397.2 📚 國考版醫垫國考 / PGY OSCE

397.2.0.1 📌 Cram Sheet

397.2.0.1.1 🔥 高 yield 15
  1. Thyrotoxicosis vs hyperthyroidism: 埌者是 thyroid 自己 making
  2. RAIU 高/䜎鑑別病因
  3. Graves’ #1, ~70-80%
  4. Graves’ triad: hyperthyroid + ophthalmopathy + pretibial myxedema
  5. TRAb / TSI for Graves’
  6. MMI 1st line; PTU only 1st trimester + storm
  7. MMI 1st trimester teratogenic (aplasia cutis, choanal/esophageal atresia)
  8. MMI/PTU agranulocytosis (fever/sore throat → 必停 + CBC)
  9. PTU fulminant hepatic necrosis (rare but fatal)
  10. β-blocker (propranolol; > 160 mg 抑 D1) symptomatic always
  11. RAI 絕對犁忌: pregnancy + lactation
  12. RAI 加重 ophthalmopathy in severe → surgery preferred
  13. Storm: β-blocker → PTU → iodine (1 hr later) → HC → cool
  14. Apathetic thyrotoxicosis 老人 (weight loss + AFib + depression)
  15. TPP (thyrotoxic periodic paralysis): Asian male + 䜎 K
397.2.0.1.2 🔢 必背
項目 æ•žå­—
MMI dose initial 5-30 mg/d
PTU dose initial 100-200 mg q6-8h
Propranolol dose 60-80 mg q6h
RAI dose Graves’ 5-15 mCi
MMI agranulocytosis rate 0.3-0.5%
MMI onset 4-6 wk
RAI hypothyroid ~80% within 6 mo
Storm Burch-Wartofsky ≥ 45 highly suggestive
Storm mortality 10-30%
Subclinical hyper TSH < 0.4

397.2.0.2 ⭐ 高 yield

397.2.0.2.1 High vs Low RAIU 病因
RAIU 病因
High Graves’, toxic adenoma, toxic MNG, TSH-oma, hCG (trophoblastic), Jod-Basedow (in nodular gland)
Low Subacute (de Quervain), silent/postpartum/lymphocytic, drug-induced thyroiditis (amio Type 2, ICI, IFN), exogenous (factitious), iodine excess (in normal gland), struma ovarii (RAIU in pelvis)
397.2.0.2.2 Treatment Comparison
Treatment Pro Con Best for
ATD (MMI/PTU) Reversible, no hypo Long course, side effect Mild Graves’, pregnancy, kids
RAI Definitive, outpatient Hypothyroid universal, eye worsens Toxic MNG, adenoma, Graves’ (no severe eye)
Surgery Definitive, fast Hypoparathyroidism, RLN 倧 goiter, severe eye, pregnant if needed, 䞍耐 ATD/RAI
397.2.0.2.3 Pregnancy Quick
  • 1st trimester: PTU
  • 2nd/3rd: MMI
  • RAI: 絕對犁忌
  • Surgery: 2nd trimester if needed
  • TRAb at 24-28 wk for fetal/neonatal risk
397.2.0.2.4 Subclinical Hyperthyroidism Treat?
Indication Treat?
TSH < 0.1 Yes
老人 ≥ 65 Yes
心血管 / osteoporosis Yes
Symptomatic Yes
Pregnancy / planning Yes
TSH 0.1-0.4 + young + asx Observe
397.2.0.2.5 Thyroid Storm Treatment Sequence
  1. β-blocker (propranolol)
  2. PTU (D1 inhibition)
  3. Iodine (Lugol) 1 hr after PTU
  4. Hydrocortisone (D1 + AI possible)
  5. Cooling (acetaminophen, NOT aspirin)
  6. Treat trigger
  7. Supportive (fluid, O2)
  8. ICU
  9. Mortality 10-30%
397.2.0.2.6 Apathetic Thyrotoxicosis (老人)
  • Weight loss + AFib + depression + weakness
  • 看䌌 cancer or depression
  • 老人 + 䞍明 weight loss / AFib → 必查 TFT

397.2.0.3 🎯 自我檢枬

  1. Graves’ Ab? → TRAb / TSI
  2. Graves’ triad? → Hyperthyroid + ophthalmopathy + pretibial myxedema
  3. RAIU 高 vs 䜎 病因? → High: Graves’/MNG/adenoma; Low: thyroiditis/factitious
  4. MMI 1st trimester teratogenic? → Aplasia cutis, choanal atresia
  5. PTU 甚圚? → 1st trimester + storm
  6. ATD agranulocytosis fever/sore throat? → 必停 + CBC
  7. Storm sequence? → β-blocker → PTU → iodine (1 hr after) → HC → cool
  8. RAI 犁忌? → Pregnancy + lactation
  9. RAI hypothyroid rate? → 80% within 6 mo
  10. RAI vs surgery in severe ophthalmopathy? → Surgery (RAI 加重)
  11. Apathetic thyrotoxicosis 衚珟? → Weight loss + AFib + depression
  12. TPP characteristic? → Asian male + low K
  13. Subacute thyroiditis ESR? → > 50
  14. Subacute biphasic? → Hyper → hypo → recover
  15. Factitious vs Graves’? → Tg 䜎 + RAIU 䜎 vs Tg 正垞/高 + RAIU 高

⚠ AI 草皿。