Endocrine: 7. Leech : Growth, Hypothalamic/pituitary Pharmacology & Pathophysiology Of The Thyroid

Front 1

gross findings of the thyroid....(just read)

Back 1

Two bulky lateral lobes
Connected by a thin isthmus
Below and anterior to the larynx
May have a pyramidal lobe/above the isthmus

Front 2

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?

Back 2

Goiter

iodine deficiency

Front 3

describe a diffuse (simple) goiter

Back 3

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

Front 4

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

Back 4

Multinodular goiter

Front 5

What is Grave's disease?

Back 5

increase 2° to hyperfunction of the gland -- hyperthyroidism

Front 6

in graves disease, what is associated with it in nearly 85% of the cases?

Back 6

Diffuse hyperplasia

Front 7

most common clinical side-effect of hyperthyroidism?

Back 7

Heart disease

increased output secondary to increased contractility and increased peripheral O2 requirements

leads to tachycardia, palpitation, cardiomegaly

arrhythmias---A fib

Front 8

What Hashimoto disease?

Back 8

Autoimmune Hypothyroidism

Front 9

lithium can cause what problem in the thyroid?

Back 9

Hypothyroid

Front 10

What is Cretinism

Back 10

hypothyroidism developing in infancy or early childhood
- associated with dietary iodine deficiency & endemic goiter
- associated with biosynthetic defect in hormone synthesis

Front 11

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?

Back 11

Cretinism--Hypothyroid

Front 12

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

Back 12

Myxedema – hypothyroidism developing in older child or adult

Front 13

gradual thyroid failure secondary to autoimmune destruction of the thyroid=?

Back 13

Hashimoto thyroiditis

Front 14

with thyroiditis there is an increased risk of what? (be specific)

Back 14

B cell lymphoma

Front 15

What is DeQuervain's disease?

Back 15

Subacute Thyroiditis

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

also called GRANULOMATOUS thyroiditis

thyroid will be very tender to touch

Front 16

what leads to DeQuervain's disease? what will a pt with it present like?

Back 16

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

Front 17

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?

Back 17

Riedel Thyroiditis

Front 18

>90% of thyroid neoplasms are what?

Back 18

Adenomas

Front 19

Adenomas are the most common thyroid neoplasm...are these likely to become cancer?

Back 19

NO

rarely precursors of cancer

Front 20

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

Back 20

Papillary ca (thyroid neoplasm)

Front 21

what is the most common congenital lesion of the thyroid?

Back 21

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

Front 22

Parathyroid glands are derived from

Back 22

pharyngeal pouches

Front 23

activity of parathyroid is controlled by what?

Back 23

controlled by level of free ionized calcium in blood

decreased levels of ionized calcium stimulate synthesis & secretion of PTH

Front 24

if you suspect a problem with the parathyroid what should you order?

Back 24

free ionized calcium

decreased levels of ionized calcium stimulate synthesis & secretion of PTH

Front 25

what normally causes primary hyperparathyroidism? leads to?

Back 25

Adenoma

leads to hypercalcemia

Front 26

how can you distinguish hypercalcemia due to parathyroid and nonparathyroid disease?

Back 26

serum PTH levels are low to undetectable in hypercalcemia from nonparathyroid disease

whereas it would be really high in primary

Front 27

what is the most common cause of secondary hyperparathyroidism?

Back 27

Renal failure

Front 28

major cause of hypoparathyroidism?

Back 28

Surgical removal of the gland

Front 29

DiGeorge syndrome can lead to what endocrine issue?

Back 29

Hypoparathyroidsim--hypocalcemia

CATCH 22

Front 30

tetany, muscle cramps and convulsions are due to what?

Back 30

hypoparathyroid

Front 31

symptoms of hypoparathyroidism

Back 31

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

Front 32

pt presents with short stature, round face, short neck, and short metacarpals/tarsals...what is going on?

Back 32

Pseudohypoparathyroidism

Front 33

what clinical feature shows up early on with hypoparathyroidism?

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Back 33

TETANY