Thyroid ´ëÀå°æ Á¤¸®
<ÃÑ·Ð>
1. TSH¿¡ ´ëÇÑ feedbackÀº T3°¡ ÁÖ·Î °ü¿©ÇÑ´Ù.
2. Àå±â°£ ¿ä¿Àµå¸¦ Åõ¿©Çϸé escape phenomenonÀÌ ³ªÅ¸³´Ù.
3. simple goiterÄ¡·á·Î thyroid hormone replace½Ã Ä¡·áÈ¿°ú ÆÇÁ¤ÀÇ ÁöÇ¥´Â? RAIU
4. thyroid scan
99mTc´Â Åõ¿©ÇÑÁö 30ºÐÀ̸é ÁÁÀº ¿µ»óÀ» ¾òÀ»¼ö ÀÖ´Ù.
thyroid scan¿¡¼ 131Iº¸´Ù 123IÀÌ ´õ ¹Ù¶÷Á÷ÇÏ´Ù.
5. ÀӽŽà TBG°¡ Áõ°¡ÇÏ¿© total T3, T4, rT3°¡ Áõ°¡Çϰí T3RU´Â °¨¼ÒÇÑ´Ù.
<Sick euthyroid syndrome>
6. NTI(non-thyroidal illness)º¸´Ù °©»ó¼± ±â´ÉÀúÇÏ¿Í ±â´ÉÇ×ÁøÀ» °í·ÁÇØ¾ß ÇÏ´Â ¼öÄ¡
°©»ó¼± ±â´ÉÀúÇÏ: TSH > 20 uU/ml
°©»ó¼± ±â´ÉÇ×Áø: TSH < 0.03 uU/ml + only moderately elevated T3, T4
<Hypothyroidism>
7. Hashimoto's thyroiditis¿¡¼ ½ÉÀåÅ©±â°¡ Á¤»óÀÏ ¶§ ÀǽÉÇØ¾ß ÇÒ »óȲ 2°¡Áö
i) pituitary hypothyroidism with secondary adrenal insufficiency
ii) coincident primary adrenal insufficiency(Schmidt syndrome)
8. TRH stimulation test°á°ú
primary hypothyroidism: Áõ°¡
pituitary hypothyroidism: subnormal response
hypothalamic : near normal
thyrotoxicosis: blunted or absent response
9. °©»ó¼± ±â´ÉÀúÇϽà T3°¡ T4º¸´Ù À¯¿ëÇÑ °æ¿ì
i) °©»ó¼±¾Ï ¼ö¼úÈÄ RIÅõ¿©Àü±îÁö ´Ü±â°£ Ä¡·á½Ã
ii) 5-deiodinase °áÇÌȯÀÚ
10. subclinical hypothyroidism Ä¡·áÀûÀÀÁõ
i) thyroid gland enlargement
ii) cholesterol¡è(ƯÈ÷ LDL/HDL > 3)
