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102 Cards in this Set

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  • Back
If you see low TSH and high free T4, what test is the next step in diagnostics?
TC or I Scan
If you have hyperthyroidism and its not coming from the thyroid, it is called?
Secondary hyperthyroidism
The first lab would obtain from a patient you suspect of thyroid disease is?
TSH
Besides the thyroid itself, what other organ can lead to hypothyroidism?

LOW TSH Tumor in pituitary or the hypothalamus

"
Tumor in pituitary or the hypothalamus
In what condition do antibodies act like TSH, thus making excess T3/T4?
Graves Disease
What signs and symptoms does Graves disease manifest with?
Diffuse enlargement of thyroid, signs of metabolic overactivity (tachycardia, heat intolerance, diarrhea, anxiety, menstrual disturbances, etc.)
What is the name of the startled look that occurs in some cases of Graves disease?
Exophthalmos
What side effect is a red flag with methimazole/Tapazole?
Sore throat which can indicate low white blood cell count
What iodine blocker is safe in early pregnancy/ first trimester?
PTU
What is a potential negative side effect of Propylthiouracil (PTU)?
Liver Damage
What is a potential negative side effect of methimazole/Tapazole?
Agranulocystosis which can manifest initially as sore throat.
What are the treatments of Graves disease?
Medications (iodine blockers), radioactive iodine, surgery
What is the common disease course for Graves disease?
Most patients overwork thyroid and then become hypothyroid.
What occurs in thyroiditis?
Inflammation of gland releasing excess thyroid hormone followed by hypothyroidism
What is a multi nodular goiter?
Enlarged and multiple nodules in the thyroid
What is a toxic multi nodular goiter?
Enlarged and multiple nodules with LOW TSH, high free T4 due to hyperthyroidism
TSH is low, free T4 is high, what your next diagnostic study?
Tc or I scan of the thyroid. This will allow you to differentiate Graves/solitary hot nodule (adenoma), toxic multinodular goiter
A cold nodule is not making thyroid hormone. Why could this be a danger?
Thyroid cancer, 10% cases of “cold nodule”
What does a cold nodules look like on the thyroid scan?
Appears as white areas in scan
“Hot” nodule, or a toxic nodule, produces excess thyroid hormone and looks like what?
Appears as dark areas in a scan
T or F: When in doubt, do a biopsy
TRUE
TSH producing tumor has what effect?
Signals Thyroid to make T3, T4
Pituitary cause of hyperthyroidism. What happens to T3/T4?
T3/T4 is HIGH
When TSH and T4 are moving in the same direction, then…
problem not in the thyroid
Amiodarone, a cardiac drug, can cause…
Hyperthyroidism
A patient taking thyroid hormone has what level of TSH?
LOW
Two layers of adrenal glands are…
Medulla and Cortex
Cortex- what is made here?
Glucocorticoids (cortisol), mineralocorticoid (Aldosterone), Androgens (DHEA)
Medulla- what is made here?
epinephrine and norepinephine
What is a pheochromocytoma?
It is an adrenal tumor that reproduces what the medulla makes including epinephrine, norepinephrine, dopamine
Signs and symptoms of pheochromocytoma include…
palpitations, headache, episodic sweating, SEVERE HYPERTENSION, fatal in pregnancy
Diagnosis of pheochromocytoma includes…
collect urine for 24 hours and check catecholamines
Androgens are responsible for
Male sex steroid, DHEA, main source of male sex steroids in female, sex drive
Excessive steroirds, adrogens, glucocorticoids, meralocorticoids can cause what in women?
Facial hair
What is cortisol and what does it do?
It is a “stress” hormone which increases glucose and reduces immune response
Aldosterone- what does it do?
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.
What is DHEA?
Male hormone (dehyroepiandrostenedione)
When is cortisol more active and when is it less active?
Levels are high in the morning, low during sleep.
Too much cortisol causes what?
Cushing syndrome
Too little cortisol causes what?
Addison disease
Cushing signs and symptoms include…
Edema, amenorrhea, osteoporosis, hirsutism, hypertension, diabetes, moon face, striae, buffalo hump, central obesity
Most common cause of Cushing syndrome is…
Iatrogenic due to use of steroid drugs as anti-inflammatories
Cushing disease v. syndrome
Disease is when pituitary releases excess cortisol due to ACTH, syndrome is any other cause of excess cortisol
Classifications of Cushing includes…
ACTH dependent (80%) or ACTH independent (20%)
Excess cortisol, check
ACTH
ACTH low, excess cortisol- What’s happening?
ACTH is being suppressed by adrenal tumor
ACTH high, excess cortisol- What’s happening?
The problem is not in the adrenal
What medicine will suppress ACTH release?
Dexamethasone
T or F: If ACTH excess is not from the pituitary, then dexamethasone will not suppress ACTH release.
TRUE
Why is it not appropriate to stop cortisol medication abruptly?
It takes a while for the ACTH levels to return, in the meantime you'll have inadequate cortisol
What percentage of T3, T4 is protein bound?
99%
What is the first lab run when evaluating the thyroid? Second?
TSH, Free T4,
If TSH is low and Free T4 is high?
Primary Hyperthyroidism
If TSH is high and Free T4 is high?
Secondary Hyperthyroidism
If TSH is high and Free T4 us LOW?
Primary Hypothyroidism
If TSH is low and Free T4 is LOW?
Secondary Hypothyroidism
If thyroid is NOT working, TSH Levels would be?
High
If thyroid is NOT working, T3, T4 Levels would be?
LOW
In Hashimoto’s Thyroiditis, are the TSH levels high or low? Free T4? Thyroid antibodies POS or NEG?
TSH: high, Free T4: low, Thyroid antibodies: POS, Radioactive Iodine uptake, not usually done in this disease
Why is Congenital Hypothyroidism so rare?
Newborn screening
What are the S&S of Congenital Hypothyroidism?
Intellectual disabilities, growth retardation, developmental delays
In Congenital Hypothyroidism, TSH is? Free T4?
TSH is HIGH, Free T4 is LOW
A tumor in the pituitary may destroy cells that make TSH. True or False?
True
A Thyroid Storm is 100% fatal without treatment. True or False?
True
Graves Disease makes up what percentage of Hyperthyroidism? What is the female to male ratio?
60-80%, female to male ration of 8:1
What causes patients with Hyperthyroid to develop Exophthalmos?
attack on extra ocular muscles and fat pad behind eye
What is meant by the term “natural history”?
what happens when a patient is NOT treated
What is the natural history of Graves disease?
patients become hypothyroid and require replacement
One of the dangers of surgery to remove the thyroid?
You can damage the recurrent laryngeal nerve , paralyzing the vocal cord on that side
What medications are used to treat a multi nodular goiter?
methimazole/Tapazole or propylthiouracil/PTU
Why would one worry about a Solitary Thyroid Adenoma?
It can be cancer
Pituitary cause of hyperthyroidism. What happens to TSH?
High
Cortisol is made where?
Adrenal Cortex
Epinephrine is made where?
Adrenal Medulla
Part of fight or flight
Adrenal Medulla
A rare hormone secreting tumor that can occur in the adrenal glands
Pheochromocytoma
Symptoms of Pheochromocytoma (hint-PHE) include…
palpitations, headache, episodic sweating, SEVERE HYPERTENSION, fatal in pregnancy
What are the three types of Adrenal cortical hormones?
Glucocorticoids, Mineralocorticoids, Androgens
An example of a glucocorticoid?
Coritisol
An example of a mineralocorticoid?
Aldosterone
An example of an androgen?
DHEA
Androgens are the main source of male sex steroids in…
females
Aldosterone, Cortisol and DHEA can all act like ________ at high dosages?
Aldosterone (mineralocorticoid)
What does the adrenal cortex produce?
Glucocorticoids (cortisol), Mineralocorticoids (aldosterone), Androgens (DHEA)
Hypersecretion of glucocorticoids results in…?
Cushing syndrome
Hypersecretion of epinephrine and norepinephrine result in what?
Pheochromocytoma
How is pheochromocytoma treated?

