DIP Episode 251 - The HY Thyroid Podcast (For Step 1-3)

Okay, welcome. My name is Divine. This is episode 251 of the Divine intervention podcasts and then this podcast I'm going to be talking about a topic that I just feel like. I don't know for whatever bizarre reason a lot of myths to them just kind of give these questions wrong and they're really not hard. They're pretty straightforward right so I'm gonna kind of like spend quite a bit of time on this. I'll hopefully try to keep it under 30 minutes because I also need to run to church but I just figured out me a podcast on thyroid.

Basically if you listen to this podcast and you master everything in this podcast then you should be in a very good situation from any kind of thyroid question that you see on an MBM exam right so let's go ahead and talk through the thyroid right so the first thing is if we look at things that embryologically right so we know that the thyroid kind of comes from the you know the base of the tongue right is this part of the tongue called the foreman's see come right the foreman see come so the foreman's see come you know it's at the back of the tongue and there is this thing called the thyroid glossol doc right that kind of props down from that right and remember this is all endoderm derived right so you know the thyroid glossol doc kind of comes down from there and then he balloons out and then we found this thyroid well the highway that got the thyroid is to where it is right you know it's supposed to disappear right so it's supposed to disappear that thyroid glossol doc highway should go away right but if it doesn't go away then the person gets into problems so how would they throw that on an MBM exam well one way they can throw this on an MBM exam is they can give you a question about a person you know that has like a neck like a neck mass right that moves with swallowing right if you see that hopefully you're thinking about like some kind of thyroid glossol doc says right and again remembers in the midline right it's in the midline so it's in the midline and it will move with swallowing right that's going to be a thyroid glossol doc says and typically for those thyroid glossol doc says usually the smart thing to do right because whenever something is cystic this is just one of these very nice general principles in the body if something is cystic although this is not always true but most of the time it is right for president has a cyst the smart thing usually to do

is to do some kind of aspiration of that cyst right you know you'll find an ultrasound probe find that cyst and then you put in a needle and treto as for example that cystic fluid and say that for for cytology right but again remember this is endodermeterate right because one thing your friends at the MBM can do to you is you know they can say hmm how about we give you a question about a person that has like again this neck mass right but again it's lateral to the midline and it does not move with swallowing if you see that I would really really hope you're thinking more along the lines of a brink your cleft cyst right and the thing is the your friends at the MBM they really really love seeing if you can really tease apart these brink your cleft cysts and these thyroid glossol doc says right so like for example what are some cellular differences between these 10s one a thyroid glossol doc says in the midline right but brink your cleft cyst is lateral to the midline right two a thyroid glossol doc says moves with swallowing a brink your cleft cyst does not move with swallowing right three a thyroid glossol doc says is derived from endoderm right it's derived from endodermal structures but a brink your cleft cysts if you remember it's derived from those pharyngeal grooves or pharyngeal clefts those are ectodermal derivatives right so those are ectodermal derivatives but remember that also if a brink has a thyroid glossol doc says right the buzzword embryologic pathophysiology mission your test right is field obliteration of the thyroid glossol doc although again if the MBM wants to be mean on a given day instead of saying oh field obliteration of a thyroid glossol doc because they know if they put that right every human being every human being that has the job description met student you know we'll get the question right so what what they will do at least what I will do

