Thyroid and Parathyroid Gland Diseases

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Questions and Answers

Which of the following is the most common cause of endogenous hyperthyroidism?

  • Thyroid cancer
  • Hashimoto's thyroiditis
  • Pituitary adenoma
  • Graves' disease (correct)

Which triad of manifestations characterizes Graves' disease?

  • Muscle weakness, fatigue, and hair loss
  • Thyrotoxicosis, exophthalmos, and pretibial myxedema (correct)
  • Cold intolerance, dry skin, and bradycardia
  • Goiter, weight gain, and constipation

What percentage of patients with Graves' disease typically exhibit exophthalmos?

  • 90%
  • 70%
  • 10%
  • 40% (correct)

Which of the following best describes pretibial myxedema?

<p>A localized, infiltrative dermopathy (C)</p> Signup and view all the answers

In Graves' disease, the autoimmune reaction involves antibodies against which of the following?

<p>TSH receptors (A)</p> Signup and view all the answers

The T cell mediated autoimmune reaction in Graves' disease is primarily involved in which of the following manifestations?

<p>Infiltrative ophthalmopathy and dermopathy (C)</p> Signup and view all the answers

Which laboratory findings are characteristic of Graves' disease?

<p>Decreased TSH, elevated free T3 and T4 (D)</p> Signup and view all the answers

In Graves' disease, radioactive iodine uptake is typically:

<p>Increased diffusely (A)</p> Signup and view all the answers

What is the underlying pathogenic mechanism in Graves' disease that leads to hyperthyroidism?

<p>Stimulating antibodies that bind to the TSH receptor (D)</p> Signup and view all the answers

Which of the following features distinguishes infiltrative ophthalmopathy of Graves' disease from other causes of proptosis?

<p>Association with diplopia and optic nerve compression (B)</p> Signup and view all the answers

Which of the following is a key feature in the pathogenesis of Graves' ophthalmopathy?

<p>T cell activation and cytokine release in the retro-orbital space (A)</p> Signup and view all the answers

Which statement accurately contrasts hyperthyroidism and hypothyroidism?

<p>Hyperthyroidism involves elevated T3/T4 and decreased TSH, while hypothyroidism involves decreased T3/T4 and elevated TSH. (D)</p> Signup and view all the answers

What distinguishes the autoantibodies in Hashimoto's thyroiditis from those in Graves' disease?

<p>Hashimoto's autoantibodies target thyroglobulin and thyroid peroxidase, while Graves' autoantibodies stimulate the TSH receptor. (D)</p> Signup and view all the answers

Which dermopathy is specifically associated with Graves' disease?

<p>Pretibial myxedema (C)</p> Signup and view all the answers

What is the MAIN difference between T3 and T4 hormones?

<p>T3 is more potent and has a shorter half-life than T4. (D)</p> Signup and view all the answers

What role do TSH receptors play in the pathogenesis of Graves' disease?

<p>They are stimulated by autoantibodies, leading to excessive thyroid hormone production. (A)</p> Signup and view all the answers

A patient presents with unexplained weight loss, heat intolerance, and increased heart rate. Which INITIAL laboratory test would be most appropriate to evaluate for hyperthyroidism?

<p>Thyroid stimulating hormone (TSH) (A)</p> Signup and view all the answers

A patient with Graves' disease is treated with radioactive iodine. What is the MOST likely long-term complication of this treatment?

<p>Hypothyroidism (A)</p> Signup and view all the answers

A patient with Graves' disease develops pretibial myxedema. Which of the following is the MOST appropriate initial management strategy for this condition?

<p>Application of topical corticosteroids (B)</p> Signup and view all the answers

A patient with Graves' disease and severe ophthalmopathy is being considered for treatment. Which of the following is the most appropriate treatment option to reduce the severity of the ophthalmopathy?

<p>Prednisone (C)</p> Signup and view all the answers

Which of the following findings suggests a diagnosis of primary hyperparathyroidism rather than secondary hyperparathyroidism?

<p>Elevated parathyroid hormone (PTH) and high serum calcium (B)</p> Signup and view all the answers

What is the effect of parathyroid hormone (PTH) on serum phosphate levels?

<p>Decreases phosphate reabsorption in the kidney (A)</p> Signup and view all the answers

Which of the following can cause hypoparathyroidism?

<p>Thyroid surgery (B)</p> Signup and view all the answers

Which clinical manifestation is associated with hypocalcemia?

<p>Tetany (D)</p> Signup and view all the answers

You're treating a patient with suspected hypoparathyroidism, who is currently experiencing acute tetany. Which of the following is the MOST appropriate immediate treatment?

<p>Intravenous calcium gluconate (A)</p> Signup and view all the answers

A patient with chronic kidney disease develops secondary hyperparathyroidism. What is the PRIMARY mechanism driving this condition?

<p>Decreased phosphate excretion, leading to hyperphosphatemia and subsequent hypocalcemia (C)</p> Signup and view all the answers

What is the expected impact of elevated PTH levels on bone remodeling?

<p>Stimulation of osteoclast activity, leading to bone resorption (C)</p> Signup and view all the answers

Which of the following is a potential long-term complication of untreated primary hyperparathyroidism?

<p>Osteoporosis (B)</p> Signup and view all the answers

Which of the following is the MOST common cause of primary hyperparathyroidism?

<p>Parathyroid adenoma (D)</p> Signup and view all the answers

What is the likely pathogenesis underlying the development of 'hungry bone syndrome' following parathyroidectomy for primary hyperparathyroidism?

