Podcast
Questions and Answers
What is the gold standard test used for screening and monitoring thyroid disease?
What is the gold standard test used for screening and monitoring thyroid disease?
- Thyrotropin Receptor Antibody (TRAb)
- T3-uptake
- Thyroid Stimulating Hormone (TSH) (correct)
- Thyroglobulin Antibody
Which type of T3/T4 measurement is available for uptake into cells?
Which type of T3/T4 measurement is available for uptake into cells?
- Thyroxine-binding Globulin bound T3/T4
- Free T3/T4 (correct)
- Total T3/T4
- T3-uptake
What is the most appropriate initial treatment for myxedema coma?
What is the most appropriate initial treatment for myxedema coma?
- 300-400mcg of levothyroxine IV loading dose followed by 50mcg daily (correct)
- 50mcg of levothyroxine IV daily
- 100mg of liothyronine IV TID
- 5000mcg of levothyroxine IV loading dose
Which antibody should ideally have a zero level, as it resides in the thyroid gland?
Which antibody should ideally have a zero level, as it resides in the thyroid gland?
Why is it safer to administer T4 rather than T3 replacement therapy?
Why is it safer to administer T4 rather than T3 replacement therapy?
What does T3-uptake indirectly measure in thyroid function tests?
What does T3-uptake indirectly measure in thyroid function tests?
What is the recommended follow-up schedule after initiating thyroid replacement therapy?
What is the recommended follow-up schedule after initiating thyroid replacement therapy?
Which type of Thyrotropin Receptor Antibody (TRAb) can be found in Graves Disease?
Which type of Thyrotropin Receptor Antibody (TRAb) can be found in Graves Disease?
What are common presenting symptoms of myxedema coma?
What are common presenting symptoms of myxedema coma?
What is a common inflammatory marker associated with Hashimoto's Thyroiditis?
What is a common inflammatory marker associated with Hashimoto's Thyroiditis?
Which imaging modality is typically used for the initial evaluation of a thyroid nodule?
Which imaging modality is typically used for the initial evaluation of a thyroid nodule?
Which of the following drugs is known to potentially cause thyroid issues?
Which of the following drugs is known to potentially cause thyroid issues?
Which condition presents with symmetric goiter, exophthalmos, elevated T3/T4, and positive Thyroid Receptor Antibody (TRAb)?
Which condition presents with symmetric goiter, exophthalmos, elevated T3/T4, and positive Thyroid Receptor Antibody (TRAb)?
What is a characteristic finding on thyroid scan in patients with Hashimoto's thyroiditis?
What is a characteristic finding on thyroid scan in patients with Hashimoto's thyroiditis?
What is the definitive treatment for hyperthyroidism in patients who are not pregnant?
What is the definitive treatment for hyperthyroidism in patients who are not pregnant?
What is a common presentation of toxic nodular goiter in older women compared to Graves disease?
What is a common presentation of toxic nodular goiter in older women compared to Graves disease?
What is the hallmark of a thyroid storm when it occurs in patients with hyperthyroidism?
What is the hallmark of a thyroid storm when it occurs in patients with hyperthyroidism?
What is one of the reasons to screen for TSH and T4 in individuals with autoimmune disorders?
What is one of the reasons to screen for TSH and T4 in individuals with autoimmune disorders?
Which type of thyroiditis can result in a patient experiencing pain, fever, and transition from hyper to hypo to euthyroid states?
Which type of thyroiditis can result in a patient experiencing pain, fever, and transition from hyper to hypo to euthyroid states?
When does postpartum thyroiditis typically develop in relation to delivery?
When does postpartum thyroiditis typically develop in relation to delivery?
What is the primary role of thyroid hormones T3 and T4 in the body?
What is the primary role of thyroid hormones T3 and T4 in the body?
Which imaging modality is contraindicated in pregnancy for evaluating the thyroid?
Which imaging modality is contraindicated in pregnancy for evaluating the thyroid?
What is the function of Thyrotropin Receptor Antibody (TRAb) in the body?
What is the function of Thyrotropin Receptor Antibody (TRAb) in the body?
In a physical exam, where does a medical provider typically stand when feeling for thyroid tissue on a patient?
In a physical exam, where does a medical provider typically stand when feeling for thyroid tissue on a patient?
What does a 'cold' nodule on the thyroid indicate?
What does a 'cold' nodule on the thyroid indicate?
Which antibody is typically positive in Hashimoto's Disease?
Which antibody is typically positive in Hashimoto's Disease?
When a patient presents with fatigue, dry skin, cold intolerance, and weight gain, they may be experiencing symptoms of:
When a patient presents with fatigue, dry skin, cold intolerance, and weight gain, they may be experiencing symptoms of:
Which physical exam finding is commonly associated with hypothyroidism and characterized by periorbital edema and a puffy flat facial appearance?
Which physical exam finding is commonly associated with hypothyroidism and characterized by periorbital edema and a puffy flat facial appearance?
In primary hypothyroidism, the levels of which hormone are typically elevated?