if I were writing MBM questions is to say field obliteration of an endodermal derivative right right versus brink your cleft cysts where you have field obliteration of the second through the fourth pharyngeal clefts of pharyngeal grooves right the same thing pharyngeal groove pharyngeal cleft means one on the same thing they are both derived from ectoder right they both derived from ectoder so that's one nice thyroid pathology that you can throw in on on exams right and then one of the classic thing is you're in a test right give your question about a person right and they'll say oh this person like this person when you were taking a shower or when you were wearing their tie or whatever they notice like a lump in the throat right that's basically like a thyroid nodule question right again thyroid nodule questions these are probably the most common thyroid questions involving thyroid nodules in my experience they are probably the most common thyroid kind of question that shows up on MBM exams right that shows up on MBM exams right so what do you want to keep in mind with these thyroid nodules right you want to know that the very first thing you should do right is to go ahead and get a TSH level right go ahead and get a TSH level right because the TSH level will guide what you do next right if the TSH is low right then that means there must be some hyperthyroid state that's causing that problem right and the TSH is low you know you're dealing with a hot nodule if you get any other kind of result it doesn't matter what it is TSH is normal TSH is high blah blah blah like no one cares that's a cold nodule right that's a cold nodule so let's maybe talk about the easier thing first and they won't go to the more complex thing right so you'll notice a thyroid nodule first thing you do is you check the TSH the TSH is again a result that is not low like anything like again reme

mber easy way to differentiate this there's a pile of TSH is low and then there's a pile for everything else if you're in the everything else pile the next thing you want to do for those people is you get an ultrasound to visualize the module then after you get an ultrasound to visualize the module you then do like a finite old aspiration of that module right just to see like what is going on here right the thing is for most people that have cold thyroid nodules right typically it's from a colloid cyst that causes about 75% of cases of thyroid nodules right but the thing is about 20% if I'm not mistaken at least from the reading I've done like from back in the day about the thyroid cancers right so thyroid cancers you know you kind of need to you don't have some kind of crystal ball that says this nodule I'm feeling this looks a lot like colloid cysts no there's no way you can do that right so that's why you need to biopsy those things just to make sure that you're not dealing with with a malignancy however if the TSH is low that tells you you have a hot module right you have a very hot module well so when you see a hot module you're like ooh TSH is low your next step when you're a test is to go ahead and do something called a rio scan right that rio scan is what is known as the radioactive iodine optic scan right the radio active iodine optic scan right and there are many different patterns you can see right so one pattern you can see is the container that oh the entire thyroid gland is hot right if the entire thyroid gland is hot if you see like increased optic in the entire thyroid gland right on it on a rio scan then you know that there must be something that is causing a global thyroid gland stimulation right something that may be like a TSH receptor agonist right potentially like a person that has grieves disease remember grieves disease is the most common cause

s very high autonomous the most common cause of hyper thyroidism in the US or at least on USMLA exams right so um so you know if you see global like global increase in optic that's gonna be a grieves disease right that's gonna be grieves disease and what do we do for people that have grieves disease well grieves disease right typically they'll they may try to ask you to you know if you're trying to choose some kind of temporizing measure you know you can give them some kind of anti thyroid medication like PT you are methamazone and again remember those things crush the presence are white blood cell counts so they can cause like a granulose cell so you give PT you methamazone right but ultimately the definitive therapy is radioactive iodine therapy right you give the present i131 and that will oblique the presence thyroid gland they'll try to trick you on your exam into picking a thyroid dectomy do not I'll see this right now do not pick a thyroid dectomy as treatment for grieves disease if you do that I am assuring you you will get the question wrong on your test and then one thing I guess I forgot to mention since I was talking about thyroid and rheology and they'll come back to this hot nodulesis remember that most times right if if they tell you that oh a person has like like they may give you like a question where they'll say oh you don't see that the person comes in with you know for some other like medical indication and then you know they do like a city of the neck or whatever and you don't find the thyroid gland but then like the person's TSC is fine T3 T for everything is fine and then they ask what is the most likely diagnosis or whatever right I'll really hope in those circumstances you're thinking about something called a lingua thyroid right remember the most common location of a topic thyroid tissue is in the tongue right because literally it descends fro

