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Endocrying > Clinical thyroid disease - First half > Flashcards

Clinical thyroid disease - First half Flashcards

1
Q

What are the main thyroid disorders?

A

Hypothyroidism

Hyperthyroidism

Goitre

Thyroid cancer

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2
Q

Identify the labels on the diagram below

A
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3
Q

What are the symptoms of hypothyroidism?

A

Hypothyroidism:

  • Weight gain
  • Lethargy
  • Feeling cold
  • Constipation
  • Dry skin/hair, hair loss
  • Heavy periods
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4
Q

What are the signs of hypothyroidism?

A

Dry skin/hair

Goitre

Bradycardia

Slow reflexes

Puffy face

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5
Q

How does severe hypothyroidism present?

A

Normal symptoms and…

puffy face

large tongue

hoarseness

coma

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6
Q

What are the symptoms of Hyperthyroidism?

A

Hyperthyroidism:

  • Weight loss
  • Anxiety/irritability
  • Heat intolerance
  • Light periods
  • Thyroid eye symptoms
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7
Q

What are the signs of hyperthyroidism?

A

Sweaty palms

Palipitations

Hyperreflexia/Tremors

Goitre

Thyroid eye symptoms/signs

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8
Q

What are the clinical types of hypothyroidism and their differences?

A

Primary (Thyroid):

  • Raised TSH, Low FT4 & FT3

Subclinical (compensated):

  • Raised TSH: Normal FT4 & FT3

Secondary (Pituitary):

  • Low TSH, Low FT4 & FT3
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9
Q

How common is hypothyroidism?

A

Commonest endocrine condition after diabetes

1/50 women get it

1/1000 men get it (very rare in men)

Subclinical hypothyroidism quite common in women over 60 (10%)

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10
Q

What are the congenital causes of hypothyroidism?

A

Developmental:

  • Agenesis / maldevelopment

Dysmorphogenesis:

  • genetic defects for synthesis of thyroid hormone
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11
Q

How common are congenital causes of hypothyroidism?

A

1 in 3500 births

  • All babies screened in the UK
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12
Q

What are the acquired types of primary hypothyroidism?

A

Autoimmune:

  • Atrophic - most common
  • Hashimoto’s thyroiditis

Iatrogenic:

  • Postoperative / post- radioactive iodine
  • Radiotherapy for head/neck cancers
  • Antithyroid drugs, Amiodarone, Lithium, Interferon

Chronic iodine deficiency

Post-partum

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13
Q

What are the causes of secondary hypothyroidism?

A

Pituitary or hypothalamic damage:

  • Pituitary tumour
  • Craniopharyngioma - Benign brain tumour begings near the pituitary
  • Post pituitary surgery or post radiotherapy
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14
Q

How do you investigate hypothyroidism?

A

Serum TSH - High TSH confirms primary hypothyroidism

Serum FT4 - Free thyroxine.

Abnormalities of levels of TSH & FT4 - used to determine which type of hypothyroidism

Autoantibodies - TPO (thyroid peroxidase antibodies)

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15
Q

How is hypothyroidism treated?

A

Levothyroxine - for life, very little side effects. 50 - 150 ug.

Other:

  • Liothyronine (T3 replacement)
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16
Q

Describe the doses n shit for levothyroxine

A

Initial dose Levothyroxine 1.6 ug/kg for adults <65 years old

In practice:

  • 100 ug for young and fit
  • 50 ug for old and small

Dosage then increased until suffice

17
Q

How is hypothyroidism treated in those with ischaemic heart disease?

A

Start at lower dose 25 ug and increase cautiously; risk of precipitating angina

18
Q

How is postpartum thyroiditis treated?

A

Trial withdrawal and measure TFT’s in 6 weeks

(normally self-limiting)

19
Q

If a patient has is in a myxedemic coma

How are they treated for their hypothyroidism?