<p>Rapid influx of calcium into bone, leading to severe hypocalcemia (B)</p> Signup and view all the answers

What is the underlying cause of DiGeorge syndrome resulting in hypoparathyroidism?

<p>Agenesis or hypoplasia of the parathyroid glands (D)</p> Signup and view all the answers

A 50-year-old female presents with fatigue, bone pain, and constipation. Her lab results show elevated serum calcium and elevated PTH levels. Further investigation reveals elevated levels of gastrin. Which condition is MOST likely?

<p>Multiple endocrine neoplasia type 1 (MEN1) (C)</p> Signup and view all the answers

During a thyroidectomy, all parathyroid glands are inadvertently removed. Post-operatively, the patient develops severe hypocalcemia. Which of the following is the MOST important IMMEDIATE step in managing this patient?

<p>Administer IV calcium gluconate (A)</p> Signup and view all the answers

Which medication class should be avoided in a patient with hyperparathyroidism due to an increased risk of hypercalcemic crisis?

<p>Thiazide diuretics (D)</p> Signup and view all the answers

What is the diagnostic challenge in familial hypocalciuric hypercalcemia (FHH) that distinguishes it from primary hyperparathyroidism?

<p>Low urine calcium excretion despite hypercalcemia (A)</p> Signup and view all the answers

A patient presents with signs and symptoms of hypercalcemia, including fatigue, muscle weakness, and constipation. Her diagnostic workup reveals an elevated serum calcium level along with a suppressed parathyroid hormone (PTH) level. What is the MOST likely etiology of her hypercalcemia?

<p>Malignancy-associated hypercalcemia (A)</p> Signup and view all the answers

A patient presents with carpopedal spasm during blood pressure measurement. Which of these would be the MOST appropriate next step to evaluate the underlying cause?

<p>Serum calcium level (A)</p> Signup and view all the answers

A patient presents with a history of chronic kidney disease and is found to have the following laboratory values: serum calcium 7.8 mg/dL (normal: 8.5-10.5 mg/dL), serum phosphate 5.8 mg/dL (normal: 2.5-4.5 mg/dL), and intact PTH 550 pg/mL (normal: 10-65 pg/mL). What is the MOST likely diagnosis?

<p>Secondary hyperparathyroidism (D)</p> Signup and view all the answers

A 30-year-old female presents with recurrent kidney stones. Further evaluation reveals hypercalcemia and elevated PTH. A Sestamibi scan reveals enlargement of two parathyroid glands. What is the MOST likely diagnosis?

<p>Primary hyperparathyroidism due to double adenoma (B)</p> Signup and view all the answers

Flashcards

Hyperthyroidism/Thyrotoxicosis

Excessive thyroid hormone levels in the body, leading to accelerated metabolism.

Graves' Disease

An autoimmune disease and the most common cause of endogenous hyperthyroidism, characterized by a triad of manifestations.

Graves' disease: Triad

A triad of manifestations including thyrotoxicosis, exophthalmos, and pretibial myxedema.

Thyrotoxicosis

Condition of diffusely enlarged, hyper functional thyroid, caused by thyrotoxicosis.

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Exophthalmos

Abnormal protrusion of the eyeballs noted in as many as 40% of patients.

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Pretibial Myxedema

Localized, infiltrative dermopathy (pretibial myxedema), seen in a minority of cases.

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Graves' Disease Pathogenesis

Autoimmune reaction against TSH receptors that bind to and stimulate thyroid follicular cells.

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T cell role in Graves’

T cell mediated autoimmune reaction involved in infiltrative ophthalmopathy and dermopathy.

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Graves' Disease: Lab Features

Elevated serum free T3 and T4, and decreased serum TSH.

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Radioactive iodine uptake in Graves’

Because of ongoing stimulation of the thyroid follicles by thyroid stimulating autoantibodies, radioactive iodine uptake is increased diffusely.

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Study Notes

  • Diseases of the thyroid and parathyroid glands will be discussed.

Contents

  • The conversation will include thyroid diseases such as hyper and hypothyroidism.
  • The conversation will include parathyroid diseases such as hyper and hypoparathyroidism.

Objectives

  • The causes, clinicopathologic features, pathophysiologic basis, and laboratory findings of both hyperthyroidism and hypothyroidism will be compared and contrasted.
  • Several causes for hyperparathyroidism and hypoparathyroidism will be listed.
  • The clinicopathologic features of hyperparathyroidism and hypoparathyroidism will be compared and contrasted.

Hyperthyroidism/Thyrotoxicosis: Graves Disease

  • Graves disease is the most common cause of endogenous hyperthyroidism.
  • It's characterized by a triad of manifestations:
  • Thyrotoxicosis is caused by a diffusely enlarged, hyper functional thyroid.
  • Infiltrative ophthalmopathy, with associated exophthalmos, is observed in as many as 40% of patients.
  • A localized, infiltrative dermopathy also called pretibial myxedema, appears in a minority of cases.

Pathogenesis of Graves Disease

  • Graves' disease is an autoimmune condition.
  • Antibody-mediated autoimmune reaction occurs against thyroid-stimulating hormone receptors that bind to and stimulate thyroid follicular cells independently of endogenous trophic hormones.
  • T cell-mediated autoimmune reaction is involved in infiltrative ophthalmopathy and dermopathy.

Lab Features of Graves Disease

  • Elevations in serum free T3 and T4 and decreased serum thyroid-stimulating hormone are included in laboratory findings.
  • Radioactive iodine uptake is increased diffusely due to continuous stimulation of thyroid follicles by thyroid-stimulating autoantibodies.

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