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Year 2- Endocrine System > Clinical Thyroid Disease > Flashcards

Clinical Thyroid Disease Flashcards

1
Q

What is the name given to the part of the thyroid gland which connects the right and left lobe?

A

Isthmus

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2
Q

Explain how thyroid function is controlled.

A

Hypothalamus produces TRH.
TRH acts on anterior pituitary.
Stimulates production of TSH.
Thyroid produces T3, the active component.

There is a negative feedback system so if there’s too much of anything, it can loop back and turn the production of the cycle off.

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3
Q

If the source of an endocrine condition is at the thyroid gland, what is this called?

A

Primary hypothyroidism

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4
Q

If the source of an endocrine condition is at the pituitary gland, what is this called?

A

Secondary hypothyroidism

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5
Q

List some of the symptoms of hypothyroidism.

A

Fatigue/lethargy
Cold intolerance
Weight gain
Non-specific weakness
Constipation
Depression
Dry skin
Thyroid pain

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6
Q

List some of the signs of hypothyroidism.

A

Coarse, dry hair
Skin and hair loss
Oedema
Vocal changes
Goitre
Bradycardia and diastolic hypertension
Delayed reflexes
Paraesthesia

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7
Q

What tests would you do if you suspected hypothyroidism?

A

Check TFT (thyroid function tests)
Possibly FBC and glucose too

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8
Q

What does TFT’s check for?

A

TSH
Free T4

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9
Q

In those with hyperthyroid disease, what are T3/4 levels like?

A

Increased

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10
Q

In those with hyperthyroid disease, what are TSH levels like?

A

Decreased

->too much TH so not releasing anymore

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11
Q

In those with hypothyroid disease, what are T3/4 levels like?

A

Decreased

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12
Q

In those with hypothyroid disease, what are TSH levels like?

A

Increased

->to try and release more TH

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13
Q

Which medication can be used to help in the treatment of hypothyroidism?

A

Levothyroxine

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14
Q

In adults <65 with hypothyroidism, how much levothyroxine should be given?

A

1.6 mcg per kg

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15
Q

In adults >65 or with pre-existing cardiac disease and hypothyroidism, how much levothyroxine should be given?

A

More cautious levels- 25-50mcg

->more cautious as medication can rapidly increase HR

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15
Q

At what point in the day should levothyroxine be taken?

A

First thing in the morning on an empty stomach

->if unable, late evening, at least two hours after meal

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16
Q

List the signs/symptoms of hypothyroidism.

A

Weight gain
Lethargy
Feeling cold
Constipation
Heavy periods
Dry skin/hair
Bradycardia
Slow reflexes
Goitre

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17
Q

List the signs/symptoms of hyperthyroidism.

A

Weight loss
Anxiety/irritability
Heat intolerance
Bowel frequency
Light periods
Sweaty palms
Palpitations
Hyperreflexia
Goitre
Thyroid eye symptoms

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18
Q

What is the most common endocrine condition?

A

Diabetes

-> hypothyroidism is the second most common

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19
Q

What is the most common cause of primary hypothyroidism?

A

Congenital- either developmental or dyshormonogenesis (hormones not getting produced or released)

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20
Q

If hypothyroidism isn’t diagnosed and treated quickly, it can lead to physical and mental retardation. How is this prevented?

A

Every baby screened in UK

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21
Q

What are some of the causes of acquired hypothyroidism?

A

Autoimmune thyroid disease
Iatrogenic cause
Chronic iodine deficiency
Post-subacute thyroiditis

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22
Q

Give an example of an autoimmune thyroid disease which can cause acquired hypothyroidism?

A

Hashimotos

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23
Q

List some causes of secondary/tertiary hypothyroidism.