A

Very rare emergency, may need IV T3 (steroid)

20
Q

A patients thyroid hormone tests have come back showing raised TSH but normal levels of FT3 and FT4

Describe their investigation and management

A

Repeat thyroid hormone tests after 2-3 months and also test TPO antibodies

If TSH > 10 - treatment

If TSH > 5 and they are symptomatic - trial therapy

If pregnant/planning to be pregnant - treat

21
Q

What is the risk of overtreatment with subclinical hypothyroidism?

A

Osteopenia (pre-osteoporosis)

Atrial fibrillation

Basically just too much thyroid is bad innit

22
Q

Describe the management plan for someone with hypothyroidism during pregnancy?

A

Increased levothyroxine requirements during pregnancy

Specific management:

  • Increase Levothyroxine dosage by 25%
    • Monitor closely
  • Aim to keep TSH in low normal range (<2.5mU/l) and FT4 in high normal range

Treat subclinical hypothyroidism if planning/pregnant

23
Q

Why is important to manage hypothyroidism tightly in pregnancy?

A

Inadequately treated hypothyroidism linked with increased foetal loss and Lower IQ

24
Q

What is Goitre?

A

Swelling of the neck resulting from some form of enlargement of the thyroid gland

25
Q

What are the types of goitre shape?

A

Nodular:

  • Multinodular goitre
  • Solitary thyroid nodule (solitary nodular goitre)

Diffuse

Tumour

Miscellaneous

26
Q

What are the causes of diffuse goitre?

(obviously different causes may produce slightly different looking diffuse goitre to this)

A

Puberty & pregnancy - this is called simple goitre

Autoimmune thyroid disease

Acute thyroiditis (de Quervain’s thyroiditis)

Iodine deficiency (endemic goitre)

Dyshormonogenesis

Goitrogens

27
Q

What autoimmune conditions can cause diffuse goitre?

A

Graves’ disease (thyrotoxicosis)

Hashimoto’s disease

28
Q

Solitary thyroid nodules may be due to tumours

What are risk factors for a patient with a solitary thyroid nodule having a tumour?

A

–Child

–Adults less than 30 or over 60 years

–Previous head and neck irradiation

–Pain, cervical lymphadenopathy

29
Q

What investigations should be done on a solitary thyroid nodule?

A

Thyroid function tests (T3,4, TSH)

Ultrasound

FNA

30
Q

What are the main types of thyroid malignancy?

For each type, what is their:

a) frequency
b) spreading behaviour
c) prognosis

A

Papillary (carcinoma):

  • most common type (70%), esp. in young people
  • Multifocal, local spreading to lymph nodes
  • Good prognosis

Follicular (carcinoma):

  • 20% of cases, more common in females
  • Metastasises to lung/bone
  • Good prognosis if resectable

Other:

  • Medullary cell
  • Anaplastic
  • Lymphoma
31
Q

How is thyroid cancer managed?

A

1) - Primary treatment option is surgical:
* Total or near-total thyroidectomy
2) - High dose radio-iodine post-operative
3) - Levothyroxine - long term suppressive doses to stop recurrence

Followups:

  • Monitor serum thyroglobulin as a tumour marker
  • Whole body iodine scanning (following 2-4 weeks of thyroxine withdrawal or recombinant TSH injections)
32
Q

For anaplastic thyroid cancer, describe the following:

a) behaviour and spreading
b) prognosis

A

Anaplastic:

a) - Aggressive and locally invasive
b) - Very poor prognosis

33
Q

For thyroid lymphoma, answer the following.

a) Frequency and specific risk factors/causes
b) Management

A

a) Rare - may arise from preexisting Hashimoto’s disease
b) Radiotherapy and chemotherapy

34
Q

What is medullary cell thyroid cancer?

A

Carcinomas that arise from parafollicular (C-cells) cells

They are quite rare, but is often associated with MEN 2 - phaeochromocytoma & hyperparathyroidism

They cause serum calcitonin levels to be raised

Endocrying (21 decks)

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