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Endocrine Week 3 2017/18 > 1: Hyperthyroidism, hypothyroidism and thyroiditis > Flashcards

1: Hyperthyroidism, hypothyroidism and thyroiditis Flashcards

1
Q

Thyroid disease can be ___ or ___.

A

primary , secondary

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2
Q

What is a goitre?

A

Lump in the thyroid gland

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3
Q

Primary thyroid disease is usually ___.

A

autoimmune

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4
Q

Secondary thyroid disease is usually caused by disease of which glands?

A

Hypothalamus

Pituitary gland

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5
Q

Which hormone is released from the anterior pituitary gland and affects the function of the thyroid gland?

A

Thyroid stimulating hormone (TSH)

also known as thyrotropin

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6
Q

TSH is also known as ___.

A

Thyrotropin

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7
Q

What are the two hormones produced by the thyroid gland?

A

T3

T4

“thyroxines”

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8
Q

99% of T3 and T4 is bound to what?

A

Transport proteins

Thyroxine binding globulin

Albumin

Pre-albumin

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9
Q

Which hormone, produced by the hypothalamus, triggers the anterior pituitary’s production of TSH?

A

Thyrotropin releasing hormone (TRH)

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10
Q

The hypothalamic-pituitary-thyroid axis is controlled by ___ feedback.

A

negative feedback

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11
Q

What happen to the levels of free T3/T4 and TSH in

a) primary hypothyroidism
b) primary hyperthyroidism?

A

a) Primary hypothyroidism - free T3/4 LOW, TSH HIGH

b) Free T3/4 HIGH, TSH LOW

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12
Q

In secondary hypothyroidism, is TSH raised?

A

No

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13
Q

Secondary hyperthyroidism is very rare. What are the levels of T3/4 and TSH?

A

Everything is high

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14
Q

What is hypothyroidism?

A

Insufficient secretion of thyroid hormones

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15
Q

What is severe hypothyroidism also known as?

A

Myxoedema

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16
Q

What is a rare sign of Graves disease, which itself causes hyperthyroidism?

A

Pretibial myxoedema

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17
Q

Hypothyroidism is very (common / uncommon).

A

common

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18
Q

Reduced intake of what can cause hypothyroidism?

A

Iodine

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19
Q

Hypothyroidism is categorised by the presence or absence of a…

A

goitre

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20
Q

What is an autoimmune cause of hypothyroidism which presents with a goitre?

A

Hashimoto’s thyroiditis

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21
Q

What occurs in Hashimoto’s thyroiditis?

A

Auotimmune destruction of thyroid gland

Reduced thyroid hormone secretion

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22
Q

Hashiomoto’s thyroiditis is more common in (men / women).

A

women

As with all autoimmune disease

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23
Q

What antibodies are seen in Hashimoto’s disease?

A

Thyroid peroxidase antibodies (TPO)

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24
Q

What is seen histologically in Hashimoto’s disease?