m the tongue right so lingua lingua thyroid that's actually something that's pretty high yield pretty high yield to know for exams right and then there's one other thing I wanted to talk about with fire oh if you see a newborn with hypothyroidism right again something they can throw in on the test if you see a newborn with hypothyroidism the thyroid gland just did not form or you formed well right that's what's known as thyroid these genesis remember that's the most common cause of hypothyroidism you know in newborns right and remember that if you see a newborn with hypothyroidism that newborn is going to have like an umbilical hernia in the question that newborn is going to have like a big tone it's going to have microglossia right in the q-stem right so again just all things you want to keep at the back of your mind on exams right if you're like with this podcast I keep expanding the backs of people's minds but anyhow it doesn't matter who cares right we're all trying to learn here okay so back to back to and actually one other thing with this hypothyroidism in newborns if your mom is taking p2 and methamasol well she's pregnant with you right those things can transiently suppress thyroid hormones synthesis in those cases right I mean there's a reason why p2 and methamasol are teradogens in the first place remember because your pleasure could this right the reason that the teradogens because I mean if your teradogens it means they must be able to cross the blood placental barrier right in some way shape of form right so you know those kids when you when those kids are delivered people freak out like oh this kid is hypothyroid just you know kind of chill for a couple of days um do like a repeat newborn screen and you'll notice that the child's tsh t34 should be fine after those drops kind of weird way from the child's up from the child's system okay so back to the ho

t nodos right so we said one pattern will be diffusing up diffusing crazy and optic on a ryan scan right and we said that oh that's pretty classic for for a greased disease right now what if they tell you that you see one hot spot in the in a on a ryan scan if you see one hot spot i'll really hope you're thinking about like a toxic had a normal right and you may see divine why is there one hot spot why is the rest of the thyroid plan not hot well think about it the thing is you have a population of cells that are not responsive to normal signals they've all actually essentially like gonorrhobe right so you have this small population of cells right they're secreting all the thyroid hormone well if the presence thyroid hormone is being secreted right the t34 be elevated that t34 will suppress the presence in dodging of tsh right and if you saw press the presence in dodging of tsh right and you'll notice that okay well if tsh is not around you're not gonna be stimulating them the remaining normal thyroid tissue so those will have decreased optic on a ryan scan right if they told you that oh you some multiple hot spots on a ryan scan right that's basically like multiple toxic hadinomas but you know we give it a different name in medicine we call it a toxic multi-modular right multiple nodes right toxic multi-modular goiter and then tell me person has a thyroid module we notice that like man there's no increase in in optique in the presence of thyroid gland right and let's say the person you know maybe recently had like an operator infection right and it tells you that oh this person has an explicitly thinned their thyroid gland right if you see that right i'll hope you're thinking about like the cravings thyroiditis although you know as many things in medicine you know we try to not use just one name for things you know want to make exams as hard as it needs to be so we g

ive it multiple names so it can be the cravings thyroiditis on your test it can be subacute thyroiditis on your test it can be ground on lomoidus thyroiditis on your test those are all different things you use for the exact same pathology on on an MD in the exam so just things you want to watch out for right so but one classic thing i think i love to bring out here is or sometimes your friends at the mbm is you know love to do on exams is to see if you can differentiate between the cravings thyroiditis and a person that is snacking on scentroid right a person that is factitiously taking thyroid hormone right so you know maybe one of you met students that are listening to me you're like oh you know what i don't really feel like going to the hospital today let me just think that i'm hyperthyroid or something so that they can be like oh stay home you're sick you're sick right so you find like some illegal store by not not condoning this is obviously bad behavior right but you know you'll find some way or maybe you find like grandma's and thyroid and you take it right to boost your metabolic rate or whatever or let's say it's a weak lifter right the i mean they love to give these questions in health care workers right but you know you can also be a person that is you know trying to lose weight right anorexic style they can easily meet this a psych question right anorexic style bulimic style patient right presents trying to lose weight sticking something that would hopefully increase their metabolism right if you see that you want to think about a person that has a factitious hyperthyroidism now you may say divine why would they want to see if you can differentiate the cravings thyroiditis from factitious hyperthyroidism on an endemic well let me explain if you think about it right i said that the cravings thyroiditis right obviously what happens in the quervancies you hav

