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48 Cards in this Set
- Front
- Back
what is contained within a thyrocyte? what enzyme organifies iodide? what does this process do?
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thyroglobulin
thyroid peroxidase active thyroid hormones are synthesized and released |
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the thyrotropin receptor responds to what? what does it stimulate the production of?
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TSH (it is a TSH receptor)
T4/T3 |
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what is the effect on autoantibodies on thyroglobulin, thyroid peroxidase, and TSH receptor respectively
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thyroglobulin: hypothyroid
thyroid peroxidase: hypo TSH receptor: over production of T3/4 |
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Antithyroglobulin causes what?
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Hashimotos disease
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Anti-TSH receptor causes?
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Grave's disease
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Amiodarone will cause what problem with the thyroid?
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hypothyroid
note: so will Lithium, radioactive iodine, thioamide drugs |
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flip to read some of the functions of the thyroid
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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 |
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two general effects of thyroid disease?
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1) Change in size or shape of the gland
2) Change in the secretion of hormones THINK: Hypometabolism or Hypermetabolism |
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diagnosis of thyroid disease is based on 3 things?
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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. |
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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?
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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. |
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Elevated TSH shows you what problem?
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HYPOthyroidism
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Decreased TSH shows you what problem?
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HYPERthyroidism
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actions of TSH?
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TSH binds to the TSH receptor-->
Stimulates individual thyrocyte growth Modulates iodide transport and organification Regulates proteolysis of thyroglobulin Controls secretion of T4,T3 |
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elevated T3/ free T3 shows what? decreased?
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Elevated- Hyperfunction
Decreased- Hypofunction |
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describe the TSH and T4 values in central hypothyroidism
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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. |
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what can you use serum thyroglobulin levels for? increased and decreased levels show?
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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. |
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What is Hashimoto's Thyroiditis? What 2 things will be present?
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most common cause of hypothyroidism in iodine-sufficient areas. AUTOIMMUNE destruction of the gland
A) anti-TPO (thyroid peroxidase) B) anti-thyroglobulin |
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What is Grave's Disease? what will be present?
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most common cause of hyperthyroidism. AUTOIMMUNE
C) TSI’s (thyroid stimulating immunoglobulins) also known as TSH-receptor Abs. |
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I 131 Uptake and Scan is used to evaluate what?
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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 |
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Hot nodules and cold nodules on I 131 scan show what respectively?
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Hot nodules- mostly benign
Cold nodules-5% malignant |
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Grave's disease vs Toxic Multinodular Goiter:
Pt age |
Grave's disease: young
Toxic Multinodular Goiter: old |
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What is the most common imaging study use for the thyroid?
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ULTRASOUND
gives size of the gland, evaluates the nodules (solid, cystic, mixed) |
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cornerstone in the assessment of a solitary thyroid nodule?
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Fine-needle aspiration biopsy ("FNAB")
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when would you want to order a CT or MRI for thyroid issues
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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. |
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a 70 year old black woman shows up to you with fatigue, feeling cold, hoarse voice and menstrual irregularities...what does she have
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hypothyroid
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pt has an acute sudden painful neck. In the history you see that they were recently diagnosed with mumps. What is going on?
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Transient hypothyroidism-->Subacute granulomatous thyroiditis (aka DeQuervians)
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severe hypothyroidism leading to Hypothermia, bradycardia ,hypotension, altered mental status and multisystem organ failure is known as?
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Myxedema Coma
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tx for hypothyroidism?
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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. |
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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?
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hyperthyroidism
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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 |
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an elderly pt presents with a fib, what thyroid problem might they have?
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hyperthyroid
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Propranolol can be an important treatment for what thyroid problem? why
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hyperthyroidism
Catecholamine receptor number increases, so beta-blockers have an important role |
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HYPERthyroidism = hypo/hyper metabolism?
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Hypermetabolism
*Excessive hormone release* |
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HYPOthyroidism = hypo/hyper metabolism?
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Hypometabolism
*Insufficent hormone release* |
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What are the two main goals of treating a thyroid disorder?
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1) Return to euthyroid state
2) Normalize TSH levels |
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What is the most common malignant thyroid nodule?
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Papillary Nodule
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What is the single most reliable test to diagnose all forms of Hypothyroidism and Hyperthyroidism?
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Serum TSH!!!
Elevated TSH = hypothyroidism Decreased TSH = hyperthyroidism |
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Patient's with biochemical evidence of central hypothyroidism need ______ to ***** the hypothalmic - pituitary region.
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an MRI
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Tertiary hypothyroidism
Vs. Secondary hypothyroidism Insufficient stimulation of thyroid gland by TSH due to hypothalmic disease |
Tertiary Hypothyroidism
(Falls under the Central Hypothyroidism category) |
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Tertiary hypothyroidism
Vs. Secondary hypothyroidism Insufficient stimulation of thyroid gland by TSH due to pituitary disease |
Secondary Hypothyroidism
(Falls under the Central Hypothyroidism category) |
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TSH secretion does not increase
T4 secretion falls |
Central Hypothyroidism
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Tumor of the ovaries that can cause the release of preformed hormones leading to hyperthyroidism
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Struma Ovarii
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Most common cause of HYPOthyroidism in idodine-sufficient areas
**anti-TPO (thyroid peroxidase) **anti-thyroglobulin |
Hashimoto's Thyroiditis
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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
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TSH - elevated
T4, T3 - decreased |
hypothyroidism
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Patient has hyperthyroidism, followed by hypothyroidism, then recovery
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**Transient Hypothyroidism**
(unregulated release of preformed thyroid hormones lasting until they are depleted) |
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TSH - decreased, low
T4, T3 - elevated |
hyperthyroidism
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Exophthalmos is associated with ______
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hyperthyroidism
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