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MEH > 13 Thyroid Disorders > Flashcards

13 Thyroid Disorders Flashcards

1
Q

What is primary hypothyroidism?
thyroid function test results

A

Low levels of blood T4 due to a problem of thyroid gland itself (often autoimmune)

T3/T4 low
TSH high

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2
Q

What is secondary hypothyroidism?
thyroid function test results

A

Low levels of T4 due to TSH deficiency (pituitary disease)
.
low T4
non elevated TSH

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3
Q

What is subclinical hypothyroidism?
thyroid function test results

A

Normal fT4 with elevated TSH

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4
Q

Treatment of subclinical hypothyroidism

A

Treatment is not always needed if asymptomatic
if TSH >10miU/L then thyroxine should be prescribed
or TSH 5-10miU/L in women planning pregnancy

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5
Q

Causes of primary hypothyroidism

A
  • autoimmunity e.g. hashimoto’s disease - most common
  • iodine deficiency
  • post surgery or radiation
  • medication e.g. amiodarone, lithium
  • dyshormonogensis - hereditary defects in thyroid hormone synthesis
  • pregnancy
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6
Q

Causes of secondary hypothyroidism

A

TSH deficiency due to hypothalamic-pituitary disease

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7
Q

Symptoms of hypothyroidism

A

lethargy
Weight gain/change in appearance
Puffy eyes (myxoedema)
Cold intolerance
Dry hair/skin
Joint/muscle ache
Constipation

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8
Q

Signs of hypothyroidism

A
  • Bradycardia
  • Slow-relaxing reflexes
  • Peaches and cream-smooth pale skin, pink cheeks
  • loss of eyebrows
  • Pre-orbital oedema
  • Carpal tunnel syndrome
  • cold hands
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9
Q

What does the sign of peaches and cream mean?

A

Smooth pale skin with pink cheeks

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10
Q

Investigations of hypothryoidism

A
  • TFTs
  • autoantibodies test (thyroid peroxide in Hasimoto’s disease)
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11
Q

Treatment of hypothyroidism

A

Thyroxine replacement therapy T4 for life
Caution needed in elderly and heart disease (lower dose needed)

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12
Q

Aims of treatment of hypothyroidism
what do the TSH levels indicate?

A

Resolution of symptoms
Normalisation of blood tests after 6-8 weeks
High TSH indicates under-replacement
Low TSH indicates over-replacement

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13
Q

What is primary hyperthyroidism/thyrotoxicosis?
thyroid function test results

A

High levels of thyroid hormones due to an overactive thyroid gland

T3/T4 high
TSH low

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14
Q

Causes of hyperthyroidism

A
  • Graves’ disease - most common
  • thyroiditis
  • excessive T4/3 therapy
  • drugs e.g. amiodarone
  • thyroid carcinoma
  • post-partum thyroiditis
  • toxic multinodular goitre
  • ectopic thyroid tissue
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15
Q

Symptoms of hyperthyroidism

A
  • weight loss with increased appetite
  • irritability
  • restlessness/insomnia
  • heat intolerance
  • sweating
  • muscle ache
  • palpitations
  • diarrhoea
  • reduced fertility
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16
Q

Signs of hyperthyroidism

A
  • resting tremor
  • hyperkinesis - state of excessive restlessness
  • resting tachycardia (sinus or atrial fibrillation)
  • warm peripheries
  • hypertension
  • proximal myopathy- symmetrical weakness of limbs
  • lid lag - upper eyelid is higher than normal when looking down
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17
Q

Proximal myopathy meaning

A

Symmetrical weakness in limbs

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18
Q

Lid lag meaning
What is it due to?

A

Upper eyelid is higher than normal when looking down
Increased sympathetic tone in upper eyelid

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19
Q

What is Graves’ disease?

A
  • Autoimmune condition
  • Immune system mistakenly attacks thyroid which cause it to be overactive > hyperthyroidism
  • caused by production of thyroid stimulating immunoglobulin
20
Q

Clinical signs specific to Graves’ disease

A
  • thyroid eye disease - exophthalmos
  • skin changes > pre tibia myxoedema
  • thyroid acropathy (similar to clubbing)
21
Q

What is nodular thyroid disease?

