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Phase 4 Surgery > Benign Thyroid Disease > Flashcards

Benign Thyroid Disease Flashcards

1
Q

How is hypothyroidism classified?

A
  1. Primary hypothyroidism (issue with thyroid gland)
  2. Secondary hypothyroidism (issue with pituitary eg, pituitary apoplexy or lesion compressing pituitary)
  3. Congenital hypothyroidism - thyroid dysgenesis or dyshormonogenesis
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2
Q

What is hashimoto’s thyroiditis?

A
  • Autoimmune hypothyroidism associated with T1DM, Addison’s or pernicious anaemia.
  • It is also asscoiated with development of MALT lymphoma
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3
Q

What is subacute thyroiditis?

A

Hypothyroidism associated with a painful goitre and a raised ESR

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4
Q

What is Riedel thyroiditis?

A

Hpothyroidism caused by fibrous tissue replacing the normal parenchyma

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5
Q

What are the causes of hypothyroidism?

A

Hashimotos,
Subacute/De Quervain’s
Riedel thyroiditis,
Postpartum thyroiditis
Drugs eg, Lithium or amiodarone
Iodine deficiency (most common cause in developing world)

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6
Q

What are some causes of hyperthyroidism?

A

Graves disease,
- Toxic multinodular goiter
- Amiodarone

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7
Q

What are the signs and symptoms of hypothyroidism?

A
  • Weight gain, lethargy and cold intolerence,
  • Dry, cold skin, non-pitting oedema, dry, coarse hair
  • Constimation
  • Menorrhagia
  • Carpal tunnel and reduced reflexes
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8
Q

What are the symptoms of hyperthyroidism?

A
  • Weight loss, restlessness and heat intolerence,
  • Palpitations and AF
  • Sweating
  • Pretibial myxoedema, thyroid acropachy,
  • Oligomenorrhea,
  • Diarrhoea
  • Anxiety and tremor
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9
Q

What TFT results should you suspect for thyrotoxicosis?

A

TSH - Low
T4 - High

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10
Q

What TFT results should you suspect for primary hypothyroidism?

A

TSH - High
T4 - Low

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11
Q

What TFT results should you suspect for secondary hypothyroidism?

A

TSH - Low
T4 - Low

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12
Q

What TFT results should you suspect for subclinical hypothyroidism?

A

TSH - High
T4 - Normal

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13
Q

Whats the treatment for Grave’s disease?

A
  • Initially give propanolol to control adrenergic effects
  • Carbimazole for 12-18months
  • Second line is propylthiouracil
  • Radioiodine is used in patients who relapse on anti-thyroid drugs, eye disease or are resistent.
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14
Q

What are the contraindications for radioiodine?

A
  • Pregnancy,
  • Under 16 years old
  • Thyroid eye disease
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15
Q

What are the investigations and treatment for toxic multinodular goitre?

A

Investigations- Nuclear scintigraphy shows patchy uptake.
Management - Radioiodine therapy

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16
Q

What is subacute/De Quervain’s thyroiditis

A

Thyroid disease which occurs following a viral infection

17
Q

Describe the presentation of subacute/De Quervain’s thyroiditis

A

Phase 1 (3-6 weeks) - Hyperthyroidism, painful goiter and raised ESR
Phase 2 (1-3 weeks) - Euthyroid
Phase 4 (weeks to months) - Hypothyroidism
Phase 4 - Thyroid structure and function returned to normal

18
Q

WHat are the investigations for subacute/De Quervain’s thyroiditis?

A

Thyroid scintigraphy - reduced uptake of iodine 131

19
Q

What is the management of subacute/De Quervain’s thyroiditis?

A

Usually self limiting but severe cases may require steroids. Pain may respond to NSAIDs

20
Q

What is sick euthyroid syndrome/non-thyroidal illness?

A
  • TSH is normal/low and T3 and T4 are low.
  • Changes are reversible upon recovery from systemic illness
21
Q

What are the effects of pregnancy on the thyroid?

A

In pregnancy there is an increase in thyroxine binding globulin which causes an increase in levels of total thyroxine. Its treated with propylthiouracil until the second trimester when they are put on carbimazole

22
Q

What is the management of subclinical hypothyroidism

A
  1. If TSH > 10 on two separate occasions, 3 months apart then give levothyroxine.
  2. If TSH is between 5.5 and 10 on two separate occasions, 3 months apart and patient is under 65 WITH symptoms then give 6m of levo
  3. If TSH is between 5.5-10 and asymptomatic then repeat in 6 months
23
Q

What are some benign thyroid lumps?

A
  • Thyroid adenoma (may become a toxic adenoma which produced lots of T3/4)
  • Toxic multinodular goitre (lots of T3/4)
  • Thyroid cyst
24
Q

What are the autoantibodies tested for in thyroid disease?

A
  • Anti-thyroid peroxidase antibodie (hashimotos)
  • TSH receptor antibodies
  • Thyroglobulin antibodies
25
Q

When is a thyroglossal cyst removed?

A

When over 4cm

26
Q

What are the indications for surgery for a goiter?

A
  • If benign only remove if there is compression ot toxicity.
  • Thy3 then do hemithyroidectomy
  • Thy4/5 - total thyroidectomy
  • Multinodular goitre
  • Retrosternal goitre
  • Thyroid cancer

Phase 4 Surgery (58 decks)

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