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Clinical Thyroid Disease Flashcards

1
Q

What are some examples of thyroid diseases?

A

Hypothyroidism

Goitre

Thyroid cancer

Hyperthyroidism

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2
Q

Give a summary of the hormones involved with the thyroid gland?

A
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3
Q

What is the clinical manifestation of hypothyroidism?

A
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4
Q

What is the clinical presentation of hyperthyroidism?

A
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5
Q

Compare and contrast the clinical presentation of hyper and hypothyroidism?

A
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6
Q

What are the different classifications of hypothyroidism?

A
  • Primary (thyroid)
    • Raised TSH, low FT4 and low FT3
  • Subclinical (compensated)
    • Raised TSH, normal FT4 and FT3
  • Secondary (pituitary)
    • Low TSH, low FT4 and FT3
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7
Q

Where is the pathology that causes primary hypothyroidism?

A

Thyroid gland

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8
Q

Where is the pathology that causes secondary hypothyroidism?

A

Pituitary gland

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9
Q

What TSH, FT3 and FT4 levels are seen in primary hypothyroidism?

A

Raised TSH

Low FT3

Low FT4

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10
Q

What TSH, FT3 and FT4 levels are seen in subclinical hypothyroidism?

A

Raised TSH

Normal FT3

Normal FT4

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11
Q

What TSH, FT3 and FT4 levels are seen in secondary hypothyroidism?

A

Low TSH

Low FT3

Low FT4

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12
Q

What are the 2 most common endocrine conditions?

A

1) Diabetes
2) Hypothyroidism

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13
Q

Does hypothyroidism affect men and woman equally?

A

No, affects more woman

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14
Q

What are some causes of primary hypothyroidism?

A

Congenital

  • developmental: agenesis, maldevelopment
  • dyshormonogenesis: trapping, organification

Acquired

  • autoimmune thyroid disease: hashimotos, atrophic
  • iatrogenic:
  • postoperative/post-radioactive iodine
  • external RT for head and neck cancers
  • antithyroid drugs (such as Lithium)
  • chronic iodine deficiency
  • post-subacute thyroiditis
  • post-partum thyroiditis
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15
Q

Are babies screened for hypothyroidism?

A

Yes, all babies are

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16
Q

What is the incidence of congenital hypothyroidism?

A

1/3500

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17
Q

What are some causes of secondary hypothyroidism?

A
  • Pituitary/hypothalamic damage
    • Pituitary tumour
    • Craniopharyngioma
    • Post pituitary surgery or radiotherapy
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18
Q

How does hormone secretion change in hypothyroidism?

A
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19
Q

What investigations are done for hypothyroidism?

A
  • TSH/fT4
  • autoantibodies
  • TPO (thyroid peroxidase antibodies)
  • FBC (MCV raised)
  • lipids (hypercholesterolaemia)
  • hyponatremia due to SIADH
  • increased muscle enzymes (ALT, CK)
  • hyperprolactinaemia
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20
Q

What autoantibody is investigated in hypothyroidism?

A

TPO (thyroid peroxidase antibodies)

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21
Q

What does TPO stand for?

A

Thyroid peroxidase antibodies

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22
Q

What is used for the treatment of hypothyroidism?

A
  • Levothyroxine (T4) tablets
  • Liothyronine (T3) tablets
  • Combination of T3 and T4 has no benefit from studies
  • After stabilisation, annual testing of TSH
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23
Q

What is the first line treatment for hypothyroidism?

A

Levothyroxine tablets (T4)

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24
Q

What is the initial dose of levothyroxine for hypothyroidism?

