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1. Internal Medicine I > 7. Thyroid disorders > Flashcards

7. Thyroid disorders Flashcards

1
Q

What are the common symptoms of hyperthyroidism?

A

General hot intolerance, sweating, agitation.

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2
Q

What are the skin symptoms of hyperthyroid disorders?

A

Hair loss, hair thinning, “Plummer’s nails” -softening, can become detached, pigment disorders.

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3
Q

What are the muscular system symptoms of hyperthyroid disorders?

A

Weakness, fatigue, prox. myopathy

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4
Q

What is thyrotoxicosis?

A

the biochemical reactions triggered by more thyroid hormone than necessary

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5
Q

What is Graves disease?

A

It is a type of hyperthyroidism.

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6
Q

What are the causes of hyperthyroidism?

A
  • Graves disease
  • Toxic nodular goitre,
  • Toxic adenoma,
  • Ectopic thyroid issue
  • Exogenous
  • Others (postpartum, amiodarone)
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7
Q

What are the diagnostic tests for thyroid disorders?

A

TSH, fT4, fT3, aTPO, thyreoglobin, cervical UH, pm.

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8
Q

What are the symptoms of hyperthyroid disorders related to the cardiac system?

A

Accelerated circulation, resting tachycardia, systolic hypertension, angina pectoris, 10-20% atrial fibrillation, mitral prolapse becomes more pronounced, cardiomyopathy may develop.

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9
Q

What are the symptoms of hyperthyroid disorders related to breathing?

A

Tracheal constriction, weakness of respiratory muscles.

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10
Q

What are the symptoms of hyperthyroid disorders related to the gastrointestinal system?

A

Weight loss with good appetite (sometimes gaining weight!), frequent, softer stools - diarrhea rare, in severe disease: nausea, vomiting, liver enzyme elevation.

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11
Q

What are the symptoms of hyperthyroid disorders related to bone metabolism?

A

Accelerated, cortical bones affected, fragility increases, moderate hypercalcemia may develop.

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12
Q

What are the hormonal changes associated with hyperthyroid disorders?

A

FSH/LH - oligo-raromenorrhea, loss of libido, impotence, infertility.

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13
Q

What are the metabolic changes associated with hyperthyroid disorders?

A

Cholesterol decreases, HDL increases, insulin secretion and resistance increases - IGT.

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14
Q

What are some nervous system symptoms of hyperthyroid disorders?

A

Agitation, restlessness, anxiety, depression, psychosis-like picture, insomnia, rapid and erratic thinking, cognitive function deterioration, increased risk of developing dementia, hypermotile but fatigable, hand and body-wide fine-wave tremor.

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15
Q

What are some ophthalmological symptoms of hyperthyroid disorders?

A

Shiny and dilated eyes, stiff eyes, slow blinking, appearance of a white stripe between the iris and upper eyelid when looking down.

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16
Q

What is Graves disease?

A

An autoimmune disease caused by an antibody produced against the TSH receptor, with predisposing factors such as female gender, genetic predisposition, infections, psychological stress, good iodine supply, and smoking.

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17
Q

What is the diagnosis for Graves disease?

A

Diffuse goitre, TSH lowered, fT3 increased, fT4 increased, and consistent enrichment on scintigram.

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18
Q

What are some specific symptoms of Graves disease?

A

Skin symptoms such as vitiligo and alopecia, and eye symptoms such as exophthalmos, eye movement disorder, and periorbital and conjunctival edema.

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19
Q

What are the specific skin symptoms associated with Graves disease?

A

Vitiligo and alopecia, pretibial infiltrative dermopathy.

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20
Q

What are the specific eye symptoms associated with Graves disease?

A

Exophthalmos, eye movement disorder, periorbital and conjunctival oedema.

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21
Q

What are the specific gastrointestinal symptoms associated with Graves disease?

A

Achlorhydria and celiac disease occur more frequently.

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22
Q

What percentage of patients with Graves also have myasthenia gravis?

A

1%.

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23
Q

What is the haematological symptom associated with Graves disease?

A

Relative lymphocytosis with low white blood cell count.

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24
Q

What is toxic nodular goitre?

