds to the TSH receptor-->

Stimulates individual thyrocyte growth

Modulates iodide transport and organification

Regulates proteolysis of thyroglobulin

Controls secretion of T4,T3
elevated T3/ free T3 shows what? decreased?
Elevated- Hyperfunction

Decreased- Hypofunction
describe the TSH and T4 values in central hypothyroidism
Central hypothyroidism- insufficient stimulation of the thyroid gland by TSH due to hypothalamic (tertiary hypothyroidism) or pituitary (secondary hypothyroidism) disease.

TSH secretion does not increase appropriately as T4 secretion falls.
what can you use serum thyroglobulin levels for? increased and decreased levels show?
A protein produced only by the thyroid gland

Used to follow patients after Radioactive Iodine Ablation therapy or surgical thyroidectomy for cancer.

Low to undetectable-no recurrence

Increasing levels- recurrent disease.
What is Hashimoto's Thyroiditis? What 2 things will be present?
most common cause of hypothyroidism in iodine-sufficient areas. AUTOIMMUNE destruction of the gland

A) anti-TPO (thyroid peroxidase)
B) anti-thyroglobulin
What is Grave's Disease? what will be present?
most common cause of hyperthyroidism. AUTOIMMUNE

C) TSI’s (thyroid stimulating immunoglobulins) also known as TSH-receptor Abs.
I 131 Uptake and Scan is used to evaluate what?
hyperthyroidism and nodules

Note: Iodine is actively trapped, concentrated and organified by the thyroid gland.

A scintigraphy camera images gamma rays emitted by the radioactively labeled iodine.

Evaluates:
1) Structure and function
2) Masses and nodules
Hot nodules and cold nodules on I 131 scan show what respectively?
Hot nodules- mostly benign

Cold nodules-5% malignant
Grave's disease vs Toxic Multinodular Goiter:

Pt age
Grave's disease: young

Toxic Multinodular Goiter: old
What is the most common imaging study use for the thyroid?
ULTRASOUND

gives size of the gland, evaluates the nodules (solid, cystic, mixed)
cornerstone in the assessment of a solitary thyroid nodule?
Fine-needle aspiration biopsy ("FNAB")
when would you want to order a CT or MRI for thyroid issues
normally you wouldn't (they're all gonna laugh at you!!)

but there are secondary uses

CT - effective method for detecting regional and distant metastasis from thyroid cancer.

MRI - effective in the diagnosis of cervical lymph node metastasis.
a 70 year old black woman shows up to you with fatigue, feeling cold, hoarse voice and menstrual irregularities...what does she have
hypothyroid
pt has an acute sudden painful neck. In the history you see that they were recently diagnosed with mumps. What is going on?
Transient hypothyroidism-->Subacute granulomatous thyroiditis (aka DeQuervians)
severe hypothyroidism leading to Hypothermia, bradycardia ,hypotension, altered mental status and multisystem organ failure is known as?
Myxedema Coma
tx for hypothyroidism?
thyroid hormone supplementation.
In young, healthy adults-

Levothyroxine

@1.6mcg/kg once a day
In elderly and pts. with cardiac disease-
Start with 25-50mcg/day and titrate.
Recheck TSH 6 weeks after treatment is initiated and adjust until patient is euthyroid and TSH is stable.
Then annual follow up with TSH levels.
white chick who is smoking (cigs not like bangin hot) comes in with a growth on the side of her neck. She complains of excessive sweating, diarrhea, insomnia, weight loss, and nervousness. What does she have?
hyperthyroidism
when assessing hyperthyroidism the following papatory findings tell you what?

Diffuse, nontender goiter-

Multiple thyroid nodules-

Single thyroid nodule-

Tender, painful goiter-

Normal thyroid gland-
Diffuse, nontender goiter-Grave’s disease

Multiple thyroid nodules-Toxic Multinodular Goiter

Single thyroid nodule- Thyroid adenoma

Tender, painful goiter-Subacute thyroiditis

Normal thyroid gland- Grave’s disease
an elderly pt presents with a fib, what thyroid problem might they have?
hyperthyroid
Propranolol can be an important treatment for what thyroid problem? why
hyperthyroidism

Catecholamine receptor number increases, so beta-blockers have an important role
HYPERthyroidism = hypo/hyper metabolism?
Hypermetabolism

*Excessive hormone release*
HYPOthyroidism = hypo/hyper metabolism?
Hypometabolism

*Insufficent hormone release*
What are the two main goals of treating a thyroid disorder?

***
1) Return to euthyroid state

2) Normalize TSH levels
What is the most common malignant thyroid nodule?

***
Papillary Nodule
What is the single most reliable test to diagnose all forms of Hypothyroidism and Hyperthyroidism?

****
Serum TSH!!!

Elevated TSH = hypothyroidism

Decreased TSH = hyperthyroidism
Patient's with biochemical evidence of central hypothyroidism need ______ to ***** the hypothalmic - pituitary region.
an MRI
Tertiary hypothyroidism
Vs.
Secondary hypothyroidism

Insufficient stimulation of thyroid gland by TSH due to hypothalmic disease
Tertiary Hypothyroidism

(Falls under the Central Hypothyroidism category)
Tertiary hypothyroidism
Vs.
Secondary hypothyroidism

Insufficient stimulation of thyroid gland by TSH due to pituitary disease
Secondary Hypothyroidism

(Falls under the Central Hypothyroidism category)
TSH secretion does not increase

T4 secretion falls
Central Hypothyroidism
Tumor of the ovaries that can cause the release of preformed hormones leading to hyperthyroidism

**
Struma Ovarii
Most common cause of HYPOthyroidism in idodine-sufficient areas

**anti-TPO (thyroid peroxidase)

**anti-thyroglobulin
Hashimoto's Thyroiditis
Most common cause of hyperthyroidism

**TSIs (thyroid stimulating Ig), AKA TSH-receptor Abs***

STIMULATE thyroid growth and thyroid hormone synthesis and release
Grave's Disease
TSH - elevated

T4, T3 - decreased
hypothyroidism
Patient has hyperthyroidism, followed by hypothyroidism, then recovery
**Transient Hypothyroidism**

(unregulated release of preformed thyroid hormones lasting until they are depleted)
TSH - decreased, low

T4, T3 - elevated
hyperthyroidism
Exophthalmos is associated with ______
hyperthyroidism