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Y2 Endocrinology > Amine Hormones > Flashcards

Amine Hormones Flashcards

1
Q

Cause of exophthalmos in TED

A

Due to increase GAGs via TSH receptors when TRAbs bind to them.( Due to production of fibroblasts).
Also due to adipocytes producing adipose tissue.
All these causes swelling in muscles and tissue behind the eye.

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2
Q

Cause of thyroid signs in pregnancy despite low TRab

A

Due to high hCG that induces transient hyperthyroidism - increases T 3 and T4 and decreases TSH

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3
Q

Causes of temporary thyoriditis

A

Viral or pospartum,

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4
Q

Causes of thyroiditis

A

Pregnancy, infection, autoimmune or drugs like amiodarone

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5
Q

Changes to deiodinase in illness

A

Conversion of T4 to T3 is impaired due to oxidative stress, altered redox state of cell and cytokine release so T3 levels also fall

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6
Q

Common causes of hypoT

A

Thyroiditis accounts for 90%- Hashimoto’s

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7
Q

Do thyroid hormones behave more like steroid hormones or peptide hormones

A

Steroid hormones

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8
Q

Four actions of thyroid hormone and pathogenic effects

A

Growth and development
Basal metabolic rate - hot and sweaty, rapid heart rate, bowels move too fast (diarrhea)
Thermogenesis in brown adipose tissue(feel hot)
Activate mental processes ( nervous and irritable, reduce concentration, slowed down thinking, low mood and depression)

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9
Q

How does free hormones fraction change in illness

A

Rises due to binding proteins like albumin being affected

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10
Q

How does illness affect TRH levels

A

Release from hypothalamus suppressed by cytokine (IL-1 and TNFa) and glucocorticoids like cortisol

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11
Q

how is fT4 in NTI

A

usually within reference range or moderately raised

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12
Q

How many Tyrosine rings in each hormone? What else is included

A

Catecholamines-1
Thyroid hormone- 2 + Iodine

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13
Q

How to differentiate TFTs in I’ll patients and patients with thyroid disease

A

Illness may increase fT4 and suppress TSH but will have low T3

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14
Q

Is glucose likely to be high or low in hyperT and why

A

Low due to increased metabolism of Cortisol in liver and increased metabolic demands which increases glucose uptake

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15
Q

Is TRAb high in thyroiditis

A

No

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16
Q

Is TSH high or low for all cases of hyperthyroidism
fT4

A

Low
High

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17
Q

Is tT3 or fT4 preferred for diagnosing Hyperthyroidism and why?

A

tT3 may be raised in patients with OCOP because of increased synthesis of thyroid binding globulin

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18
Q

Main cause of subclinical hypothyroidism

A

Autoimmune chronic thyroiditis

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19
Q

Main management of TED and additional measure

A

Manage in joint thyroid eye clinic
Achieve euthyroidism
Cease smoking
Topical lubricants for dry eyes
Selenium (200mcg daily as antioxidant)
Steroids for active eye disease

Add- rituximab and other additional immunosuppressants
Orbital dadiotherapy
Surgical decompression if raised intraocular pressure

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20
Q

Main signs of thyroiditis

A

Neck discomfort and prodromal flu symptoms

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21
Q

Past medical history to check in thyorid cases

A

Asthma- propranolol contraindicated
Rheart disease- risk of AF

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22
Q

Percentage of free T4

A

0.05%

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23
Q

Problems of I131

A

Need to avoid pregnancy for 6 months and restrict contact with children under 12 and pregnant women
Need to limit close contact with partner for 11 days
Risk of long term hypoT- higher for graves than TMNG or solitaryi nodule (80% for graves)
Risk of TED flaring up after treatment for Graves

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24
Q

Problems with hypothyroidism in pregnancy (overt Vs subclinical)

A

Infertility, miscarriage, pre-eclampsia, premature delivery, increased foetal mortality and impaired neurological development Vs neurodevelopmental delays and placental abruption

