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Endocrine System > Clinical Thyroid Disease > Flashcards

Clinical Thyroid Disease Flashcards

1
Q

What are some symptoms of hypothyroidism?

A

Fatigue/lethargy, cold tolerance, weight gain, non specific weakness, constipation, menstrual irregularities, depression, dry skin, and thyroid pain

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2
Q

What are some signs of hypothyroidism?

A

Coarse dry hair/skin, oedema (including eyelids), vocal changes, goitre, bradycardia, delayed reaction of deep tendon reflexes and paraesthesia

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3
Q

What do hypothyroid symptoms overlap with?

A

Euthyroid symptoms

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4
Q

What tests should be done for hypothyroidism?

A

Check TFTs - TSH and free T4
Consider also checking FBC and glucose/ HbA1c

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5
Q

What are the typical results of hypothyroidism?

A

FT3/4 decreased
TSH increased

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6
Q

What should a patient with hypothyroidism be started on?

A

Start Levothyroxine at 1.6 micrograms per Kg daily
If over 65 or cardiac disease then 25 to 50 micrograms a day
Measure TFTs every 3 months until TSH has stabilised
Also test thyroid peroxidase antibodies

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7
Q

How should Levothyroxine be taken?

A

Taken first thing in the morning and swallowed with water on an empty stomach
Also start on high dose

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8
Q

What are the key points of hypothyroidism?

A

Weight gain, lethargy, feeling cold, constipation, heavy periods, dry skin/hair, bradycardia, slow reflexes, goitre and severe puffy face

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9
Q

What are the key points of hyperthyroidism?

A

Weight loss, anxiety, heat intolerance, bowel frequency, light periods, sweaty palms, palpitations, hyperreflexia, tremors, goitre and thyroid eye symptoms

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10
Q

What is the prevalence of hypothyroidism?

A

Commonest endocrine condition after diabetes
Can also have subclinical hypothyroidism

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11
Q

What are some congenital causes for primary hypothyroidism?

A

Developmental - agenesis/ maldevelopment
Dyshormonogenesis - trapping/ organification of iodine
All babies screened at birth

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12
Q

What are some acquired causes of primary hypothyroidism?

A

Autoimmune thyroid disease - Hashimoto’s
Iatrogenic - post op, post radiotherapy, anti-thyroid drugs
Chronic iodine deficiency
Post subacute thyroiditis

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13
Q

What are some causes of secondary/ tertiary hypothyroidism?

A

Pituitary/ hypothalamic damage -
Pituitary damage, craniopharyngioma, and post pituitary surgery/ radiotherapy

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14
Q

What are the typical results of subclinical hypothyroidism?

A

Normal FT3/4
Increased TSH - working harder to control the normal range of T4

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15
Q

How should subclinical hypothyroidism be treated?

A

TFTs and thyroid peroxidase antibodies test
If more than 10mU/L treat like overt hypothyroidism
Or if symptoms trial medication
If not then monitoring

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16
Q

What are some alternative causes for hypothyroid symptoms?

A

DM, adrenal problems, hypopituitarism, coeliac, anaemia, hypercalcaemia, BB, statins, opioids, chronic liver or kidney disease, obesity, and stress

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17
Q

Describe thyroid pregnancy and how medication would change

A

Adequate preconception replacement
Empirical dose increase in early pregnancy
Regular monitoring
Aim is for TSH in lower half of normal range
Post natal - reduce levothyroxine to pre-pregnancy dose and re check

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18
Q

What percentage of treated hypothyroid patients have subclinical hyperthyroidism?

A

20%

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19
Q

What are the risks of overtreatment for hypothyroidism?

A

AF and osteopenia/ fracture

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20
Q

What are the typical test results of hyperthyroidism?

A

Increased FT3/4
Reduced TSH

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21
Q

What is the typical test results of subclinical hyperthyroidism?

A

Normal FT3/4
Reduced TSH

22
Q

What are the primary causes of thyrotoxicosis (hyperthyroidism)?

A

Grave’s disease
Toxic multinodular goitre
Toxic adenoma

23
Q

What are the secondary causes of thyrotoxicosis?

A

Pituitary adenoma secreting TSH

24
Q

What are some causes of thyrotoxicosis without hyperthyroidism?

A

Destructive thyroiditis - post-partum and subacute Quervain’s
Excessive thyroxine administration

25
Q

Describe Grave’s disease

A

70-80% of hyperthyroidism cases
More females
Autoimmune driven - thyroid peroxidase antibodies, TSH receptor antibodies which stimulate thyroid to produce more TH

26
Q

How is Grave’s disease diagnosed?

