Diagnostic Methods
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| A Thyroid Profile is composed of | TSH and FT4
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| Which test is used to screen hypo/hyperthyroidism given that you have normal hypothalamic/pituitary axis? | TSH; next step is FT4
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| Low levels of what stimulate production of TRH? | Low free T3 and T4
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| What is the precursor of T3? | T4; T4 is more predictable than the actions of T3 for disease states
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| ____ exerts majority of thyroidal hormone effects | T3 Triiodothyronine
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| Central Hypothyroidism | either malfunctions with the pituitary or the hypothalamus are simply called central hypothyroidism. In both, TSH levels will be suppressed
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| Hypothyroidism is associated with what lipid and electrolyte changes? | higher cholesterol, triglow sodium, decreased insulin requirementsNormochromic anemia
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| Hyperthyroidism is associated with what lipid and electrolyte changes? | decreased cholesterol and trig, hypercalcemia and liver enzymes. Higher insulin requirements in diabetics
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| If you are clinically suspicious of hyperthyroidism but T4 is normal, you can check what? | T3; may have an isolated elevation
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| Any illness can cause changes in what? | Metabolism and thus thyroid levels
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| 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
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| T3 uptake is an indirect measurement of | the patient's total T4
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| If there is a high T3 uptake, then what is the patient's T4 level? | high. Hyperthyroidism
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| T3 uptake levels in hypothyroidism | is Low.
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| 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
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| What is the most common calculation method for free T3 or T4 | Free Thyroxine Index (FTI). FTI (T7)= total T4xT3 uptake
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| FTI is low in | hypothyroidism
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| FTI is high in | hyperthyroidism
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| TSH levels in hypothyroidism | consistently elevated
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| TSH levels in hyperthyroidism and secondary hypothyroidism | depressed
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| Check TSH levels for what kind of thyroid deficiency? | Primary only; may totally miss secondary/tertiary hypothyroidism caused by an adenoma
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| Hyperthyroidism | Depressed TSH, Elevated FT4, Elevated T3 resdual, Elevated FTI
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| Hypothyroidism | Elevated TSH, Depressed FT4, Depressed T3 Residual, Depressed FTI
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| lab studies | come back to
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| lab studies | come back to
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| TRH stimulation testing is indicated for | evaluating entire thyroid-pituitary-hypothalmus feedback loop.
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| Thyroid antibody tests | Antibodies may occur in thyroiditis and diffuse hyperthyroidism or Grave's disease. Not used as frequently as in the past
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| 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
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| Lymphocytic thyroiditis is found generally in which age group? | Adolescents and peds. Causes a hashimoto's like syndrome. Have both thyroglobulin and microsomal antigens
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| 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.
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| USPSTF recommendations for screening | Insufficient clinical data to recommend screening for or against routine screening for thyroid disease in adults
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| If you suspect a thyroid disorder caused by a cancer check | TBG and Calcitonin
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