47 Questions
What is the gold standard test used for screening and monitoring thyroid disease?
Thyroid Stimulating Hormone (TSH)
Which type of T3/T4 measurement is available for uptake into cells?
Free T3/T4
What is the most appropriate initial treatment for myxedema coma?
300-400mcg of levothyroxine IV loading dose followed by 50mcg daily
Which antibody should ideally have a zero level, as it resides in the thyroid gland?
Thyroglobulin Antibody
Why is it safer to administer T4 rather than T3 replacement therapy?
The body converts T4 to T3 more efficiently than in the reverse direction
What does T3-uptake indirectly measure in thyroid function tests?
Thyroxine-binding Globulin levels
What is the recommended follow-up schedule after initiating thyroid replacement therapy?
TSH recheck every 6 weeks until steady state, then at least yearly
Which type of Thyrotropin Receptor Antibody (TRAb) can be found in Graves Disease?
Stimulating TRAb
What are common presenting symptoms of myxedema coma?
Hypothermia and extreme weakness
What is a common inflammatory marker associated with Hashimoto's Thyroiditis?
ESR
Which imaging modality is typically used for the initial evaluation of a thyroid nodule?
Ultrasound
Which of the following drugs is known to potentially cause thyroid issues?
Amiodarone
Which condition presents with symmetric goiter, exophthalmos, elevated T3/T4, and positive Thyroid Receptor Antibody (TRAb)?
Graves disease
What is a characteristic finding on thyroid scan in patients with Hashimoto's thyroiditis?
Diffuse low uptake
What is the definitive treatment for hyperthyroidism in patients who are not pregnant?
Radioactive iodine therapy
What is a common presentation of toxic nodular goiter in older women compared to Graves disease?
Asymmetric goiter and/or palpable nodules
What is the hallmark of a thyroid storm when it occurs in patients with hyperthyroidism?
Hyperpyrexia out of proportion to exam
What is one of the reasons to screen for TSH and T4 in individuals with autoimmune disorders?
To evaluate thyroid function
Which type of thyroiditis can result in a patient experiencing pain, fever, and transition from hyper to hypo to euthyroid states?
Subacute thyroiditis
When does postpartum thyroiditis typically develop in relation to delivery?
1 year after delivery
What is the primary role of thyroid hormones T3 and T4 in the body?
Enhance protein synthesis
Which imaging modality is contraindicated in pregnancy for evaluating the thyroid?
Radioactive iodine scan
What is the function of Thyrotropin Receptor Antibody (TRAb) in the body?
Positive in Grave's Disease
In a physical exam, where does a medical provider typically stand when feeling for thyroid tissue on a patient?
Behind patient
What does a 'cold' nodule on the thyroid indicate?
Malignancy
Which antibody is typically positive in Hashimoto's Disease?
Thyroid peroxidase (TPO)
When a patient presents with fatigue, dry skin, cold intolerance, and weight gain, they may be experiencing symptoms of:
Hashimoto's Disease
Which physical exam finding is commonly associated with hypothyroidism and characterized by periorbital edema and a puffy flat facial appearance?
Myxedema
In primary hypothyroidism, the levels of which hormone are typically elevated?
TSH
Which disease involves auto-immune destruction of the thyroid and is the most common cause of hypothyroidism in adults?
Hashimoto's disease
Which condition presents with symptoms of hyperthyroidism in its early stage and transitions to hypothyroidism in its late stage?
Hashimoto's disease
What is the characteristic thyroid function test profile for patients with Euthyroid sick syndrome?
Low T4 with normal TSH
When is treatment typically initiated for patients with subclinical hypothyroidism?
If TSH is greater than 5 mU/L with a positive TPO antibody
What is the recommended goal range for TSH levels in adults?
0.45 to 4.5 mU/L
Which of the following are common benign findings associated with thyroid nodules?
Colloid nodules
What must be conducted to rule out malignancy in thyroid nodules?
Biopsy
What is a common physical exam finding in patients with hyperthyroidism?
Hypertension
In which type of hyperthyroidism is TSH normal while T3/T4 is high?
Secondary hyperthyroidism
Which life-threatening complication of hyperthyroidism can be triggered by surgery, heart attack, or infection?
Thyroid Storm
What are common lab findings in patients with primary hyperthyroidism?
Low or undetectable TSH, high T3/T4
What characteristic of a thyroid nodule could suggest malignancy?
Associated with lymph adenopathy
Which treatment is typically used for thyroid cancers (excluding lymphoma)?
Thyroidectomy with radioactive iodine ablation
At what age range does medullary thyroid cancer usually onset?
20 to 50 years
How can medullary thyroid cancer be diagnosed and monitored?
Via calcitonin levels
Which type of thyroid cancer is the most common?
Papillary cancer
Why is it important to screen for abnormal thyroid hormone levels in AFib patients without a known history of thyroid disease?
To detect potential thyroid hormone dysregulation
What thyroid cancer is rare but has poor prognostics?
Anaplastic
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
Learn about the different causes of hyperthyroidism and their imaging findings, including toxic multinodular goiter, Hashimoto thyroiditis, toxic adenoma, and more. Explore how ultrasound and thyroid scan techniques can aid in the diagnosis of hyperthyroid conditions.
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