Disease Profiles Flashcards
1
Q
Diabetes: Symptoms of High Blood Glucose - Urinary Tract (4)
A
Polyuria
Thirst
Polydypsia
Genital thrush
2
Q
Diabetes: Symptoms of High Blood Glucose - General (3)
A
Blurred vision - altered osmotic pressure in the anterior chamber of the eye
Fatigue
Weight loss
3
Q
Diabetes: Investigations - Blood glucose threshold is set by what?
A
Retinopathy risk
4
Q
Diabetes: Investigations - Blood glucose in gestational diabetes is set by what?
A
Risk to the foetus or neonate
5
Q
Diabetes: Investigations - Fasting Glucose thresholds
A
> 7.0 mmol/L
6
Q
Diabetes: Investigations - Random or 2 hour glucose in OGTT threshold
A
> 11.1 mmol/L
7
Q
Diabetes: Investigations - HbA1c threshold
A
> 48mmol/mol
8
Q
HbA1c: What happens when Hb becomes exposed to glucose?
A
Glycated
9
Q
HbA1c: Extent of glycation is proportional to what?
A
Glucose concentration
10
Q
HbA1c: Level gives a representation of glucose exposure for how long?
A
90 days
11
Q
HbA1c: Must analyse cautiously in what situations?
A
Increased or Reduced RBC turnover
12
Q
Type I Diabetes Mellitus
A
Autoimmune destruction of the pancreatic beta cells resulting in Beta cell deficiency and therefore absolute insulin deficiency
13
Q
Type I Diabetes Mellitus: Average age of onset
A
<20 years old
14
Q
Type I Diabetes Mellitus: High incidence in what countries? (2)
A
Scandinavia
Saudi Arabia
15
Q
Type I Diabetes Mellitus: This is more commonly diagnosed in what sex post-puberty?
A
Males
16
Q
Type I Diabetes Mellitus: Aetiologies - Genetic cause
A
HLA Complex - DR3-DQ2 or DR4-DQ8
17
Q
Type I Diabetes Mellitus: Aetiologies - Peak age of onset
A
10-14 years
18
Q
Type I Diabetes Mellitus: Environmental Risk Factors - Maternal factors (2)
A
Older in age
Gestational infection
19
Q
Type I Diabetes Mellitus: Environmental Risk Factors - Example of a viral infection
A
Coxsackie B4
20
Q
Idiopathic Type I Diabetes Mellitus
A
Patients with permanent insulinopenia and are prone to DKA but have no evidence of Beta Cell Autoimmunity
21
Q
Latent Autoimmune Disease in Adults
A
Late onset Type I Diabetes Mellitus
22
Q
Type I Diabetes Mellitus: Pathophysiology - Autoantibodies present (4)
A
Glutamic Acid Decarboxylase (GAD-65)
Islet-antigen 2
IAA
ZnT8 Transporter (ZnT8Ab)
23
Q
Type I Diabetes Mellitus: Pathophysiology - What immune response mediates this?
A
T-cell mediated autoimmune response with production of autoantibodies to target and destroy Beta Cells
24
Q
Type I Diabetes Mellitus: Pathophysiology - What is visible on a Beta Cell Biopsy?
A
Insulitis with lymphocytic infiltrate
25
Type I Diabetes Mellitus: Clinical Presentation - Onset
Acute
26
Type I Diabetes Mellitus: Clinical Presentation - Urinary Tract Symptoms (3)
Polydypsia
Polyuria
Thrush
27
Type I Diabetes Mellitus: Clinical Presentation - General symptoms (4)
Weakness
Fatigue
Blurred vision
Severe weight loss
28
Type I Diabetes Mellitus: Diagnosis - Biochemical markers (5)
Increased glucose
Ketones
Decreased insulin
Decreased beta cell mass
Decreased C peptide
29
Type I Diabetes Mellitus: Insulin Management - Examples of Insulin Analogues
Insulin Aspart, Lispro or Glulisine
30
Type I Diabetes Mellitus: Insulin Management - Onset of insulin analogues
10-15 minutes
31
Type I Diabetes Mellitus: Insulin Management - Peak action of insulin analogues
60-90 minutes
32
Type I Diabetes Mellitus: Insulin Management -Duration of action of insulin analogues
4-5 hours
33
Type I Diabetes Mellitus: Insulin Management - Examples of soluble insulin
Actrapid or Humulin S
34
Type I Diabetes Mellitus: Insulin Management - Onset of action of Soluble Insulin
30-60 minutes
35
Type I Diabetes Mellitus: Insulin Management - Peak action of Soluble insulin
2-4 hours
36
Type I Diabetes Mellitus: Insulin Management - Duration of Soluble Insulin
5-8 hours
37
Type I Diabetes Mellitus: Isophane Basal insulin - Examples (2)
Insulatard
Humulin I
38
Type I Diabetes Mellitus: Isophane Basal insulin - Peak action
4-6 hours
39
Type I Diabetes Mellitus: Isophane Basal insulin - Duration
12 hours
40
Type I Diabetes Mellitus: Analogue Basal insulin - Examples (2)
Glargine
Detemir
41
Type I Diabetes Mellitus: Pancreas Transplantation - Options (2)
Kidney-pancreas auto-transplantation
Islet autotransplantation
42
Type I Diabetes Mellitus: Pancreas Transplantation - Indications (3)
Imminent End Stage Renal Disease
Severe hypoglycaemia or metabolic complications
Uncontrolled diabetes despite maximum treatment
43
Type I Diabetes Mellitus: Pancreas Transplantation - How are islets infued?
Into the portal vein to be transferred to the liver
44
Type I Diabetes Mellitus: Pancreas Transplantation - Immunosuppression options (2)
Mycophenalate
Tacrolimus
45
Type I Diabetes Mellitus: Associated Conditions (3)
Cystic Fibrosis
Wolfram Syndrome
Bardet-Biedl Syndrome
46
Type I Diabetes Mellitus: Pancreas Transplantation - Cystic Fibrosis DM Screening
OGTT from the age of 10
47
Type I Diabetes Mellitus: Pancreas Transplantation - Cystic Fibrosis DM Management
Insulin
48
Type I Diabetes Mellitus: Pancreas Transplantation - Wolfram Syndrome DM clinical presentation (3)
DI or DM
Optic atrophy
Deafness
49
Type I Diabetes Mellitus: Pancreas Transplantation - Bardet-Biedl Syndrome DM Clinical presentation (4)
Obesity
Polydactyly
Hypogonadism
Visual impairments
50
Type I Diabetes Mellitus: Complications - Microvascular complications are largely driven by what?
