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Thyroid- Iodine Def, nodules, displasia
Terms in this set (29)
Effects of Iodine deficiency disorder on the fetus
Stillbirth, abortions, congenital anomalies, increased perinatal mortality, endemic cretinism (lower IQ).
Iodine deficiency in neonates
Neonatal goiter and hypothyroidism, endemic mental retardation, increased susceptibility of the thyroid gland to nuclear radiation.
Iodine deficiency in child and adolescent
Subclinical hypothyroidism, impaired mental function, retarded physical development, increased susceptibility to nuclear radiation.
Iodine deficiency in the adult
Goiter, hypothyroidism, impaired mental function, spontaneous hyperthyroidism in the elderly, iodine-induced hyperthyroidism, increased susceptibility to nuclear radiation.
Geographical areas of worse iodine deficiency
Rivers and mountains, former glacier areas
Mild iodine deficiency
Normal TSH but still improved IQ with iodine. Test urine for iodine (not TSH), follicules surrounded with flattened cells, increased tranpping of iodine, upregulated sodium-potassium symporter (NIS).
What diet elements compund iron deficiency?
Thiocyanate, contained in cassava, limits entry of iodides in thyroid. Basis of drugs for thyrotoxicosis.
Percentage of people worldwide with iodine deficiency?
How many people suffer from cretinism/mental impairment from iodine deficiency worldwide?
11.2 million have overt cretinism and 43 million have mental impairment worldwide.
Effects of iodine deficiency on population IQ
Would increase average 10 points
ICCIDD (International Council for the control of Iodine Deficiency Disorders)
Established to bridge gap between knowledge of iodine deficiency by su-pporting programs. Multidisciplinary between scientists, public health workers, and technologists. cooperation with WHO and UNICEF, Kiwanis and other philanthropic organizations. Montior programs.
Daily iodine dietary requirements
50-200mcg/day, higher for infants and pregnant anad breastfeeding women (brain and thyroid development), but not more than 500mcg/day.
Indications of Iodine deficiency
Goiter in school children, thyroid volume (physical exam or ultrasound), median urinary iodine (most common), high TSH levels.
Urinary iodine levels
<20 insufficient (severe iodine deficiency), >200 risk of iodine induced hyperthyroidism
Observe the thyroid cartilage above the cricoid cartilage, above the thyroid gland. Should rise with swallowing. Nodules and goiter will move with swallowing, cancerous nodule will stay put while thyroid rises. Consistency rubbery similar to sternomastoid muscle.
1. Salt iodization>90%, 2. School children with goiter <5%, 3. Urinary iodine 100-200 median mcg/L.
Which country has the highest prevalence of iodine intake?
Painful thyroid disorders
Subacute thyroiditis, radiation thyroiditis, Acute suppurative thyroiditis, hemorrhage into thyroid nodule or cyst.
Viral infection of thyroid gland, affects production and storage of TH so that TH passively diffuses into bloodstream. Causes fever ("of unknown"), malaise, neck pain, increased erythrocyte sedimentation rate, possible thyrotoxicosis. Often misdiagnosed as throat infection, but blood tests until fever doesn't go down show low TSH, high T4, T3 and thyroglobulin. Radioiodine uptake test is low indicating a destructive process. Cyclic thyrtoxicity and hypothyroidism lasting 6-8 weeks each. Continue to be hypothyroid over time. Give TH and retest later.
Classic triad of subacute thyroiditis
Fever, thyroid pain, and high ESR (erythrocyte sedimentation rate)-only high in thyrotoxic phase.
Similar to subacute, thyrotoxicosis and hypothyroidism in 6-8 week cycle. Autoimmune (probably), not painful, can happen postpartum.
Multiufactorial disorder, large follicules, different sizes with abundant colloid, cystic and hemorrhagic degeneration, incomplete capsule surrounding nodules, pseudopapilla may be found.
Nonmalignant nodules. May be hot (toxic) or nontoxic. Complex capsule compressing adjacent tissue, different histologic pattern inside and out of capsule. Cystic, degenerative and hemorrhagic changes may be present, various cytologic types. Indistinguishable from follicular carcinoma by FNA (fine needle aspiration).
Types of malignant thyroid tumors
Epithelial cell tumors and nonepithelial cell tumors
Nonepithelial cell tumors
Medullary thyroid carcinoma of C cells, 5-10% of thyroid tumors.
Types of epithelial cell tumors
Well differentiated and poorly/undifferentiated
Well differentiated epithelial cell tumors
Papillary thyroid carcinoma (spreads through lymphatic system), follicular cell carcinoma (hematogenic spread).
Poorly undifferentiated epithelial thyroid tumors
Anaplastic (5-10%) uncommon but no cure.
Tests of thyroid cancer metastasis
1. Ability of NIS to let iodine into cell. Diagnosis with radioactive iodine: cold nodule can be cancer, do a FNA to make sure. If so, remove thyroid and inject radioiodine again to detect metastasized cells. Dependent on NIS still working in metastasized cells. 2. Blood test to see if there is thyroglobulin in the body from metastasized cells. 3. Increase TSH levels and retest thyroglobulin (TSH also used as treatment to inhibit growth of cancer cells).
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