Thyroid And Adrenal Disease

Front 1

If you see low TSH and high free T4, what test is the next step in diagnostics?

Back 1

TC or I Scan

Front 2

If you have hyperthyroidism and its not coming from the thyroid, it is called?

Back 2

Secondary hyperthyroidism

Front 3

The first lab would obtain from a patient you suspect of thyroid disease is?

Back 3

TSH

Front 4

Besides the thyroid itself, what other organ can lead to hypothyroidism?

Back 4

LOW TSH Tumor in pituitary or the hypothalamus

Front 5

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Back 5

Tumor in pituitary or the hypothalamus

Front 6

In what condition do antibodies act like TSH, thus making excess T3/T4?

Back 6

Graves Disease

Front 7

What signs and symptoms does Graves disease manifest with?

Back 7

Diffuse enlargement of thyroid, signs of metabolic overactivity (tachycardia, heat intolerance, diarrhea, anxiety, menstrual disturbances, etc.)

Front 8

What is the name of the startled look that occurs in some cases of Graves disease?

Back 8

Exophthalmos

Front 9

What side effect is a red flag with methimazole/Tapazole?

Back 9

Sore throat which can indicate low white blood cell count

Front 10

What iodine blocker is safe in early pregnancy/ first trimester?

Back 10

PTU

Front 11

What is a potential negative side effect of Propylthiouracil (PTU)?

Back 11

Liver Damage

Front 12

What is a potential negative side effect of methimazole/Tapazole?

Back 12

Agranulocystosis which can manifest initially as sore throat.

Front 13

What are the treatments of Graves disease?

Back 13

Medications (iodine blockers), radioactive iodine, surgery

Front 14

What is the common disease course for Graves disease?

Back 14

Most patients overwork thyroid and then become hypothyroid.

Front 15

What occurs in thyroiditis?

Back 15

Inflammation of gland releasing excess thyroid hormone followed by hypothyroidism

Front 16

What is a multi nodular goiter?

Back 16

Enlarged and multiple nodules in the thyroid

Front 17

What is a toxic multi nodular goiter?

Back 17

Enlarged and multiple nodules with LOW TSH, high free T4 due to hyperthyroidism

Front 18

TSH is low, free T4 is high, what your next diagnostic study?

Back 18

Tc or I scan of the thyroid. This will allow you to differentiate Graves/solitary hot nodule (adenoma), toxic multinodular goiter

Front 19

A cold nodule is not making thyroid hormone. Why could this be a danger?

Back 19

Thyroid cancer, 10% cases of “cold nodule”

Front 20

What does a cold nodules look like on the thyroid scan?

Back 20

Appears as white areas in scan

Front 21

“Hot” nodule, or a toxic nodule, produces excess thyroid hormone and looks like what?

Back 21

Appears as dark areas in a scan

Front 22

T or F: When in doubt, do a biopsy

Back 22

TRUE

Front 23

TSH producing tumor has what effect?

Back 23

Signals Thyroid to make T3, T4

Front 24

Pituitary cause of hyperthyroidism. What happens to T3/T4?

Back 24

T3/T4 is HIGH

Front 25

When TSH and T4 are moving in the same direction, then…

Back 25

problem not in the thyroid

Front 26

Amiodarone, a cardiac drug, can cause…

Back 26

Hyperthyroidism

Front 27

A patient taking thyroid hormone has what level of TSH?

Back 27

LOW

Front 28

Two layers of adrenal glands are…

Back 28

Medulla and Cortex

Front 29

Cortex- what is made here?

Back 29

Glucocorticoids (cortisol), mineralocorticoid (Aldosterone), Androgens (DHEA)

Front 30

Medulla- what is made here?

Back 30

epinephrine and norepinephine

Front 31

What is a pheochromocytoma?

Back 31

It is an adrenal tumor that reproduces what the medulla makes including epinephrine, norepinephrine, dopamine

Front 32

Signs and symptoms of pheochromocytoma include…

Back 32

palpitations, headache, episodic sweating, SEVERE HYPERTENSION, fatal in pregnancy

Front 33

Diagnosis of pheochromocytoma includes…

Back 33

collect urine for 24 hours and check catecholamines

Front 34

Androgens are responsible for

Back 34

Male sex steroid, DHEA, main source of male sex steroids in female, sex drive

Front 35

Excessive steroirds, adrogens, glucocorticoids, meralocorticoids can cause what in women?