Hyperglycaemia
51
Type I Diabetes Mellitus: Complications - Examples of microvascular complications (3)
Retinopathy
Neuropathy
Nephropathy
52
Type I Diabetes Mellitus: Complications - Examples of Macrovascular complications (4)
Myocardial infarction
ACS
Stroke
Peripheral Vascular Disease
53
Type I Diabetes Mellitus: Complications - Macrovascular complications are due to what? (3)
Hyperglycaemia
Hypertension
Dyslipidaemia
54
Type I Diabetes Mellitus: Retinopathy - 4 types
Diabetic retinopathy
Diabetic macular oedema
Cataracts
Glaucoma
55
Type I Diabetes Mellitus: Retinopathy - Cataract
Clouding of the lens
56
Type I Diabetes Mellitus: Retinopathy - Glaucoma
Increase in fluid in the eye to cause optic nerve damage due to increased pressure
57
Type I Diabetes Mellitus: Retinopathy Grading - R1 Features and Monitoring
Mild Background Diabetic Retinopathy - microaneurysms, flame exudates, >4 blot haemorrhages and cotton wool spots
Monitoring - rescreen in 12 months
58
Type I Diabetes Mellitus: Retinopathy Grading - R2
Moderate Background Diabetic Retinopathy - >4 blot haemorrhages in one hemifield
Monitoring - Rescreen in 12 months
59
Type I Diabetes Mellitus: Retinopathy Grading - R3
Severe non-proliferative or pre-proliferative Diabetic Retinopathy - >4 blot haemorrhages in both hemifields with intraretinal microvascular anolies and venous beading
Monitoring - Refer
60
Type I Diabetes Mellitus: Retinopathy Grading - R4
Proliferative Retinopathy - Vitreous haemorrhage, Retinal detachment and Neovascularisation
Monitoring - Refer
61
Type I Diabetes Mellitus: Retinopathy - Cotton wool spots indicate wht?
Areas of ischaemia
62
Type I Diabetes Mellitus: Retinopathy - Intra-retinal microvascular abnormalities are a precursor to what?
Neovascularisation
63
Type I Diabetes Mellitus: Retinopathy - Maculopathy
Hard exudate with 1 disc diameter of the fovea
64
Type I Diabetes Mellitus: Retinopathy - 3 options for management
Lasers
Vitrectomy
Intra-vitreal Anti-VEGF
65
Type I Diabetes Mellitus: Retinopathy - Laser management mechanism
Pan retinal photocoagulation - Reduces the oxygen requirement of the retina to reduce ischaemia
66
Type I Diabetes Mellitus: Retinopathy - Vitrectomy used when?
If a vitreal haemorrhage is present
67
Type I Diabetes Mellitus: Retinopathy - Management for Macular Oedema
Intra-viteal Anti-VEGF
68
Type I Diabetes Mellitus: Diabetic Nephropathy
Progressive kidney disease caused by damage to the capillaries of the kidney glomeruli characterised by proteinuria and diffuse scarring of the glomeruli
69
Type I Diabetes Mellitus: Diabetic Nephropathy -Complocations (3)
Hypertension
Decline in renal function
Accelerated vascular disease
70
Type I Diabetes Mellitus: Diabetic Nephropathy -Measure what to analyse urine protein?
Protein:Creatinine Ratio
71
Type I Diabetes Mellitus: Diabetic Nephropathy -Proteinuria diagnostic
ACR
72
Type I Diabetes Mellitus: Microalbuminuria - Urinary Albumin Excretion Rate varies with what factors (4)
Exercise
Protein load
Fluid load
Time of day
73
Type I Diabetes Mellitus: Microalbuminuria - Urinary Albumin Excretion Rate False positives (5)
Menstruation
Vaginal discharge
UTI
Pregnancy
Non-diabetic renal disease
74
Type I Diabetes Mellitus: Diabetic Nephropathy - Management First Line
ACEI or ARB
75
Type I Diabetes Mellitus: Diabetic Nephropathy - Blood pressure target
<140/80 mmHg
76
Type I Diabetes Mellitus: Diabetic Nephropathy - Glucose target for management
53 mmol/mol
77
Type I Diabetes Mellitus: Diabetic Neuropathy - Peripheral
Distal symmetric or Sensorimotor Pain or loss of feeling in the feet or hands
78
Type I Diabetes Mellitus: Diabetic Neuropathy - Proximal
Pain in the thighs, hips or bottom leading to weakness in the legs
79
Type I Diabetes Mellitus: Diabetic Neuropathy - Autonomic
Changes in automatic functions
80
Type I Diabetes Mellitus: Diabetic Neuropathy - Focal
Sudden weakness in one nerve or a group of nerves causing muscle weakness or pain
81
Type I Diabetes Mellitus: Peripheral Neuropathy - Symptoms (5)
Numbness or insensitivity
Tingling or burning
Sharp pains or cramps
Sensitivity to touch
Loss of balance or coordination
82
Type I Diabetes Mellitus: Peripheral Neuropathy - Charcot Foot
Destructive inflammatory process with fractures and bony destruction causing deformity to the foot
83
Type I Diabetes Mellitus: Peripheral Neuropathy - Charcot Foot Presentation
Hot swollen foot in someone with neuropathy
84
Type I Diabetes Mellitus: Peripheral Neuropathy - Charcot Foot Management
Non-weight bearing and total contact cast
85
Type I Diabetes Mellitus: Peripheral Neuropathy - Oral Management Options (4)
Amitryptyline
Duloxetine
Gabapentin
Pregabalin
86
Type I Diabetes Mellitus: Peripheral Neuropathy - Topical Management Option
Capsaicin cream
87
Type I Diabetes Mellitus: Proximal Neuropathy -Clinical Presentation (3)
Pain in the thighs, hips, bottom or legs on one side
Proximal muscle weakness
Marked weight loss
88
Type I Diabetes Mellitus: Autonomic Neuropathy - Digestive System Presentation (3)
Gastric slowing and reduced frequency of movement - constipation and diarrhoea
Gastroparesis - reduced speed of gastric emptying
Oesophageal nerve damage - dysphagia and weight loss
89
Type I Diabetes Mellitus: Autonomic Neuropathy - Symptoms on impact on sweating
Profuse sweating at night or whilst eating
90
Type I Diabetes Mellitus: Autonomic Neuropathy - Treatment for Excess Sweating (3)
Topical Glycopyrrolate
Clonidine
Botulinum Toxin
91
Type I Diabetes Mellitus: Mononeuropathy - Examples (2)
VI Cranial Nerve Palsy
Carpal Tunnel Syndrome
92
Type I Diabetes Mellitus: Mononeuropathy - VI Cranial Nerve Palsy
Abducens cranial nerve causes inability to abduct the eye
93
Type II Diabetes Mellitus: Onset
Middle aged adults and elderly
94
Type II Diabetes Mellitus
Impaired glucose control due to increased insulin resistance and insulin deficiency
95
Type II Diabetes Mellitus: Aetiologies (5)
Obesity
Sedentary Lifestyle
Family History
Pregnancy
Calorie-dense diet
96
Type II Diabetes Mellitus: What ethnicities are at a greater risk? (3)
South asian
African
Afro-carribean
97
Type II Diabetes Mellitus: Abnormalities of Insulin Action - How does central obesity like to this?
