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ABSITE REVIEW Thyroid/Parathyroid

ABSITE REVIEW Thyroid/Parathyroid. David Grossman M.D. 12/4/06. What is the most common thyroid abnormality in hospitalized patients with non thyroidal illness?. Low T3 concentrations. What percentage of T3 is derived from T4. 80%.

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ABSITE REVIEW Thyroid/Parathyroid

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  1. ABSITE REVIEWThyroid/Parathyroid David Grossman M.D. 12/4/06

  2. What is the most common thyroid abnormality in hospitalized patients with non thyroidal illness? • Low T3 concentrations

  3. What percentage of T3 is derived from T4 • 80%

  4. FNA of thyroid. Orphan any cells. What kind of thyroid cancer? • Papillary

  5. What is the major thyroid hormone binding protein • Thyronine binding globulin (TBG)

  6. What percentage of T4 and T3 are bound? • Greater than 99.5%

  7. What is the major cause of a decreased T3 concentration in patients with a critical illness? • Impaired peripheral conversion of T4 to T3 secondary to inhibition of the deiodination process

  8. What factors decrease TSH secretion? • Acute and chronic illness • Calorie restriction • Dopamine and dopamine agonists • Surgical stress • Minor decreases are associtated with carbamazapine, opiates, phenytoin, somatostatin

  9. Mechanism of action of PTU • Prevents DIT, MIT coupling

  10. Mechanism of action of prednisone? ( in terms of thyroid) • Blocks conversion of T4-T3

  11. A patient with a history of radiation exposure as a child was found to have an enlarged lymph node on PE. The lymph node is removed and there is normal appearing thyroid tissue in the lymph node. What is the diagnosis? • Papillary Thyroid Cancer

  12. What is the embryologic origin of the thyroid gland? • From median downgrowth of the first and second pharyngeal pouches in the area of the foramen cecum

  13. What lab abnormality is associated with DeQuervain’s thyroiditis? • Elevated ESR • Can be associated with hyperthyroidism • PE/symptoms: Tender thyroid, sore throat, mass, weakness, fatigue • Treat with steroids/ASA

  14. What genetic mutation is associated with medullary thyroid cancer? • Ret proto oncongene

  15. What is the first test after H and P to evaluate a thyroid nodule? • FNA

  16. Can radioactive iodine be safely given during pregnancy? • No

  17. True or False: Cardiac output is decreased in hypothyroidism • True

  18. What are the hemodynamics of a thyroid storm? • Tachychardia • Increased Cardiac output • Decreased SVR

  19. What muscle is not innervated by the recurrent laryngeal nerve? • Cricothyroid • Cricothyroid is innervated by? • Superior laryngeal nerve

  20. All the parathyroids typically receive their blood supply from what artery? • Inferior thyroid arteries

  21. What bone finding is pathognomonic finding for hyperparathyroidism? • Osteitis fibrosa cystica

  22. True or False: Hyperparathyroid is most commonly associated with 4 gland hyperplasia? • False: Solitary parathyroid adenoma is the most common etiology

  23. What are the 4 opthalmologic signs of hyperthyroidism? • Exopthalmos • Lid lag • Lid retraction • Periorbital swelling

  24. What is the initial treatment of thyroid storm? • IV fluids • Propranalol • PTU • Iodine • Hyothermia

  25. What are the CNS manifestations of myxedema? • Depression • Memory loss • Ataxia • Frank psychosis • Myxedema • Coma

  26. Why is the pulse pressure wide in patients with thyrotoxicosis? • Increased blood flow and vasodilation

  27. Causes of Hypercalcemia • PTH • Adrenal insufficiency • Multiple Myeloma • Pagets disease • Sarcoidosis • Cancer • Hyperthyroidism/Hypothyroidism • Milk Alkali • Immobilization • D Vitamin D/A excess • Thiazide Diuretics

  28. A 45 y/o female presents with a 2 year history of diffuse, tender thyroid enlargement, lethargy and 20 pound weight gain. What is the most likely diagnosis? • Hashimotos thyroiditis • What is the treatment? • Thryoid replacement therapy

  29. What is the appropriate treatment for patients with thyroglossal duct cysts? • Excision of the entire cyst, as well as the thyroglossal tract to its origin, at the foramen cecum, including the central portion of the hyoid bone

  30. What is the venous drainage of the thyroid gland? • The superior and middle thyroid veins drain into the internal jugular vein and the inferior thyroid vein drains into the innominate vein

  31. What is the result of injury to the recurrent laryngeal nerve? • Hoarseness

  32. What is the most common location of the recurrent laryngeal nerve? • The tracheoesophageal groove

  33. What is the definitive, non-surgical treatment of graves disease? • I31-I radioablation

  34. What are the indications for surgical treatment of Graves disease? • Extremely large glands, presence of nodules, women of childbearing age and patients who are opposed to radioiodine

  35. Follicular carcinoma metastases occur primarily by what route? • Hematogenous dissemination to the lungs, bones and other peripheral tissues

  36. How is the pathologic diagnosis of follicular thyroid carcinoma confirmed? • Identification of vascular or capsular invasion by the tumor from histologic sections

  37. True or False: Exposure to low-dose radiation therapy is considered a risk factor for thyroid carcinoma? • True

  38. What are the histiochemical characteristics of medullary thyroid carcinoma • Congo red dye positive • Apple-green birefringence consistent with amyloid • Immunohistochemistry positive for cytokeratins, CEA and calcitonin

  39. What is the embryological origin of the parathyroid glands? • The inferior parathyroid glands originate from the third pharyngeal pouch • The Superior parathyroid glands originate from the fourth pharyngeal pouch

  40. What voice problem will a patient have if there is injury to external branch of superior laryngeal nerve? • Loss of high pitched voice

  41. Recurrent laryngeal nerve supplies all laryngeal muscles except the cricothyroid which is supplied by • Superior laryngeal nerve • On the right the RLN goes around • The right subclavean artery • On the left the RLN goes around the arch of the aorta

  42. True or false: The presence of follicular cells can be used to differentiate between benign and malignant • False

  43. Which thyroid cancer has the best prognosis? • Papillary

  44. Which thyroid cancer is associated with MEN II • Medullary

  45. Which thyroid cancer is associated with psammoma bodies? • Papillary

  46. FNA of nodule reveals amyloidosis. Which thyroid cancer? • Medullary thyroid carcinoma

  47. What percent of individuals with lingual thyroids have no other thyroid tissue? • 70%

  48. What are the lab values in patients with Familial Hypercalcemic Hypocalciuria? • Calcium 9-11, normal PTH, low urinary Ca • Caused by a defect in the PTH receptor in the distal convoluted tubule that causes increased absorption of Ca • Treatment: nothing, no parathyroidectomy

  49. Twelve hours after having undergone a subtotal thyroidectomy, a 30 y/o woman develops agitation and difficulty breathing. Exam reveals tachychardia, anterior cervical swelling. Dressing is dry. The most appropriate treatement is • A. insertion of ET tube • Re-opening of cervical wound • Determination of the serum Calcium and magnesium concentrations • Administration of morphine • Administration of oxygen by nasal cannula

  50. What are the components of MEN I syndrome? • Parathyroid hyperplasia • Islet cell neoplasms • Pituitary tumors

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