e like some big time inflammation right there's a ton of macrophages big time inflammation of the presence thyroid right if you inflame the thyroid gland right you're gonna release all that preformed thyroid hormone right when you release all that preformed thyroid hormone the person will be hyperthyroid but that preformed thyroid hormone you release guess what it will kill the person's TSH if you kill the TSH you're not gonna stimulate the thyroid gland so the thyroid gland will be cold on a riu scan but think about it you will also get the exact same result if you're snacking on centroid if you're snack on centroid your thyroid hormone levels will be high that will kill the TSH you'll also have a cold thyroid on a riu scan right you have no optic on a radioactive iodine optic scan so how do you differentiate between those two things this is where your friends at the mbme and the thing is let me give you that question right here well enough to read the wound volunteer the information about the tender thyroid gland or the recent viral respiratory infection and stuff like that right just to try to mess with your head and see if you really know what's going on I would really hope on that those circumstances that you're thinking more along the lines of looking for something that is like a CPAP type in the thyroid gland right remember you know the classic question of insulinoma versus smacking on insulin right you can easily differentiate those things by just checking the CPAP type levels well there is something that is a CPAP type in the thyroid gland and it's called thyroid and one thing I'll just go ahead and say here please do not confuse thyroid gland with thiroxin binding globulin do not confuse those two things they are two totally different things right so thyroid gland is the CPAP type of a thyroid gland right so if a person is snacking on centroid that centroid

does not contain that's like the thyroid hormone bad or drugstore that is that will not those people's thyroid gland levels will be like barely detectable but if a person is having like release of endogenous thyroid hormone right because they have dequeurvings right the t3 t4 will be elevated right but the thyroid gland levels will also be elevated as well right so again that's a high-ealth thing to know to know for example right and then if they give you a question about a person that again has like signs and symptoms of hyperthyroidism right and they have like decreased optic on a rius scan right in detail that all this person has an annexel mass right I really hope on that those circumstances you're thinking about like a that's making a ton of a thyroid hormone right like a stromal viri right so stromal viri those are ovarian masses contain a topic thyroid tissue they'll make a ton of thyroid hormone right I mean I wouldn't necessarily see yeah they make a ton of thyroid hormone right that thyroid hormone also prestige so the person's like legit thyroid gland will not be stimulated right so again just all things you want to keep at the back of your mind for example right so that's how you approach a thyroid nodules and I guess since where we kind of talked about the cold thyroid nodules let's just say a few quick words about these thyroid cancers there's a very core set of things they always test all the time right so first thing they love to test right they can give you a question about a person that has an annexel mass right and then they be say oh um biopsy reveals like blah blah blah blah like papillary thyroid cancer and then they'll ask what is the biggest risk factor for this person's condition I'll really hope that you're telling me that the biggest risk factor for thyroid cancer right especially like papillary thyroid cancer is a prior history of a head an

d neck radiation so you may be a person that I don't know maybe they have like lymphomas like Hodgkin's as a kid and then they got like radiation to the head and neck and then they have like this rapidly expanding neck mass if you see that you want to think about papillary thyroid cancer right remember papillary thyroid cancer is very popular right it's the most common kind of thyroid cancer and don't forget that it's one of those pathologies on nbim exams that classically will be associated with some homopodys remember those things that we affectionately refer to in the world of medicine as a laminated calcifications right and remember those are not the only things that have some homopodys right remember that musotheliumus also have some homopodys main angiomas also have some homopodys serocystatinocrystinomas of the ovary also have some homopodys right so papillary thyroid cancer again key things some homopodys remember those anti-ofen any any nuclei right that you'd find right and one thing that your friends at the nbim love to go after is they love to see if you can differentiate between the mechanism of spread of papillary thyroid cancer versus follicular thyroid cancer right follicular thyroid cancer loves to spread via the bloodstream it spreads hematogenously right contrast this with papillary thyroid cancer that loves to spread through lymphatic channels right so it does not spread hematogenously right it does not spread and what is one nice way you can actually go after this on a test really can give you a question about a person with thyroid cancer that has metastasized to the brain I would really hope on other circumstances that you'll be thinking more along the lines of follicular thyroid cancer right again many of the all the thyroid cancers can metastasized to the brain but if they want to be mean they will just give you that question put papillary thyr