25
Risks of surgery for hyper T
Damage to recurrent laryngeal nerve and PT glands May need thyroxine treatment
26
Symptoms and signs of hyperthyroidism
Weight loss despite very good appetite Tiredness Tremor Hot and sweaty Light or absent menses Irritable or anxious Eye disease (red, gritty, painful, double vision) Muscle wasting
27
Symptoms of hypoT
Tired Weight gain and puffy eyes and skin Cold intolerance Bradyc Constipation Dry hair and skin Heavy periods Hyperlipidemia Goitre
28
Three kinds of thyroid binding proteins
Albumin 10% Transthyretin 20% Thyroid binding globulin 70%
29
Treatment for thyroiditis
Treatment with beta blockers but eventually commence thyroxine
30
Treatment of hypoT
Levothyroxine
31
Treatment regimen for graves
ATD first (12-18 months) If recurrent use I131
32
Treatment regimen for TMNG
I1311 as no chance of long term remission with course of tablets
33
What amino acids are amines hormones derived from? What do they make respectively
Tryptophan - Melatonin in Pineal Gland Tyrosine- Catecholamines and thyroid hormones
34
What are the main treatments for hyper T
ATD like Carbimazole which blocks TPO
35
What can secondary hypo T be due to and what should be used to judge adequate replacement
Non functioning pituitary macroadenoma fT4 levels to judge adequate replacements
36
What causes goitre in Graves
Due to trophic effects of TRABs
37
What conditions have TPO present
Graves Underactive thyroid disease eg. Primary autoimmune thyroid failure Autoimmune disease like Hashimoto's
38
What drug can cause hypoT
Lithium
39
What enzyme is involved in the conversion of T4 to T3
Deiodinase enzyme
40
What examination sign is almost diagnostic of graves
Bruit over goitre- rushing noise heard with stethoscope due to increased vascular flow
41
What happens after colloid reabsorption
Proteolysis by lysosome to release T4
42
What happens to T3 on disease and why
T3 is reduced due to impaired T4 uptake in the liver and hence conversion of T4 to T3
43
What inhibits TSH release and what happens to TSH during illness
DA Carbohydrate residues on TSH may be modified in NTI- affecting biological activity and plasma half life
44
What is the cause of high fT4 in thyroiditis
Due to damage from infection resulting in follicles spilling out
45
What is the recommended management of subclinical management
Treat is TSH> 10 on 2 occasions and/or TPOs are strongly positive
46
What is the treatment for papillary carcinomas
Total thyroidectomy and ablative dose of radioiodine and lifelong T4 replacement to prevent TSH from stimulating recalcitrant cancer cells
47
What medications impair T4 absorption
PPIs like Omeeprazole and lansoprazole H2 antagonists like ranitidine Iron, calcium and aluminium All must take > 4 hrs before T4
48
What serum tumour marker for papillary carcinoma for thyroid
Thyroglobulin
49
What should be normalised in primary and secondary hypoT
Primary - normalise TSH secondary - normalise fT4
50
When in gestation is maternal T4 used exclusively
Till 10/40, partially thereafter
51
When is T4/T3 needed for foetus and why
From 4-5/50 for development of CNS and growth and metabolism of foetus
52
When should surgery be considered for Hyper T
Patients with large goitre or eye disease or relapse of Graves r
53
When to increase dose of T4 for hypo G and why
if starting oestrogen or anticonvulsants Antic speeds up breakdown of T4 Oestrogen increases level of Thyroid binding globulin
54
Where is T4 converted into T3
Liver, muscle and kidney
55
Why is heart rate increased in Hyperthyroidism
Due to increased B receptor activation
56
Why might there be dyspnoea in hyperthyroidism
Increased Co2 production by T4/T3
57
What happens to TSH levels in disease
Can be suppressed acutely but rises on recovery, may be misinterpreted as hypothyroidism
58
Should total or free thyroid hormone levels be measured in pregnancy and why
Free, as oestrogen increases synthesis of TBG

Y2 Endocrinology (4 decks)

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