Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

ZA - Endocrine System > Clinical Thyroid Disease > Flashcards

Clinical Thyroid Disease Flashcards

1
Q

What are the 4 categories of thyroid disease?

A

Hyperthyroidism
Hypothyroidism
Goitre
Thyroid cancer

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

What is the thyroid hormone pathway (from hypothalamus to thyroid?

A

TRH released onto anterior pit gland

TSH released from AP gland to thyroid

T3 = tri-iodothyronine
T4 - thyroxine both are released from thyroid

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

Hypothyroid signs and symptoms ?

A

Everything slows down

Weight gain
Lethargy
Feeling cold
Constipation
Heavy periods
Dry skin/hair
Brady-cardia 
Slow reflexes

GOITRE

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

Symptoms of hyperthyroidism?

A 
Weight loss
Anxiety 
HEat intolerance
Bowel frequency 
Light periods
Palpitations 
Hyper-reflexia

GOITE

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

What will hormone levels be if it is 1y hypo-T? Where does the problem lie?

A

Raised TSH
Low FT4 and FT3

Thyroid gland

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

What will hormone levels be if it is 2y hypo-t

A

Low TSH
Low FT4 and FT3

Pit gland

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

What is subclinical hypoT? What will hormone levels look like here?

A

When the pit gland goes into overdrive to maintain normal FT3 and FT4 levels

Raised TSH and Normal FT4 and FT3

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Prevalence of hypoT?

A

Commonest endocrine disease after diabetes

More common in women

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Causes of 1y hypoT?

A

Congenital
or
Acquired

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

Describe the congenital causes of hypoT?

A

Can be developmental = agenesis/maldevelopment

Or due to dyshormonogenesis = trapping/organification/dehalogenase

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

What is dyshormonogenesis?

A

A rare condition due to genetic defects in the synthesis of thyroid hormones

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Describe the acquired causes of hypoT?

A

Autoimmune - hashimotos
Iatrogenic
Chronic iodine deficiency
Post-subacute thyroiditis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Name some iatrogenic causes of hypoT?

A

Postop/post-radioactive iodine
External radiotherapy for head and neck cancers
Antithyroid drugs

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

Cause of 2y/3y hypothyroidism?

A

Pituitary or hypothalamic damage

Tumours
Post surgery etc

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Investigations for hypothyroidism?

A

Look for levels of TSH/FT4

Auto-antibodies :TPO - thyroid peroxidase antibodies

FBC - MCV will be increased
Lipids - hypercholesterolaemia

Hypernatremia

Increased muscle enzymes

Hyperprolactinaemia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Treatment for hypothyroidism?

A

Levothyroxine (LT4) (T4 tablets) - 50mcg/day and increase after 2 weeks to 100mcg _ test regularly during this time to find perfect levels
After stabalisation organise annual check ups

There is also Liothyronine (T3)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

Is there a benefit to taking both levothyroxine and liothyronine together?

A

No - best to just take levothyroxine

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

Half life of T4?

A

4 days

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

What situations should special consideration be taken in regards to treatment?

A

Ischaemic heart disease
Pregnancy
Post-partum thyroiditis
Myxedema coma

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

What special care should be taken if patient has ischaemic heart disease?

A

Start at a lower dose 25 mcg and increase cautiously - due to risk of precipitating angina

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

What special care should be taken if patient is pregnant? Why?

A

Need an increase in LT4 dose by about 25% and keep TSH in a lower normal range and FT4 in a higher normal range

Should treat subclinical if planning on getting pregnant

Because hypothyroidism linked to foetal loss and lower IQ

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

What special care should be taken if patient has post-partum thyroiditis?

A

You should trial a withdraw and measure TFTs in 6 weeks

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

What special care should be taken if patient has myxedema coma

A

This is a very rare emergency and you may need IV T3 steroids

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

What is myxedema coma?

A

Severe hypothyroidism leading to a decreased mental status, hypothermia and other symptoms connected to slowing of multiple organs

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

When should treatment for subclinical hypothyroidism be considered?

A

Consider treatment if TSH is above 10

Above 5 with +ve thyroid antibodies

Elevated TSH with symptoms

26
Q

How should treatment be carried out in subclinical hypothyroidism?

A

Trial of therapy for 3/4 months and continue if symptomatic improvement

27
Q

What is the risks of overtreatment in subclinical hypoT?

A

Afib

Osteopenia - Bone density that is lower than normal peak density but not low enough to be osteoporosis

28
Q

Causes of goitre?

A

Physiological - puberty, pregnancy

Autoimmune - Graves, hashimotos

Thyroiditis

Iodine deficiency

Dyshormogenesis

29
Q

Goitre types

A 
Multinodular 
Diffuse - colloid and simple
Cysts
Tumours - adenoma, carcinoma, lymphoma 
Misc. - Sarcoidosis, TB
30
Q

What risk does a solitary thyroid nodule carry?