oid cancer as an answer put follicular thyroid cancer as an answer and then put a bunch of bogus answers that you're like yeah this this doesn't fit right big follicular thyroid cancer because again if something can go hematogenously right then it's something that you know potentially could go to the brain I mean think of Choreocardcinoma for example Choreocardcinoma right it's one of those ovarian cancers that just loves loves loves hematogenous spread right that's why it can go to the brain go to the lungs go to all these like weird parts of the body right so follicular thyroid cancer that's probably like it's big clean to feed on nbim exams although it has a worse prognosis than papillary thyroid cancer probably thyroid cancer as an amazing amazing amazing amazing prognosis right and then follicular thyroid cancer again hematogenous spread and the thing is follicular thyroid cancer you can never truly meet the diagnosis by just doing like like a like a fine needle aspiration if you do a fine needle aspiration and you'll find like what looks like follicular thyroid cancer they may ask for your next best step in diagnosis your next best step in diagnosis on our test is actually to do a low back to me you need to take out the entire thyroid loop to make sure that this because that's really the only way you can differentiate between a follicular adenoma and follicular chorecinoma right so what are some other thyroid cancers right I mean what if they give you a question about a person that you know has a neck mass right and they tell you that oh this person like you know it's having like seizures and they show you like the calcium is like six right or they can show you like oh person has like a neck mass and they show you like an EKG you see the cutie interval is prolonged right if you see this right and then even give you like some bogus during the question about like

how like many family members like maybe like two or three of them have died from some neck mass or something if you see that right that's NEM2 E or 2 B right this person has a preliminary thyroid cancer remember medallary thyroid cancer is associated with NEM2 E and 2 B right and people that have NEM2 E and 2 B they can easily make like a preventive medicine question where they say what is like what like what kind of surgical procedure is indicated in these people it will be a prophylactic thyroid dectomy right because again when people have NEM2 E2 B it's not a matter of if they will get medallary thyroid cancer it's a matter of when they will get a medallary thyroid cancer so you know typically for those people you're going to do a prophylactic thyroid dectomy because medallary thyroid cancer does not have the best prognosis in the world right so back to my original stem about like oh why is person having seizures why do they have hypocalsemia well think about it what is the tumor marker for medallary thyroid cancer well I would hope you're telling me that it's calcium toning remember calcium toning calcium tones down your blood calcium levels right it tones down your blood calcium levels it tones down your blood calcium levels right so they can give you like antecedents of hypocalsemia to test medallary thyroid cancer on your on your endemic exams right so again just keep in mind and remember that that calcium toning right you know it can polymerize and form amaloid right so classically they give you a question about a person that has like you know some thyroid malignancy and they tell you that oh they do a book congrats they need up all green viral fringes the works right that's going to be medallary thyroid cancer right that's going to be medallary thyroid cancer and remember it's like it's not a cancer of the actual thyroid it's actually a cancer of the C cells that you

