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Pathology | Medical (MD/DO) School Study Aid


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Thyroid & Parathyroid Disorders
23 Picmonics to Learn | 44 mins

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Subacute Thyroiditis Pathophysiology
Characteristics
Self-Limiting
Triphasic Response
Thyrotoxic Phase
Thyrotoxic Phase
Damaged Follicular Cells Release Pre-formed Colloid
2-8 Weeks
Hypothyroid Phase
Hypothyroid Phase
Decreased Thyroid Hormone Synthesis
2-8 Weeks
Euthyroid Phase
Euthyroid Phase
Thyroid Gland Recovery
2 mins
Subacute Lymphocytic Thyroiditis
Etiology
Drugs
Autoimmune Disorders
Postpartum Thyroiditis
Clinical Features
Hyperthyroidism and Hypothyroidism
Painless Thyroid
Diagnosis
Thyroid Function Tests
Elevated ESR
Decreased Radioactive Iodine Uptake (RAIU)
Lymphocytic Infiltrate
Treatment
Beta Blockers
Levothyroxine
Avoid Antithyroid Drugs
3 mins
Subacute Granulomatous Thyroiditis (de Quervain)
Etiology
Viral Upper Respiratory Infection
Presentation
Tender Thyroid
Hyperthyroidism and Hypothyroidism
Diagnosis
Thyroid Function Tests
Elevated ESR
Decreased Radioactive Iodine Uptake (RAIU)
Multinucleated Giant Cells
Management
Beta Blockers
NSAIDs
Avoid Antithyroid Drugs
2 mins
Thyroid Nodule Assessment
Initial Tests
Thyroid-Stimulating Hormone (TSH)
Ultrasound
Normal / Elevated TSH
Fine Needle Aspiration
Most Accurate Test
Decreased TSH
Radioactive Iodine Uptake (RAIU)
Hot Nodules Rarely Malignant
Free T3 and T4
Considerations
Repeat Ultrasound 6 -18 Months
2 mins
Thyroid Function Screening Tests
If TSH High
Free T4 (FT4)
If TSH Low
Free T4 (FT4) and T3 (Triiodothyronine)
Consider Serum Total T4 (Thyroxine)
Considerations
Only Total T4 Increases in Pregnancy
T4 is Converted to T3
Avoid for Inpatient Screening
2 mins
Hypothyroidism Assessment
Assessment
Weight Gain - Edema
Lethargy
Cold Intolerance
Bradycardia
Hypertension
Brittle Nails and Dry Skin
Constipation
Goiter
Prolonged Menses
Slowed Thinking
Diagnostic Tests
Decreased Free T4
Increased TSH
2 mins
Hypothyroidism Intervention
Medications
Levothyroxine (Synthroid)
Liothyronine (Cytomel)
Complication
Myxedema Coma
Nursing Considerations
Lifelong Replacement Hormone
Monitor Vital Signs
Fluids and Fiber
Low Calorie, Low Fat Diet
Medication Education
No Switching Brands
2 mins
Hyperthyroidism Assessment
Assessment
Heat Intolerance
Exophthalmos
Warm, Moist Skin and Silky Hair
Tremors
Goiter
Diarrhea
Weight Loss
Tachycardia
Hypertension
Amenorrhea
Diagnosis
Decreased TSH with Elevated Free T4
Radioactive Iodine Uptake (RAIU)
2 mins
Hyperthyroidism Interventions
Drug Therapy
Propylthiouracil (PTU)
Methimazole (Tapazole)
Iodine
Beta Blockers
Other Therapies
Radioiodine Ablation
Thyroidectomy
Complications
Thyrotoxicosis
Post-Surgery Hypocalcemia
2 mins
Hashimoto's Thyroiditis
Symptoms
Hypothyroidism with Bouts of Hyperthyroidism
Enlarged, Nontender Thyroid
Mechanism
Autoimmune
Anti-Thyroid Peroxidase (TPO)
Anti-Thyroglobulin
Lab Findings
Hurthle Cells
Lymphoid Follicles
Associations
HLA-DR5 and HLA-DR3
Increased Risk Of Non-Hodgkin Lymphoma