Increased plasma levels of FFA causes impaired insulin-dependent glucose uptake into hepatocytes, myocytes and adipocytes
98
Type II Diabetes Mellitus: Abnormalities of Insulin Action - What role does increased tyrosine kinase have in this?
Decreased activation of downstream pathways causing decreased GLUT channel expression and decreased cellular glucose uptake
99
Type II Diabetes Mellitus: Abnormalities of Insulin Secretion - Early sign is loss of what?
Normal biphasic insulin secretion
100
Type II Diabetes Mellitus: Abnormalities of Insulin Secretion - What is toxic to Beta Cells in this? (2)
Increased FFAs and Adipokines
101
Type II Diabetes Mellitus: Onset
Gradual onset
102
Type II Diabetes Mellitus: Clinical signs
Acanthosis nigricans - insulin driven epithelial overgrowth
103
Type II Diabetes Mellitus: Clinical presentation
Obesity
Standard - polyuria, polydypsia and fatigue
104
Type II Diabetes Mellitus: HbA1c threshold
<7% or 53mmol.mol
105
Type II Diabetes Mellitus: HbA1c threshold for patients on triple oral therapy or insulin
58 mmol/mol
106
Type II Diabetes Mellitus: First line management
Lifestyle management + Metformin
107
Type II Diabetes Mellitus: Management - Diabetics with Atherosclerotic CVD
Metformin + GLP-1 Receptor Antagonist
108
Type II Diabetes Mellitus: Management - Diabetics with HF or CKD
Metformin + SGLT2 Inhibitors (GLP-1 antagonist second line)
109
MODY
Maturity Onset Diabetes of the Young
110
MODY: Definition
Early onset (<25 years old) of non-insulin dependent diabetes
111
MODY: Aetiology
Single gene mutation
112
MODY: 3 types of mutation (3)
Glucokinase
Transcription factors
MODY X
113
MODY: Glucokinase Mutations Pathophysiology
Activity impairment results in glucose sensing defect, causing an increase in the threshold for insulin secretion
114
MODY: Transcription Factor Mutations - Main mutations (3)
HNF-1-alpha
HNF-1-Beta
HNF-4-alpha
115
MODY: Clinical Presentation - Glucokinase Mutation onset and presentation
Onset at birth
Stable hyperglycaemia
116
MODY: Clinical Presentation - Transcription factor mutation onset and presentation
Adolescent onset
Progressive hyperglycaemia
117
MODY: Diagnosis - Main test
Oral Glucose Tolerance Test
118
MODY: Diagnosis - OGTT Glucokinase Mutations result
High fasting blood glucose but brings glucose down with oral challenge
119
MODY: Diagnosis - OGTT Transcription Factor Mutations result
Normal fasting blood glucose with bad response to glucose challenge
120
Neonatal Diabetes: Main aetiology
Monogenic mutation
121
Neonatal Diabetes: Pathophysiology
Mutations within the K-ATP Channel - mainly Kir6.2 mutations
122
Neonatal Diabetes: Diagnosis - Timeframe
<6 months
123
Neonatal Diabetes: Diagnosis - Clinical presentation (4)
Polydypsia
Polyuria
Dehydration
DKA
124
Neonatal Diabetes: Management
Sulphonylureas - inhibit K-ATP channel
125
Congenital Hyperinsulinism: Mutations
Kir6.2 or SUR1 mutation
126
Congenital Hyperinsulinism: Characterised by what?
Inappropriate and unregulated insulin secretion resulting in severe hypoglycaemia in newborns or children
127
Congenital Hyperinsulinism: Management
Diazoxide
128
Diabetic Ketoacidosis
Disordered metabolic state occurring due to absolute or relative insulin deficiency accompanied by an increase in counter-regulatory hormones
129
Diabetic Ketoacidosis: More commonly a complication of what?
Type I Diabetes Mellitus
130
Diabetic Ketoacidosis: Increased Insulin Demand - 5 Aetiologies
Infection
Inflammation
Intoxication
Infarction
Iatrogenic
131
Diabetic Ketoacidosis: Aetiologies - Examples of Infections (3)
Pneumonia
UTI
Cellulitis
132
Diabetic Ketoacidosis: Aetiologies - Examples of Inflammatory (2)
Pancreatitis
Cholecystitis
133
Diabetic Ketoacidosis: Aetiologies - Examples of Intoxication (4)
Alcohol
Cocaine
Salicyclate
Methanol
134
Diabetic Ketoacidosis: Aetiologies - Examples of Iatrogenic causes (2)
Steroids
Surgery
135
Diabetic Ketoacidosis: Pathophysiology - Ketone bodies are formed where?
Liver mitochondria
136
Diabetic Ketoacidosis: Pathophysiology - Ketone bodies are important for metabolism where? (2)
Heart
Renal cortex
137
Diabetic Ketoacidosis: Pathophysiology - When are ketones formed?
If pyruvate or oxalonacetate is limited, excess Acetyl CoA diverted into ketones
138
Diabetic Ketoacidosis: Pathophysiology - When does this occur?
If insulin supplementation is missed
139
Diabetic Ketoacidosis: Pathophysiology - Why is it rare in Type II DM?
There is still inhibition of lipolysis
140
Diabetic Ketoacidosis: Pathophysiology - Why can this occur in starvation?