find intermixed in the thyroid gland just kind of a high old tidbit to know there you know it's classified as a thyroid cancer but is it really right so I'll just go ahead and throw that out there it's a cancer of the C cells right the C cells the clears like the the C cells that surround the thyroid gland okay and then the last thyroid cancer this one is going to be in an old person right if they give you like a 30 something year or 40 something year old that has this that like with thyroid cancer don't pick the sensor if you do that you'll get it wrong right you'll be an old person like you'll be a person like in the elite 60s 70s 80s has like like like white spread like very firm neck very firm thyroid gland everything that's going to be an aplastic thyroid cancer this one has an awful prognosis most people are dead I think within like six to 12 months terrible terrible terrible don't wish this on don't wish this on on your enemy okay now one of the pathology I want to talk about here right so what did they give you a question about like 25 year old guy you know he's a big-time heavy drug user he's had like bunker type big-time bunker tightest that has led to sepsis he has had to be in the ICU right and then they give you a bunch of labs right and I know your friends are you are they love this stuff right they love the stuff so they give you like some strange question about like this person's TSC she's fine this person's T4 is fine this person's T3 is low right and then they are trying to get you to make a diagnosis right and then they put all these words you'll fricking the as you're reading the question you're like freaking out you're like paying your pants right you don't have to do any of those things right whenever you see a person right that is very sick right so like a person that is like in the ICU present that is critically ill a person that has anorexia

nervosa right or a person that has fasted big time right if you see that you want to think about something called u-thirate sex syndrome right u-thirate sex syndrome and the thing is one thing that they kind of care about on exams is sometimes he may ask you a question which of the fluen is the most likely which of which of the fluen would most likely be found on a further lab test in or whatever you want to think about an increase in something called reverse T3 okay so usually on exams again there are many different permutations you may see but what do you really need to know for purposes of the USML exams people that have u-thirate sex syndrome will be a person that is very sick or has recently lost a ton of weight right and then those people will have normal TSH usually normal T4 right decrease T3 would an increase in something called reverse T3 and the thing is there are many proposed mechanisms for this right but those mechanisms thankfully you don't really need to know for exams right because many of these mechanisms they are still like wishy-washy if you kind of review the literature right but don't forget that increase in reverse T3 that's actually a very high yielder tidbit to keep out the back of your mind for for exams right keep out the back of your mind for exams and I guess some context that we give you like maybe like to find why is it that when a person is critically ill or when a person has lost weight why does this cause this u-thirate sex syndrome the thing is if you think about it right when a person is critically ill right those people they have like an anorexic response they don't want to eat too much right if you're not eating much right your body needs to find a way to conserve energy well if you want to conserve that energy I would really hope that you're trying to cut down on your metabolic rate right trying to cut down your metabolic rate ju

st the same thing when you fast right your body is like okay there's not much food around let's try to crop down on our metabolic rate a little right so you will try to decrease your thyroid hormone level right like your T3 because remember T3 is the metabolically active form of thyroid hormone right because all that will kind of like decrease your metabolic rate in fact there's actually been studies in the literature if you read the literature there's actually been studies that have shown that when people fast their T3 levels go down and their reverse T3 levels go up right so this all kind of lens credence to this whole like a new thyroid sicker syndrome I just wanted to throw in that context to kind of give you like some like oh this is not just like some completely random phenomenon you know it actually kind of makes sense if you if you think about it right now one of the things that you want to keep at the back of your mind on MDM is right with the thyroid right you want to think keep you know keep Hashimoto's right in mind right so Hashimoto's will be the most common cause of hypothyroidism in any human being you see on an MDM exam other than a newborn a newborn as a describe already will be thyroid will be thyroid this genesis right so you know so if they give you a person you know T3 T4 is low TSH is high that's going to be Hashimoto right and for those people you just give them like try try Ayodothyronin right so like T3 or you can give them lethal thyroxin that's T4 street menton on the test right although they can give you a question about this and usually when they give you Hashimoto's question or any auto immune disease question for that matter right they will almost always include some kind of history of some other kind of auto immune disease in the presence of pass medical history right that's just like a nice test against strategy there if a question in

