Thyroiditis and Thyroid Storm
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Questions and Answers

What is a characteristic feature of painful thyroiditis on physical examination?

  • Exophthalmos
  • A firm and tender thyroid gland (correct)
  • A diffusely enlarged thyroid gland without tenderness
  • A palpable thyroid nodule

    • Which of the following is NOT a precipitating factor for thyroid storm?

  • Trauma
  • Withdrawal from antithyroid drugs
  • Infection
  • Pregnancy (correct)

    • What does an elevated 24-hour radioactive iodine uptake (RAIU) indicate?

  • Thyroiditis
  • Thyroid cancer
  • True hyperthyroidism (correct)
  • Hypothyroidism

    • In thyrotoxic Graves' disease, what is the characteristic pattern of hormone production?

    <p>Increased overall hormone production rate with a disproportionate increase in T3 relative to T4</p> Signup and view all the answers

    What is the typical presentation of thyroid storm?

    <p>Fever, tachycardia, tachypnea, dehydration, delirium, coma, nausea, vomiting, and diarrhea</p> Signup and view all the answers

    What is the significance of a low 24-hour radioactive iodine uptake (RAIU)?

    <p>Thyroiditis</p> Signup and view all the answers

    What is the typical thyroid function test result in thyrotoxicosis?

    <p>Undetectable TSH, elevated free T4, and elevated free T3</p> Signup and view all the answers

    What is the characteristic feature of painless thyroiditis?

    <p>A diffusely enlarged thyroid gland without tenderness</p> Signup and view all the answers

    What is the significance of elevated T3 resin uptake?

    <p>Saturation of TBG due to elevated serum levels of T4 and T3</p> Signup and view all the answers

    What is the typical presentation of thyrotoxicosis?

    <p>Fever, malaise, and weight loss</p> Signup and view all the answers

    What is the primary mechanism of thyroid hormone production?

    <p>Coupling of iodinated tyrosine residues</p> Signup and view all the answers

    What is the primary function of thyroid peroxidase in thyroid hormone production?

    <p>Oxidation of inorganic iodide</p> Signup and view all the answers

    What is the primary cause of thyrotoxicosis in痛painful subacute thyroiditis?

    <p>Viral infection</p> Signup and view all the answers

    What is the term for hyperthyroidism caused by ingestion of exogenous thyroid hormone?

    <p>Thyrotoxicosis factitia</p> Signup and view all the answers

    What is the primary hormone secreted solely from the thyroid?

    <p>Thyroxine (T4)</p> Signup and view all the answers

    What is the term for a condition characterized by follicles with autonomous function?

    <p>Multinodular goiter</p> Signup and view all the answers

    What is the term for a severe and life-threatening form of thyrotoxicosis?

    <p>Thyroid storm</p> Signup and view all the answers

    What is the term for a type of thyroiditis characterized by a painless and often self-limited course?

    <p>Painless thyroiditis</p> Signup and view all the answers

    What is the primary role of thyroid-binding globulin (TBG)?

    <p>Transport of thyroid hormone</p> Signup and view all the answers

    What is the primary mechanism of thyroid hormone regulation?

    <p>Feedback inhibition by thyroid hormone</p> Signup and view all the answers

    What is the percentage of patients that may experience overt hypothyroidism due to amiodarone?

    <p>5% of patients</p> Signup and view all the answers

    Which of the following symptoms is NOT typically associated with thyrotoxicosis?

    <p>Weight gain</p> Signup and view all the answers

    What is the name of the condition characterized by hyperthyroidism, diffuse thyroid enlargement, and extrathyroidal findings of exophthalmos, pretibial myxedema, and thyroid acropachy?

    <p>Graves' Disease</p> Signup and view all the answers

    What is the percentage of iodine by weight in amiodarone?

    <p>37% by weight</p> Signup and view all the answers

    Which of the following physical signs is associated with thyrotoxicosis?

    <p>Warm, smooth, moist skin</p> Signup and view all the answers

    What is the name of the condition characterized by severe pain in the thyroid region, which often extends to the ear?

    <p>Subacute Thyroiditis</p> Signup and view all the answers

    What is the term for the leakage of thyroglobulin and thyroid hormones from the thyroid gland?

    <p>Destructive Thyroiditis</p> Signup and view all the answers

    What is the term for the condition characterized by an excessive amount of thyroid hormone in the blood, but without any symptoms of hyperthyroidism?

    <p>Euthyroid Hyperthyroxinemia</p> Signup and view all the answers

    What is the percentage of patients that may experience subclinical hypothyroidism due to amiodarone?

    <p>25% of patients</p> Signup and view all the answers

    Which of the following is a symptom of Graves' Disease?