A

Solid or fluid filled lumps within thyroid

22
Q

Investigations of hyperthyroidism
thyroid function test results

A
  • TFTs
  • autoimmune antibodies - TSH receptor stimulating antibodies (TSHrAb) for Graves’
  • thyroid USS
  • nuclear imaging - thyroid scintigraphy (to determine cause)
23
Q

What is the imaging process to look at the thyroid gland?

A

Thyroid scintigraphy
Using technetium-99m isotope

24
Q

What is seen on thyroid scintigraphy in the following conditions?
- Graves’ disease
- nodular disease
- thyroiditis
- thyroid cancer

A
  • Graves’ disease: uniform increased uptake
  • nodular disease: increased uptake in autonomonous nodules
  • thyroiditis: absent uptake
  • thyroid cancer: cold/absent area
25
Q

Treatment of hyperthyroidism

A
  • Medication - thionamides: carbimazole + propylthiouracil
  • B blockers to control symptoms until thyroid function returns to normal
  • thyroidectomy
  • single dose of I131 radioactive iodine
26
Q

What are the medications used to treat hyperthyroidism?

A

thionamides
Carbimazole
Propylthiouracil

27
Q

How do thionamides work?
How long does it take?
What can be given in the meantime?

A
  • reduces T3/T4 synthesis by preventing thyroid peroxidase from coupling + iodinating tyrosines
  • 4-6 weeks
  • B blockers to control symptoms
28
Q

Side effects of thionamides
What should patients be warned of?

A
  • rash
  • bone marrow suppression
    .
  • if they get an unexplained fever or sore throat, an urgent FBC is needed to exclude pancytopaenia
29
Q

What must patients be advised to do after being administered radioactive iodine + why?

A

avoid children + pregnant women for a few week after treatnet
a small amount of radiation is emitted post treatment

30
Q

Complications of thyroid surgery

A
  • bleeding
  • infection
  • damage to recurrent laryngeal nerve
  • damage to parathyroid gland > temporary or permanent hypocalcaemia
31
Q

What is thyroid crisis/storm?

A

Large amount of thyroxine released in short amount of time
Rare complication of hyperthyroidism
Medical emergency - life threatening

32
Q

Symptoms of thyroid crisis/storm

A

Hyperpyrexia >41.5°C
Tachycardia
Cardiac failure
Liver dysfunction

33
Q

What can happen in pregnancy with hyperthyroidism?

A

In Graves’ disease antibodies can cross placenta
Baby can be born with hyperthyroidism

34
Q

What is goitre?

A

Enlargement of thyroid gland

35
Q

Types of goitre

A
  • Diffuse goitre- simple goitre, autoimmune thyroid disease, thyroiditis
  • Nodular goitre- multinodular goitre, solitary nodule RED FLAH SYMPTOM
  • Fibrotic goitre- Riedel’s thyroiditis RARE
  • Iodine deficiency- common worldwide, rare in UK
36
Q

Red flag symptoms of thyroid cancer

A

Very young or old
Rapid enlargement of lump in neck
Hoarse voice + dysphagia -swallowing issues
Family history

Hard irregular thyroid mass
Fixed to surrounding structures
Cervical lymph nodes

37
Q

Where does a thyroglossal cyst present?

A

Exact midline
Moves up when you stick tongue out

38
Q

Investigation of suspected thyroid cancer

A

Thyroid ultra-sound
Fine needle aspiration
CT scan thorax and mediastinum - space within chest

39
Q

What does hypothyroidism cause in infants + adults?

A

Infants - cretinism
Adults - myxoedema

40
Q

what is severe hypothyroidism in infants + how does it present?

A

Cretinism
- dwarfed stature
- mental deficiency
- poor bone development
- slow pulse
- muscle weakness

41
Q

What does TRH stand for?

A

Thryoptropin-releasing hormone

42
Q

Thyroid function test in hashimoto’s disease

A

Low T3+4
High TSH

43
Q

Thyroid function test in grave’s disease

A
  • increased T3+4
  • low TSH
44
Q

What does a high T3/T4 with non suppressed TSH suggest?

A

TSHoma
thyroid hormone resistance
assay interference

45
Q

What antibodies are related to thyroid disorders?

A
  • anti-TPO - Grave’s disease+ Hashimoto’s thyroiditis
  • anti-thyroglobulin - Grave’s disease, Hashimoto’s thyroiditis + thyroid cancer
  • TSH receptor antibodies - Grave’s disease

MEH (23 decks)

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