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Diabetes & Endocrinology > Clinical thyroid disease > Flashcards

Clinical thyroid disease Flashcards

1
Q

Symptoms of hypothyroidism

A 
weight gain and lethargy 
cold intolerance 
constipation 
heavy periods 
dry skin/hair 
bradycardia
slow reflexes 
goitre 
severe = puffy face, large tongue, hoarseness, coma
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2
Q

Symptoms of hyperthyroidism

A 
weight loss 
heat intolerance 
bowel frequency 
light periods 
palpitations 
goitre 
thyroid eye symptoms 
hyperreflexia tremors
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3
Q

What is the “odd” symptom out when it comes to hyper/hypo thyroidism?

A

menstruation

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4
Q

List the TSH and FT3/4 for the 3 types of hypothyroidism

A

primary = TSH high, fT3/4 - low
secondary - both low
subclinical - TSH high, T3/4 - normal

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5
Q

Epidemiology of hypothyroidism

A

most common endocrine condition after Type 1DM
more women effected than men
subclinical hypothyroidism common in older women
1 in 3500 births - congenital hypothyroidism

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6
Q

Congenital causes of primary hypothyroidism

A

dyshormonogenesis

developmental eg agenesis

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7
Q

Acquired causes of primary hypothyroidism

A

autoimmune eg Hashimoto’s
Iatrogenic eg radioiodine, post operative
chronic iodine deficiency
post sub acute thyroiditis eg postpartum thyroiditis

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8
Q

Causes of secondary/tertiary hypothyroidism

A 
pituitary tumour 
craniopharyngioma 
Isolated TRH deficiency 
post pituitary surgery 
Sheehan's syndrome
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9
Q

Investigations for hypothyroidism

A 
TSH/fT4 
autoantibodies - TPO
FBC 
muscle enzymes 
lipids 
hyperprolactinaemia 
hyponatraemia
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10
Q

Most common treatment for hypothyroidism

A

levothyroxine - T4

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11
Q

Levothyroxine treatment regimen

A

50 micrograms a day –> 100 micrograms after 2 weeks
annual TSH testing
half life is 7 days
increase dose until TSH is normal

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12
Q

Other treatment methods for hypothyroidism

A

T3 tablets

mixture of T3/4 tablets

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13
Q

Treating hypothyroidism in someone with IHD

A

treatments increase heart rate
lower dose and increase cautiously
can precipitate angina

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14
Q

Treating hypothyroidism in pregnancy

A

Need more - higher levothyroxine dose

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15
Q

When should treatment be considered in subclinical hypothyroidism?

A

TSH>10
TSH>5 with positive thyroid antibodies
TSH elevated with symptoms - trial therapy

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16
Q

Risks of over treating (subclinical) hypothyroidism

A

AF

osteopenia

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17
Q

Why is it important to treat hypothyroidism (subclinical included) before/during pregnancy?

A

More levothyroxine is required

reduce risk of foetal loss and lower IQ

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18
Q

6 causes of goitre

A 
physiological eg puberty/pregnancy 
autoimmune destruction eg graves/hashimotos 
iodine deficiency 
thyroiditis eg acute, chronic fibrotic 
dyshormonogenesis 
goitrogens
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19
Q

5 types of goitre

A 
multinodular 
diffuse eg colloid, simple 
cysts
tumours eg adenoma, carcinoma, lymphoma 
miscellaneous eg TB, sarcoidosis
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20
Q

Risk factors for solitary thyroid nodule malignancy

A

child, under 30, over 60
head and neck irradiation
pain, cervical lymphadenopathy

21
Q

Investigations for solitary nodule thyroid

A 
thyroid function test 
FNA 
isotope scanning if low TSH 
USS 
Chest and thoracic inlet x-rays
22
Q

2 types of differentiated thyroid cancer

A

papillary

follicular

23
Q

Papillary thyroid cancer

A

commonest, multifocal, local spread

excellent prognosis

24
Q

Follicular thyroid cancer

A

mets - lung, bone
usually single lesion
good prognosis if treatable

25
Q

Poor prognostic factors for thyroid cancer

A

spread out of capsule, under 16 and over 45, mets, TNM, tumour size

26
Q

Management of thyroid cancer

A

thyroidectomy
high dose radioiodine
long term suppressive thyroxine

27
Q

Follow up of thyroid cancer

A

thyroglobulin - tumour marker

whole body iodine scan followed by 2-4 weeks of thyroxine withdrawl

28
Q

3 other types of thyroid cancer

A

anaplastic
lymphoma
medullary

29
Q

Anaplastic thyroid cancer

A

rare, aggressive, locally invasive

poor prognosis - does not respond to radioiodine

30
Q

Medullary thyroid cancer

A

parafollicular c cells
MEN 2 association
serum calcitonin increased
treat with total thyroidectomy and prognosis variable

31
Q

3 broad causes of thyrotoxicosis

A

primary
secondary
thyrotoxicosis without hyperthyroidism

32
Q

Primary causes of thyrotoxicosis

A

graves disease
toxic multinodular goitre
toxic adenoma

33
Q

Secondary causes of thyrotoxicosis

A

pituitary adenoma secreting TSH

34
Q

Causes of thyrotoxicosis without hyperthyroidism

A

excessive thyroxine administration

destructive thyroiditis

35
Q

Investigation of Graves disease

A

family history - autoimmune
TSH receptor antibodies
Thyroid peroxidase antibodies

36
Q

Diagnosis of graves disease

A 
thyroid eye symptoms 
pretibial myxoedema 
clubbing 
gynaecomastia 
Hyperthyroidism 
Thyroid antibodies 
goitre
37
Q

What is multinodular goitre?

A

common cause of thyrotoxicosis in elderly
no graves disease
will spontaneously go into remission

38
Q

Explain subacute thyroiditis

A

younger patients with viral trigger eg enterovirus
painful goitre, myalgia, fever
ESR increased
followed by period of hypothyroidism - months
short term steroids and NSAIDs

39
Q

Management of hyperthyroidism

A

radioactive iodine
anti-thyroid drugs
thyroidectomy
beta blockers - symptomatic

40
Q

What is the main anti-thyroid drug?

A

carbimazole

41
Q

Side effects of carbimazole

A

rash

agranulocytosis - neutropenia

42
Q

2 methods of carbimazole administration

A

block-replace

titration regimen

43
Q

Explain the titration regimen of carbimazole

A

start on high dose
reduce until 5mg/day is reached
most common method
50% cure, 30% hypothyroidism

44
Q

Explain the block-replace method for carbimazole

A

block with carbimazole
replace with thyroxine
higher side effects

45
Q

3 selected cases for long term low dose carbimazole

A

elderly
cardiac problems
unwilling for Radioactive iodine

46
Q

When is radioactive iodine not used?

A

pregnancy and young people

with severe eye disease

47
Q

2 methods of radioiodine administration

A

high dose ablative

variable calculated

48
Q

Is high dose ablative or variable calculated used more for radio iodine administration?

A

high dose ablative

high chance of becoming hypothyroid

49
Q

What is meant by subclinical hyperthyroidism? When should it be treated

A

TSH reduced but fT3/4 unaffected as of yet
AF and osteopenia risk
ATD/RAI if persistent and those at cardiac risk

Diabetes & Endocrinology (24 decks)

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