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Endocrine > 1: Hyperthyroidism, Thyroid Storm, Neck Lumps > Flashcards

1: Hyperthyroidism, Thyroid Storm, Neck Lumps Flashcards

1
Q

What is thyrotoxicosis

A

Clinical manifestation of excess thyroid hormone

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2
Q

Which gender is hyperthyroidism more common

A

Females

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3
Q

What age does Grave’s disease tend to present

A

20-30 years-old

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4
Q

What age does toxic adenoma tend to present

A

30-50

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5
Q

What age does toxic multi nodular goitre present

A

Over 50

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6
Q

What is the most common cause of hyperthyroidism

A

Grave’s disease

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7
Q

Which gender is Grave’s disease more common

A

Female (20-30 years-old)

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8
Q

What causes Grave’s disease

A

Autoantibodies to thyrotropin receptors

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9
Q

What % of hyperthyroidism is due to toxic multi nodular goitre

A

20-30%

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10
Q

In which population is toxic multi nodular goitre more common

A

Elderly

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11
Q

What are toxic multi nodular goitres

A

Several nodules secreting thyroid hormone

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12
Q

What is a toxic adenoma

A

Solitary nodule in the thyroid gland releasing T3 and T4

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13
Q

What is a feature of toxic adenoma on isotope scan

A

‘Hot nodule’

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14
Q

What is the most common cause of ectopic thyroid tissue

A

Metastatic follicular carcinoma

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15
Q

What is struma ovarii

A

Ovarian teratoma with thyroid tissue

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16
Q

What can cause bHCG mediated hyperthyroidism

A

hydratidiform mole

choriocarcinoma

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17
Q

What are exogenous causes of hyperthyroidism

A

Iodine

Medication

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18
Q

How will excess levothyroxine present

A

High T4, Low T3

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19
Q

What two medications cause hyperthyroidism

A

Amiodarone

Lithium

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20
Q

What is subacute de quervains thyroiditis

A
  • Self-resolving condition that occurs post-viral infection.
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21
Q

What is a predominant feature of subacute de quervains thyroiditis

A

PAINFUL goitre

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22
Q

what are the four-stages of subacute de quervain thyroiditis

A
  • Hyperthyroidism (3-6W)
  • Euthyroid (1-3W)
  • Hypothyroidism (Months)
  • Normal
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23
Q

what is a clinical feature of stage 1 subacute dequervains thyroiditis

A

PAINFUL goitre

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24
Q

what investigation is raised in subacute dequervains thyroiditis

A

ESR

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25
Q

what is stage two of dequervains thyroiditis

A

Euthyroid (1-3W)

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26
Q

what is stage 3 of subacute De Quervains thyroiditis

A

Hypothyroid (Weeks - Months)

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27
Q

what are two RF for grave’s disease

A
  • FH

- Other autoimmune diseases

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28
Q

what is main risk factor for Grave’s opthalmology

A

Smoking

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29
Q

what are general symptoms of thyrotoxicosis

A

Sweating

Heat intolerance

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30
Q

when does ophthalmological involvement in hyperthyroidism only occur and why

A

Grave’s disease.

Autoantibodies cross-react with orbital antigens

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31
Q

what are the symptoms of grave’s opthalmology

A
  • Ptosis
  • Endopathalmos
  • Opthalmoplegia
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32
Q

what does an afferent pupillary defect in thyrotoxicosis indicate

A

Compression optic.N

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33
Q

what is exophthalmos

A

Eye protrudes from orbit

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34
Q

what causes ophthalmoplegia

A

Swelling and fibrosis of extra-ocular muscles

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35
Q

what gaze is particularly affetted

A

Upward gaze

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36
Q

what goitre is present in grave’s disease

A

Smooth, diffusely enlarged swelling

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37
Q

what is main way to identify De Quervains thyroiditis

A

Painful goitre

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38
Q

what are GI symptoms of thyrotoxicosis

A
  • Weight loss
  • Increase appetite
  • Diarrhoea
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39
Q

what are CV symptoms of thyrotoxicosis

A
  • Tachycardia

- Palpitations

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40
Q

what are MSK symptoms of thyrotoxicosis

A
  • Tremor

- Increased reflexes

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41
Q

what may hyperthyroidism cause in females

A

Oligomenorrhoea

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42
Q

why does hyperthyroidism cause oligomenorrhoea

A

Increases sex-hormone binding globulin - which decreases concentration of circulating oestrogen