Oxaloacetate is consumed for gluconeogenesis and when glucose is not available fatty acids are oxidised to provide energy - excess Acetyl-CoA is converted into ketones
141
Diabetic Ketoacidosis: Clinical Presentation - Osmotic related (2)
Thirst and Polyuria
Dehydration
142
Diabetic Ketoacidosis: Clinical Presentation - Ketone body related (5)
Flushed
Vomiting
Abdominal pain and tenderness
Increased respiratory rate
Distinct smell on breath
143
Diabetic Ketoacidosis: Clinical Presentation - Associated conditions (2)
Underlying sepsis
Gastroenteritis
144
Diabetic Ketoacidosis: Diagnosis - 3 things monitored
Ketonaemia - >3 mmol/L or >2 on urine stick
Blood Glucose - >11
Bicarbonate - <15 mmol/L or venous pH <7.3
145
Diabetic Ketoacidosis: Diagnosis - Impact on potassium
>5.5 mmol/L
146
Diabetic Ketoacidosis: Diagnosis - Creatinine
Increased
147
Diabetic Ketoacidosis: Diagnosis - Sodium
Reduced
148
Diabetic Ketoacidosis: Diagnosis - Amylase
Increased - can be due to pancreatitis
149
Diabetic Ketoacidosis: Diagnosis - WCC
Increased
150
Diabetic Ketoacidosis: Management - Fluid Losses
1L NaCl 0.9% in the first hour
2L NaCl 0.9% by the end of hour 2
3L NaCl 0.9% by the end of hour 3
151
Diabetic Ketoacidosis: Management - If blood glucose concentration falls below 14 mmol/L
IV glucose 10% in addition to 0.9% NaCl infusion
152
Diabetic Ketoacidosis: Management - For electrolyte losses (3)
NaCl 0.9%
IV Potassium
Phosphate replacement - rare
153
Diabetic Ketoacidosis: Management - Insulin replacement
IV insulin 0.1 units/kg per hour with usual subcutaneous daily basal insulin - continue until ketoacidosis has been resolved
154
Diabetic Ketoacidosis: Monitoring and timing
Every hour - Blood Ketone and Blood Glucose
Every 2-4 hours - Blood gas and electrolytes
155
Diabetic Ketoacidosis: Dehydration increases the risk of what?
Thromboembolism
156
Diabetic Ketoacidosis: Complications - Main one in children
Cerebral oedema
157
Diabetic Ketoacidosis: Complications - Main ones in adults (3)
Hypokalaemia - can lead to cardiac arrest and paralytic ileus
Aspiration pneumonia
ARDs
158
Alcoholic Ketoacidosis
Metabolic acidosis caused by increased production of ketone bodies with normal or low glucose levels resulting from alcohol and starvation
159
Alcoholic Ketoacidosis: Most common patient groups
Malnourished individuals with alcohol dependency
160
Alcoholic Ketoacidosis: Associated with episodes of what?
Binge drinking with poor food intake, dehydration and vomiting
161
Alcoholic Ketoacidosis: Why is there an accumulation of ketone bodies? (3)
Depleted glycogen stores in the liver from malnutrition
Increased lipolysis and FFA release
Volume depletion e.g. due to vomiting
162
Alcoholic Ketoacidosis: Clinical Presentation (4)
Nausea and Vomiting
Abdominal pain
Increased respiratory rate
Dehydration
163
Alcoholic Ketoacidosis: Management (4)
IV Pabrinex - high dose vitamins with thymine
IV fluids - 5% dextrose in 0.9% NaCl
IV anti-emetics
Insulin occasionally
164
Alcoholic Ketoacidosis: High dose vitamins used to prevent what?
Wernicke Encephalopathy
165
Hyperthyroidism
Conditions in which overactivity of the thyroid gland leads to thyrotoxicosis
166
Thyrotoxicosis
Clinical, physiological and biochemical state arising when tissues are exposed to excess thyroid hormone
167
Hyperthyroidism: Main cause
Grave's Disease - 85% of cases
168
Hyperthyroidism: Graves Disease - More common in what sex?
Females
169
Hyperthyroidism: Graves Disease - Usual age of presentation
20-40 years
170
Hyperthyroidism: Graves Disease - Chance of developing autoimmune thyroid disease if mother has it?
5-8%
171
Hyperthyroidism: Graves Disease - Associated genes? (3)
HLA genes
CTLA-4
PTPN-22
172
Hyperthyroidism: Three aetiologies
Graves Disease
Excessive Thyroid stimulation
Thyroid nodules
173
Hyperthyroidism: Causes of Excessive Thyroid Stimulation (4)
Hashitoxicosis
Thyrotopinoma
Thyroid Cancer
Choriocarcinoma
174
Hashitoxicosis
Transient hyperthyroidism causes by inflammation due to Hashimoto's Thyroiditis - followed by hypothyroidism
175
Thyrotropinoma
TSH secreting pituitary adenoma
176
Choriocarcinoma
Trophoblast tumour secreting hCG
177
Thyrotoxicosis: Causes of thyrotoxicosis not associated with hyperthyroidism (3)
Thyroid inflammation
Exogenous Thyroid hormones
Ectopic thyroid tissue
178
Thyrotoxicosis: Causes of Thyroid Inflammation (3)
Subacute Thyroiditis - de Quervain's
Post-partum Thyroiditis
Drug-induced Thyroiditis
179
Thyrotoxicosis: Cause of Drug-induced thyroidits
Amiodarone
180
Thyrotoxicosis: Causes of exogenous thyroid hormones (2)
Over treatment with Levothyroxine
Thyrotoxicosis factitia
181
Thyrotoxicosis: Causes of Ectopic Thyroid Tissue (2)
Metastatic thyroid carcinoma
Struma ovarii - teratoma containing thyroid tissue
182
Hyperthyroidism: Graves Disease - Pathophysiology
Auto-antibodies target the TSH receptor, thyroid peroxisomes and thyroglobulin - anti-TSH receptor antibodies stimulate the thyroid to increase function
183
Hyperthyroidism: Clinical Presentation - General symptoms (3)
Weight loss - despite increased appetite
Sweating
Heat intolerance
184
Hyperthyroidism: Clinical Presentation - GI symptom
Frequent loose bowel movements
185
Hyperthyroidism: Clinical Presentation - Thyroid symptom
Goitre
- Graves - diffuse
- Toxic multinodular Goitre - firm nodules
186
Hyperthyroidism: Clinical Presentation - Thyroid sign
Thyroid bruit
187
Hyperthyroidism: Clinical Presentation - What does a thyroid sign demonstrate?
Hypervascularity of the thyroid
188
Hyperthyroidism: Clinical Presentation - Eyes (2)
Double vision
Graves Opthalmopathy
189
Hyperthyroidism: Clinical Presentation - Cardiac (3)
Increased pulse rate
Palpitations
Atrial Fibrillation
190
Hyperthyroidism: Clinical Presentation - Musculoskeletal (2)
Fine tremor of outstretched fingers
Muscle weakness - in thighs and upper arms
191
Hyperthyroidism: Clinical Presentation - Neuropsychiatric (4)
Increased nervousness
Sleep disturbance
Depression
Insomnia
192
Hyperthyroidism: Clinical Presentation - Hair and Skin (2)
Hair - thin and brittle
Rapid fingernail growth
193
Hyperthyroidism: Clinical Presentation - Reproductive in females
Menstrual cycle changes - lighter bleeding with less frequent periods
194
Hyperthyroidism: Clinical Presentation of Graves Disease - Presentation on legs
Pretibial myxoedema - thick scaly skin and swelling on the lower legs
195
Hyperthyroidism: Clinical Presentation of Graves Disease - Thyroid Acropachy
Thickening of the extremities manifested by digital clubbing, soft tissue swelling of the hands and feet and periosteal new bone formation
196
Hyperthyroidism: Graves Eye Disease
Autoimmune inflammatory disorder of the orbit and periorbital tissues
197
Hyperthyroidism: Graves Eye Disease - Characterised by what? (6)
Upper eye lid retraction
Lid lag
Swelling
Erythema
Conjunctivitis
Bulging eyes - Exophthalmos
198
Hyperthyroidism: Graves Eye Disease - Results from autoimmune inflammation of what?
