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PANCE Prep Pearls: 3rd Ed. (2019) | Physician Assistant (PA) School Study Aid
Thyroid Gland
- Characteristics
- TSH Stimulates T3 and T4 Release
- Metabolism Regulation
- Blood Calcium Sensor
- Calcitonin Release
- Blood Calcium Decreases
- Bone Building
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
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
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
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
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 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
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
Propylthiouracil (PTU) and Methimazole (MMI)
- Indications
- Hyperthyroidism
- Mechanism
- Inhibits Thyroid Peroxidase
- PTU Blocks Peripheral Conversion of T4 to T3
- Side Effects
- Agranulocytosis
- Skin Rash
- Hepatotoxicity (PTU)
- Teratogen (MMI)
1 min
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
Levothyroxine
- Indications
- Hypothyroidism
- Myxedema Coma
- Mechanism of Action
- Isomer of Thyroid Hormone (T4)
- T3 has Higher Potency
- Side Effects
- Hyperthyroid Symptoms
57 secs
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
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
Follicular Thyroid Carcinoma
- Characteristics
- 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
Medullary Thyroid 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
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
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
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