22. Thyroid Disorders Flashcards
How can you image a thyroid gland?
Thyroid ultrasound
Radio-isotope scan
X-ray
CT scan
What is myxoedema?
Hypothyroidism
What are the symptoms of hypothyroidism?
Tiredness Weight gain Cold intolerance Change in appearance Depression Psychosis Joint/muscle ache Dry hair/skin Puffy eyes
What are the signs of hypothyroidism?
Peri-orbital oedema Loss of eyebrows Dry, thin hair Bradycardia Slow-relaxing reflexes Carpal tunnel syndrome Cold peripheries
What are the causes of hypothyroidism?
Auto-immune atrophic Hashimoto’s thyroiditis Post-partum thyroiditis Dyshormonogenesis Medication Iodine deficiency
What is the treatment for hypothyroidism?
Thyroxine replacement therapy
- levothyroxine (T4) for life
- starting dose depends on severity
- 100micrograms for young fit person
What are the aims of treatment of hypothyroidism?
Resolution of symptoms
Normalisation of blood tests - takes 6-8 weeks
High TSH suggests under-replacement
Low TSH suggests over-replacement
What is myxoedema coma?
Severe hypothyroidism usually in elderly - rare
Hypothermia and fluid overload in heart - pericardial effusion
50% mortality
What are the symptoms of hyperthyroidism?
Weight loss Irritability Restlessness Insomnia Malaise Itching Sweating Palpitations Tremor Muscle ache
What are the signs of hyperthyroidism?
Tremor Hyperkinesis Tachycardia Atrial fibrillation Warm peripheries Hypertension Proximal myopathy Lid lag
What are the causes of hyperthyroidism?
Graves’ disease
Modular thyroid disease
Thyroiditis
What is Graves’ disease?
Autoimmune mediated stimulation of TSH receptor
What is thyroiditis?
Inflammation of thyroid
Release of thyroxine into circulation
What can cause thyroiditis?
Viral infection
Postpartum
Medication - amiodarone
What medication is given to treat hyperthyroidism?
Carbimazole or propylthiouracil
Beware of agranulocytosis (risk of infections) - neutropenia
Beta-blockers for symptoms control
What are the 3 ways that hyperthyroidism can be treated?
Medication
Surgery
Radioactive iodine
Why is surgery given in hyperthyroidism?
If side effects on medication or patient preference
Small risk of laryngeal nerve palsy and hypocalcaemia
What is thyroid crisis or thyroid storm?
Rare condition with 10% mortality
Hyperpyrexia, tachycardia, cardiac failure, liver dysfunction
Needs urgent treatment on HDU
Why can hyperthyroidism in pregnancy be bad?
In Graves’ disease antibodies can cross placenta
Baby can be born with hyperthyroidism
What are the types of goitre?
Diffuse - simple goitre, autoimmune thyroid disease, thyroiditis
Modular - multinodular, solitary nodule (red flag symptoms)
Fibrotic - Riedels thyroiditis (rare)
Iodine deficiency
What are the red flag symptoms of thyroid cancer in the history?
Very young or old patient
Rapid enlargement of lump in neck
Hoarse voice and dysphagia
Family history
What are the red flag symptoms of thyroid cancer on examination?
Hard irregular thyroid mass
Fixed to surrounding structures
Cervical lymph nodes
What is the investigation of suspected thyroid cancer?
Thyroid ultrasound
Fine needle aspiration
CT scan thorax and mediastinum
