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D&E Pathology > Clinical Thyroid Disease > Flashcards

Clinical Thyroid Disease Flashcards

1
Q

What does the hypothalamus secrete to stimulate the thyroid?

A

TRH

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2
Q

What does the thyroid secrete?

A

T3 Triiodothyronine

T4 Thyroxine

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3
Q

What are the symptoms of hypothyroid?

A 
Weight gain
Goitre 
Mood changes 
Dry skin/hair 
Heavy periods
Feeling Cold
Lethargy 
Bradycardia
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4
Q

What are the symptoms of severe hypothyroid?

A

Puffy face
Large tongue
Hoarseness
Coma

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5
Q

What are the symptoms of hyperthyroid?

A 
Weight loss
Overheating
Anxiety/irritability
Bowel frequency 
Sweaty palms
Palpitations
Tremors
Goitre
Thyroid eye signs
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6
Q

How does primary Hypothyroidism present hormonally?

A

Raised TSH

Low T3, T4

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7
Q

How does subclinical Hypothyroidism present hormonally?

A

Raised TSH

Normal T3, T4

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8
Q

How does secondary Hypothyroidism present hormonally?

A

Low TSH

Low T3, T4

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9
Q

How common is hypothyroidism?

A

2% of women

0.1% of men

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10
Q

How common is congenital hypothyroidism?

A

1:3500

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11
Q

What are the causes of primary hypothyroidism?

A

Congenital
- Developmental
- Dyshormonogenesis
Acquired

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12
Q

What are the causes of acquired primary Hypothyroidism?

A

Autoimmune (hashimotos)
Iatrogenic
Chronic iodine deficiency
Post-subacute thyroiditis

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13
Q

What procedures have a risk of causing hypothyroidism?

A 
Post-op
Post-radiotherapy
Post radioactive iodine
Antithyroid drugs
Amiodarone
Lithium
Interferon
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14
Q

What are the causes of secondary/tertiary hypothyroidism?

A 
Pituitary tumour
Craniopharyngioma
Post-pituitary surgery
Sheehan's syndrome
Isolated THR deficiency
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15
Q

What is the effect of low T3/T4 on TSH, TRH?

A

Elevated TSH

Elevated TRH

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16
Q

How is hypothyroidism investigated?

A

TSH
T4
Thyroid peroxidase antibodies
(FBC, Lipids, Na+, ALT, PLT)

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17
Q

How is hypothyroidism treated?

A

Levothyroxine (T4) at 50mcg/day → 100mcg
Until dose normal
Annual testing of TSH after stabilising
(Liothyronine (T3)?)

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18
Q

How is hypothyroidism treated if they present with ischaemic heart disease?

A

Start at a lower dose 25mcg
Increase slowly
(risk angina)

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19
Q

Which factors require special treatment if the patient is hypothyroid?

A

Ischaemic heart disease
Pregnancy
Postpartum thyroiditis
Myxedema coma

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20
Q

How is hypothyroidism treated if they present with pregnancy?

A

Increase in LT4 dose

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21
Q

How is hypothyroidism treated if they present with postpartum thyroiditis?

A

Trial withdrawal and measure TFTs in 6 weeks

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22
Q

How is hypothyroidism treated if they present with myxedema coma?

A

May need IV T3

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23
Q

When is treatment considered in subclinical hypothyroidism?

A

TSH > 10
TSH > 5 with +ve thyroid antibodies
TSH elevated with symptoms
When the patient is considering pregnancy/pregnant

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24
Q

What are the risks of overtreatment of subclinical hypothyroidism?

A

Osteopenia

Atrial fibrillation

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25
Q

What is the line of therapy for subclinical hypothyroidism?

A

Trial therapy 3-4months

Continue if symptomatic improvement

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26
Q

Inadequate hypothyroid treatment during pregnancy is associated with what?

A

Foetal loss

Lower IQ

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27
Q

How is hypothyroid treatment different in pregnancy?

A

Increased LT4 by 25% and monitor closely
Keep TSH in low normal range
Keep FT4 in high normal range
Treat subclinical hypothyroidism if planning pregnancy

28
Q

What are the causes of goitre?

A 
Physiological: Puberty, pregnancy
Autoimmune: Graves', Hashimotos
Thyroiditis (acute or chronic)
Iodine deficiency
Dyshormonogenesis
Giotrogens
29
Q

What are the types of goitre?

A 
Tumour
Cyst
Sarcoid, TB
Diffuse (colloid/simple)
Multinodular
30
Q

What is the risk associated with solitary nodule thyroid?

A

Risk malignancy:
<30 or >60, child
Previous H&N radiation
Cervical lymphadenopathy

31
Q

How is a solitary nodule thyroid investigated?