A

Hyperthyroidism
Thyroid antibodies - TSH receptor antibodies
Symptoms and signs - thyroid eye disease, goitre, acropachy…

27
Q

Describe multi-nodular goitre

A

Most common cause of thyrotoxicosis in elderly
Goitre and absence of Grave’s
Will not go into spontaneous remission

28
Q

Describe subacute (de Quervain’s) thyroiditis

A

Generally younger patients <50
Viral trigger
Often recall painful goitre and possible fever/ myalgia and ESR elevated
May require short term steroids and NSAIDs

29
Q

What is used for management of hyperthyroidism?

A

Radio-iodine therapy
Anti-thyroid drugs
Surgery
BBs for tremor, tachycardias and palpitations

30
Q

What are the anti-thyroid drugs used?

A

Carbimazole
Propylthiouracil - more side effects
Can use titration regimen or block then replace (more side effects)
Both can cause hypothyroidism and 50% cure

31
Q

What are the side effects to anti-thyroid drugs?

A

Both can cause agranulocytosis
Propylthiouracil - rash
Both hypothyroidism

32
Q

When is long term dose of ATD used?

A

Elderly
Cardiac complications
Unwilling for RAI

33
Q

Describe radio-iodine therapy

A

Definitive treatment
High dose ablation had most cure rate but more chance of hypothyroidism
Compared to variable calculated but less cure and hypothyroidism
May need steroids

34
Q

When is RAI avoided?

A

In severe eye disease

35
Q

Describe subclinical hyperthyroidism

A

TSH supressed but normal free TH
Concerns if bone density is decreased postmenopausal and AF
Treatment - ATD/ RAI if persistent esp. if older and risk of cardiac risk

36
Q

What are the typical results of secondary hypothyroidism?

A

FT3/4 decreased
TSH normal or low

37
Q

What is the results of resistance to thyroid hormone (TSHoma)?

A

Increased FT3/4
Normal or increased TSH

38
Q

What are some causes for goitre?

A

Puberty, pregnancy, Grave’s, Hashimoto’s, acute thyroiditis, chronic fibrotic thyroiditis, iodine deficiency, dyshormogenesis and goitrogens

39
Q

What are the different types of goitre?

A

Multinodular goitre, diffuse (colloid or simple), cysts, tumours and miscellaneous - sarcoidosis and TB

40
Q

Describe a solitary nodule thyroid

A

Risk of malignancy - child, adults between 30-60, previous head/ neck irradiation and cervical lymphadenopathy
5% chance of malignancy

41
Q

What are the investigations for solitary thyroid nodule?

A

Thyroid function tests
Then US
Then fine needle aspirations - Thy1 inadequate
Thy2 benign
Thy5 cancer

42
Q

Describe thyroid cancer incidence

A

Most common endocrine malignancy
Lowe mortality than most cancers

43
Q

What are the types of differentiated thyroid cancer?

A

Papillary and Follicular

44
Q

Describe papillary thyroid cancer

A

Commonest
Multifocal and local spread to lymph nodes
Good prognosis

45
Q

Describe follicular thyroid cancer

A

Usually single lesion
Metastases to lung/ bone
Good prognosis if resectable

46
Q

When is prognosis poorer for thyroid cancer?

A

If age less than 16 or more than 55
Tumour bigger than 4cm
Spread outside thyroid capsule and metastasised
TMN staging

47
Q

Explain thyroid cancer management

A

Near total thyroidectomy
High dose radio-iodine
Long term suppressible doses of thyroxine
Follow up - thyroglobulin marker
Whole body iodine scanning and dynamic risk stratification

48
Q

What increases the likelihood of giving radio-iodine?

A

Bigger tumours, multifocal, invasion, adverse histology and large lymph nodes

49
Q

Describe anaplasic thyroid cancer

A

Less than 5% of thyroid cancers
Aggressive and locally invade
Very poor prognosis as does not respond radio-iodine - external RT may help

50
Q

Describe lymphoma thyroid cancer

A

Rare
May arise in pre-existing Hashimoto’s thyroiditis
External RT more helpful and combined with chemo

51
Q

Describe medullary thyroid cancer

A

Arises from parafollicular C cells
Often associated with MEN2
Serum calcitonin levels raised
Treatment - total thyroidectomy
Prognosis is variable

Endocrine System (23 decks)

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