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Mod 5 - Human Disease > Endocrine 2 > Flashcards

Endocrine 2 Flashcards

1
Q

where is the thyroid gland located?

A

sits just below the larynx near the base of the neck

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2
Q

What are the 2 main hormones the thyroid gland produces, stores and secretes?

A

T4 ( thyroxine)
T3 (tri-iodothyronine)

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3
Q

Explain the thyroid negative feed back loop

A
  • the hypothalamus detects a fall in T3 and T4
  • the hypothalamus then releases TRH (thyrotropin releasing hormone)
  • TRH stimulates the pituitary gland to release TSH (thyroid stimulating hormone)
  • TSH acts on the thyroid gland to produce and release more T3 and T4 into the blood
  • The hypothalamus will detect when there is adequate T3 and T4 in the blood stream and will stop secreting TRH
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4
Q

What is a primary endocrine disease?

A

there is a direct issue with the gland leading to over/under production of the hormone

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5
Q

what is a secondary endocrine disease?

A

there is an issue with the control mechanism of the gland (hypothalamus/pituitary) leading to over/under production of the hormone

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6
Q

what is thyrotoxicosis?

A

also known as hyperthyroidism
this is when the thyroid gland produces excess T3/T4 thyroid hormone

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7
Q

What are the primary causes of hyperthyroidism?

A
  • graves disease
  • toxic multi-nodular goitre/toxic adenoma
  • viral thyroiditis
  • drugs (amiodarone)
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8
Q

what drug can cause hyperthyoidism?

A

amiodarone - used to treat arrhythmia

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9
Q

what is the most common cause of hyperthyroidism?

A

Graves disease

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10
Q

What is graves disease?

A

an autoimmune disease
auto antibodies stimulate TSH receptors on the thyroid gland resulting in excess thyroid hormone (T3/T4)
also causes hyperplasia of the thyroid cells = goitre

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11
Q

What is a goitre?

A

A goitre is a lump or swelling at the front of the neck caused by a swollen thyroid.

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12
Q

What is the secondary cause of hyperthyroidism?

A

pituitary tumour - TSH secreting pituitary adenoma

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13
Q

What are the symptoms of hyperthyroidism?

A
  • sweating
  • heat intolerance
  • irritability
  • poor sleep
  • anxiety
  • heart palpitations
  • increased appetite
  • weight loss
  • diarrhoea
  • breathlessness
  • irregular metabolism
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14
Q

What are the signs of hyperthyroidism?

A
  • Exophthalmos (bulging eyeballs)
  • tachycardia
  • increased BP
  • fine tremour
  • goitre or nodule
  • pre-tibial myxoedema (swelling and thick, scaly plaques in the lower legs)
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15
Q

what is pre-tibial myxoedema

A

swelling and thick, scaly plaques in the lower legs

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16
Q

what is exophthalmos?

A

Buldging eyes
caused by inflammation of the retro-orbital tissues causing proptosis, lid retraction and ophthalmoplegia (paralysis of eye muscles)

17
Q

what would these clinical signs suggest:
- Exophthalmos (bulging eyeballs)
- tachycardia
- increased BP
- fine tremour
- goitre or nodule
- pre-tibial myxoedema (swelling and thick, scaly plaques in the lower legs)

A

Hyperthyroidism

18
Q

what would these symptoms suggest:
- sweating
- heat intolerance
- irritability
- poor sleep
- anxiety
- heart palpitations
- increased appetite
- weight loss
- diarrhoea
- breathlessness
- irregular metabolism

A

hyperthyroidism

19
Q

For primary hyperthyroidism:
What results would you expect to see from a thyroid function test?

A
  • decreased TSH
  • increased T3 and T4
20
Q

For secondary hyperthyroidism:
What results would you expect to see from a thyroid function test?

A
  • increased TSH
  • increased T3 and T4
21
Q

What blood test is used to diagnose hyperthryoidism?

A

Thyroid function tests
- increased T3 and T4
- low TSH (but in pituitary adenoma TSH may be normal or elevated)

TSH receptor antibodies (TRAb)
- positive in graves disease

22
Q

What would you expect to see in a patient with graves disease blood tests?

A
  • low TSH
  • increased T3 and T4
  • TRAb (TSH receptor antibodies) present
23
Q

Apart from blood tests, what else can be used to diagnose hyperthyroidism?

A

Radiology
- thyroid USS
- thyroid radioisotope scan
Tissue
- US guided fine needle aspirate/biopsy

24
Q

What drugs can be used to manage hyperthryoidism?

A

Anti-thyroid drugs
- Carbimazole, proylthiourcil
Beta blockers (control symtpoms of tachycardia and tremour while the other treatments work

25
Q

What are the surgery options for hyperthyroidism?

A

primary cause - partial or complete thyroidectomy
secondary - transnasal transsphenoidal endoscopic surgery for pituitary adenoma
graves disease - eye surgery can also be considered

26
Q

What are the primary causes of hypothyroidism?

A
  • Hashimoto’s thyroiditis (autoimmune disease)
  • idiopathic gland atrophy
  • radioiododine treatment/thyroidectomy surgery
  • iodine deficiency
  • drugs (carbimazole, lithium)
  • congenital
27
Q

What are the secondary causes of hypothyroidism?

A

hypothalamic dysfunction
(brain tumours, traumatic brain injuries, previous brain surgery/radiotherapy, congenital disorders)

28
Q

What are the symptoms of hypothyroidism?

A
  • lethargy (slowed metabolic rate)
  • cold intolerance
  • weight gain
  • constipation
  • hoarse voice
  • puffed face and extremities
  • mental slowness
  • poor memory
  • low mood
  • hair loss
29
Q

What are the signs of hypothyroidism?

A
  • bradycardia (slow pulse)
  • macroglossia (large tongue)
  • thin/dry hair, loss of eyebrows
  • eyelid oedema
  • goitre (more uncommon in hypothyroidism but can be present in autoimmune thyroiditis)
  • coarsening of features
  • rare but come or hypthermia
30
Q

For secondary hypothyroidism:
What results would you expect to see from a thyroid function test?

A
  • TSH low or normal
  • Decreased T3 and T4
31
Q

For primary hypothyroidism:
What results would you expect to see from a thyroid function test?

A
  • increased TSH
  • decreased T3 and T4
32
Q

What would you expect to see in a patient with Hashimotos thyroiditis blood test?

A
  • high TSH
  • low T3 and T4
  • TPOAb raised (auto-antibodies)
33
Q

What is the management of hypothyroidism?

A

treatment is lifelong
replacement with levothyroxine (TSH is checked frequently)

34
Q

What are the symptoms of thyroid cancer?

A
  • thyroid nodule
  • difficulty swallowing (dysphagia)
  • difficulty breathing (dyspnoea)
  • hoarse voice
35
Q

is thyroid cancer more prevalent in males or females

A

females 3:1

36
Q

What is the most commonb type of thyroid cancer?

A

papillary (80%)
then follicular

37
Q

What are the dental aspects to be aware of, of thyroid disease?

A
  • goitre may be detectable by dentist
  • macroglossia in hypothyroidism
  • burning mouth syndrome in hypothyroidism
  • can interfere with sedation in both hypo and hyperthyroidism
  • uncontrolled hyperthyroidism is a contraindication to the use of adrenaline in LA
38
Q
A

Mod 5 - Human Disease (6 decks)

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