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