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

80% of the causes of Cushing Syndrome are…
ACTH dependent
If no treatment is sought for Cushing Syndrome there is a 50% chance of death in 5 years due to…
Cardiovascular disease
A disorder in which the adrenal glands do not produce enough hormone
Addison (add-some) disease aka hypocortisolism
What hormone increases BP by increasing Na+ and decreasing K+ levels
Aldosterone
Cushing disease is caused by…
Pitituatary adenoma (usually microadenoma) or hyperplasia
Cushing syndrome=______?
Cortisol excess / ACTH excess NOT from pituitary
Symtoms of primary aldosteronism
Elevated BP, hypokalemia (low K+), episodic weakness
Treatment of aldosteronism
Remove tumor, meds-spironolactone/Aldactone (blocks ALDO receptors) side effects: gynecomastia
Characteristics of aldosteronism?
Hypertension, hypokalemia (low K+)
In primary adrenal insufficiency ACTH levels would be
High
Primary adrenal insufficiency symptoms
Orthostatic hypotension, salt cravings, hyperpigmentation, hyperkalemia
Drug to treat tachycardia and hypertension in hyperthryroidism?
Beta blockers (propanalol)
Why do patients get hyperpigmentation in primare Addison Syndrome?
ACTH acts like MSH (melanocyte stimulating hormone) at high doses
Why don't patients get hyperpigmentation in primary Addison Syndrome?
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.)