2 mins
Graves' Disease Characteristics
Women 20-40 years old
Pathophysiology
Anti-TSH Receptor Antibodies
Symptoms
Ophthalmopathy
Exophthalmos
Hyperthyroidism
Goiter
Pretibial Myxedema
1 min
Graves' Disease Labs and Treatment
Labs
Decreased TSH
Increased T3
Increased T4
Radioactive Iodine Uptake (RAIU)
Treatment
Beta blocker
Methimazole
Radioiodine Ablation
1 min
Thyroid Storm
Symptoms
Diarrhea
Liver Failure
Insulin Resistance
Tachycardia
Lid lag
Change in LOC (Altered Mental Status)
High fever
Treatment
Propranolol (Or Esmolol)
PTU (Thionamides) Initially
Iodine Solution (Lugol Iodine)
Glucocorticoids
Cooling Blanket
3 mins
Thyroid Storm Causes
Pathophysiology Causes
Sepsis
Thyroid Trauma
Surgery
Childbirth
Grave's Disease
Excessive Thyroid Hormone Ingestion
TSH-secreting Tumors
Hyperfunctioning Goiter or Nodule
McCune Albright Syndrome
2 mins
Papillary Thyroid Carcinoma
Characteristics
Most Common Thyroid Cancer
Excellent Prognosis
Lymphatic Spread
Diagnosis
Orphan Annie Nuclei
Empty Nuclei with Central Clearing
Psammoma Bodies
Risk Factors
Head and Neck Radiation
RET and BRAF Mutations
Gardner Syndrome
Cowden Syndrome
2 mins
Medullary Carcinoma
Sporadic and Familial Types
Arises from Parafollicular C cells
Produces Calcitonin
Hypocalcemia
May Produce ACTH
Diagnosis
Sheets of Cells With Amyloid Deposition
Increased calcitonin with Pentagastrin Infusion
Risk Factors
MEN 2A and 2B
2 mins
Follicular Carcinoma
Pathophysiology
Most Common to Present as Solitary Cold Nodule
Hematogenous spread
Good Prognosis
Histological findings
Uniform Follicles
May Invade Capsule
Risk factors
Head and Neck Radiation
1 min
Anaplastic Thyroid Cancer
Pathophysiology
Rapidly Progressive
Poor Prognosis
Hoarseness
Diagnosis
Invades Local Structures
Mixed Morphology
Risk Factors
Multinodular Goiter
Older Age
History of Thyroid Disease
2 mins
Primary Hyperparathyroidism
Assessment
Hypercalcemia
Kidney Stones
Osteoporosis
Arrhythmias
Diagnostic Tests
Increased Calcium and Decreased Phosphorus
Considerations
Prevent Injury
Medication Education
Surgery
1 min
Hypoparathyroidism
Assessment
Hypocalcemia
Lethargy
Tetany
Arrhythmias
Diagnostic Tests
Decreased Calcium and Increased Phosphorus
Considerations
IV Calcium Chloride
Rebreather Mask
Lifelong Medications
Oral Calcium Supplements with Vitamin D
2 mins
MEN 1 (Multiple Endocrine Neoplasia)
Pathophysiology
Autosomal Dominant
Menin Mutation (Tumor Suppression Gene)
Chromosome 11
Signs and Symptoms
Pancreatic Endocrine Tumors
Pituitary Tumors
Parathyroid Adenomas
2 mins
Thymic Aplasia (DiGeorge Syndrome)
Pathophysiology
DiGeorge Syndrome
22q11 Deletion
Failure to Develop Third and Fourth Pharyngeal Pouches
Signs and Symptoms
Undeveloped Thymus
T Cell Deficiency
Recurrent Viral and Fungal Infections
Undeveloped Parathyroids
Hypocalcemia
Tetany
Aortic Defects
Congenital Heart Defects
Diagnosis
Absent Thymic Shadow on CXR
2 mins
MEN 2A (Multiple Endocrine Neoplasia)
Pathophysiology
Autosomal Dominant
RET Gene
Signs and Symptoms
Medullary Thyroid carcinoma
Calcitonin
Parathyroid
Pheochromocytoma
44 secs

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