¼±Åà - È­»ìǥŰ/¿£ÅÍŰ ´Ý±â - ESC

 

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