A

It is a somatic mutation of TSH receptor or Gs subunit.

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25
Q

What are the predisposing factors for toxic nodular goitre?

A

Over 40 years of age, iodine deficiency.

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26
Q

What is the diagnosis for toxic nodular goitre?

A

Nodular goitre (one or more nodules), TSH decreased, fT3 increasd, fT4 increased, nodular enrichment on scintigraphy.

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27
Q

What is iodine-induced hyperthyroidism?

A

It is high doses of iodine taken with autonomous thyroid function.

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28
Q

What is the most common cause of iodine-induced hyperthyroidism?

A

Contrast agent administration.

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29
Q

What is the effect of amiodarone treatment on iodine uptake?

A

After amiodarone treatment, iodine uptake is 3-10%.

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30
Q

What are the non-thyroid causes of thyrotoxicosis?

A

Diet, psychiatric illness, consumption of animal thyroid gland, ovarian cystic teratoma.

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31
Q

What is the thyroglobulin level in non-thyroid thyrotoxicosis?

A

Thyroglobulin is low, with no pm.

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32
Q

What are some non-thyroid causes of thyrotoxicosis?

A

Diet, psychiatric illness, consumption of animal thyroid gland, ovarian cystic teratoma.

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33
Q

What are some possible causes of TSH-induced hyperthyroidism?

A

Pituitary adenoma, T3 resistance syndrome.

34
Q

What are the advantages and disadvantages of using tireostatics as a treatment option for thyroid disorders?

A

Advantages: easily accessible, reversible, daily treatment, cheap.

35
Q

What are some examples of thionamides used as tireostatics?

A

Methimazole, propylthiouracil.

36
Q

What is the maximum daily dose of methimazole?

A

40 mg per day.

37
Q

What is the first line of choice in the case of early Graves’ disease?

A

Thionamides.

38
Q

What is the possibility of durable remission with thionamides in the case of early Graves’ disease?

A

70 to 30 percent.

39
Q

What is Kocher’s blood count?

A

A blood test used to monitor the white blood cell count in patients taking thionamides.

40
Q

What are some possible side effects of propylthiouracil?

A

Similar to methimazole.

41
Q

What is the time to onset of action for propylthiouracil?

A

2 to 3 weeks.

42
Q

What are some drugs used in the treatment of hyperthyroid disorders?

A

Lithium carbonate, iodine, beta-blockers, dexamethasone.

43
Q

What is the mechanism of action of beta-blockers in thyroid disorders?

A

They inhibit T4 -T3 conversion.

44
Q

What is the purpose of Dexamethasone in thyroid disorders?

A

It inhibits T4 -T3 conversion.

45
Q

What is the recommended duration of skipping Tionamide drugs before radioiodine treatment?

A

1 week.

46
Q

What is the recommended measurement before radioiodine treatment?

A

24-hour iodine uptake measurement.

47
Q

What are the side effect restrictions of radioiodine treatment?

A

Hypothyroidism, worsened orbitopathy (smoking!), and pregnancy after 1 (1/2) year.

48
Q

What is subclinical hyperthyroidism?

A

TSH between 0.1 and 0.45.

49
Q

What are the possible complications of subclinical hyperthyroidism?

A

Cardiovascular issues, osteoporosis, and dementia.

50
Q

What are the primary symptoms of thyroid crisis?

A

Fever, profuse sweating, tachycardia, frequent arrhythmias, tense nervousness, psychosis, apathy, stupor, coma, nausea, vomiting, diarrhea, and possibly abdominal pain.

51
Q

What is the recommended treatment for thyroid crisis?

A

Intensive treatment including fluid replacement, circulatory support, hydrocortisone (2-4x150 mg infusion daily), and beta-blockers (4x40-80 mg propranolol per day).

52
Q

What is the recommended treatment for thyreotoxic crisis?

A

Fluid replacement, circulatory support, hydrocortisone, beta blockers (propranolol), inhibition of hormone production with thiamazole / methimazole, inhibition of hormone secretion with lithium carbonate, dexamethasone

53
Q

What is the prevalence of clinical hypothyroidism in the total population?