A

Risk of a malignancy - 5%

31
Q

Solitary thyroid nodule investigations?

A 
TFTs
Ultrasound 
Isotope scanning
Fine needle aspiration 
Chest and thoracic inlet X-rays if there is large retrosternal extensions
32
Q

When would ultrasound scanning be useful?

A

Useful for separating into benign or malignant

33
Q

When would isotope scanning be used?

A

If low TSH - hot nodule

34
Q

What is a cold nodule?

A

A non-functioning thyroid nodule

35
Q

What are the types of thyroid cancer?

A

Differentiated
Anaplastic
Lymphoma
Medullary

36
Q

What are the 2 differentiated cancers?

A

Papillary and follicular

37
Q

Features of papillary?

A

Commonest
Is multi-focal, local spread to lymph nodes
Good prognosis

38
Q

Features of follicular?

A

Usually a single lesion
Mets to lung/bone
Good prognosis of tumour is resectable

39
Q

Management of differentiated thyroid cancer?

A

Prognosis is poorer compared to other thyroid disease

Treatment is a near total thyroidectomy
High dose radioiodine (ablative)
Long term suppressive doses of thyroxine

Follow ups with thyroglobulin and whole body iodine scanning following 2-4 weeks of thyroxine withdrawal

40
Q

Is anaplastic cancer aggressive or not?

A

Aggressive and has poor prognosis - doesn’t respond to radio-iodine

External RT may be useful

41
Q

Features of a lymphoma?

A

Rare
May arise from pre-exisiting hashimotos thyroiditis

Treatment - best is external RT combined with chemotherapy

42
Q

Where does a medullary thyroid cancer arise from?

What is it associated with?

What hormone will be raised?

Treatment and prognosis?

A

Parafollicular C cells`

Associated with MEN 2 - phaeochromocytoma and hyperparathyroidism

Serum calcitonin is raised

Treatment - total thyroidectomy, there is NO role for radioiodine. Prognosis is variable

43
Q

What are some 1y causes of thyrotoxicosis (hyperthyroidism)

A

Graves disease most common at 70%
Toxic multinodular goitre
Toxic adenoma

44
Q

What are some 2y causes of thyrotoxicosis

A

Pituitary adenoma secreting TSH

45
Q

When can their be thyrotoxicosis without hyperthyroidism?

A

Destructive thyroiditis

Excessive thyroxine administration (meds)

46
Q

What can cause Destructive thyroiditis ?

A

Post-partum
Amiodarone induced
Subacute

47
Q

Prevalance of graves?

A

2-3 per 1000 per year

More common in women

48
Q

Graves features?

A

Autoimmune driven condition

Thyroid peroxidase antibodies and TSH receptor antibodies involved

49
Q

What part of the Hx should be taken into special consideration if a patient presents with suspected graves?

A

Family history of concurrent autoimmune disease

50
Q

Graves disease diagnosis?

A

Test for TSH - will be low

T3 and T4 will be high

51
Q

Symptoms specific to graves?

A

Clubbing like features
Gynaecomastia
Bulging eyes
(Hyperthyroidism symptoms also)

52
Q

Features of multi-nodular goitre?

A

Toxic nodules that secrete TH

Seen in elderly and iodine def. patients

Has a goitre but no graves disease and will not go into spontaneous remission

53
Q

Features of subacute thyroiditis?

A

Also called de Quervain’s
Generally younger patients - less than 50

Viral trigger - enterovirus or coxsackie

54
Q

Symptoms of subacute? Treatment?

A

Painful goitre with/without fever or myalgia. HAs an increased ESR

May need short term steroid and NSAIDs

55
Q

What is the overall management plan for hyperthyroidism

A

Beta blockers
Anti thyroid drugs
Radioactive iodine
Surgery

56
Q

What is the most commonly used anti thyroid med?

A

Carbimazole

57
Q

How is carbimazole used?

A

2 ways - Titration or block regimens

Titration - start on a high dose and gradually reduce to the lowest dose that works

Block - block thyroid gland with a carbimazole then replace treatment with thyroxine before thyroid gland can recontinue

Both have a 50% cure rate and a 30£ hypothyroidism rate, but block has higher side effects

58
Q

When would ATDs be used over the others?

A

Elderly
Cardiac complications
Unwilling for RAI

59
Q

2 ways RAI/radioiodine is used?

A

HIgh dose ablative - 90% cure but 70% hypothyroidism

Variable calculated - 60-90% cure and less hypoTs

60
Q

Risks of RAI?

A

High risk of hypothyroidism

61
Q

Do patients usually choose ATD or RAI? What mode is usually given? When is it avoided?

A

ATD before RAI is tried
Usually gived as a high dose albative

Avouided in severe eye disease

62
Q

What is subclinical HYPERthyroidism?

A

TSH is suppressed but there is normal FT3 and FT4

ZA - Endocrine System (21 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions