1: Hyperthyroidism, Thyroid Storm, Neck Lumps Flashcards
1
Q
What is thyrotoxicosis
A
Clinical manifestation of excess thyroid hormone
2
Q
Which gender is hyperthyroidism more common
A
Females
3
Q
What age does Grave’s disease tend to present
A
20-30 years-old
4
Q
What age does toxic adenoma tend to present
A
30-50
5
Q
What age does toxic multi nodular goitre present
A
Over 50
6
Q
What is the most common cause of hyperthyroidism
A
Grave’s disease
7
Q
Which gender is Grave’s disease more common
A
Female (20-30 years-old)
8
Q
What causes Grave’s disease
A
Autoantibodies to thyrotropin receptors
9
Q
What % of hyperthyroidism is due to toxic multi nodular goitre
A
20-30%
10
Q
In which population is toxic multi nodular goitre more common
A
Elderly
11
Q
What are toxic multi nodular goitres
A
Several nodules secreting thyroid hormone
12
Q
What is a toxic adenoma
A
Solitary nodule in the thyroid gland releasing T3 and T4
13
Q
What is a feature of toxic adenoma on isotope scan
A
‘Hot nodule’
14
Q
What is the most common cause of ectopic thyroid tissue
A
Metastatic follicular carcinoma
15
Q
What is struma ovarii
A
Ovarian teratoma with thyroid tissue
16
Q
What can cause bHCG mediated hyperthyroidism
A
hydratidiform mole
choriocarcinoma
17
Q
What are exogenous causes of hyperthyroidism
A
Iodine
Medication
18
Q
How will excess levothyroxine present
A
High T4, Low T3
19
Q
What two medications cause hyperthyroidism
A
Amiodarone
Lithium
20
Q
What is subacute de quervains thyroiditis
A
- Self-resolving condition that occurs post-viral infection.
21
Q
What is a predominant feature of subacute de quervains thyroiditis
A
PAINFUL goitre
22
Q
what are the four-stages of subacute de quervain thyroiditis
A
- Hyperthyroidism (3-6W)
- Euthyroid (1-3W)
- Hypothyroidism (Months)
- Normal
23
Q
what is a clinical feature of stage 1 subacute dequervains thyroiditis
A
PAINFUL goitre
24
Q
what investigation is raised in subacute dequervains thyroiditis
A
ESR
25
what is stage two of dequervains thyroiditis
Euthyroid (1-3W)
26
what is stage 3 of subacute De Quervains thyroiditis
Hypothyroid (Weeks - Months)
27
what are two RF for grave's disease
- FH
| - Other autoimmune diseases
28
what is main risk factor for Grave's opthalmology
Smoking
29
what are general symptoms of thyrotoxicosis
Sweating
| Heat intolerance
30
when does ophthalmological involvement in hyperthyroidism only occur and why
Grave's disease.
| Autoantibodies cross-react with orbital antigens
31
what are the symptoms of grave's opthalmology
- Ptosis
- Endopathalmos
- Opthalmoplegia
32
what does an afferent pupillary defect in thyrotoxicosis indicate
Compression optic.N
33
what is exophthalmos
Eye protrudes from orbit
34
what causes ophthalmoplegia
Swelling and fibrosis of extra-ocular muscles
35
what gaze is particularly affetted
Upward gaze
36
what goitre is present in grave's disease
Smooth, diffusely enlarged swelling
37
what is main way to identify De Quervains thyroiditis
Painful goitre
38
what are GI symptoms of thyrotoxicosis
- Weight loss
- Increase appetite
- Diarrhoea
39
what are CV symptoms of thyrotoxicosis
- Tachycardia
| - Palpitations
40
what are MSK symptoms of thyrotoxicosis
- Tremor
| - Increased reflexes
41
what may hyperthyroidism cause in females
Oligomenorrhoea
42
why does hyperthyroidism cause oligomenorrhoea
Increases sex-hormone binding globulin - which decreases concentration of circulating oestrogen
43
what can hyperthyroidism cause in men
- Gynaecomastia
- Decrease libido
- ED
44
what psychiatric anomalies occur in hyperthyroidism
- Irritable
| - Emotionally labile
45
what are 3 signs of grave's disease
- Opthalmoplegia
- Thyroid acropathy
- Pre-tibial myxoedema
46
what is pre-tibial myxoedema
Swelling above lateral malleolus
47
what is thyroid acropatchy
Extreme manifestation: Swelling fingers. Pain in fingers and toes
48
what is primary hyperthyroidism
problem thyroid gland
49
how does primary hyperthyroidism present on TFTs
- Low TSH
| - High T3, T4
50
what is secondary hyperthyroidism
Problem pituitary
51
how does secondary hyperthyroidism present on TFTs
- High TSH
| - High T3, T4
52
what is tertiary hyperthyroidism
Problem hypothalamus
53
how does tertiary hyperthyroidism present
- High TSH
| - High T3, T4
54
Explain subclinical hyperthyroidism
- Low TSH
| - Normal T3, T4
55
What blood tests are ordered in hyperthyroidism
TFT, FBC, ESR, LFT, Calcium
56
What is FBC ordered
Grave's can cause neutropenia
57
Why is ESR ordered
High in DeQuervains thyroiditis
58
What is second-line test for hyperthyroidism
Autoantibodies
59
what antibodies are most common in grave's disease
TSH-receptor stimulating antibodies
60
apart from TSH-receptor stimulating antibodies, what antibodies are present in 75% cases of grave's
anti thyroid peroxidase antibodies (TPO)
61
what imaging is ordered in hyperthyroidism
USS
62
why is USS ordered
Distinguish nodule from cyst
63
why is isotope scan ordered
- Used to determine if lesion is hot or cold
| - Find ectopic thyroid tissue
64
what does a solitary hot nodule indicate
Toxic adenoma
65
what is given to manage symptoms of hyperthyroidism
Propanolol
66
when are anti-thyroid medications indicated
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
what is first line for hyperthyroidism
Carbimazole
68
what is a risk of carbimazole
Agranulocytosis
69
what is radio iodine
give radioactive iodine which destroys the gland
70
when should radio-iodine not be used
active thyroid disease - due to causing thyroid storm
71
what is risk of thyroidectomy
damage to recurrent laryngeal nerve
| hypothyroidism
72
what is a complication of thyrotoxicosis
HF - more common in elderly
AF
Osteoporosis
73
what are two causes of hyperthyroidism in pregnancy
- bHCG mediated
| - Grave's
74
how does bHCG mediated hyperthyroidism present
Typically subclinical
75
if hyperthyroidism in first-trimester what is given
Propylthiouracil = due to carbimazole being teratogenic
76
what is given after first trimester and why
Carbimaozle - to avoid liver SE associated with propylthiouracil
77
what 3 arteries supply the thyroid gland
Superior thyroid artery
Thyroid IMA artery
Inferior thyroid artery
78
where does superior thyroid artery arise from
External Carotid Artery
79
where does inferior thyroid artery arise from
Thyrocervical trunk - branch of subclavian aftery
80
where does thyroid ima artery arise
Brachiocephalic trunk
81
what 3 veins supply the thyroid
Superior thyroid vein
Middle thyroid vein
Inferior thyroid vein
82
where does superior and middle thyroid veins drain
- Internal jugular vein
83
where does the inferior thyroid vein drain
- Brachiocephalic vein
84
what does inferior thyroid artery run by and what is the risk
Recurrent laryngeal nerve - risk damage during surgery
85
what does superior thyroid atery run close to and what is the risk
superior thyroid artery - risks damage in surgery
86
when should sick euthyroid syndrome be considered
ITU patients
87
what cause sick euthyroid syndrome
Low TSH, Low T3 and T4
88
how will poor compliance with thyroxine present
high TSH
| normal T3, T4
89
what is a serious immediate complication of thyroidectomy
thyroid haematoma
90
what can post-thyroidectomy haematoma cause
airway obstruction
91
in suspected post-thyroidectomy haemaotma what should be done immediately
open up wound immediately (on the ward) to enable drainage. Then take to surgery to stop bleeding
92
what should be checked the day after thyroidectomy and why
PTH and serum calcium.
| As parathyroid glands can be removed or damaged - leading to hypoparathyroidism
93
what structure related to the thyroid is close to recurrent laryngeal nerve
inferior thyroid artery
94
what does unilateral recurrent laryngeal nerve injury cause
hoarse voice
95
what does biilateral recurrent laryngeal nerve injury cause
stridor - requiring tracheostomy
96
how do thyroid cancers usually present
multiple palpable nodules
97
what are red flags of thyroid malignancy
```
rapid growth
painful
cough
hoarse voice
stridor
multiple enlarged cervical lymph nodes
tethering
```
98
what is the most common thyroid cancer
papillary carcinoma
99
what % of thyroid cancer is papillary carcinoma
75
100
what age does papillary carcinoma occur
40-50 year-old
101
how does papillary carcinoma present
multiple lesions
102
how does papillary carcinoma spread
lymphatics
103
what is the second most common cancer
follicular carcinoma
104
in which population does follicular carcinoma occur
40-50 year-old females
105
how does follicular carcinoma present
single encapsulated lesion
106
how does follicular carcinoma spread
haematogenously
107
where do medullary carcinomas arise
C-cells (Calcitonin)
108
what % of cancers are medullary carcinomas
3%
109
what is a feature of medullary carcinoma
Causes raised calcitonin
110
what conditions are medullary carcinomas associated with
MEN2A and MEN2B
111
what % of thyroid cancers are anapaestic
5%
112
in which population does anapaestic thyroid cancer occur
Elderly
113
how does anapaestic thyroid cancer present
Very aggressive exhibits rapid growth and early metastases
114
what is the most common cause of neck swelling
Reactive lymphadenopathy
115
how does reactive lymphadenopathy present
Multiple enlarged PAINFUL nodules following recent viral illness
116
how does lymphoma present as a neck swelling
Painless rubbery lymphadenopathy
| Rare - phenomenon described where there is pain on drinking alcohol
117
how does goitre present
Midline swelling that rises on swallowing but not protruding tongue
118
when is thyroglossal cyst more common
Under 20year-olds
119
where do thyroglossal cysts present
between thyroid and hyoid
120
explain presentation of thyroglossal cyst on examination
Elevates on swallowing and tongue protrusion
121
when may a thyroglossal cyst cause a painful lump
If infected
122
in which population does a pharyngeal pouch occur
Elderly males
123
what causes pharyngeal pouch
Posterior-medial herniation through thyropharyngeus and circopharyngeus muscles
124
explain presentation of pharyngeal pouch
Normally does not cause lump in the neck. However can do if large. Gurgles on palpation.
125
what are typical symptoms of pharyngeal pouch
- Hallitosis
- Regurgitation
- Dysphagia
- Aspiration
- Chronic cough
126
what is a cystic hygroma
Congenital lymphatic lesion
127
when is cystic hygroma most common
Present at birth
128
when do cystic hygroma present before
Before 2-years
129
what is a branchial cyst
Oval mobile mass between SCM and pharynx
130
what causes a branchial cyst
Fail obliteration of second branchial cleft
131
when does branchial cyst usually present
Early adulthood
132
when is cervical rib most common
Adult females
133
what can cervical rib cause
Thoracic outlet syndrome
134
how does a carotid aneurysm present
Pulsatile lateral mass
135
how does a carotid body tumour present
Pulsatile
| Can be moved side-to-side, but not up and down
136
how does a laryngocele present
reducible tense mass, returns on coughing or nose-blowing
137
what is a key feature of cystic hygroma
trans-illumable
138
what is thyrotoxic storm
Acute exacerbation of hyperthyroidism causing a life-threatening metabolic state
139
in which gender is thyrotoxic storm more common
Female
140
what causes thyroid storm
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
What are symptoms of thyrotoxic storm
Pyrexia
Sweating
CV: AF, Tachycardia
Neurological: anxiety, confusion, coma
GI: N+V, Diarrhoea
142
What is first line management of hy
Fluid
143
What drugs are given to manage thyrotoxic storm
1. Chlorpromazine (Sedation)
2. Carbimazole (Anti-thyroid)
3. B-blocker
4. Hydrocortisone
144
What is given 4h after carbimazole
Lugol solution = to prevent hypothyroidism
145
Why is hydrocortisone given
Prevent conversion T4 to T3
146
When should carbimazole be reduced after thyroid storm
5d
147
When is propranolol and lugol solution stopped
10-days