A

Thyroid function test
Ultrasound
FINE NEEDLE ASPIRATION
Isotope scanning if low TSH

32
Q

What is a hot/cold nodule?

A

Cold: Nodule of thyroid which isnt functioning
Hot: Nodule of thyroid which functions

33
Q

What are the different types of thyroid cancer?

A 
Papillary
Follicular
Anaplastic
Lymphoma
Medullary
34
Q

What is papillary thyroid cancer?

A

Common
Muiltifocal lesions
Local lymphatic spread
Good prognosis

35
Q

What is follicular thyroid cancer?

A

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

36
Q

Thyroid cancer has poor prognosis when?

A

<16, >45
Spread outside thyroid capsule
TNM stage

37
Q

How is thyroid cancer treated?

A

Near total thyroidectomy
Ablative high dose radioiodine
Long term suppressive doses of thyroxine
THYROGLOBULIN

38
Q

What is anaplastic thyroid cancer?

A

<5%
Aggressive, local invasion
Very poor prognosis
External RT

39
Q

What is thyroid lymphoma?

A

Rare
?Preexisting hashimotos thyroiditis
External RT and chemo

40
Q

What is medullary thyroid cancer?

A

Tumour of Parafollicular C-cells

Elevated serum calcitonin

41
Q

What is the treatment for medullary thyroid cancer?

A

Total thyroidectomy

42
Q

Medullary thyroid cancer is associated with what?

A

MEN 2
Phaeochromocytoma
Hyperparathyroidism

43
Q

What are the primary causes of thyrotoxicosis?

A

Grave’s disease
Toxic multinodular goitre
Toxic adenoma

44
Q

What are the secondary causes of thyrotoxicosis?

A

Pituitary adenoma secreting TSH

45
Q

What are the causes of thyrotoxicosis without hyperthyroidism?

A

Destructive thyroiditis
Amiodarone
Excessive thyroxine

46
Q

What is the biggest cause of hyperthyroidism?

A

Grave’s disease - 70-80%

47
Q

What is the prevalence of Grave’s disease?

A

2-3:1000
2% female
0.16% male

48
Q

What is the cause of Grave’s disease?

A

Autoimmune

  • Thyroid peroxidase antibodies
  • TSH receptor antibodies
  • Review FH for autoimmune disease
49
Q

What are the symptoms of Graves’ disease?

A 
Hyperthyroidism
Eye bulging
Clubbing
Gynaecomastia
Goitre
Pretibial myxedema
50
Q

How is thyrotoxicosis disease diagnosed?

A 
Hyperthyroidism symptoms
Thyroid antibodies (TSH receptor)
51
Q

What is multi-nodular goitre?

A

Most common cause of thyrotoxicosis in the elderly
Goitre in absense of Grave’s disease
WIll not go into spontaneous remission

52
Q

Most common cause of thyrotoxicosis in the elderly?

A

Multi-nodular goitre

53
Q

How does Subacute (de Quervain’s) thyroiditis usually present?

A 
<50y/o
Viral trigger
Painful goitre +/- fever/myalgia
ESR raised
3-6 weeks thyrotoxicosis
3-6 months hypothyroidism
54
Q

How is Subacute (de Quervain’s) thyroiditis treated?

A

Short term steroid

NSAIDs

55
Q

What are the most common treatments for thyrotoxicosis?

A

Surgery
Radiation
Antithyroid drugs
Beta blockers (symptoms)

56
Q

What drugs are used to treat hyperthyroidism?

A

Carbimazole
Propylthiouracil
(Titrate or replacement)

57
Q

What are the side effects of antithyroid drugs?

A

Hypothyroidism (30%)
Rash
Agranulocytosis

58
Q

Which patients are best suited for antithyroid drugs?

A

Elderly
Cardiac complications
Unwilling to have radioiodine

59
Q

What are the two forms of radioiodine therapy for hypothyroidism?

A

High dose ablative:
(90% cure, 70% hypothyroid)
Variable/calculated:
(60-90% cure, less hypo)

60
Q

When is radioiodine avoided?

A

Severe eye disease

61
Q

What is subclinical hyperthyroidism?

A

Suppressed TSH

Normal free thyroid hormones

62
Q

What concerns are associated with subclinical hyperthyroidism?

A

Postmenopausal reduced bone density

3x risk AF over 60s

63
Q

When is treatment considered for subclinical hyperthyroidism?

A

Antithyroid/RAI
In elderly
Increased cardiac risk

64
Q

Which drug can cause destructive thyroiditis?

A

Amiodarone

65
Q

What are the symptoms of agranulocytosis?

A

Sudden onset:
Sore throat
Fever
Rigors

66
Q

What must radioiodine patients be aware of?

A

Pls dnt get preggers

Don’t go near children for 2-3 weeks

D&E Pathology (18 decks)

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