hypothyroidism + hyperparathyroidism

Question 1

What is hypothyroidism?

Answer 1

A congenital or acquired deficiency of thyroid hormone (TH).

Question 2

What are the main causes of hypothyroidism?

Answer 2

Lack of thyroid gland development, deficient synthesis of TH, destruction of thyroid gland, impaired secretion of TSH or TRH.

Question 3

What are other potential causes of hypothyroidism?

Answer 3

Autoimmunity, genetic defects, injury to the gland, iodine deficiency.

Question 4

What is Hashimoto thyroiditis?

Answer 4

Autoimmune hypothyroidism that can destroy the thyroid gland; the most common form of hypothyroidism.

Question 5

How does hypothyroidism typically present clinically?

Answer 5

“Low and slow” – fatigue, weakness, lethargy, weight gain, cold intolerance, constipation, dry skin, coarse hair, impaired reproduction, impaired memory, goiter, myxedema.

Question 6

Why is hypothyroidism sometimes described as “low and slow”?

Answer 6

Because metabolic processes slow down due to low thyroid hormone levels, leading to fatigue, weakness, lethargy, and cold intolerance.

Question 7

What specific signs are unique to hypothyroidism?

Answer 7

Myxedema

Question 8

How is hypothyroidism diagnosed?

Answer 8

History and physical examination, laboratory studies.

Question 9

What lab values are typical in hypothyroidism?

Answer 9

TSH: high; T3: low; T4: low.

Question 10

What additional labs may be checked for hypothyroidism?

Answer 10

Thyroid autoantibodies, including antithyroglobulin antibodies.

Question 11

What is the main treatment for hypothyroidism?

Answer 11

Lifelong thyroid hormone replacement therapy.

Question 12

What is the most common medication used for treatment for hypothyroidism?

Answer 12

Levothyroxine (Synthroid).

Question 13

What is hyperparathyroidism?

Answer 13

A condition where there is an increase in parathyroid hormone (PTH).

Question 14

What does PTH do in the body?

Answer 14

Regulates serum calcium and phosphate levels by stimulating bone resorption for calcium, renal tubular reabsorption of calcium, and activation of vitamin D.

Question 15

What happens when PTH is overproduced?

Answer 15

Elevated serum calcium levels (hypercalcemia) and decreased phosphate levels (calcium and phosphate are inversely related).

Question 16

What are the types of hyperparathyroidism?

Answer 16

Primary, secondary, and tertiary.

Question 17

What is primary hyperparathyroidism?

Answer 17

Increase in PTH secretion causing problems with calcium, phosphate, and bone metabolism; most commonly due to a benign parathyroid tumor.

Question 18

What is secondary hyperparathyroidism?

Answer 18

Compensatory response to hypocalcemia from vitamin D deficiency, malabsorption, CKD, or hyperphosphatemia.

Question 19

What is tertiary hyperparathyroidism?

Answer 19

Hyperplasia of the parathyroid gland with loss of negative feedback from circulating calcium; may occur in kidney transplant patients after long-term dialysis.

Question 20

What are common clinical manifestations of hyperparathyroidism?

Answer 20

Many patients asymptomatic; symptoms due to hypercalcemia include loss of appetite, constipation, fatigue, emotional disorders, short attention span, and muscle weakness.

Question 21

What complications can arise from hyperparathyroidism?

Answer 21

Osteoporosis, renal failure, kidney stones, pancreatitis, cardiac dysrhythmias, fractures of long bones, ribs, and vertebrae.

Question 22

What lab values are seen in hyperparathyroidism?

Answer 22

PTH: increased; Ca: increased; Phosphate: decreased. Other labs: increased urine Ca, Cl, uric acid, creatinine, amylase, alkaline phosphatase.

Question 23

What imaging is used for hyperparathyroidism?

Answer 23

CT or MRI to identify parathyroid tumors and determine the type.

Question 24

What is the main goal of hyperparathyroidism treatment?

Answer 24

Prevent complications and manage symptoms.

Question 25

What is the primary treatment for hyperparathyroidism?

Answer 25

Surgery – partial or full removal of parathyroid gland; may include autotransplantation of normal tissue.

Question 26

What are considerations after parathyroid surgery?

Answer 26

Rapid reduction in calcium levels; may require lifelong calcium replacement; risk of developing hypoparathyroidism.

Question 27

What are nonsurgical treatment options for hyperparathyroidism?

Answer 27

Watch-and-see approach if calcium is controlled and symptoms are minimal.