Thyroid Nodules
This is the first-line test for evaluating a thyroid nodule.
What is TSH level?
Most common cause of hyperthyroidism in the U.S.
What is Graves disease?
Most common cause of hypothyroidism worldwide vs. in the US.
What is iodine deficiency vs. Hashimoto thyroiditis?
Most specific antibody for Hashimoto thyroiditis.
What is anti-thyroid peroxidase (anti-TPO)?
Hot nodules on radionuclide scan are generally this. (Hint: malignancy risk)
What is benign?
A thyroid nodule with low TSH should be followed by this imaging study.
What is a radionuclide thyroid scan?
This antibody stimulates the TSH receptor.
What is thyroid-stimulating immunoglobulin (TSI)?
TSH normal but low T4 suggests this.
What is central hypothyroidism?
This antibody is often elevated in Graves disease but not specific.
What is anti-thyroglobulin antibody?
Diffuse high uptake on scan suggests this condition.
What is Graves disease?
Nodules ≥ this size and ultrasound feature strongly suggests malignancy.
What is nodule size >1 cm and microcalcifications?
Low uptake on radioactive iodine scan suggests this condition.
What is thyroiditis?
Amiodarone can cause both hypo- and hyperthyroidism due to this property.
What is high iodine content?
This antibody confirms Graves disease.
What is TSH receptor antibody (TRAb/TSI)?
Patchy uptake suggests this diagnosis.
What is toxic multinodular goiter?
Follow-up for a benign FNA nodule is required with serial US when it grows by these two % spatial measurements?
What is 20% in two dimensions and 50% volume?
Treatment contraindicated in first trimester pregnancy.
What is methimazole?
This is an emergency diagnosis and provide at least 3 physical exam findings.
What is Myxedema coma and Nonpitting edema (myxedema), especially face/periorbital; Dry, coarse skin; hypothermic, cool extremities; macroglossia, hoarseness; delayed reflexes
Postpartum thyroiditis is associated with this antibody.
What is anti-TPO?
Near-absent RAIU uptake is seen in this exogenous condition. (Name the condition)
What is factitious thyrotoxicosis?
This Bethesda category carries the highest risk of malignancy.
What is Bethesda VI (malignant)?
A postpartum patient experiencing hyperthyroid symptoms has this diagnosis and is treated with this.
What is Lymphocytic thyroiditis and Beta-blocker (symptomatic treatment only).
Management of Myxedema coma. (Provide 3 out of the 5 listed)
- IV levothyroxine (T4),
- Empiric IV hydrocortisone (until adrenal insufficiency excluded),
- Passive rewarming (avoid aggressive warming → vasodilation collapse),
- Treat precipitating cause (infx, etc)
- Support airway/ventilation
Blocking vs. stimulating forms of this antibody can cause alternating thyroid states.
What are TSH receptor antibodies?
RAIU uptake <5% with anti-TPO antibodies and elevated thyroglobulin is seen in this condition
What is Thyroiditis?