Extra-ocular muscles as orbital fat and connective tissue TSH receptors
199
Hyperthyroidism: Graves Eye Disease - Associated with what modifiable factor?
Smoking
200
Hyperthyroidism: Diagnosis - Primary Hyperthyroidism
TSH low
Free T3/T4 high
201
Hyperthyroidism: Diagnosis - Secondary hyperthyroidism
TSH high
Free T3/T4 high or normal
202
Hyperthyroidism: Diagnosis - Thyroid Antibodies (3)
Anti-TPO
Anti-thyroglobulin antibody
TSH receptor stimulating antibody
203
Hyperthyroidism: Diagnosis - When is Scintiscan used?
To look for toxic nodular disease if antibodies are negative
204
Hyperthyroidism: Graves Disease - First line management
Carbimazole
205
Hyperthyroidism: Graves Disease - First line management in first trimester of pregnancy
Propylthiouracil
206
Hyperthyroidism: Graves Eye Disease - Management
Mild - Lubricants
Severe - Steroids, Radiotherapy or Surgery
207
Hyperthyroidism: Graves Disease - Management for symptomatic relief
Beta Blockers - CCBs in asthma
208
Hyperthyroidism: Graves Disease - Management if relapse present or Nodular thyroid disease
Radioiodine
209
Hyperthyroidism: Graves Disease - If radioiodine used in Graves Disease what is there a high risk of?
Hypothyroidism
210
Hyperthyroidism: Management - Thyroidectomy useful when?
When radioiodine is contraindicated
211
Hyperthyroidism: Management - Thyroidectomy risks (3)
Recurrent laryngeal nerve palsy
Hypothyroidism
Hypoparathyroidism
212
Hyperthyroidism: Complications - Main complication
Thyroid Storm
213
Hyperthyroidism: Thyroid Storm
Rapid deterioration of hyperthyroidism
214
Hyperthyroidism: Thyroid Storm - Presentation (5)
Hyperpyrexia
Tachycardia
Restlessness
Cardiac failure
Liver dysfunction
215
Hyperthyroidism: Thyroid Storm - Typically seen in what patients?
Hyperthyroid patient with an acute infection or recent thyroid surgery
216
Hyperthyroidism: Thyroid Storm - Management
High dose carbimazole
Beta Blockers - Propanolol
Potassium Iodide
Hydrocortisone
IV fluids
217
Hyperthyroidism: Diagnosis - Primary Hyperthyroidism Calcium
Hypercalcaemia
218
Hyperthyroidism: Diagnosis - Primary Hyperthyroidism Alkaline Phosphatase
Increased
219
Hyperthyroidism: Diagnosis - Primary Hyperthyroidism Hypercalcaemia and Alkaline Phosphatase reflective of what?
Increased bone turnover and osteoporosis
220
Hyperthyroidism: Diagnosis - Primary Hyperthyroidism WCC
Leucopenia - due to ATD-induced Agranulocytosis
221
Hyperthyroidism: Management - Carbimazole side effects
Aplasia cutis in early pregnancy
222
Hyperthyroidism: Management - Propylthiouracil Mechanism of Action
Inhibits DIO1 to reduce T4 to T3 conversion
223
Hyperthyroidism: Management - Side effects of Propylthiouracil
Liver failure
224
Hyperthyroidism: Management - What is advised if agranulocytosis occurs?
Do not use Anti-tyroid Drugs again
225
Hyperthyroidism: Management - Risk of agranulocytosis is highest when?
First 6 weeks
226
Hyperthyroidism: Management - When is radioiodine contraindicated? (2)
Pregnancy
Active thyroid eye disease
227
Hyperthyroidism: Management - Dose titration for Graves Disease
12-18 months or Block and replace for 6 months
228
Myxoedema Coma: Most common patient group
Elderly women
229
Myxoedema Coma: Diagnosis - ECG results (3)
Bradycardia with low voltage complexes
T wave inversion
Prolonged QT interval
230
Myxoedema Coma: Diagnosis - Respiratory sign
Type II Respiratory failure - Hypoxia + Hypercarbia + Respiratory Acidosis
231
Subacute Thyroiditis
Transient patchy inflammation of the thyroid
232
Subacute Thyroiditis: 3 types
De Quervain's Thyroiditis
Post-partum Thyroiditis
Drug-induced Thyroiditis
233
De Quervanin's Thyroiditis
Presentation of a viral infection with fever, neck pain and tenderness, dysphagia and features of hyperthyroidism
234
De Quervanin's Thyroiditis: Peak Age
20-50 years old
235
De Quervanin's Thyroiditis: May be triggered by what?
Viral infection
236
De Quervanin's Thyroiditis: Clinical presentation (3)
Painful firm goitre
Fever
Malaise
237
De Quervanin's Thyroiditis: Phase Pathophysiology
Hyperthyroid phase followed by a hypothyroid phase as TSH levels fall
238
De Quervanin's Thyroiditis: Management
NSAIDs for pain and inflammation
Beta Blockers for Symptomatic relief of hyperthyroidism
239
Drug-induced Thyroiditis: Drugs involved (2)
Amiodarone
Lithium
240
Drug-induced Thyroiditis: How does Amiodarone cause this?
Inhibits DIO1 - increases T4, decreases T3 and normal TSH
241
Drug-induced Thyroiditis: Hypothyroidism occurs where?
Iodine rich areas
242
Drug-induced Thyroiditis: Drug-induced Thyroiditis: Hyperthyroidism occurs where?
Iodine deficient areas
243
Hypothyroidism
Insufficient secretion of thyroid hormones from the thyroid gland
244
Hypothyroidism: Congenital Causes (4)
Absent or under-developed thyroid gland
Dyshormogenesis - cannot synthesise thyroid hormones
Iodine deficiency during pregnancy
Maternal transmission of anti-thyroid drugs
245
Hypothyroidism: Aetiologies of Primary Hypothyroidism (3)
Hashimoto's Thyroiditis
Iodine deficiency
Iatrogenic - due to Radioiodine or Surgery
246
Hypothyroidism: Primary Hypothyroidism - Hashimoto's Thyroiditis is most common where?
