USMLE Internal Medicine Review 10 02 Introduction To Thyroid Disorders

USMLE Internal Medicine Review 10 02 Introduction To Thyroid Disorders

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Begin 10 02 Introduction To Thyroid Disorders Transcription

First we’ll talk briefly about disorders of the thyroid in general and then on Hypo and hyperthyroidism. Patients with thyroid disease usually present complaining of one or more of four conditions.

First, which thyroid abnormality that can either be diffuse or nodular?

  • Thyroid enlargement.

Second, present with symptoms of thyroid deficiency referred to as what condition?

  • Hypothyroidism.

Third, with symptoms of thyroid hormone excess called what condition?

  • Hyperthyroidism.

And fourth, complications of which specific form of hyperthyroidism whose symptoms may include striking prominence of the eyes or more rarely thickening of the skin over the lower legs?

  • Graves’ disease.

What is the clinical term for striking prominence of the eyes?

  • Exophthalmos.

And the term for the thickening of the skin over the lower legs?

  • Thyroid dermopathy.

Student doctor please pause the tape and repeat the four conditions with which a patient with thyroid disease may present.

  • Patients with thyroid disease usually present complaining of thyroid enlargement, either diffuse or nodular, symptoms of thyroid deficiency or hypothyroidism, symptoms of thyroid hormone excess or hyperthyroidism, or with complications of graves disease whish may include striking prominence of the eyes, exophthalmos, or more rarely thickening of the skin over the lower legs, thyroid dermopathy. History of the patient with thyroid disease should include evaluation of symptoms related to the four presenting complaint along with questioning for certain risk factors for thyroid disease.

Exposure to what type of radiation in childhood has been associated with an increased incident of thyroid disease including cancer?

  • Exposure to ionizing radiation.

Iodide commonly ingested in what two forms may induce goiter, hypothyroidism or hyperthyroidism?

  • Iodide ingested in the form of kelp tablets or iodide containing cough preparations.

By what action can large amounts of iodide cause hypothyroidism?

  • Large amounts of iodide can cause hypothyroidism by blocking thyroid hormone synthesis.

And which anti-rheumatic and antilithic agent also used in the treatment of bipolar effective disorders can also induce the same conditions?

  • Lithium carbonate.

Family history should also be explored for goiter, hypo or hyperthyroidism, as well as for immunologic disorders such as the following six:

First, a condition of hair lose starting with a?

  • Alopecia.

Second, which chronic progressive form of anemia occurring mostly in older adults due to failure to absorb vitamin B12?

  • Pernicious anemia.

Third, which form of arthritis more common in female affecting the connective tissues?

  • Rheumatoid Arthritis.

Fourth, a common metabolic disease in which carbohydrate utilization is reduced in lipid and protein enhances in severe cases, this disease is characterized by glycosuria, hyperglycemia, ketoacidosis, and water and electrolyte lose.

What is the condition?

  • Diabetes.

Fifth, a disorder of neuromuscular transmission marked by fluctuating weakness especially in ocular facial and proximal limb muscles?

  • Myasthenia Gravis.

And sixth, the term for the appearance of otherwise normal skin of nonpigmented white patches of different sizes often symmetrically distributed and bordered by hyperpigmented areas?

  • Vitiligo.

Student doctor please pause the tape and summarize six immunologic disorders to inquire after in the family history of a patient with thyroid disease.

  • Family history of the patient with thyroid disease should be explored for goiter, hypothyroidism and hyperthyroidism, as well as for immunologic disorders including alopecia, pernicious anemia, rheumatoid arthritis, diabetes, myasthenia gravis, and vitiligo. Considering now a physical examination of a patient with thyroid disease.

The thyroid is firmly attached to the anterior trachea midway between which two structures?

  • They thyroid is firmly attached to the anterior trachea midway between the sterna notch and the thyroid cartilage.

Please pause the tape and summarize in your own words three maneuvers for physical exam of the thyroid.

  • The patient should have a glass of water with a good light source behind the examiner the patient is asked to swallow a sip of water.
  • First, observe the thyroid gland as it moves up and down. Enlargement and nodularity can sometime be noted.
  • Second, palpate the gland anteriorly while gently pressing down with one thumb on one side of the gland to rotate the other lobe forward. Palpate as the patient swallows.
  • Third, palpate the gland from behind the patient with the middle three fingers on each lobe while the patient swallows. An outline of the gland can be traced on the skin of the neck and measured for reference. Nodules can also be measured this way.

The palpable bulbous portion of each lobe of a normal thyroid gland measures about what dimensions?

  • A normal thyroid measures about 2 cm vertically and 1 cm horizontally above the isthmus.

What’s the general term for an enlarged thyroid gland?

  • Goiter.

Generalized thyroid enlargement is called diffuse goiter while irregular or lumpy enlargement is referred to how?

  • As nodular goiter.

****END OF TRANSCRIPTION****

 

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