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Kumar and clark endocrine > day 2 > Flashcards

day 2 Flashcards

1
Q

what cells are round the outside of colloid

A

follicular

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2
Q

what levels can discriminate between hyper, hypo and euthydroidism

A

TSH levels

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3
Q

exceptions of when low TSH and low/normal T3 and T4

A

hypopituitarism

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4
Q

tests for hyperthyroidism

A

TSH plus free T4 or T3

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5
Q

tests for hypothyroidism

A

TSH plus serum free T4

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6
Q

what levels are greatly increased in pregnancy

A

TBG and total T4 but free T4 is normal.

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7
Q

what does amiodarone do

A

decrease t4 to t3 conversion and so t4 level may be higher than expected

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8
Q

what antibodies are specific for graves

A

TSH receptor IgG antibodies

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9
Q

what is the most common hypothyroidism

A

atrophic

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10
Q

what autoimmune thyroiditis leads to goitre formation

A

Hashimotos thyroiditis

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11
Q

what may cause hyperthyroidism, hypothyroidism or the 2 sequentially

A

post partum thyroiditis

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12
Q

post partum thyroididits has a high chance of proceeding to permanent

A

hypothyroidism

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13
Q

what is the mechanism of goitre

A

borderline hypothyroidism leading to TSH stimulation and thyroid enlargement in the face of continuing iodine deficiency

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14
Q

specific signs of hypothyroidism

A

dry thin hair, bradycardia, dry skin, slow relaxing reflexes

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15
Q

slow, dry haired, thick skinned, deep voiced, weight gain, cold intolerance, bradycardia and constipation is a classic picture of

A

hypothyroidism

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16
Q

what confirms primary hypothyroidism

A

high TSH levels with low T4

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17
Q

why should complete suppression of TSH be avoided

A

risk of atrial fib and osteoporosis

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18
Q

pregnant woman should have optimal replacement as mothers with elevated TSH during pregnancy can result in kids with

A

reduction in cognitive function

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19
Q

severe hypothyroidism may present with

A

confusion or even coma

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20
Q

what mental health illness is common in hypothyroidism

A

depression

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21
Q

nearly all cases of hyperthyroidism are caused by

A

intrinsic thyroid disease

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22
Q

most common cause of hyperthyroidism

A

graves disease

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23
Q

what condition produces antibodies that pretend to be TSH

A

graves

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24
Q

signs of thyrotoxicosis, diffuse goitre and extra thyroidal manifestations eg opthalmopathy

A

graves

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25
Q

signs of thyrotoxicosis, palpable solitary nodule or multinodualr goitre

A

solitary multinodular thyrotoxicosis

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26
Q

signs of thyrotoxicosis, diffuse goitre and tender on palpation

A

thyroiditis

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27
Q

specific signs of hyperthyroidism

A

tremor, hyperkinesis (excessive restlessness), tachycardia or atrial fibrillation, full pulse, warm vasodilator peripheries, exophthalmus( bulging eyes), lid lag and stare (upper eyelid retraction), goitre bruit

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28
Q

what is transient hyperthyroidism from an acute inflammatory process, probably viral in orgin

A

de quervains thyroiditis

29
Q

what may flow after de quervains thyroiditis after a few weeks

A

hypothyroidism

29
Q

what may flow after de quervains thyroiditis after a few weeks

A

hypothyroidism

30
Q

treatment of de quervains thyroiditis

A

acute phase - aspirin
short term in severely symptomatic - prendisolone

31
Q

what drug has high iodine content

A

amiodarone

32
Q

some cancer drugs eg ipilimumab can cause

A

thyroiditis

33
Q

what is infiltration. of the skin on the shin

A

pretibial myxoedema

34
Q

frequently present with atrial fib is common in elderly in

A

hyperthyroidism/ graves - not sure which one

35
Q

children with excessive height, weight gain and hyperactivity have

A

hyperthyroidism

36
Q

very useful clinical symptom of hyperthyroidism

A

weight loss despite normal appetite

37
Q

signs that differentiate hyperthyroidism from anxiety

A

eye signs, diffuse goitre, proximal myopathy and wasting

38
Q

what confirms the diagnosis fo hyperthyroidism

A

serum TSH is suppressed and raised free T3 or T4

39
Q

antibodies seen in graves

A

TSH receptor stimulating antibodies and thyroid peroxidase antibodies (TPO)
Tsh is 97-99% specific for graves
TPO are present in80% of graves but are also found in normal individuals

40
Q

most used anti thyroid drug in UK

A

carbimazole

41
Q

what is another option that is also an antithyroid drug

A

propylthiouracil

42
Q

how long does it take for anti thyroid drugs. to work

A

10-20 days

43
Q

what drug can provide symptomatic control in hyperthyroidism

A

beta blockers eg propanolol

44
Q

what % of patients relapse after a course of carbimazole or propylthiouracil within the following 2 years

A

50

45
Q

side effects of carbimazole

A

angranuclocytosis
may develop sore throat or unexplained fever and should have white blood cell counted

46
Q

when is radioactive iodine contraindicated

A

pregnancy and while breast feeding

47
Q

patients should not be on antithyroid drugs when on

A

radio iodine

48
Q

is there increased risk of malignancy after radioactive iodine

A

no

49
Q

some drugs given in thyroid storm

A

propranolol immediately, potassium iodide, antithyroid drugs, corticosteroids

50
Q

what is the preferred antithyroid drug at conception and during first trimester

A

propythiouracil

51
Q

why is propythiouracil given during conception and first trimester in hyperthyroidism

A

due to rare reports of congenital abnormalities

52
Q

why is carbimazole recommended during 2 and 3 trimester

A

as liver problems more frequently described on PTU

53
Q

high levels of HCG found in pregnancy causes what to TSH receptor and t3 and t4

A

suppressed TSH with slightly elevated T3/4

54
Q

if a mother has ever had graves she may still have circulating thyroid stimulating immunoglobulin and so

A

may stimulate metal thyroid and so foetus can become hyperthyroid

55
Q

what do you measure in foetus for thyroid status

A

foetal heart rate

56
Q

thyroid hormone resistance is an – condition

A

inherited

57
Q

what is mutated and abnormal in thyroid hormone resistance

A

thyroid hormone receptor

58
Q

thryroid hormone resistance is diagnosed on basis of

A

raised t3/4 and normal TSH

59
Q

long term risk of hyperthyroidism may cause

A

osteoporosis and atrial fib which may predispose to thromboembolic disease

60
Q

graves orbitopathy can cause swelling and oedema of the muscles around the eye leading to

A

limitation of movement and proptosis

61
Q

proptosis and lid retraction in graves may limit the ability to

A

close eyes completely

62
Q

is goitre physiological or pathological

A

can be either

63
Q

excessive doses of what will induce goitre

A

carbimazole or PTU

64
Q

what Amy produce a diffuse increase in size of the thyroid

A

puberty and pregnancy

65
Q

goitre which is smooth and soft and may be associated with thyroid growth stimulating antibodies

A

simple goitre

66
Q

what 2 diseases are associated with firm diffuse goitre of variable size

A

Hashimoto’s thyroididits and graves disease thyrotoxicosis

67
Q

when is a bruit in a goitre often present

A

thyrotoxicosis

Kumar and clark endocrine (3 decks)

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