Iodine-sufficient regions
247
Hypothyroidism: Primary Hypothyroidism - Hashimoto's Thyroiditis affects what group of people?
Middle aged women - 45-60 years
248
Hypothyroidism: Primary Hypothyroidism - Hashimoto's Thyroiditis associated with what genetics?
HLA-DR3 or -DR5
249
Hypothyroidism: Secondary Hypothyroidism
Pituitary disorders resulting in TSH deficiency
250
Hypothyroidism: Tertiary Hypothyroidism
Hypothalamic disorders resulting in TRH deficiency
251
Hypothyroidism: Hashimotos Thyroiditis - Pathophysiology
Autoimmune destruction of thyroid tissue causing gradual failure of thyroid function
252
Hypothyroidism: Hashimotos Thyroiditis - What are the associated antibodies? (2)
Anti-thyroglobulin antibodies
Anti-peroxidase antibodies
253
Hypothyroidism: Hashimotos Thyroiditis - What cells may mediate destruction of thyroid epithelium?
CD8+ T cells
254
Hypothyroidism: Hashimotos Thyroiditis - What mediates cell death?
Cytokines
255
Hypothyroidism: Hashimotos Thyroiditis - Role of Gamma Antibodies
Production from T cell activation recruits macrophages to destroy thyroid follicles
256
Hypothyroidism: Hashimotos Thyroiditis - May be preceded by what?
Transient hyperthyroidism
257
Hypothyroidism: Hashimotos Thyroiditis - Most common in what sex?
Females
258
Hypothyroidism: Hashimotos Thyroiditis - Most common in what age range?
45-60 years old
259
Hypothyroidism: Hashimotos Thyroiditis - Higher incidence in what populations?
White populations
260
Hypothyroidism: Hashimotos Thyroiditis - Histology (4)
Prominent lymphoid infiltrate - lymphocytes, plasma cells and reactive follicles with germinal centres
Thyroid follicles atrophy
Hurthle Cells - Follicular cells with abundant eosinophilic cytoplasm
Progressive fibrosis within the gland
261
Hypothyroidism: Primary Hypothyroidism - Goitrous causes (4)
Hashimotos Thyroiditis
Iodine deficiency
Drug-induced
Maternally transmitted Anti-Thyroid drugs
262
Hypothyroidism: Primary Hypothyroidism - Non-Goitrous causes (4)
Atrophic thyroiditis
Post-ablative therapy - Radioiodine and Surgery
Post-radiotherapy
Congenital defect
263
Hypothyroidism: Clinical Presentation - Hair and Skin (6)
Coarse hair and loss of eyebrow hair
Periorbital face - dull and expressionless
Pale cool skin
Vitiligo
Hypercarotenamia
Dry skin
264
Hypothyroidism: Clinical Presentation - Cardiac features (4)
Bradycardia
Cardiac dilatation
Pericardial effusion
Worsening heart failure
265
Hypothyroidism: Clinical Presentation - Metabolic features (4)
Hyperlipidaemia
Decreased appetite
Weight gain
Fatigue
266
Hypothyroidism: Clinical Presentation - Gastrointestinal Features (3)
Constipation
Megacolon and intestinal obstruction
Ascites
267
Hypothyroidism: Clinical Presentation - Respiratory features (4)
Deep hoarse voice
Macroglossia - large tongue
Obstructive sleep apnoea
Goitre - enlarged thyroid
268
Hypothyroidism: Clinical Presentation - Gynaecological features (4)
Menorrhagia
Oligomenorrhoea
Hyper-prolactinaemia - due. toincreased TRH
Infertility
269
Hypothyroidism: Clinical Presentation - Mxyoedma
Accumulation of mucopolysaccharide in subcutaneous tissue
270
Hypothyroidism: Clinical Presentation - Myopathy (30
Myalgia
Stiffness
Cramps
271
Hypothyroidism: Clinical Presentation of Congenital Hypothyroidism
Cretinism - dwarfism and limited neural functioning
272
Hypothyroidism: Diagnosis - Primary Hypothyroidism Thyroid Hormones
Low Free T3/4
High TSH
273
Hypothyroidism: Diagnosis - Primary Hypothyroidism Cell factors
Macrocytosis
274
Hypothyroidism: Diagnosis - Primary Hypothyroidism CK
Increased
275
Hypothyroidism: Diagnosis - Primary Hypothyroidism LDL Cholesterol
Increased
276
Hypothyroidism: Diagnosis - Primary Hypothyroidism Sodium
Hyponatraemia - decreased renal tubular water loss
277
Hypothyroidism: Diagnosis - Primary Hypothyroidism Prolactin
Hyperprolactinaemia
278
Hypothyroidism: Diagnosis - Primary Hypothyroidism Autoantibodies present (3)
Anti-TPO Antibody
Anti-Thyroglobulin Antibody
TSH-Receptor Antibody
279
Hypothyroidism: Diagnosis - Secondary Hypothyroidism
Low Free T3/4
Low or Normal TSH
280
Hypothyroidism: Management - Young patients
Levothyroxine - 50-100 micrograms per day
281
Hypothyroidism: Management - Elderly Patients or a History of CHD
Levothyroxine - 25-50 micrograms per day and adjusted every 4 weeks
282
Hypothyroidism: Management - TSH checked when?
Every 12-18 months
283
Hypothyroidism: Management - Secondary Hypothyroidism
Titrate the dose of Levothyroxine to free T4 level
284
Hypothyroidism: Management - Levothyroxine administration when?
Before breakfast - must be on an empty stomach
285
Hypothyroidism: Management - Levothyroxine absorption is impacted by what? (30
PPI
Iron tablets
Calcium tablets
286
Subclinical Thyroid Disease
Abnormal TSH concentration with normal thyroid hormone concentration
287
Subclinical Thyroid Disease: Diagnosis - Subclinical Hypothyroidism
Increased TSH with normal T3/T4
288
Subclinical Thyroid Disease: Subclinical Hypothyroidism - Risk of progressing to what?
Overt hypothyroidism
289
Subclinical Thyroid Disease: Subclinical Hypothyroidism - Higher risk of progressing if what is present?
Strong TPO Antibody positive result
290
Subclinical Thyroid Disease: Subclinical Hypothyroidism - Management advised when?
TSH > 10
291
Subclinical Thyroid Disease: Subclinical Hypothyroidism - Pregnancy management
Always treat to maintain normal TSH
292
Subclinical Thyroid Disease: Subclinical Hyperthyroidism
Decreased TSH with normal hormone levels
293
Subclinical Thyroid Disease: Subclinical Hyperthyroidism - Risk of progression to what?