Back 35

Facial hair

Front 36

What is cortisol and what does it do?

Back 36

It is a “stress” hormone which increases glucose and reduces immune response

Front 37

Aldosterone- what does it do?

Back 37

Increases sodium, decreases potassium. By pulling salt into the body, it also pulls water. If fluid volume gets too high, you will get high blood pressure.

Front 38

What is DHEA?

Back 38

Male hormone (dehyroepiandrostenedione)

Front 39

When is cortisol more active and when is it less active?

Back 39

Levels are high in the morning, low during sleep.

Front 40

Too much cortisol causes what?

Back 40

Cushing syndrome

Front 41

Too little cortisol causes what?

Back 41

Addison disease

Front 42

Cushing signs and symptoms include…

Back 42

Edema, amenorrhea, osteoporosis, hirsutism, hypertension, diabetes, moon face, striae, buffalo hump, central obesity

Front 43

Most common cause of Cushing syndrome is…

Back 43

Iatrogenic due to use of steroid drugs as anti-inflammatories

Front 44

Cushing disease v. syndrome

Back 44

Disease is when pituitary releases excess cortisol due to ACTH, syndrome is any other cause of excess cortisol

Front 45

Classifications of Cushing includes…

Back 45

ACTH dependent (80%) or ACTH independent (20%)

Front 46

Excess cortisol, check

Back 46

ACTH

Front 47

ACTH low, excess cortisol- What’s happening?

Back 47

ACTH is being suppressed by adrenal tumor

Front 48

ACTH high, excess cortisol- What’s happening?

Back 48

The problem is not in the adrenal

Front 49

What medicine will suppress ACTH release?

Back 49

Dexamethasone

Front 50

T or F: If ACTH excess is not from the pituitary, then dexamethasone will not suppress ACTH release.

Back 50

TRUE

Front 51

Why is it not appropriate to stop cortisol medication abruptly?

Back 51

It takes a while for the ACTH levels to return, in the meantime you'll have inadequate cortisol

Front 52

What percentage of T3, T4 is protein bound?

Back 52

99%

Front 53

What is the first lab run when evaluating the thyroid? Second?

Back 53

TSH, Free T4,

Front 54

If TSH is low and Free T4 is high?

Back 54

Primary Hyperthyroidism

Front 55

If TSH is high and Free T4 is high?

Back 55

Secondary Hyperthyroidism

Front 56

If TSH is high and Free T4 us LOW?

Back 56

Primary Hypothyroidism

Front 57

If TSH is low and Free T4 is LOW?

Back 57

Secondary Hypothyroidism

Front 58

If thyroid is NOT working, TSH Levels would be?

Back 58

High

Front 59

If thyroid is NOT working, T3, T4 Levels would be?

Back 59

LOW

Front 60

In Hashimoto’s Thyroiditis, are the TSH levels high or low? Free T4? Thyroid antibodies POS or NEG?

Back 60

TSH: high, Free T4: low, Thyroid antibodies: POS, Radioactive Iodine uptake, not usually done in this disease

Front 61

Why is Congenital Hypothyroidism so rare?

Back 61

Newborn screening

Front 62

What are the S&S of Congenital Hypothyroidism?

Back 62

Intellectual disabilities, growth retardation, developmental delays

Front 63

In Congenital Hypothyroidism, TSH is? Free T4?

Back 63

TSH is HIGH, Free T4 is LOW

Front 64

A tumor in the pituitary may destroy cells that make TSH. True or False?

Back 64

True

Front 65

A Thyroid Storm is 100% fatal without treatment. True or False?

Back 65

True

Front 66

Graves Disease makes up what percentage of Hyperthyroidism? What is the female to male ratio?

Back 66

60-80%, female to male ration of 8:1

Front 67

What causes patients with Hyperthyroid to develop Exophthalmos?

Back 67

attack on extra ocular muscles and fat pad behind eye

Front 68

What is meant by the term “natural history”?