volves like a lot of auto immune phenomena the presence of pass medical history and auto immune phenomenon is probably going to be part of the presence probably going to be part of the right answer on the probably going to be part of the right answer on the on the test right and then one nice thing that we can do to you on an MDM on an MDM exam with regards to Hashimoto's right is they can tell you who a person has a a person has like you know history of Hashimoto's right and then they tell you that oh this person is having like this rapidly expanding neck mass and then they tell you that they obtain a biopsy and then they find like a ton of like lymphocyte or like a lot of germinal follicles if you see that right I would really really really hope right I would really really hope that you think about a thyroid lymphoma one of those circumstances remember a thyroid lymphoma is one of those classic SQL ion in me means that people usually don't watch out for with regards to Hashimoto's are thyroiditis right with regards to Hashimoto's are thyroiditis and then another thing in me is you know an in me means that my thyroid storm right so be a person that you know has some history of like graves or whatever and then they tell you that this person is like decompensating right like super tacky cardic super hypertensive altered mental status if you see that that's thyroid storm right well how do you manage thyroid storm on your test the first thing I would hope you're giving those people is a non selective beta blocker or a beta blocker of any sort right but just find the answer that says beta blocker usually is propellant along your test right propellant along is the first thing and the reason I'm seeing this is they'll give you many other drugs that can help in thyroid storm if you pick any of those other drugs over propellant law first and promising you you will get that qu

estion wrong right so you got a big propellant along right propellant law first will help with all those hypoagrinersic things because remember thyroid hormone right puts more beta one receptors on the surface of a person's on the surface of a person's like cardiac myocyte right so you know it kind of causes like this pseudo hypoagrinergic state right so it has a permissive effect basically on this empathetic nervous system kind of like cortisol right so that's why you give propellant law when it kills those hypoagrinergic symptoms but it propellant law also can inhibit that peripheral peripheral or five-friend diode amines that converts to a T4 to T3 that's one thing right so I think you've propellant law in your next step is to give PTU right you see all these P's right one propellant law two PTU right again PTU again inhibits thyroid peroxidase inhibits thyroid hormone synthesis right but it will also kill that peripheral five-friend diode amines that helps you convert T4 to T3 and remember PTU is the anti-thera drug you can give in the first trimester second third trimester you go more the alpha-fuck methemozo and then after that you can begin to do things like SSKI right so things you receive refer to as lugells solution on a test SSKI means super saturated solution of potassium iodide right so super saturated solution of potassium are super saturated solution of potassium iodide basically what it does is you're taking advantage of of the wolf chikof effect right the wolf chikof effect right when you give a present thyroid hormone like a ton of like iodine right that basically shuts down transiently thyroid hormones synthesis right and then after that usually they don't go beyond that on a test but some other things you can do you can give like steroids for example right to help with the presence of thyroid start right and again if a person has a hypothyroidism o

n an embankment exam one relatively specific thing is the person will have like a low heart rate right the person will usually have a low heart rate they'll be pretty cardiac that's like a thing you may find in like 80 to 90 percent of embankment questions that involves a person that is that is hypothyroid right and remember that people that are hypothyroid tend to be infertile on an embankment exam so I'm sure some of you may be like hmm define why would a person be infertile if they are hypothyroid well kind of think about it well if your hypothyroid what happens to your levels of TRH your TRH levels will go up right and remember that another name for TRH is prolactin release in factor well if you're releasing a ton if your TRH is high because your hypothyroid you release a ton of prolactin if you release a ton of prolactin what does prolactin do to generate levels it kills it right so your hispg axis will basically get shut down right so you're not gonna be making any of the stability in your ovaries and all that stuff right so the person will basically become a infertile right and again if a person has like like a coma like a mixed dima coma from just powerful powerful powerful hypothyroidism usually those people have like non-pidinidema in the q-stem right and then another thing you may see is again they'll be super pretty cardiac those people just give them like IV thyroid hormone to kind of read them out of that uh read them out of that uh of that state right and then in terms of like one other thing that you may see with thyroid on him being exams sorry these ideas are just gonna pop in in mind um they may make this a psych question right psych question right if you're taking an anti-psychotic right those things inhibit uh dopamine right those things that dopamine receptor blockers remember another name for dopamine is prolactin inhibiting factor right so if y