Overt hyperthyroidism
294
Subclinical Thyroid Disease: Subclinical Hyperthyroidism - Often seen in what cases?
Multinodular goitre
295
Subclinical Thyroid Disease: Subclinical Hyperthyroidism - Associated with what diseases? (2)
Osteoporosis
Atrial fibrillation
296
Subclinical Thyroid Disease: Subclinical Hyperthyroidism - Management advised when?
TSH <0.1
Osteoporosis
Fracture
Atrial Fibrillation
297
Thyroid Nodules: More common in what sex?
Females
298
Thyroid Nodules: What % are benign?
95%
299
Thyroid Nodules: Size of a thyroid mass
>4cm
300
Thyroid Nodules: Size of a Thyroid Nodule
1-4 cm
301
Thyroid Nodules: Size of a thyroid lesion
<1cm
302
Thyroid Nodules: Microcarcinomas
<10mm
303
Thyroid Nodules: Benign - 4 types
Cyst
Colloid Nodule
Benign follicular adenoma
Hyperplastic nodule
304
Thyroid Nodules: Benign - Clinical presentation
Soft smooth mobile nodules with pain
305
Thyroid Nodules: Malignant - % of cases
5%
306
Thyroid Nodules: Malignant - Examples (4)
Papillary thyroid carcinoma
Medullary thyroid carcinoma
Lymphoma
Anaplastic Thyroid Nodules
307
Thyroid Nodules: Malignant - Anaplastic Nodule
Poorly differentiated aggressive nodules
308
Thyroid Nodules: Malignant - Clinical presentation
Firm hard and immobile nodule that is increasing in size (>4cm)
309
Thyroid Nodules: Clinical Presentation - How to know if this is in the thyroid?
Lump moves on swallowing - shows investment in the pretracheal fascia
310
Thyroid Nodules: Clinical Presentation - Pain is associated with what?
Intra-thyroidal bleed into a cyst
311
Thyroid Nodules: Clinical Presentation - Signs of malignancy (2)
Enlarged neck lymph nodes
Hoarseness
312
Thyroid Nodules: Hot nodule
Functioning nodule
313
Thyroid Nodules: Cold Nodule
Non-functioning nodule
314
Thyroid Nodules: Diagnosis - US Classifcation (U2-5)
U2 - Benign
U3 - Atypical
U4 - Probably malignant
U5 - Malignant
315
Thyroid Nodules: Diagnosis - When is Fine Needle Aspiration Used?
Any U4 or U5
U3/4 - >1cm
U3 - >1.5cm
316
Thyroid Nodules: Scoring System - Thy1/1c
Insufficient or Insufficient cystic
317
Thyroid Nodules: Scoring System - Thy2/2c
Non-neoplastic or cystic
318
Thyroid Nodules: Scoring System - Thy3a
Neoplasm is possible - nuclear are atypical
319
Thyroid Nodules: Scoring System - Thy3f
Neoplasma possible - Follicular or Oncocytic neoplasms
320
Thyroid Nodules: Scoring System - Thy4
Malignancy possible
321
Thyroid Nodules: Scoring System - Thy5
Malignancy
322
Thyroid Nodules: Diagnosis - Requirements (4)
Thyroid function tests
Thyroid imaging
Nodule cytology
323
Thyroid Nodules: Management - Thy3a or Thy3f
Diagnostic Hemi-thyroidectomy or repeat FNA - consider thyroidectomy + radioactive iodine if cancerous
324
Thyroid Nodules: Management - Thy4 or 5
Hemi-thyroidectomy or Complete Thyroidectomy + Radioactive Iodine
325
Thyroid Nodules: Thyroidectomy - Complication of stridor due to what?
Deep haematoma and thus laryngeal oedema
326
Thyroid Nodules: Thyroidectomy - Complication of Chyle Leak occurs when?
Left level VI lymph node dissection
327
Follicular Adenoma
Benign encapsulated tumour of the thyroid gland that is surrounded by a thin fibrous capsule
328
Follicular Adenoma: More common in what sex?
Females
329
Follicular Adenoma: Increased incidence where?
Regions of iodine deficiency
330
Follicular Adenoma: Genetic Mutations (3)
Ras
PIK3CA
TSH Receptor signalling pathways
331
Follicular Adenoma: 1% develop into what?
Toxic adenoma
332
Follicular Adenoma: Toxic adenoma
Benign tumour that produces thyroid hormone autonomously
333
Follicular Adenoma: Histology
Neoplastic thyroid follicles encapsulated by a surrounding collagen cuff
334
Follicular Adenoma: Clinical presentation
Discrete solitary mass in an otherwise normal thyroid gland - larger tumours may present with local symptoms e.g. dysphagia
335
Follicular Adenoma: Investigations
US
FNA
Serum TSH
336
Follicular Adenoma: Problem with FNA
Cannot distinguish between follicular adenoma and carcinoma
337
Follicular Adenoma: Management
Lobectomy with biopsy for definitive diagnosis and management
338
Thyroid Carcinomas: Affects which sex more commonly?
Females
339
Thyroid Carcinomas: 4 types
Papillary
Follicular
Analplastic
Medullary
340
Thyroid Carcinomas: Where are they derived from?
Follicular epithelium - except for Medullary Carcinomas which arise from C cells
341
Thyroid Carcinomas: Most common
Papillary
342
Papillary Carcinoma: Derived from where?
Follicular epithelium
343
Papillary Carcinoma: Associated with what disease?
Hashimoto's Syndrome
344
Papillary Carcinoma: Associated with what environmental factor?
Ionising radiation
345
Papillary Carcinoma: Associated mutations (5)
Activate the MAP Kinase Pathway
- Ras
- Point mutation in BRAF
- Rearrangements of RET or NTKR1
346
Papillary Carcinoma: Histology
Solitary nodule in the thyroid that is cystic or multi-focal
347
Papillary Carcinoma: May be calcified to form what?
Psammoma bodies
348
Papillary Carcinoma: When is analysis required for an occult papillary carcinoma?
If thyroid tissue or a psammoma body is found in the lymph node
349
Papillary Carcinoma: Main route of spread
Lymphatics
350
Papillary Carcinoma: Spread to where via the blood?
Lung
Bone
Liver
Brain
351
Papillary Carcinoma: Local Presentation (4)
Hoarsness
Dysphagia
Cough
Dyspnoea
352
Papillary Carcinoma: Prognosis worsened by what? (3)
Age >40
Extra-thyroid extension
Distant metastasis
353
Papillary Carcinoma: Investigations
TSH
US
US-FNA - can involve excisional biopsy of the lymph node
354
Papillary Carcinoma: What should be conducted if vocal cord palsy is suspected?
