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DM Thyroid
Diagnostic Methods
| Question | Answer |
|---|---|
| A Thyroid Profile is composed of | TSH and FT4 |
| Which test is used to screen hypo/hyperthyroidism given that you have normal hypothalamic/pituitary axis? | TSH; next step is FT4 |
| Low levels of what stimulate production of TRH? | Low free T3 and T4 |
| What is the precursor of T3? | T4; T4 is more predictable than the actions of T3 for disease states |
| ____ exerts majority of thyroidal hormone effects | T3 Triiodothyronine |
| Central Hypothyroidism | either malfunctions with the pituitary or the hypothalamus are simply called central hypothyroidism. In both, TSH levels will be suppressed |
| Hypothyroidism is associated with what lipid and electrolyte changes? | higher cholesterol, triglow sodium, decreased insulin requirementsNormochromic anemia |
| Hyperthyroidism is associated with what lipid and electrolyte changes? | decreased cholesterol and trig, hypercalcemia and liver enzymes. Higher insulin requirements in diabetics |
| If you are clinically suspicious of hyperthyroidism but T4 is normal, you can check what? | T3; may have an isolated elevation |
| Any illness can cause changes in what? | Metabolism and thus thyroid levels |
| TBG | Thyroxine Binding Globulin: carrier protein. It can be measured directly or by T3 uptake (THBR: Thyroid hormone binding ratio/index). Inverse relationship to TBG, if T3 is not taken up, TBG is low. So you are measuring residual T3 |
| T3 uptake is an indirect measurement of | the patient's total T4 |
| If there is a high T3 uptake, then what is the patient's T4 level? | high. Hyperthyroidism |
| T3 uptake levels in hypothyroidism | is Low. |
| Factors affecting TBG levels | Estrogen increases TBG in serum, therefore low T3 uptake values (less residual)Androgens decrease amount of TBG in serum, so high T3 uptake values |
| What is the most common calculation method for free T3 or T4 | Free Thyroxine Index (FTI). FTI (T7)= total T4xT3 uptake |
| FTI is low in | hypothyroidism |
| FTI is high in | hyperthyroidism |
| TSH levels in hypothyroidism | consistently elevated |
| TSH levels in hyperthyroidism and secondary hypothyroidism | depressed |
| Check TSH levels for what kind of thyroid deficiency? | Primary only; may totally miss secondary/tertiary hypothyroidism caused by an adenoma |
| Hyperthyroidism | Depressed TSH, Elevated FT4, Elevated T3 resdual, Elevated FTI |
| Hypothyroidism | Elevated TSH, Depressed FT4, Depressed T3 Residual, Depressed FTI |
| lab studies | come back to |
| lab studies | come back to |
| TRH stimulation testing is indicated for | evaluating entire thyroid-pituitary-hypothalmus feedback loop. |
| Thyroid antibody tests | Antibodies may occur in thyroiditis and diffuse hyperthyroidism or Grave's disease. Not used as frequently as in the past |
| Long Acting Thyroid Stimulator (LATS) definition | IgG autoantibodies that are directed against thyroid cell receptors for TSH. Only 78% of Grave's pts have these antibodies. More specific than sensitive |
| Lymphocytic thyroiditis is found generally in which age group? | Adolescents and peds. Causes a hashimoto's like syndrome. Have both thyroglobulin and microsomal antigens |
| Euthyroid Sick Syndrome definition | Severe underlying illness that may induce lab and clinical findings indicative of hypothyroid. Ex: someone really sick in the hospital. Clinical symptoms of hypothyroidism; can order TSH test to confirm euthyroid. Just watch these pts. |
| USPSTF recommendations for screening | Insufficient clinical data to recommend screening for or against routine screening for thyroid disease in adults |
| If you suspect a thyroid disorder caused by a cancer check | TBG and Calcitonin |
Created by:
ltm12