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43
Q

what can hyperthyroidism cause in men

A
  • Gynaecomastia
  • Decrease libido
  • ED
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44
Q

what psychiatric anomalies occur in hyperthyroidism

A
  • Irritable

- Emotionally labile

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45
Q

what are 3 signs of grave’s disease

A
  • Opthalmoplegia
  • Thyroid acropathy
  • Pre-tibial myxoedema
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46
Q

what is pre-tibial myxoedema

A

Swelling above lateral malleolus

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47
Q

what is thyroid acropatchy

A

Extreme manifestation: Swelling fingers. Pain in fingers and toes

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48
Q

what is primary hyperthyroidism

A

problem thyroid gland

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49
Q

how does primary hyperthyroidism present on TFTs

A
  • Low TSH

- High T3, T4

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50
Q

what is secondary hyperthyroidism

A

Problem pituitary

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51
Q

how does secondary hyperthyroidism present on TFTs

A
  • High TSH

- High T3, T4

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52
Q

what is tertiary hyperthyroidism

A

Problem hypothalamus

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53
Q

how does tertiary hyperthyroidism present

A
  • High TSH

- High T3, T4

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54
Q

Explain subclinical hyperthyroidism

A
  • Low TSH

- Normal T3, T4

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55
Q

What blood tests are ordered in hyperthyroidism

A

TFT, FBC, ESR, LFT, Calcium

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56
Q

What is FBC ordered

A

Grave’s can cause neutropenia

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57
Q

Why is ESR ordered

A

High in DeQuervains thyroiditis

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58
Q

What is second-line test for hyperthyroidism

A

Autoantibodies

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59
Q

what antibodies are most common in grave’s disease

A

TSH-receptor stimulating antibodies

60
Q

apart from TSH-receptor stimulating antibodies, what antibodies are present in 75% cases of grave’s

A

anti thyroid peroxidase antibodies (TPO)

61
Q

what imaging is ordered in hyperthyroidism

A

USS

62
Q

why is USS ordered

A

Distinguish nodule from cyst

63
Q

why is isotope scan ordered

A
  • Used to determine if lesion is hot or cold

- Find ectopic thyroid tissue

64
Q

what does a solitary hot nodule indicate

A

Toxic adenoma

65
Q

what is given to manage symptoms of hyperthyroidism

A

Propanolol

66
Q

when are anti-thyroid medications indicated

A

Short-term: prior to surgery

Medium-term: induce remission in thyroid storm prior to operating

Long-term: if radio-iodide or surgery is CI

67
Q

what is first line for hyperthyroidism

A

Carbimazole

68
Q

what is a risk of carbimazole

A

Agranulocytosis

69
Q

what is radio iodine

A

give radioactive iodine which destroys the gland

70
Q

when should radio-iodine not be used

A

active thyroid disease - due to causing thyroid storm

71
Q

what is risk of thyroidectomy

A

damage to recurrent laryngeal nerve

hypothyroidism

72
Q

what is a complication of thyrotoxicosis

A

HF - more common in elderly
AF
Osteoporosis

73
Q

what are two causes of hyperthyroidism in pregnancy

A
  • bHCG mediated

- Grave’s

74
Q

how does bHCG mediated hyperthyroidism present

A

Typically subclinical

75
Q

if hyperthyroidism in first-trimester what is given

A

Propylthiouracil = due to carbimazole being teratogenic

76
Q

what is given after first trimester and why

A

Carbimaozle - to avoid liver SE associated with propylthiouracil

77
Q

what 3 arteries supply the thyroid gland

A

Superior thyroid artery
Thyroid IMA artery
Inferior thyroid artery

78
Q

where does superior thyroid artery arise from

A

External Carotid Artery

79
Q

where does inferior thyroid artery arise from

A

Thyrocervical trunk - branch of subclavian aftery

80
Q

where does thyroid ima artery arise

A

Brachiocephalic trunk

81
Q

what 3 veins supply the thyroid

A

Superior thyroid vein
Middle thyroid vein
Inferior thyroid vein

82
Q

where does superior and middle thyroid veins drain

A
  • Internal jugular vein
83
Q

where does the inferior thyroid vein drain

A
  • Brachiocephalic vein
84
Q

what does inferior thyroid artery run by and what is the risk

A

Recurrent laryngeal nerve - risk damage during surgery

85
Q

what does superior thyroid atery run close to and what is the risk

A

superior thyroid artery - risks damage in surgery

86
Q

when should sick euthyroid syndrome be considered

A

ITU patients

87
Q

what cause sick euthyroid syndrome

A

Low TSH, Low T3 and T4

88
Q

how will poor compliance with thyroxine present

A

high TSH

normal T3, T4

89
Q

what is a serious immediate complication of thyroidectomy

A

thyroid haematoma

90
Q

what can post-thyroidectomy haematoma cause

A

airway obstruction

91
Q

in suspected post-thyroidectomy haemaotma what should be done immediately

A

open up wound immediately (on the ward) to enable drainage. Then take to surgery to stop bleeding

92
Q

what should be checked the day after thyroidectomy and why

A

PTH and serum calcium.

