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Endocrinology and Diabetes > Clinical Thyroid Disease > Flashcards

Clinical Thyroid Disease Flashcards

1
Q

What are the symptoms of hypothyroidism?

A 
Weight gain
Lethargy
Feeling cold
Constipation
Heavy periods
Dry skin/hair
Bradycardia
Slow reflexes 
Goitre
If severe- puffy face, large tongue, hoarseness, coma
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2
Q

What are the symptoms of hyperthyroidism?

A 
Weight loss
Anxiety/irritability
Heat intolerance
Bowel frequency
Light periods
Sweaty palms
Palpitations
Hyperreflexia/tremors
Goitre
Thyroid eye symptoms/signs
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3
Q

What thyroid function tests would be expected of someone with primary hypothyroidism?

A

Raised TSH

Low FT4 and FT3

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4
Q

What thyroid function tests would be expected of someone with subclinical/compensated hypothyroidism?

A

Raised TSH

Normal FT4 and FT3

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5
Q

What thyroid function tests would be expected of someone with secondary hypothyroidism?

A

Low TSH

Low FT4 and FT3

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6
Q

What are the causes of primary hypothyroidism?

A 
Congenital
Autoimmune thyroid disease
Iatrogenic
Chronic iodine deficiency
Post-subacute thyroiditis
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7
Q

What are the caused of secondary/tertiary hypothyroidism?

A

Pituitary/hypothalamic damage:

  • Pituitary tumour
  • Craniopharyngioma
  • Post pituitary surgery or radiotherapy
  • Sheehan’s syndrome
  • Isolated TRH deficiency
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8
Q

What are the main investigations for hypothyroidism?

A

TSH/fT4

Autpantibodies- TPO (thyroid peroxidase antibodies)

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9
Q

How is hypothyroidism treated?

A

Levothyroxine (T4) tablets
Liothyronine (T3)
Initial dose lezothyroxine 50mg/day, increase dose until TSH normal
After stabilisation annual testing of TSH

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10
Q

When does hypothyroidism require special treatment?

A

Ischaemic heart disease- start at lower dose and increase cautiously as risk of inducing angina
Pregnancy- most need an increase in LT4 dose
Postpartum thyroiditis- trial withdrawal and measure TFTs in 6 weeks
Myxedema coma- very rare, may need IV T3

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11
Q

When is treatment of subclinical hypothyroidism indicated?

A

TSH >10
TSH >5 with positive thyroid antibodies
TSH elevated with symptoms

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12
Q

What are the risks of over treatment of subclinical hypothyroidism?

A

Osteopenia

Atrial fibrillation

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13
Q

What is the significance of hypothyroidism in pregnancy?

A

Increased levothyroxine requirements during pregnancy

Inadequately treated hypothyroidism linked with increased foetal loss and lower IQ

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14
Q

How should treatment of hypothyroidism be altered in pregnancy?

A

Increase LT4 dose by ~25% and monitor closely
Aim to keep TSH in low normal range and FT4 in high normal range
Treat subclinical hypothyroidism if planning pregnancy/pregnant

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15
Q

What are the causes of goitre?

A 
Physiological:
-Puberty
-Pregnancy
Autoimmune:
-Grave's disease
-Hashimoto's disease
Thyroiditis (acute or chronic)
Iodine deficiency
Dyshormonogenesis
Goitrogens
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16
Q

What are the different kinds of goitres?

A 
Multinodular goitre
Diffuse goitre (colloid or simple)
Cysts
Tumours (adenoma, carcinoma, lymphoma)
Miscellaneous (Sarcoidosis, tuberculosis)
17
Q

What are the red flags for malignancy in a solitary nodule thyroid?

A

Child
Adult less than 30 or over 60
Previous head and neck irradiation
Pain, cervical lymphadenopathy

18
Q

How is a solitary thyroid nodule investigated?

A

Fine needle aspiration
Tyroid function test
Ultrasound- useful to differentiate benign/malignant
Isotope scanning if low TSH to test for hot nodule

19
Q

What is the difference between a hot and cold thyroid nodule?

A

Hot thyroid nodules produce excess thyroid hormone

Cold thyroid nodules are non-functioning

20
Q

What are the characteristics of papillary and follicular thyroid cancer?

A 
Both differentiated
Papillary:
-Commonest
-Multifocal with local spread to lymph nodes
-Good prognosis
Follicular:
-Usually single lesion
-Metastases to lung/bone
-Good prognosis if resectable
21
Q

Describe the management of thyroid cancer

A 
Prognosis poorer if <16 or >45, large tumour or spread outside the thyroid capsule
Near total thyroidectomy
High dose radioiodine
Long term suppressive doses of thyroxine
Follow up:
-Thyroglobulin
-Whole body iodine scanning
22
Q

What are the characteristics of anaplastic thyroid cancer?

A

Rarer
Aggressive and locally invasive
Do not respond to radioiodine, external radiotherapy may help briefly

23
Q

What are the characteristics of thyroid lymphoma?

A

Rare- may arise from Hashimotos thyroiditis

External radiotherapy combined with chemotherapy can be helpful

24
Q

What are the characteristics of medullary thyroid cancer?

A

Tumour arisen from parafollicular C cells
Often associated with MEN 2
Serum calcitonin levels raised
Treatment- total thyroidectomy, radioiodine not indicated

25
Q

What are the causes of thyrotoxicosis?

A 
Primary:
-Grave's disease
-Toxic multinodular goitre
-Toxic adenoma
Secondary:
-Pituitary adenoma secreting TSH
Thyrotoxicosis without hyperthyroidism:
-Destructive thyroiditis
-Excessive thyroxine administration
26
Q

What are the characteristics of Grave’s disease?

A

Accounts for ~70% of cases of hyperthryoidism
F:M = 5:1
Autoimmune driven condition:
-Thyroid peroxidase antibodies
-TSH receptor antibodies
-Review personal/family history for concurrent autoimmune disease

27
Q

How is Grave’s disease diagnosed?

A

Presence of hyperthyroidism

Thyroid antibodies- TSH receptor antibodies

28
Q

What are the characteristics of a multi-nodular goitre?

A

Most common cause of thyrotoxicosis in the elderly
Characteristic goitre
Absence of Grave’s disease

29
Q

What are the characteristics of subacute thyroiditis?

A

Also known as de Quervain’s thyroiditis
Generally patients <50
Viral trigger
Often recall painful goitre +/- fever/myalgia
ESR increased
May require short term steroids and NSAIDs

30
Q

What are the side effects of antithyroid drugs?

A

Rash

Agranulocytosis

31
Q

What are the common antithyroid drugs and how are they delivered?

A

Carbimazole
Propylthiouracil
Titration regimen over 12-18 months

32
Q

What other treatment can be given for hyperthyroidism other than antithyroid drugs?

A

Radioiodine- contraindicated in pregnancy
Steroids
Surgery-thyroidectomy

33
Q

What are the characteristics of subclinical hyperthyroidism?

A

TSH suppressed
Normal free thyroid hormones
Concerns- decreased bone density and atrial fibrillation
Treatment considered if persistent

Endocrinology and Diabetes (21 decks)

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