A

T cell infiltration

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25
Why are the symptoms of thyroid disease so diverse?
**Systemic impact of hormones**
26
What is seen in the **hair** and **skin** of someone with hypothyroidism?
**Coarse, sparse hair** **Expressionless, puffy face** **Pale, cold skin** **Vitiligo** **Hypercarotenaemia** (orange skin)
27
People with hypothyroidism will complain of being very (hot / cold).
**cold**
28
What is seen in the ankles of people with hypothyroidism?
**Pitting oedema**
29
What are some cardiovascular complications of hypothyroidism?
**Bradycardia** **Cardiac dilatation** **Effusions** **Hyperlipidaemia** (inc. xanthelasma)
30
People with **hypothyroidism** have a **REDUCED** appetite - what happens to their weight?
**They gain weight anyway**
31
Which systems does hypothyroidism also affect?
**GI** **Resp** **Neuro**
32
In primary hypothyroidism, you see (high / low) levels of TSH and (high / low) levels of T3/4.
**high TSH** (body trying to compensate) ## Footnote **low thyroid hormones**
33
Which autoantibodies are raised in a) Autoimmune hypothyroidism in general (Hashimoto's) b) Graves disease?
**Hashimoto's** - anti-TPO **Graves** - TSH receptor
34
How is hypothyroidism managed?
**Levothyroxine** tablets ## Footnote **25-100 µg**
35
In primary hypothyroidism, levothyroxine dose is tailored to the levels of what?
**TSH**
36
What is levothyroxine also known as?
**T4**
37
When should patients take their levothyroxine?
**Before breakfast**
38
Why is levothyroxine taken before breakfast?
**Food, drugs affect its absorption** e.g PPIs
39
Pregnant women require **(higher / lower)** doses of levothyroxine.
**higher**
40
What is an emergency associated with untreated hypothyroidism?
**Myxoedema coma**
41
Myoxedema coma is seen in ___ patients with untreated hypothyroidism. How do they present?
**elderly** Bradycardia, heart block Respiratory failure
42
What is a) hyperthyroidism b) thyrotoxicosis?
**Hyperthyroidism** - overproduction of thyroid hormones by thyroid gland **Thyrotoxicosis** - state caused by excess thyroid hormone
43
What does **thyrotoxicosis** look like?
**Cardiac symptoms** - palpitations, AF **Tremor** **Sweating** Anxiety, nervous, irritable, insomnia
44
How do the bowel movements change in thyrotoxicosis?
**Frequent, loose stools**
45
What is a distinct facial presentation of thyrotoxicosis?
**Lid retraction** **Double vision** **Bulging eyes (proptosis)**
46
What is the most common cause of thyrotoxicosis?
**Hyperthyroidism** caused by **Graves disease**
47
Apart from Graves disease, what else causes hyperthyroidism?
**Thyroid nodules** act independently, don't respond to hypothalamic / pituitary axis and are toxic
48
Not all thyrotoxicosis is caused by hyperthyroidism. What else can cause it?
**Thyroiditis** - de Quervain's, post-partum and drug-induced (e.g amiodarone) **Levothyroxine overdose** - thyrotoxicosis factitia **Ectopic thyroid tissue** i.e metastasis of thyroid cancer
49
Graves disease causes (hyper / hypo)thyroidism and is more common in **(men / women)**.
**hyperthyroidism** **women**
50
What **lifestyle factor** is thought to be involved in the onset of **Graves disease**?
**Smoking**
51
In Graves disease, what changes are seen in a) TSH b) T3/4 levels?
**a)** TSH decreases (to compensate for hyperthyroidism) **b)** T3/4 increases (overproduction)
52
What bone issues are seen in Graves disease?
**Osteoporosis** so hypercalcaemia and increased ALP
53
What antibody is raised in Graves disease?
**TSH receptor antibody** note that it's not an AUTOANTIBODY - stimulates cells rather than getting them destroyed
54
What is a rare sign of early Graves disease?
**Pre-tibial myxoedema** (which is confusing bc myxoedema means hypothyroidism)
55
What general sign is sometimes seen in Graves disease?
Specific type of finger clubbing called **THYROID ACROPACHY**
56
What can sometimes be heard on auscultation of a thyroid of someone with Graves disease?
**Bruit**
57
Graves disease causes serious ___ disease.
**eye**
58
Apart from Graves disease, what other thyroid disease can cause thyrotoxicosis?
**Nodular thyroid disease**
59
What does the goitre look like in a) Graves disease b) Nodular thyroid disease?
**a) Grave's** goitre is symmetrical and smooth **b)** Nodular goitres are... nodular and asymmetrical
60
What does a thyroid function test look like in nodular thyroid disease?
**TSH** decreases **T3/4** increases
61
Are people with nodular thyroid disease positive for TSH receptor antibody?
**No**
62
What is an emergency which can occur in people with untreated hyperthyroidism?
**Thyroid storm**
63
What does thyroid storm present as?
**Respiratory** and **cardiac collapse** ## Footnote **Hyperthermia**
64
How is thyroid storm treated?
**Cooling** **Inhibition of thyroid gland with potassium iodide** **Beta blockers to control sympathetic symptoms**
65
How is hyperthyroidism treated?
**Antithyroid drugs**
66
What is an example of an antithyroid drug?
**Carbimazole**
67
What are some side effects of antithyroid drugs?
**Skin reactions** **Liver disease** **AGRANULOCYTOSIS** - neutrophils cannot produce granules to fight infection
68
What is the presentation of agranulocytosis?
**Fever** **Infection of mouth and throat**
69
If patients develop agranulocytosis after taking an antithyroid drug, can they start using them again?
**No**
70
Which beta blocker is used in people with hyperthyroidism?
**Propranolol**
71
What is a possible side effect of propranolol?
**Bronchospasm** in patients with asthma
72
If a patient's asthma worsened after taking propranolol for their hyperthyroidism, what would you give them instead?
**CCB** e.g diltiazem
73
If a patient's Graves disease / nodular thyroid disease relapses after stopping drugs, what would you try instead?
**Radioiodine**
74
Can radioiodine be given to pregnant women?
**No**
75
What do patients have to be advised about if they are on radioiodine?
**Contact with other people** - their necks are radioactive
76
If both drugs and radioiodine have failed in patients with hyperthyroidism, what can be done?
**Surgery**
77
What are some complications of thyroidectomy?
**Hypothyroidism** **Hypoparathyroidism** **Damage to recurrent laryngeal nerves (revise)**

Endocrine Week 3 2017/18 (11 decks)

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