iii) exercise tolerance¡é
iv) mild CHF
<Hyperthyroidism>
11. Euthyroid hyperthyroxinemiaÀÇ ¿¹
: sick euthyroid syndrome, acute psychiatric illness, hyperemesis gravidarum
radiocontrast, propranolol, amiodarone, heparin, levothyroxine
12. T3 thyrotoxicosis¸¦ ÀÏÀ¸Å³¼ö ÀÖ´Â Áúȯ
Graves' disease, Multinodular goiter, hyperfunctioning adenoma
13. Graves' disease¿¡¼ º¼¼ö ÀÖ´Â ±ÙÁúȯ
i) chronic thyrotoxic myopathy
ii) thyrotoxic periodic paralysis
iii) exophthalmic ophthalmoplegia
iv) myasthenia gravis
14. Graves' disease¿¡¼ ALP´Â Áõ°¡µÇ¾î ÀÖ´Ù.
15. Graves' diseaseÀÇ precipitating factors
i) iodine excess
ii) viral or bacterial infection
iii) glucocorticoid withdrawal or stress
iv) parturition
v) lithium therapy
16. Graves' diseaseÀÇ Áö¼ÓÀû °üÇØ ¿¹ÃøÀÎÀÚ
i) goiter size°¨¼Ò
ii) TSH Á¤»óÈ ¶Ç´Â TRH stimulation test¿¡ Á¤»ó¹ÝÀÀ
iii) TRAbÀÇ ¼Ò½Ç
17. Graves' dsÀÇ ophthalmopathyÀÇ °ü¸®
ºÎÁ¾ÀÌ ÀÖÀ¸¸é ÀÌ´¢Á¦¸¦ Åõ¿©ÇÑ´Ù.
»ö¾È°æÀ» Âø¿ëÇÏ¿© ¹Ù¶÷, ºû, ¸ÕÁö¸¦ Â÷´ÜÇÑ´Ù.
¾ß°£¿¡ º£°³·Î ¸Ó¸®¸¦ ³ô¿©ÁØ´Ù.
18. Graves' disease¿¡¼ ÃÊ·¡µÉ¼ö ÀÖ´Â ´«ÀÇ º´º¯ 3°¡Áö
i) exophthalmopathy
ii) ophthalmoplegia
iii) congestive oculopathy
19. °©»ó¼± ±â´ÉÇ×ÁøÁõ¿¡¼ ¿ä¿Àµå(Lugol solution)»ç¿ëÀÇ ÀûÀÀÁõ
i) thyrotoxic crisisÀÇ Ä¡·á
ii) ¼ö¼úÀüóġ
iii) ÁßÁõ °©»ó¼± ±â´ÉÇ×ÁøÁõ¿¡¼ RI or antithyroid drugÀ¸·Î Ä¡·á½Ã ºü¸¥ È¿°ú¸¦ ¾ò±â À§ÇÑ
º¸Á¶¹æ¹ý
iv) Ç×°©»ó¼±Á¦°¡ ±Ý±âÀÎ ÁßÁõȯÀÚ¿¡¼ RAI Ä¡·áÀü¿¡ Áõ»óÀÇ ºü¸¥ È£ÀüÀ» À§ÇØ
v) ½ÉÇÑ ½ÉÀåÁúȯÀÌ µ¿¹ÝµÈ °æ¿ì
20. Graves' diseaseȯÀÚ¿¡¼ PTU·Î Ä¡·áÇÏ´ø Áß ¹ß»ýÇÑ agranulocytosis¶§
lithium carbonate¸¦ ÀϽÃÀûÀ¸·Î »ç¿ëÇÒ¼ö ÀÖ´Ù.
<goiter & nodular thyroid disease>
21. Toxic multinodular goiter
ophthalmopathy°¡ µå¹°´Ù.
thyrotoxicosisÀÇ Á¤µµ´Â Graves' diseaseº¸´Ù ´úÇÏ´Ù.
CHF³ª arrhythmia°¡ ÈçÈ÷ µ¿¹ÝµÈ´Ù.
long standing simple goiter°¡ ÀÖ´ø ȯÀÚ¿¡¼ »ý±â±â ¶§¹®¿¡ ³ëÀο¡¼ ´õ ÈçÇÏ´Ù.
22. thyrotoxicosisȯÀÚ¿¡¼ ½É¹æ¼¼µ¿½Ã warfarin¿ë·®Àº usual doseº¸´Ù Àû°Ô ¿ä±¸µÈ´Ù.
23. non-toxic diffuse goiter°¡ ÀÖ°í TSH°¡ »ó½ÂµÇ¾î ÀÖÀ» ¶§ T4Ä¡·á°¡ À¯¿ëÇÏ´Ù.