Back 68

what happens when a patient is NOT treated

Front 69

What is the natural history of Graves disease?

Back 69

patients become hypothyroid and require replacement

Front 70

One of the dangers of surgery to remove the thyroid?

Back 70

You can damage the recurrent laryngeal nerve , paralyzing the vocal cord on that side

Front 71

What medications are used to treat a multi nodular goiter?

Back 71

methimazole/Tapazole or propylthiouracil/PTU

Front 72

Why would one worry about a Solitary Thyroid Adenoma?

Back 72

It can be cancer

Front 73

Pituitary cause of hyperthyroidism. What happens to TSH?

Back 73

High

Front 74

Cortisol is made where?

Back 74

Adrenal Cortex

Front 75

Epinephrine is made where?

Back 75

Adrenal Medulla

Front 76

Part of fight or flight

Back 76

Adrenal Medulla

Front 77

A rare hormone secreting tumor that can occur in the adrenal glands

Back 77

Pheochromocytoma

Front 78

Symptoms of Pheochromocytoma (hint-PHE) include…

Back 78

palpitations, headache, episodic sweating, SEVERE HYPERTENSION, fatal in pregnancy

Front 79

What are the three types of Adrenal cortical hormones?

Back 79

Glucocorticoids, Mineralocorticoids, Androgens

Front 80

An example of a glucocorticoid?

Back 80

Coritisol

Front 81

An example of a mineralocorticoid?

Back 81

Aldosterone

Front 82

An example of an androgen?

Back 82

DHEA

Front 83

Androgens are the main source of male sex steroids in…

Back 83

females

Front 84

Aldosterone, Cortisol and DHEA can all act like ________ at high dosages?

Back 84

Aldosterone (mineralocorticoid)

Front 85

What does the adrenal cortex produce?

Back 85

Glucocorticoids (cortisol), Mineralocorticoids (aldosterone), Androgens (DHEA)

Front 86

Hypersecretion of glucocorticoids results in…?

Back 86

Cushing syndrome

Front 87

Hypersecretion of epinephrine and norepinephrine result in what?

Back 87

Pheochromocytoma

Front 88

How is pheochromocytoma treated?

Back 88

Surgery, but Rx with alpha (phenoxybenzmine) & beta blockers (propranolol) to get hypertension under control

Front 89

80% of the causes of Cushing Syndrome are…

Back 89

ACTH dependent

Front 90

If no treatment is sought for Cushing Syndrome there is a 50% chance of death in 5 years due to…

Back 90

Cardiovascular disease

Front 91

A disorder in which the adrenal glands do not produce enough hormone

Back 91

Addison (add-some) disease aka hypocortisolism

Front 92

What hormone increases BP by increasing Na+ and decreasing K+ levels

Back 92

Aldosterone

Front 93

Cushing disease is caused by…

Back 93

Pitituatary adenoma (usually microadenoma) or hyperplasia

Front 94

Cushing syndrome=______?

Back 94

Cortisol excess / ACTH excess NOT from pituitary

Front 95

Symtoms of primary aldosteronism

Back 95

Elevated BP, hypokalemia (low K+), episodic weakness

Front 96

Treatment of aldosteronism

Back 96

Remove tumor, meds-spironolactone/Aldactone (blocks ALDO receptors) side effects: gynecomastia

Front 97

Characteristics of aldosteronism?

Back 97

Hypertension, hypokalemia (low K+)

Front 98

In primary adrenal insufficiency ACTH levels would be

Back 98

High

Front 99

Primary adrenal insufficiency symptoms

Back 99

Orthostatic hypotension, salt cravings, hyperpigmentation, hyperkalemia

Front 100

Drug to treat tachycardia and hypertension in hyperthryroidism?

Back 100

Beta blockers (propanalol)

Front 101

Why do patients get hyperpigmentation in primare Addison Syndrome?

Back 101

ACTH acts like MSH (melanocyte stimulating hormone) at high doses

Front 102

Why don't patients get hyperpigmentation in primary Addison Syndrome?

Back 102

ACTH is being suppressed by adrenal tumor, excess ACTH is what leads to the excess pigmentation (ACTH acts like MSH (melanocyte stimulating hormone) at high doses.)