In primary hypothyroidism, the levels of which hormone are typically elevated?
Which disease involves auto-immune destruction of the thyroid and is the most common cause of hypothyroidism in adults?
Which disease involves auto-immune destruction of the thyroid and is the most common cause of hypothyroidism in adults?
Which condition presents with symptoms of hyperthyroidism in its early stage and transitions to hypothyroidism in its late stage?
Which condition presents with symptoms of hyperthyroidism in its early stage and transitions to hypothyroidism in its late stage?
What is the characteristic thyroid function test profile for patients with Euthyroid sick syndrome?
What is the characteristic thyroid function test profile for patients with Euthyroid sick syndrome?
When is treatment typically initiated for patients with subclinical hypothyroidism?
When is treatment typically initiated for patients with subclinical hypothyroidism?
What is the recommended goal range for TSH levels in adults?
What is the recommended goal range for TSH levels in adults?
Which of the following are common benign findings associated with thyroid nodules?
Which of the following are common benign findings associated with thyroid nodules?
What must be conducted to rule out malignancy in thyroid nodules?
What must be conducted to rule out malignancy in thyroid nodules?
What is a common physical exam finding in patients with hyperthyroidism?
What is a common physical exam finding in patients with hyperthyroidism?
In which type of hyperthyroidism is TSH normal while T3/T4 is high?
In which type of hyperthyroidism is TSH normal while T3/T4 is high?
Which life-threatening complication of hyperthyroidism can be triggered by surgery, heart attack, or infection?
Which life-threatening complication of hyperthyroidism can be triggered by surgery, heart attack, or infection?
What are common lab findings in patients with primary hyperthyroidism?
What are common lab findings in patients with primary hyperthyroidism?
What characteristic of a thyroid nodule could suggest malignancy?
What characteristic of a thyroid nodule could suggest malignancy?
Which treatment is typically used for thyroid cancers (excluding lymphoma)?
Which treatment is typically used for thyroid cancers (excluding lymphoma)?
At what age range does medullary thyroid cancer usually onset?
At what age range does medullary thyroid cancer usually onset?
How can medullary thyroid cancer be diagnosed and monitored?
How can medullary thyroid cancer be diagnosed and monitored?
Which type of thyroid cancer is the most common?
Which type of thyroid cancer is the most common?
Why is it important to screen for abnormal thyroid hormone levels in AFib patients without a known history of thyroid disease?
Why is it important to screen for abnormal thyroid hormone levels in AFib patients without a known history of thyroid disease?
What thyroid cancer is rare but has poor prognostics?
What thyroid cancer is rare but has poor prognostics?
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Study Notes
Thyroid Gland and Function
- The thyroid gland produces thyroid hormones (T3 and T4) that regulate metabolic rate
- Iodine is essential for thyroid hormone production
- Follicular cells in the thyroid gland secrete T3 and T4
- Thyroid hormones increase basal metabolic rate to enhance protein synthesis and break down fats and carbs for energy
Physical Exam of Thyroid Gland
- Conducted from behind the patient with both hands on the neck
- Patient is asked to swallow to feel for thyroid tissue
- Goiter is the enlargement of the thyroid gland, but it does not indicate functionality (hyper or hypo)
Thyroid Nodules
- Common incidental findings on physical exams
- Mostly benign (e.g., follicular adenomas, colloid nodules, or cysts)
- Cannot rule out malignancy without further imaging
- First-line imaging is ultrasound
- First-line lab for thyroid function is TSH due to longer half-life in blood
Hypothyroidism
- Common physical exam findings: myxedema (periorbital edema, puffy flat facial appearance with dry skin), delayed reflexes, bradycardia, goiter
- Lab findings: high TSH, low T3/T4
- Hashimoto's disease is the most common cause of hypothyroidism in adults
Hyperthyroidism
- Common physical exam findings: heat intolerance, nervousness, weight loss, hunger, palpitations, hypertension, tachycardia, atrial fibrillation, wide pulse pressure, brisk reflexes, tremors, exophthalmos
- Lab findings: low or undetectable TSH, high T3/T4
- Grave's disease is the autoimmune overproduction of thyroid-stimulating immunoglobulin (TSI)
- Toxic nodular goiter is hyperthyroidism caused by autonomous hyperfunctioning nodules, more common in older women
Thyroid Storm
- Life-threatening complication of hyperthyroidism
- Causes: surgery, radioactive iodine therapy, uncontrolled diabetes, heart attack, or infection
- Presentation: hyperpyrexia, flushing, sweating, agitation
- Treatment: ICU admission, beta blockade, antithyroid medication, hydrocortisone, iodine
Atrial Fibrillation and Thyroid Hormone Levels
- Atrial fibrillation (AFib) can develop secondary to thyroid hormone dysregulation
- Both hypothyroidism and hyperthyroidism increase the risk of developing AFib
- Measuring thyroid hormone levels is crucial in patients with AFib
- Screening for abnormal thyroid hormone levels is beneficial in patients with no known history of thyroid disease
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