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Best initial test in suspecting thyroid disease?
How do you differentiate between exogenous and endogenous thyroid hormone production?
exogenous wont have high thyroid binding globulin but endogenous will
what increases thyroid binding globulin?
what decreases it?
- increases---pregnancy, ocp
- decreases--nephrotic syndrome, liver disease
increased T4 and T3, low TSH and high RAI uptake scan is high?
increased T4 and T3, low TSH and low RAI?
low T4 and T3, low TSH and LOW RAI?
- graves--diffuse uptake
- toxic nodular goiter-- focal uptakes
exogenous thyroid or acute thyroditis
how is graves disease diagnosed?
- decreased tsh
- increased t4 and t3
best initial rx for graves?
Long term rx?
- PTU in pregnancy
adverse effect of ptu or methimazole?
rx for pregnant woman with graves?
new onset of afib in an elderly?
toxic multinodular goiter
- fever of 104
rx for thyroid storm?
- anti thryoid meds
- cooling blankets
most common cause of hypothyrodism?
most common causes of hypothyrodism?
- post ablative surgery
- iodine deficiency
- biosynthetic defects
causes of bilateral carpal tunnel syndrome?
How long does it take for tsh to come down to normal?
rx of hypothyrodism with suspected secondary hypothyrodism?
- replace thyroid hormone
- give hydrocortisone
severe form of hypothyrodism?
only case where u give t3?
rx of myxedema coma
most accurate test for hashimotos?
when does a euthyroid sick syndrome occur?
in severe sickness like in sepsis
When a tsh is normal but t3 is low, what is it?
next appropriate test in exogenous thyroid intake?
what is the only hyperthyroid state that has proptosis?
all non functional nodules on the thyroid are presumed to be what?
cancers untill proven otherwise
toxic nodule has what chance of being a cancer?
no chance at all
what factors make thyroid cancer more likely?
- radiotion therapy to the head and neck
next best step with a non funcitoning thyroid nodule?
with multiple nodules, whichone do you nodule?
the biggest one
at the onset of a new nodule, what do you do?
biopsy the new nodule
most common thyroid cancer?
how do you make sure its gone?
- thyroid binding globulin
what is the next step when on fine needle aspiration you see a follicular cell?
you go to sx and see if it is a malignant or benign adenoma
which thyroid cancer spreads hematagneously while the others spread to lymph nodes?
which men syndromes are associated with the ret gene?
- men2b--medullary pheo
- marfanoid habitus
who gets anaplastic thyroid cancer?
how do you follow the cancer activity post thyrodectomy?
what drugs cause hypothyrodism?
why is thyroid replacement is above the normal level post thyrodectomy for cancer?
to suppress tsh bc cancers respond to tsh and grow
2 cases when u give t3 replacement?
function of pth?
- pulls ca and po4 from bone
- reabsorbs ca in kidney
- excretes po4 in kidney
dd for vitamin d deficiency?
- no light
- no vit d in food
- pancreatic insufficiency
- proximal small intestine pathology like crohns, celiac, tropic, whipple
vit d function?
- increases ca absorbption from intestine
- increase po4 in proximal tubule
how does malignancy cause hypercalcemia?
- pth like peptide
dd for hypercalcemia?
- familial hypocalciuric hypercalcemia
- prolonged immobilization
what is the only cause of hypercalcemia that has low calcium in the urine?
familial hypocalciuric hypercalcemia
side effects of loops and thiazide diuretics?
what changes occur with high calcium on ekg?
short qt interval
mngt of hypercalcemia?
- furosemide after fluids have been given and the patient is hydrated
acute way of lowering hypercalcemia?
chronic way of lowering hypercalcemia?
primary hyperparathyrodism is due to what?
- most of the time due to a single adenoma
- 4 gland hyperplasia in 25% of the time