A

0.3-0.4%.

54
Q

What are some symptoms of thyroid disorders?

A

Weakness, fatigue, sleepiness, memory problems, cold intolerance, tendency to gain weight, skin dryness, hair loss, muscle weakness, muscle cramp.

55
Q

What are some preventive therapeutic effects on the thyroid gland?

A

Preventing injury.

56
Q

What are some drugs that affect thyroid function?

A

Thiamazole, methimazole, propylthiouracil, potassium iodide, iodate, sodium iodide, lithium carbonate, dexamethasone.

57
Q

What are some environmental factors that can cause thyroid diseases?

A

Unknown.

58
Q

What are some diseases of the pituitary-hypothalamus?

A

Thyroid diseases.

59
Q

What are some common symptoms of hypothyroid disorders?

A

Weakness, fatigue, sleepiness, memory problems, cold intolerance, tendency to gain weight, skin dryness, hair loss, muscle weakness, hearing loss, infertility, loss of libido, puffiness, vitiligo, goitre, bradycardia

60
Q

What is the recommended treatment for hypothyroid disorders?

A

Levothyroxine substitution treatment

61
Q

How often should TSH levels be monitored during levothyroxine substitution treatment?

A

TSH levels should be monitored only 4-6 weeks after the last L-T4 dose change.

62
Q

What should be done if there are simultaneously high serum TSH and T4 levels during levothyroxine substitution treatment?

A

Poor compliance (possibly lab error) should be considered.

63
Q

What is the achievable serum TSH level for young, middle-aged, and very old individuals?

A

Young individuals: 0.5-2.5 mE/l, middle-aged individuals: 0.5-3.5 mE/l, and very old individuals: 4.0-6.0 mE/l.

64
Q

What is the achievable serum TSH level for young individuals?

A

0.5-2.5 mE/l.

65
Q

What is the achievable serum TSH level for middle-aged individuals?

A

0.5-3.5 mE/l.

66
Q

What is the achievable serum TSH level for very old individuals?

A

4.0-6.0 mE/l.

67
Q

What are the symptoms of myxoedematous coma?

A

Heart failure, pericardial effusion, hyponatraemia, respiratory failure, ileus, drug sensitivity, hypothermia, delirium, convulsions, stupor, coma.

68
Q

What are the causes of De Quervain thyroiditis?

A

Viral infections, often upper respiratory tract infections (Coxackie, mumps, adenovirus).

69
Q

What is the female to male ratio for De Quervain thyroiditis?

A

05:01

70
Q

What is the HLA haplotype often associated with De Quervain thyroiditis?

A

HLA-B35.

71
Q

What are the common symptoms of De Quervain thyroiditis?

A

Neck pain, tenderness in more than 90% of cases, pain may radiate to the neck, ear, jaw.

72
Q

What is the treatment for neck pain associated with an upper respiratory tract infection?

A

NSAIDs (ASA, Ibuprofen), and if no improvement, steroids (prednisone) for a few days.

73
Q

What is the symptomatic treatment for hyperthyroidism?

A

Beta-blocker (propranolol).

74
Q

Are thionamides effective in treating symptomatic hyperthyroidism?

A

No, they are ineffective.

75
Q

What is the genetic influence on thyroid disorders?

A

Identical twins have a 30-60% chance of having thyroid disorders, while siblings have a 20% chance.

76
Q

What percentage of patients with thyroid disorders are referred to the hospital?

A

20-50%.

77
Q

What are some conditions that can cause thyroid disorders?

A

Inflammatory processes, malignancies, liver and kidney diseases, circulatory diseases, traumas, surgical interventions, inadequate caloric intake, and acute life-threatening conditions.

78
Q

What are the four types of thyroid hormones?

A

TSH, fT4, fT3, and rT3.

79
Q

What is the thyroid adaptation syndrome?

A

It is a condition where the thyroid gland adapts to changes in the body’s metabolic rate.

80
Q

What is sick euthyroid illness?

A

It is a condition where the thyroid gland is functioning normally, but the patient has abnormal thyroid hormone levels due to a non-thyroidal illness.

1. Internal Medicine I (20 decks)

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