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203 theme 1 > 8. Thyroid Disease > Flashcards

8. Thyroid Disease Flashcards

1
Q

hypothyroidism

A

underproduction of thyroid hormone
primary = due to thyroid problem
secondary = due to hypothalamic/pituitary problem

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2
Q

hyperthyroidism

A

thyrotoxicosis

overproduction of thyroid hormone

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3
Q

euthyroid

A

normal production of thyroid hormone

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4
Q

goitre

A

enlargement of thyroid gland

patient would be hyper, hypo or euthyroid

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5
Q

how to examine thyroid

A 
low down in neck, feel for thyroid cartilage - down and laterally 
moves on swallowing
listen to bruit (increased blood flow)
retrosternal extension
check cervical lymph nodes
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6
Q

thyroid function tests

A

TSH, FT4, FT3

thyroid antibodies - anti-TPO (thyroid peroxidase), TRAB-TSH receptor

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7
Q

TSH

A

best biomarker of thyroid status
slow to respond to change
assumes normal pituitary function
negative feedback regulation

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8
Q

thyroid autoantibodies

A

different types: destructive or stimulatory

marker of risk for autoimmune condition

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9
Q

hypothyroidism symptoms

A 
may be none
lethargy
mild weight gain
cold intolerance
constipation
facial puffiness
dry skin
hair loss
hoarseness 
heavy menstrual periods
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10
Q

signs of severe hypothyroidism

A 
change in appearance (face puffy and pale) 
preorbital oedema 
dry, flaky skin 
diffuse hair loss
bradycardia
carpal tunnel (median nerve compression
effusions
croaky voice
goitre 
delayed relaxation of reflexes
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11
Q

causes of primary hypothyroidism

A 
autoimmune hypothyroidism 
hypothyroidism after treatment for hyperthyroidism (iatrogenic)
thyroiditis 
drugs 
congenital hypothyroidism 
iodine deficiency
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12
Q

causes of secondary hypothyroidism

A

rare

diseases of hypothalamus or pituitary

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13
Q

hypothyroidism investigations

A

blood tests to confirm - TSH high, FT4 low
could check thyroid antibodies
no imaging necessary

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14
Q

hypothyroidism treatment

A

daily thyroxine

aim = normal FT4 without TSH suppression

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15
Q

autoimmune hypothyroidism

A

chronic autoimmune thyroiditis - hashimoto’s

myxoedema (coma)

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16
Q

myxoedema

A

accumulation of glycosaminoglycans in interstitial spaces of tissues
occurs in very severe hypothyroidism
coma

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17
Q

thyrotoxicosis symptoms

A 
weight loss
lack of energy 
heat intolerance 
anxiety/irritability 
increased sweating 
increased appetite 
thirst
palpitations 
pruritus 
weight gain 
loose bowels 
oligomenorrhora
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18
Q

signs of severe thyrotoxicosis

A 
tremor 
warm, moist skin 
tachycardia
brush reflexes 
eye signs 
thyroid bruit 
muscle weakness 
atrial fibrillation
19
Q

thyroid eye disease (TED) and thyroid associated opthalmopathy (TAO)

A 
associated with Grave's in ~20% 
increased risk in smokers 
antibody mediated 
inflammation of all orbital tissues except eye (fat, muscles, conjunctiva, eyelids) 
CT scan imaging helpful
20
Q

TED/TAO mild symptoms

A

itchy/dry eyes

prominent eyes, change in appearance

21
Q

TED/TAO worrisome symptoms

A 
diplopia/loss of sight 
loss of colour vision
redness/swelling of conjunctiva 
unable to fully close eyes
ache/pain/tightness in or behind eye
22
Q

signs associated with thyrotoxicosis - hands

A

fine tremor

warm, moist

23
Q

signs associated with thyrotoxicosis - pulse

A

sinus tachycardia

atrial fibirillation

24
Q

signs associated with thyrotoxicosis - neck

A

goitre
move when swallow
smooth/not
bruit/not

25
Q

signs associated with thyrotoxicosis - eyes

A

lid retraction/lag
proptosis/exopthalmos
opthalmoplegia (abnormal eye movements, causes diplopia)
inflammation (of conjunctiva)

26
Q

causes of thyrotoxicosis

A 
autoimmune hyperthyroidism (Grave's) 
toxic multi nodular goitre 
toxic adenoma 
thyroiditis 
drugs (eg amiodarone)
gestational
27
Q

Grave’s disease

A

autoantibody stimulates TSH receptor
causes excess thyroid hormone production and thyroid growth (goitre)
accounts for 70% cases

28
Q

gestational thyroiditis

A

placental beta-hCG is structurally similar to TSH - has similar action on thyroid
more likely if hyperemesis/twins
settles after 1st trimester

29
Q

Grave’s - helpful diagnostic features

A

personal or family history of any autoimmune endocrine disease
goitre with bruit
thyroid eye disease
positive thyroid antibody titre

30
Q

hypothyroidism investigations

A

low TSH, high FT3 and FT4
thyroid antibodies
may not need imaging
thyroid uptake scan (isotype test)

31
Q

Grave’s treatment options

A

medical
radioiodine
surgery

32
Q

risks of untreated Grave’s

A

symptoms worsen
atrial fibrillation
osteoporosis

33
Q

Grave’s - medical treatment

A 
carbimazole of propylthiouracil 
18 months-2 years
rare side effect = agranulocytosis 
~1/3 cure rate
2/3 relapse: usually in first year
34
Q

Grave’s - radioiodine treatment

A

oral - radioiodine concentrates in thyroid, radiation kills thyroid cells
medical treatment used until euthyroid
~40% risk fo hypothyroidism after
must avoid close treatment for 1-2 weeks after
not if severe thyroid eye disease

35
Q

Grave’s - surgery

A

subtotal thyroidectomy (almost total)
patients must be euthyroid post-op
medical therapy first
risks: anaesthetic, neck scar, hypothyroidism, hypoparathyroidism, vocal cord palsy

36
Q

toxic adenoma/multinodular goitre treatment

A

initially: short term medical therapy

subsequent curative treatment: radioiodine

37
Q

thyroid eye disease treatment

A

encourage smoking cessation
steroids/other immunosuppressives
radiotherapy
surgical treatment: orbital decompression, eyelid surgery

38
Q

thyroid storm

A

thyrotoxic crisis
rare, usually occurring in 2nd degree Grave’s
incomplete treatment - erratic compliance, start-stop, early in treatment
high mortality rate, ITU level care

39
Q

features of thyroid storm

A 
multi-system
Grave's 
hyperpyrexia
CNS - agitation, delirium 
CV - tachycardia, ventricular dysfunction, heart failure 
GI - nausea, vomiting, diarrhoea
40
Q

thyroiditis

A

usually self-limiting
inflammation of thyroid
transient mild: always resolves 1-2 months
longer hypothyroid phase: 4-6 months, 80% after 1 year

41
Q

autoimmune endocrine diseases associated with thyroid disease

A 
type 1 diabetes 
pernicious diabetes
coeliac anaemia
coeliac disease 
premature ovarian failure 
Addison's disease
42
Q

syndromes associated with thyroid disease

A

Turner syndrome

Down’s syndrome

43
Q

euthyroid goitre

A

common
more common in iodine deficient areas
may be multi-nodular
usually nothing to worry about

44
Q

thyroid nodule

A

must exclude cancer (~5%)
ultrasound characteristics helpful
fine-needle aspiration biopsy for cytology

203 theme 1 (16 decks)

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