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Endocrine System > Endocrine Pathology - The Thyroid Gland > Flashcards

Endocrine Pathology - The Thyroid Gland Flashcards

1
Q

Tests to be performed when hyperthyroidism is suspected.

A
  • T3
  • T4
  • TSH

All will have ↓TSH (except the rare TSH-secreting pituitary adenoma). Most have ↑T4 but around 1% have only raised T3.

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2
Q

Tests to be performes when hypothyroidism suspected or monitoring replacement

A
  • T4
  • TSH

T3 does not add any extra information. Perfrom TSH at same time when monitoring as it vaires throughout the day. (Trough at 2pm, 30% higher in the evenings.

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3
Q

Sick euthyroidism

A

In any systemic illness, TFTs may become derranged. The typical pattern is for everything to be low. The test should be repeated after recovery.

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4
Q

Diagnosis for ↑TSH, ↓T4

A

Hypothryroidism

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5
Q

Diagnosis for ↑TSH, normal T4

A

Treated hypothyroidism or subclinical hypothyroidism

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6
Q

Diagnosis for ↑TSH, ↑T4

A

TSH secreting tumour or thyroid hormone resistance

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7
Q

Diagnosis for ↑TSH, ↑T4, ↓T3

A

Slow conversion of T4 to T3 or thyroid hormone antibody artefact

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8
Q

Diagnosis for ↓TSH, normal ↑T4 T3

A

Subclinical hyperthyroidism

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9
Q

↓TSH, ↓T4

A

Central hypothyroidism (hypothalamic or pituitary disorder)

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10
Q

↓TSH, ↓T4 and ↓T3

A

Sick euthyroidism or pituitary disease

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11
Q

Normal TSH, abnormal T4

A

Consider changes in thyroid binding globulin, assay interference, amiodarone, or pituitary TSH tumour.

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12
Q

Other tests for thyroid disease

A
  • Thyroid autoantibodies - increased in Hashimoto’s or Grave’s disease
  • TSH receptor antibody - may be increased in Grave’s disease
  • Serum thyroglobulin - useful in monitoring the treatment of carcinoma and in detection of factitious (self-medicated) hyperthyroidism where it is low
  • Ultrasound - distinguishes cystic (usually benign) from solid (possibly malignant) nodules
  • If solitary large nodule do a fine needle aspiration for thyroid cancer
  • Isotope scan
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13
Q

Screen the follwing for abnormalities in thyroid function

A
  • Patients with atrial fibrillation
  • Patients with hyperlipidaemia
  • Diabetes mellitus - on annual review
  • Patients on amiodorone or lithium (6 monthly)
  • Patients with Down’s or Turner’s syndrome, or Addison’s disease (yearly)
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14
Q

Symptoms of thyrotoxicosis

A
  • diarrhoea
  • ↓weight
  • ↑appetite
  • over-active
  • heat intolerance
  • palpitations
  • tremor
  • irritability
  • oligomenorrhoea +/- infertility
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15
Q

Signs of thyrotoxicosis

A
  • pulse fast/irregular
  • warm moist skin
  • fine tremor
  • palmar erythema
  • thin hair
  • lid lag
  • lid retraction
  • goitre, thyroid nodule or bruit depending on the cause
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16
Q

Signs of Grave’s disease

A
  • Thyroid eye disease - exophthalmos, opthalmoplegia
  • Pretibial myxoedema (oedematous swellings above lateral malleoli)
  • Thyroid acropachy (extreme manifestations with clubbing, painful finger and toe swelling, and periosteal reaction in limb bones
17
Q

Causes of thyroitoxicosis

A
  • Grave’s disease
  • Toxic multinodular goitre
  • Toxic adenoma
  • Etopic thyroid tissue
  • Exogenous - iodine excess
18
Q

Treatment of thyrotoxicosis

A
  • Pharmacological
    • Beta blockers - for rapid control of symptoms
    • Carbimazole
  • Radioiodine
  • Thyroidectomy
19
Q

Complications of thyrotoxicosis

A
  • Heart failure
  • Angina
  • AF
  • Osteoporosis
  • Opthalmopathy
  • Gynaecomastia
  • Thyroid storm
20
Q

Symtoms of thyroid eye disease

A
  • eye discomfort
  • grittiness
  • ↑tear production
  • photophobia
  • diplopia
  • ↓acuity
  • afferent pupillary defect - may indicate optic nerve compression
21
Q

Signs of thyroid eye disease

A
  • Exophthalmos (appearance of the protruding eye)
  • Proptosis (eyes protrude beyond the orbit - look from above in the same plane as the forehead)
  • Loss of colour vision
  • Opthalmoplegia
22
Q

Symptoms of hypothyroidism

A
  • constipation
  • ↑weight
  • lethargic/tired
  • cold intolerance
  • hoarse voice
  • ↓mood
  • ↓memory and cognition
  • menorrhagia
23
Q

Signs of hypothyroidism

A

BRADYCARDIC

  • Bradycardic
  • Reflexes relax slowly
  • Ataxia (cerebellar)
  • Dry thin hair / skin
  • Yawning / drowsy
  • Cold hands / ↓temperature
  • Ascites +/- non-piting oedema +/- pericardial/pleural effusion
  • Round puffy face / obese
  • Defeated demenour
  • Immobile +/- ileus
  • Congestive cardiac failure

Also: nephropathy, myopathy, goitre

24
Q

Primary causes of hypothyroidism

A
  • Primary atrophic hypothyroidism
  • Hashimoto’s thyroiditis
  • Iodine deficiency (chief cause worldwide)
  • Post thyroidectomy or radioiodine treatment
  • Drug induced - antithyroid drugs, amiodarone, lithium, iodine
  • Subacute thyroiditis
25
Q

Causes of secondary hypothyroidism

A

Not enough TSH due to hypopituitarism - very rare

26
Q

Treatment of hypothyroidism

A

Levothyroxin

Endocrine System (11 decks)

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