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case 16: diabetes > chemical pathology: thyroid disease > Flashcards

chemical pathology: thyroid disease Flashcards

1
Q

What three hormone are produced by the thyroid

A

T3, T4 & calcitonin

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2
Q

Where does the hormone act

A

Intracellular hormone that binds inside nucleus & alter gene expression

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3
Q

What is the three functions of thyroid hormones

A
  1. Growth
  2. Mental development
  3. Affects general metabolic activity
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4
Q

What is the hormone’s pathway

A
  1. Hypothalamus secretes TRH
  2. Stimulating the pituitary to secrete TSH
  3. Stimulating the thyroid to secrete T3 & T4
  4. T4 gets converted to T3
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5
Q

How does thyroid hormones get transported

A

Bound to plasma proteins

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6
Q

What is the three plasma proteins that bind thyroid hormone

A

Thyroxine binding globulin
Albumin
Transthyretin

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7
Q

When is the drug biologically active

A

Unbound

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8
Q

What factor increase TBG

A

Estrogen

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9
Q

What three factors decrease TBG

A

Protein losing states, malnutrition & corticosteroids

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10
Q

Is the bound or free thyroid hormone tested

A

Free hormone

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11
Q

What response first after treatment

A

T4 changes rapidly & TSH takes longer

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12
Q

What is the three thyroid tests

A
  1. TSH
  2. Free T4
  3. Free T3
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13
Q

When is TSH used for testing

A

First line testing & for screening

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14
Q

When is free T4 used for testing

A

Abnormal TSH, known disease or for monitoring disease

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15
Q

When is free T3 used for testing

A

T3 toxicity, non-thyroidal illness, drugs

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16
Q

What is three other thyroid tests that can be done

A
  1. Thyroglobulin
  2. Calcitonin
  3. Thyroid antibodies
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17
Q

When is thyroglobulin used for testing

A

Tumour marker for thyroid cancer

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18
Q

When is calcitonin used for testing

A

Tumour marker for medullary thyroid cancer

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19
Q

When is thyroid antibodies used for testing

A

Autoimmune disease

20
Q

What is the thyroid antibody present in Graves

A

Anti-TSH receptor antibody

21
Q

What is the thyroid antibody present in Hashimoto’s

A

Anti-thyroid peroxidase antibody

22
Q

What is the clinical features of hyperthyroidism

A

Eyelid retraction, proptosis, diplopia
Weight loss, sweating, heat intolerance or fatigue

23
Q

What is the three causes of hyperthyroidism

A
  1. Graves disease
  2. Multinodular goiter
  3. Toxic adenoma
24
Q

What is the testing results for hyperthyroidism

A

TSH <0.01
T3 & T4 high

25
Q

What is the clinical features of hypothyroidism

A

Not specific symptoms
Dryness coarsening of skin & hair
Lethargy, tiredness, cold intolerance, weight gain

26
Q

What is the two causes of hypothyroidism

A

Autoimmune
Iatrogenic

27
Q

What is the testing results for hypothyroidism

A

TSH high
T3 & T4 low
Prolactin high
Cholesterol high
CK high

28
Q

What is congenital hypothyroidism

A

Most common treatable cause of mental retardation

29
Q

What is the cause of congenital hypothyroidism

A

Sporadic due to enzyme deficiency or thyroid not developing

30
Q

What is the clinical presentation of congenital hypothyroidism

A

Few/no clinical manifestation,
Jaundice
Decreased activity
Increased sleep

31
Q

What is the complications of congenital hypothyroidism

A

Poor bone growth
Motor & cognitive impairment

32
Q

What is the results of sub clinical hypothyroidism

A

TSH high & normal T4

33
Q

What is the three risks of sub clinical hypothyroidism

A

Increased risk for developing overt hypothyroidism
CVD & dyslipidemia

34
Q

What is the results of sub clinical hyperthyroidism

A

TSH low & normal T4

35
Q

What is the three risks of sub clinical hyperthyroidism

A

Increased risk for developing overt hyperthyroidism
Atrial fibrillation & decreased bone density

36
Q

What is the cause of non thyroidal illness

A

Severe illness that changes thyroid function

37
Q

What is the three cause of non thyroidal illness

A
  1. Decreased peripheral conversion of T4 to T3
  2. Changes in concentration/affinity of binding proteins
  3. Disturbance in HPT axis
38
Q

What two things causes a decrease in TSH & T4

A
  1. NTI
  2. Recent treatment of hyperthyroidism
39
Q

What three things causes a decrease in TSH & normal T4

A
  1. Subclinical hyperthyroidism
  2. NTI
  3. Recent treatment of hyperthyroidism
40
Q

What causes a decrease in TSH & increase T4

A

Overt hyperthyroidism

41
Q

What causes a increase in TSH & decrease in T4

A

Overt hypothyroidism

42
Q

What three things causes a increase in TSH & normal T4

A
  1. Subclinical hypothyroidism
  2. Recent treatment of hypothyroidism
  3. NTI
43
Q

What causes a increase in TSH & T4

A

Recent treatment of hypothyroidism

44
Q

What two things causes a normal TSH & decreased T4

A
  1. NTI
  2. Recent treatment of hyperthyroidism
45
Q

What causes a normal TSH & increased T4

A

Intermittent T4 therapy

case 16: diabetes (9 decks)

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