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33 Cards in this Set

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  • Back
gross findings of the thyroid....(just read)
Two bulky lateral lobes
Connected by a thin isthmus
Below and anterior to the larynx
May have a pyramidal lobe/above the isthmus
this is the most common manifestation of thyroid disease in which a pt has a slow growing mass in the neck that is only a cosmetic problem....what is this and what is it due to?

iodine deficiency
describe a diffuse (simple) goiter
diffuse involvement of entire gland without nodularity
- enlarged follicles are filled with colloid – colloid goiter
- endemic – areas where low levels of iodine - - see in mountainous areas – Alps, Andes, Himalayas
- sporadic – peak incidence in young adult - - women caused by a number of conditions – ingestion of substances that interfere with hormone synthesis (veggies & plants); hereditary enzymatic defects - - most related to iodine use
this is due to a long standing simple goiter and may be non-toxic or can induce thyrotoxicosis...this will produce the most extreme thyroid enlargement
Multinodular goiter
What is Grave's disease?
increase 2° to hyperfunction of the gland -- hyperthyroidism
in graves disease, what is associated with it in nearly 85% of the cases?
Diffuse hyperplasia
most common clinical side-effect of hyperthyroidism?
Heart disease

increased output secondary to increased contractility and increased peripheral O2 requirements

leads to tachycardia, palpitation, cardiomegaly

arrhythmias---A fib
What Hashimoto disease?
Autoimmune Hypothyroidism
lithium can cause what problem in the thyroid?
What is Cretinism
hypothyroidism developing in infancy or early childhood
- associated with dietary iodine deficiency & endemic goiter
- associated with biosynthetic defect in hormone synthesis
a young child presents to your office with impaired development of the skeletal system and CNS...they have short stature, coarse facial features, protruding tongue, wide set eyes, severe mental retardation...what is going on?
pt presents with

generalized fatigue, apathy, mental sluggishness (may mimic depression in early stages), cold intolerant, frequently overweight
- reduced cardiac output --> shortness of breath, decreased exercise capacity
decreased sympathetic activity -->constipation, decreased sweating
- skin is cool and pale
- deepening of voice
Myxedema – hypothyroidism developing in older child or adult
gradual thyroid failure secondary to autoimmune destruction of the thyroid=?
Hashimoto thyroiditis
with thyroiditis there is an increased risk of what? (be specific)
B cell lymphoma
What is DeQuervain's disease?
Subacute Thyroiditis

less frequent than Hashimoto, women 3 – 5:1; age 30 – 50

also called GRANULOMATOUS thyroiditis

thyroid will be very tender to touch
what leads to DeQuervain's disease? what will a pt with it present like?
2° viral infection or postviral inflammatory process
- Cox sackievirus, mumps, measles, adenovirus

(look for previous URI leading to Patients experiencing a hyperthyroid period as the cellular lining of colloid spaces fails, allowing abundant colloid into the circulation, with neck pain and fever. Patients typically then become hypothyroid as the pituitary reduces TSH production and the inappropriately released colloid is depleted before resolving to euthyroid)

Remember: this is subacute thyroiditis, also known as granulomatous thyroiditis; it will be very tender to touch
this problem is uncommon and of unknown etiology. It is a fibrosing process--thyroid through the capsule into the contiguous neck structures. Can have gland atrophy and resulting hypothyroidsim...what is this?
Riedel Thyroiditis
>90% of thyroid neoplasms are what?
Adenomas are the most common thyroid neoplasm...are these likely to become cancer?

rarely precursors of cancer
woman comes to your office saying they felt a little nodule on their neck upon palpation you find the nodule and a mass in the cervical lymph nodes...what should you be thinking
Papillary ca (thyroid neoplasm)
what is the most common congenital lesion of the thyroid?
thyroglossal duct cyst

a remnant of the tubular development of the thyroid
may present at any age – midline cyst or mass anterior to trachea
often significant lymphocyte infiltrate
rare transformation to ca
Parathyroid glands are derived from
pharyngeal pouches
activity of parathyroid is controlled by what?
controlled by level of free ionized calcium in blood

decreased levels of ionized calcium stimulate synthesis & secretion of PTH
if you suspect a problem with the parathyroid what should you order?
free ionized calcium

decreased levels of ionized calcium stimulate synthesis & secretion of PTH
what normally causes primary hyperparathyroidism? leads to?

leads to hypercalcemia
how can you distinguish hypercalcemia due to parathyroid and nonparathyroid disease?
serum PTH levels are low to undetectable in hypercalcemia from nonparathyroid disease

whereas it would be really high in primary
what is the most common cause of secondary hyperparathyroidism?
Renal failure
major cause of hypoparathyroidism?
Surgical removal of the gland
DiGeorge syndrome can lead to what endocrine issue?

tetany, muscle cramps and convulsions are due to what?
symptoms of hypoparathyroidism
neuromuscular – tetany, muscle cramps, convulsions
mental status – irritability, psychosis
intracranial – Parkinsonian-like movement disorders,  intracranial pressure & papilledema
ocular changes – calcification of lens, cataract formation
cardiac – conduction defects which produce prolongation of QT interval
pt presents with short stature, round face, short neck, and short metacarpals/tarsals...what is going on?
what clinical feature shows up early on with hypoparathyroidism?