A

1.6mcg/kg

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25
How does ischaemic heart disease impact the initial treatment for hypothyroidism?
Lower dose of levothyroxine used (25mcg) and increased cautiously
26
When should treatment be given for subclinical hypothyroidism?
- if TSH \> 10 - or TSH \> 5 with symptoms: therapy should be trialled for 6 months
27
If subclinical hypothyroidism is diagnosied, when should tests be repeated?
2-3 months later with TPO antibodies
28
How does pregnancy impact treatment for hypothyroidism?
- increase LT4 dose by about 25% and monitor closely - aim to keep TSH in normal range (\<2.5mU/L) and FT4 in high normal range
29
What is inadequately treated hypothyroidism during pregnancy associated with?
Increased foetal loss and lower IQ
30
What is goitre?
Swelling of the thyroid gland
31
What is swelling of the thyroid gland called?
Goitre
32
What are some causes of goitre?
- physiological: puberty, pregnancy - autoimmune: graves disease, hashimoto’s disease - thyroiditis: acute (de Quervian’s), chronic fibrotic (Reidel’s) - iodine deficiency (endemic goitre) - dyshormogenesis - goitrogens
33
What are some different goitre types?
- multinodular goitre - diffuse goitre: colloid, simple - cysts - tumours: adenomas, carcinoma, lymphoma - miscellaneous: sarcoidosis, tuberculosis
34
What tumours can cause goitre?
Adenoma Carcinoma Lymphoma
35
What is solitary nodule thyroid?
Defined as palpable discrete swelling within an otherwise normal gland
36
What risk comes with solitary nodule thyroid?
Risk of malignancy (5% chance)
37
What investigations are done for solitary nodule thyroid?
- thyroid function test: solitary toxic nodule - ultrasound: useful in differentiating between benign and malignant - fine needle aspiration (FNA): Thy1 is inadequate, Thy2 is benign to Thy5 which is cancer
38
What is the most common endocrine malignancy?
Thyroid cancer
39
What are the different classifications of thyroid cancer?
* Papillary * Commonest * Multifocal, local spread to lymph nodes * Good prognosis * Follicular * Usually single lesion * Metastases to lung/bone * Good prognosis if resectable
40
Which form of thyroid cancer is the most common, papillary or follicular?
Papillary
41
Where does papillary thyroid cancer often spread to?
Local spread to lymph nodes
42
Where does follicular thyroid cancer often metastasis to?
Lung or bone
43
What is the management of thyroid cancer?
- near total thyroidectomy - high dose radioiodine (ablative) - long term suppressive doses of thyroxine - follow u
44
What surgery can be done to treat thyroid cancer?
Thyroidectomy
45
Other than follicular and papillary thyroid cancer, what are some other thyroid cancers?
Anaplastic Lymphoma Medullary thyroid cancer
46
What does anoplastic thyroid cancer not respond to?
Radioiodine
47
What is lymphoma thyroid cancer best treated with?
External RT, combined with chemotherapy
48
What does the tumour that causes medullary thyroid cancer arise from?
Parafollicular C cells
49
What genetic syndrome is medullary thyroid cancer associated with?
MEN2
50
What is the treatment for medullary thyroid cancer
Total thyroidectomy No role for radioiodine
51
How does hyperthyroidism impact hormones?
52
What are some causes of hyperthyroidism?
- primary: grave’s disease (70%), toxic multinodular goitre (20%), toxic adenoma - secondary: pituitary adenoma secreting TSH - thyrotoxicosis without hyperthyroidism: thyroiditis, excess T4 administration
53
What is the most common cause of primary hyperthyroidism?
Grave's disease (70%)
54
What is thyrotoxicosis?
Excess thyroid hormone in the body
55
What are some causes of thyrotoxicosis without hyperthyroidism?
Destructive thyroiditis Excessive thyroxine administration
56
What is the M:F ratio of Grave's disease?
1:5 (more females affected)
57
What kind of condition is Grave's disease?
Autoimmune condition
58
What antibodies are present in grave's disease?
Thyroid peroxidase antibodies TSH receptor antibodies
59
What is the diagnosis of Grave's disease done by?
Hyperthyroidism present Thyroid antibodies (TSH receptor antibodies)
60
What is the most common cause of thyrotoxicosis in the elderly?
Multinodular goitre
61
What triggers subacute (de Quervain's) thyroiditis?
Viral trigger (enteroviruses, coxsackie)
62
What is the clinical presentation of subacute (de Quervain's) thyroiditis?
Painful goitre Maybe fever/myalgia ESR increased
63
What treatment may subacute (de Quervain's) thyroiditis require?
Short term steroids and NSAIDs
64
What is the management of hyperthyroidism?
- radioiodine (RAI) - anti-thyroid drugs (ATD): carbimazole, propylthiouracil - beta blockers for symptoms
65
What are examples of anti-thyroid drugs?
Carbimazole Propylthiouracil
66
What are some concerns for patients with subclinical hyperthyroidism?
- bones: decreased density postmenopausal - atrial fibrillation: 3x increased risk in over 60s
67
What treatment is considered for subclinical hyperthyroidism and when?
- ATD/RAI if persistent - especially in elderly or those with increased cardiac risk

endocrine system (27 decks)

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