ou blocked dopamine receptors well you're taking out the action of something that inhibits the action of prolactin right so those people's prolactin will go up remember it's the two-barrow infantibola pathway right of dopamine that controls that right so again people can become a hypothyroid for those uh I mean uh um sorry what am I seeing here uh I think in my mind I was completing like uh uh sorry that does not even relate at all sorry again these things uh many of these podcasts I give them off the cough so sometimes I mean uh see things that I didn't really need um I don't know for whatever reason I was thinking of thyroid and an anti-psychotics what link was I trying to make here let's see um is there any link nah it's just dopamine and prolactin okay my apologies so just get pretty much scratch what I said in the last one minute my apologies there although I think maybe the reason that came to mind was because I was thinking of infertility um which is something that's what an antisaicotic right because again that tuber for developed pathway you blocked dopamine receptors you're prolactin goes up right and uh uh your uh that kind of shuts down your shuts down your HPG access okay so that shuts down your HPG access so I think if you kind of understand all these things I've mentioned I feel like it should be pretty good with a thyroid hormone uh naming me exams um I feel like I've covered pretty much maybe like what it was like 97 to maybe like 99% of what you may see on Amy and me exams from a thyroid perspective and unfortunately today I won't share any life lessons but please subscribe to the website divideinterventionpodcast.com and these podcasts also on uh Spotify, Google Play Apple Podcast please subscribe and then I have a You Tube channel called divideintervention USMV Podcasts and videos please subscribe to that um any little bit of support helps and again

um um I do have uh uh 10 hours step two ck comprehensive review course and we cover about like this again more than 600 concepts easily the next one is on the eighth of August so if you're interested in that just go ahead and shoot me an email either divideintervention podcasts with an s at the endagymail.com or you can send me an email through the through the website and then we'll kind of take things from there again it's like on the eighth it's from six to teni and pacific time noon to four p and pacific time and six to e p and pacific time on the eighth and again we'll cover psych neuro obi-guine i m p's and surgery right in a ten hour period and again many people have gone through the course they found you to be extremely helpful to them okay and I keep making the course better and better every time so like I make changes to the content actually pretty pretty frequently again just to stay updated still to up to part with what your friends at the mme seem to be going after these days so thank you for listening I'll probably have like a life lesson in the next podcast but I'm really happy that the mb is speaking of tomorrow I cannot wait to watch my leakers are I'll play against the clippers tomorrow I love my LeBron so I guess we'll pick up there next time thank you for listening God bless you goodbye

Thyrogenesis failure (the thyroid gland failed to form or develop properly).

Graves' disease.

1. Beta-blocker (to control symptoms), 2. Anti-thyroid drug (PTU/Methimazole), 3. Iodine solution (SSKI).

Papillary Thyroid Cancer (PTC).

The presence of calcitonin-producing cells/elevated serum calcitonin.

Low T3 with an increase in Reverse T3 (Starvation syndrome).

Thyroglossal is midline, moves with swallowing; Branchial is lateral to the midline.

Papillary Thyroid Cancer (PTC).

Hashimoto's Thyroiditis.

Elevated calcitonin levels and association with MEN 2 syndrome.

Toxic Adenoma.

Umbilical hernia and microglossia.

PTU inhibits both thyroid peroxidase and peripheral T4 to T3 conversion.

Hypothalamic-Pituitary-Gonadal (HPG) axis shutdown, leading to infertility due to high TRH/Prolactin levels.

Papillary Thyroid Cancer (PTC).

Hashimoto's Thyroiditis.

Elevated calcitonin levels and association with MEN 2 syndrome.

Toxic Adenoma.

Umbilical hernia and microglossia.

PTU inhibits both thyroid peroxidase and peripheral T4 to T3 conversion.

Hypothalamic-Pituitary-Gonadal (HPG) axis shutdown, leading to infertility due to high TRH/Prolactin levels.