Gen Thyroid 1
Gen Thyroid 2 / Treatment
Treatment
Nodules & Goiter
Thyroid Cancer
100

Most common cause of primary hypothyroidism

Hashimoto (chronic lymphocytic) thyroiditis

100

Describe lab pattern for nonthyroidal illness syndrome

Low TSH, low or normal fT4 and T3 (in setting of critical illness)

100

Treatment for myxedema coma, other than supportive measures

IV T4 + steroids (hydrocortisone)

- exclude concurrent adrenal insufficiency

100

Next step for incidental thyroid nodule >1cm associated with low TSH

Radioactive iodine uptake scan (suspicious for autonomously functioning adenoma)

- confirmed hot nodules do not need FNA

100

This form of thyroid cancer is the least common, making up 4% of all cases, and may be associated with MEN 2A & 2B

Medullary thyroid cancer

200

This specific blood pressure abnormality is associated with hypothyroidism

Diastolic hypertension

200

In nonthyroidal illness syndrome, TFTs normalize in _____, after recovery from acute illness

4-8 weeks

200

Expected Levothyroxine dose change during pregnancy

Increase by 30-50%, usually 1st trimester

200

Next step for incidental thyroid nodule & normal or high TSH

Thyroid ultrasound

- if high-risk features, proceed to FNA

200

Strongest environmental risk factor for thyroid cancer

Radiation exposure to thyroid during childhood (<15 yrs old, but especially <5 yrs old)

300

Name 3 potential triggers for myxedema coma

Acute medical event, surgery, opiates

300

Frequency of thyroid function testing in pregnancy

Every 4 weeks

300

Name 2 patient groups where you would "start low and go slow" with Levothyroxine dosing

Age >60 years, history of CAD

300

Indication for thyroidectomy in multinodular goiter with no evidence of malignancy

Local compressive symptoms (airway, esophageal, neurovascular)

300

Treatment for medullary thyroid cancer

Total thyroidectomy + central neck dissection

400

Name 3 causes of medication-induced hypothyroidism

Lithium, interferon, IL-2, amiodarone, iodine

400

Levothyroxine should be taken _____ and at least _____ before food

on empty stomach; 1 hour

400

Recommended Levothyroxine start dose for hypothyroid patients <60 years old

1.6 micrograms/kg/day

400

Name at least 2 treatment options for hyperfunctioning solitary thyroid nodules

Radioactive iodine ablation, surgery, methimazole

400

This test is recommended before surgery in medullary thyroid cancer, to exclude MEN-associated pheochromocytoma

RET proto-oncogene testing

500

Name 3 possible consequences of overt/untreated hypothyroidism in pregnancy

Fetal neurocognitive impairment, premature birth, low birth weight, increased risk of miscarriage, increased risk of fetal death

500

Name 3 OTC supplements/meds that can interfere with Levothyroxine absorption

Calcium, iron, PPIs, psyllium

500

Name 3 indications for treating subclinical hypothyroidism

TSH >10, symptomatic, pregnant or planning pregnancy

500

Name 3 high-risk ultrasound findings for a thyroid nodule that would indicate FNA

microcalcifications, irregular margins, hypoechoic

500

In addition to thyroidectomy/lobectomy and levothyroxine suppression, radioactive iodine therapy is used to treat non-medullary thyroid cancer for these 3 indications

Extrathyroidal extension, metastatic disease, poorly differentiated/aggressive histology