Pathophysiology Thyroid Disease

Front 1

Hypothyroidism is

Back 1

Insufficient thyroid hormone

Front 2

Hyperthyroidism is

Back 2

Excessive thyroid hormone

Front 3

Thyroid hormone release is controlled by

Back 3

The hypothalamic pituitary axis (TSH)

Front 4

Thyroid hormone contains

Back 4

Iodine

Front 5

Thyroid hormone effects are

Back 5

Tells your body how fast to work (basal metabolic rate)

Front 6

Other thyroid hormone effects include (2)

Back 6

Needed for normal maturation of the nervous system, needed for normal growth

Front 7

Which is produced in greater amounts T4 or T3?

Back 7

80% of thyroid hormone production is T4, 20% T3

Front 8

Which is more active T4 or T3

Back 8

T3 is more active T4 is converted to T3 in peripheral tissues

Front 9

How much thyroid hormone is protein bound?

Back 9

99% plus

Front 10

Why is measuring total thyroid hormone inaccurate?

Back 10

Because the amount of protein that holds inactive thyroid hormone can change

Front 11

What's the first lab to get to diagnose thyroid disease?

Back 11

TSH level

Front 12

If there is excessive thyroid hormone what would the TSH level be?

Back 12

If the problem was in the thyroid, it would be low (negative feedback). If a tumor is secreting TSH, both the Thyroid hormone level and the TSH level would be elevated

Front 13

What tests can be used to evaluate thyroid disease?

Back 13

Bloodwork (TSH, free T4, antithyroid antibodies, thyroid stimulating immunoglobulins – TSI) ultrasound, fine needle aspiration,Tc or I* scanning

Front 14

What is the most common cause of hypothyroidism in the United States?

Back 14

Hashimoto thyroiditis

Front 15

List Some causes of hypothyroidism

Back 15

Hashimoto thyroiditis (most common), posttreatment for hyperthyroidism, congenital, lack of iodine – Third World

Front 16

You can think of symptoms for hypothyroidism as?

Back 16

Not enough, too slow

Front 17

What are some symptoms of hypothyroidism?

Back 17

Weight gain, slow heartbeat, depression, impaired memory, sensitivity to cold, constipation, fatigue, menstrual irregularities, skin edema

Front 18

What is the special kind of skin edema found in hypothyroidism called?

Back 18

Myxedema

Front 19

The TSH is high, the Free T4 low – what's the next lab test to get?

Back 19

Antithyroid antibodies – you're thinking about Hashimoto thyroiditis here

Front 20

In what situation with the TSH be low AND the Free T4 low as well?

Back 20

A pituitary tumor that destroyed the cells making TSH could be responsible here. This would be SECONDARY hypothyroidism

Front 21

What's the difference between primary hypothyroidism and secondary hypothyroidism?

Back 21

Primary hypothyroidism is a problem in the thyroid gland itself, secondary hypothyroidism is some cause besides the thyroid gland

Front 22

What's the drug of choice for treating hypothyroidism?

Back 22

Thyroxine (T4)

Front 23

You can think of symptoms for hyperthyroidism as?

Back 23

Too much, too fast

Front 24

Some symptoms of hyperthyroidism include (don't expect you to memorize these)

Back 24

Hyperactivity, dysphoria, heat intolerance, sweating, palpitations, fatigue and weakness, weight loss with increased appetite, diarrhea, changes in menses – tachycardia (-A Fib in the elderly), tremor, goiter, warm moist skin, proximal muscle weakness, lid leg, gynecomastia,

Front 25

What we call the life and death situation of severe hyperthyroidism?

Back 25

Thyroid storm

Front 26

What is the most common cause of hyperthyroidism in the US?

Back 26

60 to 80% of hyperthyroidism in the US is Graves Disease

Front 27

What is the cause of Graves Disease?

Back 27

The body makes antibodies (TSI – thyroid stimulating immunoglobulins) that stimulate the TSH receptors in the thyroid

Front 28

What do we call the condition of bulging eyes in Graves' disease?

Back 28

Exophthalmos

Front 29

What is the cause of exophthalmos?

Back 29

Antibodies attack the extraocular muscles and the fat pad behind the eye in Graves disease.

Front 30

What does the bloodwork show in Graves Disease?

Back 30

TSH – LOW, free T4 – HIGH, TSI (thyroid stimulating immunoglobulin) POSITIVE

Front 31

What would radio nucleotide scanning (Tc or I*) show in Graves Disease?

Back 31

Diffuse enlargement of the gland

Front 32

What are treatments for Graves Disease?

Back 32

Medications, radioactive iodine ablation of the gland, surgery

Front 33

What medications are useful in hyperthyroidism

Back 33

propylthiouracil (PTU), methimazole (Tapazole), beta blockers (propranolol, etc.)

Front 34

Which medication used in hyperthyroidism is safe in early pregnancy?

Back 34

propylthiouracil (PTU)

Front 35

What side effect can occur with propylthiouracil (PTU)

Back 35

Liver damage

Front 36

What life-threatening side effect can occur with methimazole (Tapazole)?

Back 36

Agranulocytosis – life-threatening scarcity of white blood cells

Front 37

You're concerned about agranulocytosis, how do you warn your patient?

Back 37

Give your patient written instructions to report a sore throat immediately.

Front 38

What do we mean by "natural history"

Back 38

What happens in the course of the disease if the patient is NOT treated

Front 39

What is the natural history of Graves Disease?

Back 39

Eventually the gland burns out in the patient becomes hypothyroid

Front 40

Can Hashimoto thyroiditis cause HYPERTHYROIDISM?

Back 40

Yes – in the initial stages of inflammatory thyroid disease access thyroid hormone can be released.