A

Pituitary tumour
Post pituitary surgery/ radiotherapy

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24
Suppressed TSH has an increased risk of what?
Atrial fibrillation Osteopenia Fracture
25
What is subclinical hypothyroidism?
Elevated TSH to ensure that FT3/4 levels are normal ->therefore, the pituitary gland is working a lot harder
26
What are some of the causes of primary hyperthyroidism?
Grave's disease Toxic Multinodular Goitre Toxic adenoma
27
What is another term for hyperthyroidism?
Thyrotoxicosis
28
What is usually the cause of secondary hyperthyroidism?
Pituitary adenoma secreting TSH
29
What is meant by thyrotoxicosis without hyperthyroidism?
Thyroid gland itself is not producing excess TH, it is due to destructive thyroiditis
30
What causes the majority of cases of hyperthyroidism?
70-80%
31
What is Grave's disease?
An autoimmune driven condition in which stimulating antibodies stimulate the thyroid gland to overproduce TH
32
Which antibodies in Grave's disease stimulate the thyroid gland to overproduce TH?
TSH receptor antibodies
33
How is a diagnosis of Grave's disease made?
When patient has hyperthyroidism and is thyroid receptor antibody positive
34
What is the most common cause of thyrotoxicosis in the elderly?
Multi-nodular goitre
35
Who is more likely to be affected by subacute thryoiditis?
Younger patients <50yrs
36
What often triggers subacute thyroiditis?
Viral trigger
37
What are the symptoms of subacute thyroiditis?
Painful goitre Fever/myalgia ESR increased
38
Which medications are given to those with subacute thyroititis?
Short terms steroids and NSAIDs
39
What are the three treatment options for hyperthyroidism?
Antithyroid drugs Radioiodine Surgery ->antithyroid drugs do not cure the condition but are a holding measure
40
Which type of drug can be used to reduce some of the manifestations of hyperthyroidism e.g. tremors, tachycardia, palpitations?
Beta blockers
41
Give two examples of antithyroid drugs.
Carbimazole Propylthiouracil
42
What are some of the side effects of antithyroid drugs?
Rash Agranulocytosis*- serious -> * deficiency of granulocytes in the blood, causing increased vulnerability to infection.
43
What should be done if a patient on antithyroid drugs has a severe sore throat or mouth ulcers or infections out of the ordinary?
FBC
44
In selected cases of hyperthyroidism, long term low does antithyroid drugs may be used. Give some examples of patients who may be treated using this option
Elderly Those with cardiac complications Patients who are unwilling for radioiodine or surgery
45
What can radioiodine cause as a result?
Hypothyroidism
46
What are some of the negatives of radioiodine?
Stays in thyroid glad for four weeks but anyone the patient comes into contact with is exposed to radiation from the radioiodine. Can trigger eye disease ->worth warning that the radiation can set off security alarms in airports for a couple of months
47
What line of treatment if radioiodine usually?
Usually second line of treatment
48
A 38yo women with two children has a reoccurrence of Graves hyperthyroidism. What would be the probable choice of treatment?
Surgery ->not radioiodine as would expose her children to radiation
49
What is subclinical hyperthyroidism?
TSH supressed but normal free TH
50
What are some of the concerns of subclinical hyperthyroidism?
Decreases bone density Can increase risks of AF
51
What are the treatment options for subclinical hyperthyroidism?
If persistent, antithyroid drugs or radioiodine to treat, especially those who are elderly or those w increased cardiac risk
52
There is a genetic condition called RTH (resistance to TH). What are FT3/4 levels and TSH levels like in this condition?
TSH normal or slightly elevated FT3/4 elevated
53
Goitre?
Swelling of the thyroid gland
54
What are some of the physiological causes of goitre?
Puberty Pregnancy
55
What are some of the autoimmune causes of goitre?
Graves disease Hashimoto's disease
56
What are some of the thyroiditis related causes of goitre?
Acute/ de Quervain's Chronic fibrotic/Reidel's
57
What are some of the other causes of goitre?
Iodine deficiency Dyshormogenesis Goitrogens- medications blocking the formation of thyroid hormones
58
List some of the different types of goitre.
Multinodular Diffuse Cysts Tumours Miscellaneous
59
What is a single nodule in the thyroid known as?
Solitary nodule
60
Who is at increased risk of malignancy via a solitary nodule of the thyroid?
Children Adults <30 or >60 Previous head and neck irridation
61
What % chance is there that the solidary nodules of the thyroid turn malignant?
5%
62
Which investigations are used for investigating solitary nodule of the thyroid?
TFT's Ultrasound- to differentiate between benign and malignant Fine needle aspiration
63
What is the usual first line investigation of solitary thyroid nodules?
Ultrasound -> then if ultrasound is suspicious, FNA carried out
64
Thyroid cancer can be termed as differentiated or undifferentiated. Name the two classicisation's of differentiated thyroid cancer.
Papillary Follicular
65
Which type of differentiated thyroid cancer is more common?
Papillary
66
Describe papillary thyroid cancer.
Commonest Multifocal, local spread to lymph nodes
67
Describe follicular thyroid cancer.
Usually a single nodule Metastases to lung/bone
68
Differentiated thyroid cancer usually has a good prognosis. What are some of the factors in which prognosis is likely to be poorer?
Age <16 or >55 Bigger tumour size Spread outwith thyroid capsule
69
What is the treatment for thyroid cancer?
Near total thyroidectomy -> if high risk, high dose radioiodine would be considered
70
Those who have had thyroid cancer will have to be on long term doses of what?
Long term suppressive doses of thyroxine
71
What is the marker for thyroid cancer?
Thyroglobulin
72
What treatment is used if it is thought that the thyroid cancer has a high chance of spreading?
Radioiodine ablation
73
Describe anaplastic thyroid cancer
Aggressive and locally invasive Very poor prognosis Does not respond to radioiodine
74
Describe thyroid lymphoma.
Rare, may arise from pre-existing Hashimotos. External RT more helpful, combined with chemo
75
In medullary thyroid cancer, where does the tumour arise from?
Parafollicular C cells
76
What is medullary thyroid cancer often associated with?
MEN 2
77
What is the treatment for medullary thyroid cancer?
Total thyroidectomy -> no role for radioiodine
78

Year 2- Endocrine System (27 decks)

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