Pre-operative laryngyoscopy
355
Follicular Carcinoma: Derived from what?
Follicular epithelium
356
Follicular Carcinoma: Increased incidence in what sex?
Females
357
Follicular Carcinoma: Higher incidence in what age group?
40-50 years old
358
Follicular Carcinoma: Incidence higher where?
Regions of iodine deficiency
359
Follicular Carcinoma: Associated Genetic Mutations (5)
- Mutations in the PI3K/AKT Pathway
- Mutations in the ras family
- Translocation involving Pax8 and PPAR-gamma 1
360
Follicular Carcinoma: Diagnosis depends on what?
Invasion of the capulse or vasculature
361
Follicular Carcinoma: Widely invasive characteristics (2)
Solid architecture - less follicular architecture
More mitotic activity
362
Follicular Carcinoma: Minimally invasive characteristics (2)
Well-differentiated follicular architecture
Surrounding capsule may be present
363
Follicular Carcinoma: Most common spread of disease mechanism
Haematagenous
364
Follicular Carcinoma: Haematagenous spread most common to wear? (3)
Bones
Lungs
Liver
365
Follicular Carcinoma: Prognosis is dependent on what?
Extent of invasion
Stage at presentation
366
Follicular Carcinoma: Clinical presentation
Slowly enlarging painless single nodule carcinoma that is not functional
367
Follicular Carcinoma: Investigations
TSH
US
US-FNA - can involve excisional biopsy for the lymph node
368
Follicular and Papillary Carcinomas: Management - What are the low risk group?
Aged <50 years or tumour <4cm
369
Follicular and Papillary Carcinomas: Management - Low risk surgical option
Tyroid lobectomy + biopsy and thyroidectomy following biopsy if required
370
Follicular and Papillary Carcinomas: Management - High risk group characteristics
Stage Thy3 or higher on FNA
371
Follicular and Papillary Carcinomas: Management - High risk group surgical option
Sub-total or Total thyroidectomy +/- Radioactive iodine
372
Follicular and Papillary Carcinomas: Management - Whole body Iodine Scanning used for what patients?
3-6 months after a sub-total or total thyroidectomy
373
Follicular and Papillary Carcinomas: Management - RAI ablation mechanism
Ablate residual thyroid tissue to destroy the occult microfoci
374
Follicular and Papillary Carcinomas: Management - RAI ablation increases risk of what?
Acute Myeloid Leukaemia
375
Follicular and Papillary Carcinomas: Management - What can be used as a tumour marker for monitoring?
Thyroglobulin
376
MTC
Medullary Thyroid Carcinoma
377
Medullary Carcinoma
Tumour of the C cells - neuroendocrine parafollicular cells that secrete Calcitonin
378
Medullary Carcinoma: Associated with what disease?
Multiple Endocrine Neoplasia Type 2a - Phaeochromocytoma and Hyperthyroidism
379
Medullary Carcinoma: Occurs in what age if sporadic or familial cases?
40-50 years old
380
Medullary Carcinoma: Occurs in what age in MEN cases?
Young adults
381
Medullary Carcinoma: Genetic mutation
RET mutations
382
Medullary Carcinoma: Morphology - Sporadic cases are often what type?
Solitary nodule
383
Medullary Carcinoma: Morphology - Familial cases are often what type?
Bilateral or Multi-centric
384
Medullary Carcinoma: Histology
Spindle or polygonal cells arranged into nests, trabeculae or follicles
385
Medullary Carcinoma: Morphology - Associated with deposition of what?
Amyloid
386
Medullary Carcinoma: Amyloid deposition represents what?
Abnormally folded calcitonin protein
387
Medullary Carcinoma: Clinical Presentation - Local effects (3)
Dysphagia
Hoarseness
Airway compromise
388
Medullary Carcinoma: Clinical Presentation - Paraneoplastic Syndrome with Symptoms
VIP Production - Diarrhoea
ACTH Production - Cushing's Syndrome
389
Medullary Carcinoma: Investigations
US-FNA
Serum base calcitonin
24 hoururinary metanephrines
390
Medullary Carcinoma: Management
Total thyroidectomy
391
Medullary Carcinoma: Prognosis - Increased by what? (3)
Young age
Female
Tumour confined to the thyroid with no metastases
392
Medullary Carcinoma: Prognosis - Decreased by what? (5)
Necrosis
Many mitoses
Squamous metaplasia
Small cell morphology
<50% cells are calcitonin positive
393
Anaplastic Carcinoma
Undifferentiated aggressive tumours derived from the follicular epithelium
394
Anaplastic Carcinoma: Can arise due to what?
Dedifferentiation of carcinomas
395
Anaplastic Carcinoma: Most common age range
>60 years old
396
Anaplastic Carcinoma: Strong association with what mutations? (5)
TP53
Over expression of Cyclin D1
Low expression of p27
Inactivation of PTEN and p16
Mutations of Beta Catenin
397
Anaplastic Carcinoma: Investigations
TSH
US-FNA or Biopsy
398
Anaplastic Carcinoma: Management
Total thyroidectomy +/- adjuvant radiochemotherapy
399
Thyroid Cancers: Post-operative Care - Calcium
Monitor within 24 hours - replace if corrected calcium <2mmol/L
400
Thyroid Cancers: Post-operative Care - Process of Whole Body Iodine Scanning
rhTSH injected and 1-2 days later 2-4 mCi I-131 is admnistered as capsule then returns for imaging two days later
401
Thyroid Cancers: Thyroid Remnant Ablation - Side effects (2)
Sialadenitis
Sore throat
402
Thyroid Cancers: Thyroid Remnant Ablation - Process
Pre-treatment with rhTSH then admitted to a lead lined room and 2/3 of a GBq capsule of I-131 is administered
403
Thyroid Cancers: Thyroid Remnant Ablation - When to discharge?
Count rate <500cps at 1m
404
Thyroid Cancers: Thyroid Remnant Ablation - Treatment afterwards
Patients maintained on T4
405
Thyroid Cancers: Thyroid Remnant Ablation - T4 treatment aim
TSH <0.1mU/L
FT4 <25
406
Thyroid Cancers: Thyroid Remnant Ablation - Advice in pregnancy
Avoid pregnant women for 11 days and do not try to conceive for 4 months
407
Thyroid Lymphoma
Lymphoma that arises from the thyroid gland
408
Thyroid Lymphoma: Most common sex
Female
409
Thyroid Lymphoma: Most common age
70-80 years
410
Thyroid Lymphoma: Investigation
Core biopsy
