Chempath 9: Thyroid Flashcards

1
Q

Which auto-antibodies are seen in Hashimoto’s thyroiditis ?

A

anti-TPO

also anti-TG

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2
Q

Which auto-antibodies are seen in Grave’s disease?

A

anti-TSH receptor (activates Thyroid production)

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3
Q

what is the most common type of thyroid cancer?

A

Pappilary thyroid cancer

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4
Q

In which cancer are Psammoma bodies seen on histology ?

A

Papillary thyroid

also ovarian serous cyst adenoma

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5
Q

which thyroid cancer is associated with MEN2 ?

A

Medullary thyroid cancer

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6
Q

Which thyroid cancer releases calcitonin ?

A

Medullary thyroid cancer

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7
Q

List the 3 cancers seen in MEN1

A

Pituitary
Parathyroid
Pancreatic (Insulinoma)

3 Ps

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8
Q

List the 3 cancers seen in MEN2a

A

Phaeochromocytoma
Parathyroid
Medullary thyroid

2 Ps 1 M

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9
Q

List the 3 cancers seen in MEN2b

A

Phaeochromocytoma
Medullary thyroid
Mucocutaneous neuromas
1 P 2 Ms

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10
Q

What is the mode of inheritance for MEN ?

A

Autosomal dominant

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11
Q

List 2 causes of hyperthyroidism with high iodine uptake ?

A

Grave’s disease

Multinodular goitre

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12
Q

List 2 causes of hyperthyroidism with low iodine uptake ?

A

De Quervains thyroiditis

Post partum thyroiditis

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13
Q

List causes of hypothyroidism ?

A
Hashimoto's thyroiditis 
Atrophic hypothyroidism 
Iodine deficiency 
post thyroidectomy/Post radioactive iodine 
Drugs- Lithium, Amiodarone
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14
Q

Which drug can be used to treat hyperthyroidism without inducing permanent hypothyroidism?

A

carbimazole

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15
Q

how is thyroxine made

A

TSH controls the uptake of iodide to the thyroid (blocked by perchlorate)
Iodide goes through the membrane via Na+/l+/ATPase
Iodide converted to iodine by thyroid peroxidase
Iodine taken up by thyroglobulin and converted into thyroxine (T4)
Converted to T3 in the periphery

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16
Q

how is most thyroxine transported around the body

A

bound to thyroxine binding globulin (TBG)

17
Q

list causes of hypothyroidism

A
Hashimotos thyroiditis 
atrophic thyroid
post-graves disease
drugs (amiodarone, lithium)
thyroid agenesis/dysgenesis
18
Q

why would you do an ECG in someone with hypothyroidism

A

if they have an underlying cardiovascular disease, their myocardial contractility will increase - risk of ischaemia

19
Q

how is hypothyroidism treated

A

T4 (levothyroxine)

20
Q

features of subclinical hypothyroidism

A

T4 is normal and TSH high

associated with hypercholesterolaemia

21
Q

describe thyroid function in pregnancy

A

hCG has a similar structure to TSH
too much hCG - thyroid gland makes too much thyroxine
rise in hCG in first trimester makes free T4 levels increase slightly
TBG levels increase dramatically in pregnancy (under control of oestrogen)

22
Q

features of neonatal hypothyroidism

A

diagnosed via Guthrie test
48-72 hours
may be very high if you detect maternal TSH

23
Q

features of sick euthyroid

A

alteratio in pituitary axis in non-thyroidal illness
low T4 and T3
normal/high TSH
in any severe illness

24
Q

causes of hyperthyroidism

A

graves (40-60%)
toxic multinodiular goitre (30-50%)
single toxic adenoma (5%)

use a technetium scan to see which parts of the thyroid are making excessive thyroid hormone

25
Q

management for hyperthyroidism

A
beta blocker if pulse >100 
ECG
bone mineral density 
radioactive iodine 
thionamides - carbimazole, propylthiouracil, prevent the conversion of iodine to iodine by thyroid peroxidase
26
Q

what is a rare side effects of thionamides

A

agranulocytosis

27
Q

features of thyroiditis

A

can be asymptomatic
some form of pain in the neck
initial inflammation of the thyroid releasing excessive amounts of thyroid hormone
long-term treatment = thyroid replacement therapy

28
Q

list the 2 most common types of thyroid carcinoma

A

papillary thyroid cancer

follicular thyroid cancer

29
Q

treatment for thyroid carcinoma

A

total thyroidectomy
radioiodine after surgery to remove any remaining thyroid cells
after this, given high dose thyroxine to lower TSH levels so TSH doesn’t stimulate any remaining cancer cells
TG measured in the serum as a tumour marker

30
Q

features of medullary carcinoma of the thyroid gland

A

rare
can be sporadic, familial, or part of MEN 2
cancer of the C cells of the thyroid gland (these make calcitonin)
tumour makers:
- calcitonin
- CEA (carcionoembryonic antigen)