Question | Answer |
Graves dz: etiology | Auto-antibody reacting with the TSH receptor. Thyroid-stimulating immunoglobulin (TSI) 80-95% positive |
Graves dz: exam | Symmetric non-tender goiter (80%) - bruit pathognomonic. Ocular findings (30%). Pretibial myxedema. Fine hair. Fine tremor of tongue. Hyper DTRs. |
Female, weight loss, palpitations, atrial fibrillation | Hyperthyroid (work it up with TSH, T4) |
Exopthalmos, palpitations, wt. loss. Elevated radioactive iodine uptake (RAIU) | Hyperthyroid, Graves Dx |
Post thyroidectomy: monitor for this electrolyte abnormality | Hypocalcemia |
Graves dz: predictors of remission | small goiter (decreases w/thioamides, eg, PTU); FT3 predominance; neg TSI titer (IgG Ab vs thyroid cell TSH rec) |
toxic multinodular goiter etiology | multicell autonomic fn |
toxic multinodular goiter exam | >50 yo. Large irregular asymmetric nodular thyroid. TSH, FT4, FT3, uptake & scan |
Toxic thyroid nodule: etiology | activation of TSH receptors via receptor gene mutation |
Multinodular goiters | 2-4% prev in iodine-sufficient areas; F 5-15 x M; multifactorial; genetic cause? |
HLA-B8 & HLA-DR3: associated with: | Graves dz |
thyroid neoplasm s/s | painless neck swelling; single firm nontender nodule: stony, hard gland; medullary: flushing, Cushing; anaplastic: hoarse (recurrent laryng n.) |
toxic multinodular goiter Tx | Rx RAI |
Toxic nodule: etiology | activation of TSH receptors via rec gene mutation |
Toxic nodule: exam | 30-40 yo; large irreg nodular thyroid; onycholysis; TSH, FT4, uptake & scan; Rx RAI |
Multinodular goiters | 2-4% prev in iodine-sufficient areas; F 5-15 x M; multifactorial; genetic cause? |
Multinodular goiters: tx | thyroxine suppression of TSH; surg if obstruction |
Thyroid nodule/neoplasia: exam | benign hx; s/s hypo or hyper; tender nod; FH hypo, nod, or goiter |
Thyroid nodule: eval for neoplasm | TSH; US (80%); FNA is TOC; indicated esp if >1cm. CT may help in large nodule (assess for tracheal compression) |
Most likely post-thyroidectomy injury | Recurrent laryngeal nerve = hoarseness |
Non-Graves causes of hyperthyroidism | Toxic multinodular goiter, solitary hyperfunctioning nodule, early deQuervain, exogenous thyroid hormone, secondary hyper 2/2 pituitary tumor |
Hyperthyroid sx/sx | Anxiety, poor concentration, insomnia, emotional, tremor. Wt loss, diarrhea. Dyspnea, palps, ?HF. Sweating, hot, fatigue, diplopia. |
Hyperthyroid tx | RAI is TOC in non-PG pt. PTU. Methimazole (preferred but CI in PG). Beta blockers for sxs. Surgery for recalcitrant dz |
Thyroid storm sx/sx | high fever, delirium, N/V, tremor, dehydration. +/-A-fib, hypotension. |
Thyroid storm mgmt | IV Na iodide. PTU/methimazole. glucocorticoids (prevent peripheral T3->T4 conversion) |
thyroid nodule: suspect neoplasm if: | rapid growth, fixed (do movement w/swallow). Early h/o head/neck XRT. Young male. Hoarse/vocal cord paralysis. Punctate calcification. Increase in size w/thyroxine tx |
4 types of thyroid nodule | Papillary (50-80%), follicular (20%), medullary (<10%), anaplastic (5-10%, most aggressive). F>M, <20 yo and >70 yo |
On histology, fronds and psammoma bodies (laminated microcalcifications) are noted: | Papillary thyroid cancer |
Type of thyroid cancer associate with pheochromocytoma, parathyroid adenoma, and neuroma: | Medullary |
Type of thyroid cancer: patients are in 5th decade; slow-growing, may be associated with bone mets: | Follicular |
Signs of hyperthyroidism with cervical LAD suggest: | malignancy |
Thyroid cancer mgmt | Radioactive iodine ablation +/- chemo (doxorubicin) |
Papillary thyroid cancer: surgical tx | Thyroid lobectomy and isthmectomy |
Medullary thyroid cancer: surgical tx | Total thyroidectomy required (bc of multicentricity) |
Follicular thyroid cancer: surgical tx | Near-total thyroidectomy is favored |
Anaplastic thyroid cancer: surgical tx | Total thyroidectomy and radical neck dissection for resectable tumors. Surgery in most cases is palliative |