<Neoplasms>
24. FNA»ó ¾ÏÀ» ½Ã»çÇÏ´Â Á¶Á÷¼Ò°ß
follicular cell clumping, psammoma body, orphan annie eye cell
cf. follicular cell cytoplasmÀÇ acidophillic degenerationÀº ¾Æ´Ô
25. thyroid cancer¼ö¼úÈÄ Àç¹ßÀÇ 10%¿¡¼´Â TgÀÌ Á¤»óÀ̹ǷΠTgÀÌ Á¤»óÀÌ´õ¶óµµ Àç¹ßÀ»
¹èÁ¦ÇÒ ¼ö´Â ¾ø´Ù.
anti-Tg Ab°¡ ¾ç¼ºÀÎ °æ¿ì´Â Tg³óµµ¸¦ Á¤È®È÷ ÃøÁ¤ÇÏ´Â °ÍÀÌ ºÒ°¡´ÉÇÏ´Ù.
26. thyroid adenoma
Á¤ÀÇ: follicular cell·Î ±¸¼ºµÈ solitary encapsulated nodule
solitary thyroid noduleÀÇ °¡Àå ÈçÇÑ ¿øÀÎÀÌ´Ù.
follicular adenoma°¡ °¡Àå ÈçÇϰí papillary adenoma´Â ¸Å¿ì µå¹°´Ù.
malignancy¿Í °ü°è¾ø´Ù.
27. MCTȯÀÚ¿¡¼ calcitoninÀ¯¹ß°Ë»çÀÇ ºÐºñÀÚ±ØÁ¦·Î °¡Àå ¸¹ÀÌ ÀÌ¿ëµÇ´Â °Í 2°¡Áö?
: calcium, pentagastrin
28. MCT: Çö¹Ì°æ»ó amyloid°¡ ħ¹üµÈ ¼Ò°ßÀ» º¸ÀδÙ.
29. follicular carcinoma¼ö¼úÈÄ s-TgÀÇ Áõ°¡¸¦ º¸¿© 131I-WBSÀ» ½ÃÇàÇÏ¿´À¸³ª Ưº°ÇÑ º´¼Ò°¡
³ªÅ¸³ªÁö ¾Ê¾Ò´Ù. ´ÙÀ½¿¡ ÇÊ¿äÇÑ °Ë»ç? bone scan, chest X-ray
30. 131I WBSÀÌ Á¤»óÀÏ ¶§ °í·ÁÇÒ¼ö ÀÖ´Â ÇÙÀÇÇÐÀû ¿µ»ó¹æ¹ý?
201Tl, 99mTc-sestamibi, 99mTc-tetrofosmin, PET
31. oncogene
papillary cancer: RET gene rearrangement
medullary cancer: RET gene point mutation
follicular cancer: MET gene overexpression
<Thyroiditis>
32. subacute thyroiditis
40´ë ¿©ÀÚ¿¡¼ ºóµµ°¡ ³ô°í HLA-B35¿Í ¿¬°üÀÌ ÀÖ´Ù.
33. Graves' disease¿Í postpartum thyroiditisÀÇ °¨º°¿¡ ÇÊ¿äÇÑ °Ë»ç?
: RAIU, TSI, urinary iodine excretion
34. postpartum thyroiditis
IDDMȯÀÚ 25%¿¡¼ ¹ß»ýÇÑ´Ù.
´ÙÀ½ Ãâ»ê½Ã Àç¹ßÀ» ÀßÇÑ´Ù.
35. thyrotoxic periodic paralysis
ÀþÀº µ¿¾ç°è ³²ÀÚ¿¡°Ô ÈçÇÏ´Ù.
±Þ¼º ¹ßÀ۽ÿ¡´Â KÅõ¿©°¡ µµ¿òÀÌ µÇ°í, ¥â-blocker°¡ ¹ßÀÛÀÇ ºóµµ¿Í Ƚ¼ö¸¦ ÁÙÀδÙ.
acetazolamide°¡ ¿¹¹æ¿¡ µµ¿òÀÌ µÇÁö ¾Ê´Â´Ù.
36. Pendred syndrome
partial organification defect + overt or subclinical hypothyroidism
severe sensorineural hearing loss