Case 7 - Thyroid Disease Flashcards
What are the 3 commonest causes of hyperthyroidism?
Graves’ disease
Toxic multinodular goitre
Solitary toxic adenoma
Which clinical features are only found in hyperthyroidism due to Graves’ disease?
Thyroid acropachy (swelling of hands and clubbing)
Exophthalmos (bulging of eye anteriorly)
Pretibial myxodemema
What are the common symptoms of hyperthyroidism?
Weight loss Increased appetite Diarrhoea Irritability Sweats Heat intolerance Palpitations Oligomenorrhoea (lack of periods)
What are the common signs of hyperthyroidism?
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
What are the rarer signs seen in hyperthyroidism?
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
What is the main treatment of hyperthyroidism?
Carbimazole
What is the potentially serious side effect of carbimazole?
What advice would you give when starting a patient on this drug?
Neutropenia and agranulocytosis
Report any signs of infection especially sore throat - check FBC if these signs are present
What is the mechanism of neonatal hyperthyroidism?
Thyroid stimulating antibodies (in Graves’ disease) can cross the placenta and stimulate the thyroid gland of the foetus
What are the possible treatment options for hyperthyroidism when carbimazole is ineffective?
Thyroidectomy
Radioactive iodine - note this is contraindicated in patients who are pregnant or breast feeding
What are the symptoms of hypothyroidism?
Lethargic Low mood Weight increase Cold intolerance Constipation Menorrhagia Hoarse voice Decrease in memory Weakness
What are the signs seen in hypothyroidism?
Bradycardia Slow reflexes Ataxia (lack of voluntary coordination) Dry thin hair Cold hands Ascites Round puffy face
What is Sheehans syndrome?
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
What is the most common cause of primary hypothyroidism in the UK?
Hashimotos disease (chronic autoimmune thyroiditis)
What is secondary hypothyroidism?
Hypothyroidism due to TSH deficiency due to pituitary or hypothalamic disease
TFTs show low free T4 and low TSH levels
What are the possible side effects of over replacement of levothyroxine?
Atrial fibrillation
Osteoporosis
What are the 3 drugs used to treat a hyperthyroid crisis?
Beta blockers - treat tachycardia
Carbimazole - reduce raised serum thyroid hormones
Hydrocortisone - treat underlying adrenal insufficiency
What are the different types of autoantibodies found in Graves’ disease and Hashimoto’s thyroiditis?
TSH receptor autoantibodies - found in graves
Anti-TPO (anti thyroid peroixdase) - found in hashimotos
What are the major complications of thyroid surgery?
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
What would be the result of TFTs if compliance with levothyroxine was poor?
Why is this the case?
Normal free T4 levels
High TSH levels
Implying that over recent days/weeks the body has been thyroxine deficient
Which drug most commonly causes abnormalities in thyroid function tests and may cause both hypothyroidism and hyperthyroidism?
Why?
Amiodarone
It releases free iodine which increases the iodine load on the thyroid
What is the most important modifiable risk factor for the development of thyroid eye disease?
Smoking
What is the most common type of thyroid cancer?
Papillary carcinoma
Which type of thyroid cancer is associated with the parafollicular (C) cells?
Medullary carcinoma
What are the “red flag” symptoms regarding a swelling or lump in the neck
Growth over short period of time Dysphagia Neck pain Hoarseness History of radiation to neck Family history of thyroid cancer