    <p>Gynecomastia in men</p> Signup and view all the answers

    What is the significance of an increased 24 hour RAIU in a non-pregnant or non-lactating patient?

    <p>The thyroid gland is inappropriately using iodine to produce more thyroid hormone when the patient is thyrotoxic</p> Signup and view all the answers

    What is the diagnosis of a patient with autonomous function, normal TSH levels, and normal T4 levels, but elevated T3 levels?

    <p>T3 toxicosis</p> Signup and view all the answers

    What is the characteristic of thyroid scans in patients with multinodular goiters?

    <p>Patchy areas of autonomously functioning thyroid tissue</p> Signup and view all the answers

    What is the diagnostic criterion for TSH induced hyperthyroidism?

    <p>Elevated TSH levels, diffuse thyroid gland enlargement, and elevated free thyroid hormone levels</p> Signup and view all the answers

    What is the significance of a 'normal' or elevated TSH level in a thyrotoxic patient?

    <p>Inappropriate production of TSH</p> Signup and view all the answers

    What is the diagnostic criterion for TSH secreting pituitary adenomas?

    <p>Lack of TSH response to TRH stimulation, inappropriate TSH levels, elevated TSH α subunit levels, and radiologic imaging</p> Signup and view all the answers

    What is the characteristic of thyroid function tests in patients with subacute thyroiditis?

    <p>Triphasic course with initially elevated T4 levels, followed by a decrease, and then a return to normal</p> Signup and view all the answers

    What is the significance of a normal TSH level in a patient with thyrotoxicosis?

    <p>Inappropriate production of TSH</p> Signup and view all the answers

    What is the diagnostic criterion for toxic adenomas?

    <p>Isolated elevation of serum T3 with autonomously functioning nodules</p> Signup and view all the answers

    What is the significance of a suppressed TSH level in a patient with thyrotoxicosis?

    <p>Appropriate production of TSH</p> Signup and view all the answers

    Study Notes

    Thyroid Disorders

    • Thyroid disorders involve alterations in metabolic stability due to thyroid hormone production or secretion.
    • Symptoms include fever, malaise, myalgia, and signs of thyrotoxicosis.

    Thyrotoxicosis

    • Characterized by decompensated thyrotoxicosis, high fever, tachycardia, tachypnea, dehydration, delirium, coma, nausea, vomiting, and diarrhea.
    • Precipitating factors include infection, trauma, surgery, radioactive iodine treatment, and withdrawal from antithyroid drugs.
    • Symptoms: nervousness, anxiety, palpitations, emotional lability, easy fatigability, heat intolerance, weight loss, and increased frequency of bowel movements.
    • Physical signs: warm, smooth, moist skin, fine hair, onycholysis, lid lag, tachycardia, widened pulse pressure, and systolic ejection murmur.

    Thyroid Hormone Physiology

    • Thyroxine (T4) and triiodothyronine (T3) are formed within thyroglobulin, a large glycoprotein synthesized in the thyroid cell.
    • Inorganic iodide enters the thyroid follicular cell, is oxidized by thyroid peroxidase, and covalently bound to tyrosine residues of thyroglobulin.
    • Iodinated tyrosine residues combine to form iodothyronines, with T4 formed from two molecules of DIT and T3 formed from MIT and DIT.
    • Proteolysis releases thyroid hormone into the bloodstream, where it is transported by thyroid binding globulin (TBG), transthyretin, and albumin.
    • Only unbound (free) thyroid hormone can diffuse into cells, elicit biologic effects, and regulate TSH secretion from the pituitary.

    Thyroiditis

    • Painless thyroiditis has a triphasic course, mimicking painful subacute thyroiditis.
    • Presents with mild thyrotoxic symptoms, lid retraction, and lid lag, but absent exophthalmos.
    • Thyroid gland is diffusely enlarged without tenderness.
    • Painful subacute thyroiditis often develops after a viral syndrome, but rarely has a specific virus identified in thyroid parenchyma.

    Diagnosis

    • Elevated 24-hour RAIU indicates true hyperthyroidism, with the patient's thyroid gland overproducing T4, T3, or both.
    • Low RAIU indicates excess thyroid hormone is not caused by thyroid gland hyperfunction, but by thyroiditis, struma ovarii, follicular cancer, or exogenous thyroid hormone ingestion.
    • In thyrotoxic Graves' disease, there is an increase in overall hormone production rate, with a disproportionate increase in T3 relative to T4.
    • Measurement of serum free T4, total T4, total T3, and TSH confirms the diagnosis of thyrotoxicosis.

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    Description

    This quiz covers the symptoms and characteristics of thyroiditis and thyroid storm, including systemic symptoms, physical examination findings, and presentations of thyrotoxicosis.

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