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Endocrine > Clinical Thyroid Disease > Flashcards

Clinical Thyroid Disease Flashcards

1
Q

Symptoms of hypothyroid conditions?

A
  • Weight gain
  • Lethargy
  • Feeling cold
  • Constipation
  • Heavy periods
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2
Q

Clinical signs of hypothyroidism?

A
  • Dry skin / hair
  • Bradycardia
  • Slow reflexes
  • Goitre
  • Puffy face
  • Large tongue
  • Peri-orbital puffiness
  • Coma
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3
Q

What’s an alternative name for T4?

A
  • Thyroxine
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4
Q

Symptoms of hyperthyroid conditions?

A
  • Weight loss
  • Anxiety / irritability
  • Heat intolerance
  • Bowel frequency
  • Light periods
  • Sweaty palms
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5
Q

Clinical signs of hyperthyroidism?

A
  • Palpitations
  • Hyper-reflexia
  • Tremors
  • Goitre
  • Thyroid eye symptoms / signs (bulging / inflammation)
  • Hair loss
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6
Q

Describe the difference in hormone levels between primary and secondary hypothyroidism

A
  • Primary: raised TSH, low T3 & T4

- Secondary: low TSH (pituitary), Low T3 & T4

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7
Q

How common is hypothyroidism in men vs women?

A
  • Much more common in women
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8
Q

Causes of primary hypothyroidism?

A
  • Congenital (agenesis etc.)
  • Autoimmune (Hashimoto’s)
  • Iatrogenic (post-operative / radio-iodine)
  • Drugs (amiodarone / lithium)
  • Chronic iodine deficiency
  • Post-subacute thyroiditis (post-partum)
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9
Q

Investigations for suspected hypothyroidism?

A
  • Thyroid function test: ratio of TSH : FT4 (F = free)
  • Autoantibodies: TPO (thyroid peroxidase antibodies)
  • FBC (lipids / muscle enzymes)
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10
Q

Management of hypothyroidism?

A
  • Levothyroxine (T4) Tablets
  • Initial dose 1.6mcg/kg for adults, titrate in 25mcg steps
  • After stabilization annual TSH testing

(can get Liothyronine (T3) tablets too)

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11
Q

Management of hypothyroidism is individuals with Ischaemic heart disease / those >65 years old?

A
  • Start at lower dose of thyroxine and increase cautiosly

- Risk of precipitating angina

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12
Q

What is a Myxoedema Coma? Management?

A
  • Severe complication of advanced hypothyroidism, involves decreased mental status, hypothermia and slowing of organ function
  • Treat with IV T3
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13
Q

What is subclinical hypothyroidism? Management?

A
  • TSH raised, FT4 / 3 normal

- Treat with oral levothyroxine

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14
Q

How does management of hypothyroidism differ in pregnant individuals?

A
  • Increased levothyroxine requirements during pregnancy

- Increase dose by about 25% and monitor, aim to keep TSH in low normal range and FT4 in high normal range

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15
Q

List some causes of Goitres

A
  • Grave’s Disease
  • Hashimoto’s Disease
  • Thyroiditis (acute or chronic)
  • Iodine deficiency
  • Dyshormogenesis
  • Goitrogens (foods etc. that disrupt TH synthesis)
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16
Q

List some types of Goitres

A
  • Multinodular goitre
  • Diffuse goitre (colloid / simple)
  • Cysts
  • Tumours
  • Miscellaneous (sarcoidosis / TB)
17
Q

Investigations for solitary thyroid nodules?

A
  • Thyroid function test
  • Ultrasound (malignancy?)
  • Fine needle aspiration (malignancy?)
18
Q

What are the commonest types of thyroid cancer? Where does each commonly metastasize to?

A
  • Papillary: most common, spreads to local lymph nodes

- Follicular: metastases to lung / bone

19
Q

Management of thyroid cancer?

A
  • Near total thyroidectomy
  • High dose radioiodine (shrinks, ultimately destroys gland)
  • Long term suppressive doses of thyroxine
  • Follow up: after thyroxine withdrawal: Thyroglobulin & iodine levels
20
Q

What are the less common types of thyroid cancer? Prognosis? Treatment?

A
  • Anaplastic: agressive, poor prognosis. Does not respond to radioiodine
  • Medullary thyroid cancer: tumour of the parafollicular C cells. Serum calcitonin raised, total thyroidectomy to treat.
21
Q

What is thyrotoxicosis?

A

Hyperthyroidism

22
Q

Causes of thyrotoxicosis?

A
  • Grave’s Disease
  • Toxic multinodular goitre
  • Adenoma
  • Destructive thyroiditis
  • Excessive thyroxine administration
23
Q

How much of hyperthyroidism does Grave’s account for? More common in men or women?

A

70 - 80% of all hyperthyroidism is Grave’s

5:1 female to male ratio

24
Q

Pathophysiology of Grave’s?

A
  • Thyroid-stimulating immunoglobulins (TSIs) bind to and activate thyrotropin receptors, causing the thyroid gland to grow and the thyroid follicles to increase synthesis of thyroid hormone
25
Q

Investigations for Grave’s Disease?

A
  • TSH receptor antibodies

- Thyroid function tests: elevated FT4 and FT3, depressed TSH

26
Q

Symptoms of Grave’s disease? (additional to the hyperthyroidism symptoms)

A
  • Thyroid acropachy (basically finger clubbing)

- Gynaecomastia

27
Q

What is the most common cause of thyrotoxicosis in the elderly?

A
  • Multi-nodular goitre
28
Q

Causes of subacute (de Quervain’s) thyroiditis? Symptom progression?

A
  • Viral triggers: enteroviruses, coxsackie

Symptoms:

  • First 3-6 weeks thyrotoxicosis symptoms
  • From 3-6 months hypothyroidism symptoms
  • Painful goitre +/- fever / myalgia
29
Q

What drugs are used to treat hyperthyroidism?

A
  • Radioiodine
  • Beta blockers
  • Anti-thyroid drugs

Not all used in every case

30
Q

First line drugs for thyrotoxicosis? How successful is the treatment? Treatment regimen?

A
  • Antithyroid drugs: carbimazole & propylthiouracil
  • 50% cure rate (30% result in hypothyroidism)
  • Give via a titration regimen for 12-18 months
31
Q

If antithyroid drugs don’t cure thyrotoxicosis, what is the second line? Success rate? Complications?

A
  • Radioiodine ablation
  • 90% cured
  • 70% result in hypothyroidism post treatment, avoided in severe eye disease
32
Q

What is subclinical hyperthyroidism? Management?

A
  • Suppressed TSH, normal free TH levels

- Consider anti-thyroid drugs / radioiodine if persistent (especially in elderly / those with cardiac risk)

Endocrine (30 decks)

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