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Year 3 > Case 7 - Thyroid Disease > Flashcards

Case 7 - Thyroid Disease Flashcards

1
Q

What are the 3 commonest causes of hyperthyroidism?

A

Graves’ disease
Toxic multinodular goitre
Solitary toxic adenoma

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2
Q

Which clinical features are only found in hyperthyroidism due to Graves’ disease?

A

Thyroid acropachy (swelling of hands and clubbing)
Exophthalmos (bulging of eye anteriorly)
Pretibial myxodemema

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3
Q

What are the common symptoms of hyperthyroidism?

A 
Weight loss
Increased appetite 
Diarrhoea 
Irritability 
Sweats 
Heat intolerance 
Palpitations
Oligomenorrhoea (lack of periods)
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4
Q

What are the common signs of hyperthyroidism?

A 
Fast and irregular pulse 
Warm moist skin 
Fine tremor
Palmer erythema
Thin hair 
Exophthalmos (bulging of eyeball anterioly)
Lid lag sign (eyelid lags behind eyes descent as patient watches finger descend slowly)
Presence of goitre
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5
Q

What are the rarer signs seen in hyperthyroidism?

A

Onycholysis (painful seperation of nail from nail bed)
Acropachy (swelling of hangs and clubbing of fingers)
Conjunctival oedema (swelling of the conjunctiva in the eyes)
Proximal myopathy (symmetrical weakness of proximal upper/lower limbs)
Pretibial myxedema (localised lesions of skin anterior to tibia)
Hyperreflexia

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6
Q

What is the main treatment of hyperthyroidism?

A

Carbimazole

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7
Q

What is the potentially serious side effect of carbimazole?

What advice would you give when starting a patient on this drug?

A

Neutropenia and agranulocytosis

Report any signs of infection especially sore throat - check FBC if these signs are present

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8
Q

What is the mechanism of neonatal hyperthyroidism?

A

Thyroid stimulating antibodies (in Graves’ disease) can cross the placenta and stimulate the thyroid gland of the foetus

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9
Q

What are the possible treatment options for hyperthyroidism when carbimazole is ineffective?

A

Thyroidectomy

Radioactive iodine - note this is contraindicated in patients who are pregnant or breast feeding

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10
Q

What are the symptoms of hypothyroidism?

A 
Lethargic 
Low mood 
Weight increase
Cold intolerance 
Constipation 
Menorrhagia 
Hoarse voice
Decrease in memory 
Weakness
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11
Q

What are the signs seen in hypothyroidism?

A 
Bradycardia 
Slow reflexes 
Ataxia (lack of voluntary coordination)
Dry thin hair 
Cold hands
Ascites 
Round puffy face
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12
Q

What is Sheehans syndrome?

A

Hypothyroidism seen post partum

Anaemia after birth due to blood loss can cause hypoxia to the pituitary gland so it doesn’t produce as many hormones

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13
Q

What is the most common cause of primary hypothyroidism in the UK?

A

Hashimotos disease (chronic autoimmune thyroiditis)

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14
Q

What is secondary hypothyroidism?

A

Hypothyroidism due to TSH deficiency due to pituitary or hypothalamic disease

TFTs show low free T4 and low TSH levels

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15
Q

What are the possible side effects of over replacement of levothyroxine?

A

Atrial fibrillation

Osteoporosis

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16
Q

What are the 3 drugs used to treat a hyperthyroid crisis?

A

Beta blockers - treat tachycardia
Carbimazole - reduce raised serum thyroid hormones
Hydrocortisone - treat underlying adrenal insufficiency

17
Q

What are the different types of autoantibodies found in Graves’ disease and Hashimoto’s thyroiditis?

A

TSH receptor autoantibodies - found in graves

Anti-TPO (anti thyroid peroixdase) - found in hashimotos

18
Q

What are the major complications of thyroid surgery?

A

Anatomical complication - damage to laryngeal nerve
Bleeding - owing to the confined space haemotomas may rapidly lead to respiratory compromise owing to laryngeal oedema
Damage to parathyroid glands - resulting in hypocalcaemia

19
Q

What would be the result of TFTs if compliance with levothyroxine was poor?

Why is this the case?

A

Normal free T4 levels
High TSH levels

Implying that over recent days/weeks the body has been thyroxine deficient

20
Q

Which drug most commonly causes abnormalities in thyroid function tests and may cause both hypothyroidism and hyperthyroidism?

Why?

A

Amiodarone

It releases free iodine which increases the iodine load on the thyroid

21
Q

What is the most important modifiable risk factor for the development of thyroid eye disease?

A

Smoking

22
Q

What is the most common type of thyroid cancer?

A

Papillary carcinoma

23
Q

Which type of thyroid cancer is associated with the parafollicular (C) cells?

A

Medullary carcinoma

24
Q

What are the “red flag” symptoms regarding a swelling or lump in the neck

A 
Growth over short period of time 
Dysphagia 
Neck pain 
Hoarseness
History of radiation to neck 
Family history of thyroid cancer
25
Q

How would you investigate a lump on the neck?

A

Ultrasound followed by fine needle aspiration (FNA) of the lump

26
Q

How are thyroid cancers treated?

A

Surgery (total thyroidectomy or lobectomy)
Post operative radioactive iodine treatment
Thyroid hormone suppression

27
Q

What dose of levothyroxine should patients with ischaemic heart disease be started on?

A

25mmcg and increase in doses of 25 due to adverse effect on heart

28
Q

How does radioactive iodine work?

A

Taken orally (drink or capsule)
Rapidly taken up by the thyroid gland
Then a release of radiation destroys the tissue over a period of 6-18 weeks

29
Q

What dosages should levothyroxine be adjusted in?

A

25mcg steps

30
Q

What other conditions are associated with medullary cell carcinoma

A

Phaeochromocytoma (Adrenal tumour)

Hyperparathyroidism

31
Q

What are the differentials for weight loss?

A 
Malignancy of any kind
GI issue - e.g, coeliac, IBD
Depression 
Eating disorder
Diabetes 
Drugs of abuse e.g, cannabis 
Tuberculosis 
HIV
Hyperthyroidism
32
Q

What should patients be counselled with before undergoing radioactive iodine?

A

Safe - no apparent cancer risk
No fertility problems
Hypothyroidism is inevitable
Don’t have pregnancy up to 6 months after
Restrictions on contact for up to 3 weeks
Care with eye disease

Year 3 (24 decks)

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