As parathyroid glands can be removed or damaged - leading to hypoparathyroidism

93
Q

what structure related to the thyroid is close to recurrent laryngeal nerve

A

inferior thyroid artery

94
Q

what does unilateral recurrent laryngeal nerve injury cause

A

hoarse voice

95
Q

what does biilateral recurrent laryngeal nerve injury cause

A

stridor - requiring tracheostomy

96
Q

how do thyroid cancers usually present

A

multiple palpable nodules

97
Q

what are red flags of thyroid malignancy

A 
rapid growth 
painful 
cough 
hoarse voice 
stridor 
multiple enlarged cervical lymph nodes 
tethering
98
Q

what is the most common thyroid cancer

A

papillary carcinoma

99
Q

what % of thyroid cancer is papillary carcinoma

A

75

100
Q

what age does papillary carcinoma occur

A

40-50 year-old

101
Q

how does papillary carcinoma present

A

multiple lesions

102
Q

how does papillary carcinoma spread

A

lymphatics

103
Q

what is the second most common cancer

A

follicular carcinoma

104
Q

in which population does follicular carcinoma occur

A

40-50 year-old females

105
Q

how does follicular carcinoma present

A

single encapsulated lesion

106
Q

how does follicular carcinoma spread

A

haematogenously

107
Q

where do medullary carcinomas arise

A

C-cells (Calcitonin)

108
Q

what % of cancers are medullary carcinomas

A

3%

109
Q

what is a feature of medullary carcinoma

A

Causes raised calcitonin

110
Q

what conditions are medullary carcinomas associated with

A

MEN2A and MEN2B

111
Q

what % of thyroid cancers are anapaestic

A

5%

112
Q

in which population does anapaestic thyroid cancer occur

A

Elderly

113
Q

how does anapaestic thyroid cancer present

A

Very aggressive exhibits rapid growth and early metastases

114
Q

what is the most common cause of neck swelling

A

Reactive lymphadenopathy

115
Q

how does reactive lymphadenopathy present

A

Multiple enlarged PAINFUL nodules following recent viral illness

116
Q

how does lymphoma present as a neck swelling

A

Painless rubbery lymphadenopathy

Rare - phenomenon described where there is pain on drinking alcohol

117
Q

how does goitre present

A

Midline swelling that rises on swallowing but not protruding tongue

118
Q

when is thyroglossal cyst more common

A

Under 20year-olds

119
Q

where do thyroglossal cysts present

A

between thyroid and hyoid

120
Q

explain presentation of thyroglossal cyst on examination

A

Elevates on swallowing and tongue protrusion

121
Q

when may a thyroglossal cyst cause a painful lump

A

If infected

122
Q

in which population does a pharyngeal pouch occur

A

Elderly males

123
Q

what causes pharyngeal pouch

A

Posterior-medial herniation through thyropharyngeus and circopharyngeus muscles

124
Q

explain presentation of pharyngeal pouch

A

Normally does not cause lump in the neck. However can do if large. Gurgles on palpation.

125
Q

what are typical symptoms of pharyngeal pouch

A
  • Hallitosis
  • Regurgitation
  • Dysphagia
  • Aspiration
  • Chronic cough
126
Q

what is a cystic hygroma

A

Congenital lymphatic lesion

127
Q

when is cystic hygroma most common

A

Present at birth

128
Q

when do cystic hygroma present before

A

Before 2-years

129
Q

what is a branchial cyst

A

Oval mobile mass between SCM and pharynx

130
Q

what causes a branchial cyst

A

Fail obliteration of second branchial cleft

131
Q

when does branchial cyst usually present

A

Early adulthood

132
Q

when is cervical rib most common

A

Adult females

133
Q

what can cervical rib cause

A

Thoracic outlet syndrome

134
Q

how does a carotid aneurysm present

A

Pulsatile lateral mass

135
Q

how does a carotid body tumour present

A

Pulsatile

Can be moved side-to-side, but not up and down

136
Q

how does a laryngocele present

A

reducible tense mass, returns on coughing or nose-blowing

137
Q

what is a key feature of cystic hygroma

A

trans-illumable

138
Q

what is thyrotoxic storm

A

Acute exacerbation of hyperthyroidism causing a life-threatening metabolic state

139
Q

in which gender is thyrotoxic storm more common

A

Female

140
Q

what causes thyroid storm

A
  1. Excess circulating TH
  2. Surgery in TH
    - Surgery
    - Radio-iodine
    - Cease thyroid medications
  3. Stress-related catecholamine surgery
    - Infection
    - MI
    - Trauma
    - Labour
    - Sepsis
141
Q

What are symptoms of thyrotoxic storm

A

Pyrexia
Sweating

CV: AF, Tachycardia

Neurological: anxiety, confusion, coma

GI: N+V, Diarrhoea

142
Q

What is first line management of hy

A

Fluid

143
Q

What drugs are given to manage thyrotoxic storm

A
  1. Chlorpromazine (Sedation)
  2. Carbimazole (Anti-thyroid)
  3. B-blocker
  4. Hydrocortisone
144
Q

What is given 4h after carbimazole

A

Lugol solution = to prevent hypothyroidism

145
Q

Why is hydrocortisone given

A

Prevent conversion T4 to T3

146
Q

When should carbimazole be reduced after thyroid storm

A

5d

147
Q

When is propranolol and lugol solution stopped

A

10-days

Endocrine (20 decks)

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