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CP3 Medicine > Endocrinology - The Thyroid > Flashcards

Endocrinology - The Thyroid Flashcards

1
Q

What is a goitre

A

Painless enlargement of the thyroid gland

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2
Q

DDx diffuse goitre - physiological

A

Puberty

Pregnancy

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3
Q

DDx diffuse goitre - autoimmune

A

Grave’s

Hashimoto’s

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4
Q

DDx diffuse goitre - thyroiditis

A

De Quervains

Rediel’s thyroiditis

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5
Q

DDx diffuse goitre - drugs (4)

A

Antithyroid Dx
Lithium
Iodine excess
Amiodarone

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6
Q

Multinodular goitre DDx

A

Toxic multinodular goitre

Subacute thyroiditis

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7
Q

Solitary nodule goitre DDx (5)

A 
Follicular adenoma 
Benign nodule 
Thyroid malignancy 
Lymphoma 
Metastasis
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8
Q

Infiltration nodular goitre cause

A

TB

Sarcoid

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9
Q

Ix thyroid swelling (7)

A 
FBC (anaemia)
ESR
TFT
Thyroid autoantibodies 
CT neck/thorax
USS
FNAC
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10
Q

When would treatment be required on a euthyroid pt with a goitre? (3)

A

Cosmesis
Possibility of malignancy
If causing pressure Sx

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11
Q

M:F Thyrotoxicosis

A

1:5 M:F

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12
Q

Causes thyrotoxicosis (7)

A 
Graves
Toxic multinodular goitre 
Solitary toxic adenoma 
Thyroiditis 
Dx induced 
XS iodine intake 
Hashitotoxicosis
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13
Q

Who gets toxic multinodular goitre

A

Older women

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14
Q

What is Plummers disease

A

Toxic multinodular goitre

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15
Q

Drugs that induce thyrotoxicosis (2)

A

amiodarone

XS levothyroxine

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16
Q

Rare 2’ causes thyrotoxicosis (2)

A

TSH secreting pit adenoma

Resistance to thyroid hormone

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17
Q

Sx hyperthyroidism (7)

A 
Weight loss 
Increased appetite 
Irritability 
Restlessness 
Tremor 
Heat intolerance 
Palpitations
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18
Q

Signs hyperthyroidism (9)

A 
Tremor 
Hyperkinesis 
TachyC/AF
Full pulse
Warm vasodilated peripheries 
Exophthalmos 
Lid lag/stare 
Goitre/bruit 
Thyroid acropachy
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19
Q

Grave’s ophthalmology (4)

A

Lagophthalmos
Exophthalmos
Ophthalmoplegia
Periorbital oedema

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20
Q

Mortality rate thyroid storm

A

10%

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21
Q

What causes thyroid storm? (5)

A 
Period of stress
Infection
Surgery 
Childbirth 
Untx/uncontrolled hyperthyroidism
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22
Q

Sx thyroid storm (6)

A 
Hyperpyrexia 
Severe tachyC
Extreme restlessness 
Profuse sweating 
Confusion/psychosis 
Liver dysfunction
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23
Q

Tx thyroid storm (5)

A 
Propylthiouricale 
Propranolol
K iodide 
High dose steroids 
Supportive measures
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24
Q

Ix hyperthyroidism (5)

A 
TSH
Free T3/4 
TRAb 
Technetium uptake scan 
CT/MRI orbit
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25
Q

Technetium uptake scan pattern - graves

A

diffuse pattern

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26
Q

Technetium uptake scan pattern - Toxic nodular goitre

A

One or more ‘hot’ nodules

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27
Q

Technetium uptake scan pattern - thyroiditis

A

Reduced/absent uptake

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28
Q

Mx hyperthyroidism - 1’ care:

A

20-40mg propranolol tds

Consider starting carbimazole if not controlled

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29
Q

What are the 2 types of antithyroid therapy for hyperthyroidism

A

Titration

Block and replace

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30
Q

Titration regime antithyroid drugs

A

Start at high dose

Titrate down until patient is euthyroid

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31
Q

block and replace titration regime

A

high dose

Then levothyroxine added back once T3/4 levels controlled

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32
Q

1st line antthyroid drug

A

Carbimazole

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33
Q

2nd line antithyroid drug

A

Propylthyrouracil

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34
Q

Why is PTU 2nd line antithyroid drug

A

B/c risk severe liver injury 1/10,000

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35
Q

How do both antithyroid drugs work

A

Preffered substrate for TPO

36
Q

Risk carbimazole (3)

A

Skin rashes
Agranulocytosis
Cholestatic jaundice

37
Q

If a patient is on carbimazole, when should you advise them to see the GP?

A

If the develop any mouth ulcers, sore throats or fever

38
Q

What is 1st line Tx hyperthryoidism in non-graves pt

A

Radioactive iodine therapy

39
Q

How does radioactive iodine therapy work?

A

131I = taken up by thyroid cells

–> Induces DNA damage + cell death

40
Q

What must be done 1 week before starting radioiodine therapy?

A

Discontinue anti-thyroid drugs

41
Q

C/I Radio active iodine (3)

A

Pregnancy
Brest feeding
Active Grave’s ophthalmology

42
Q

What should patients avoid after radio active iodine/

A

Avoid contact w/ children 3 w

Do not try to concieve 6 months

43
Q

what is the small increase risk of in patients who have radio active iodine therapy?

A

Thyroid cancer

44
Q

Types of surgical Mx hyperthyroidism (2)

A

Total

or sub-total thyroidectomy

45
Q

Post-op complications thyroidectomy (4)

A

Haematoma –> asphyxia
Hypothyroidism
Hypocalcaemia
VC paresis b/c dmaage to rec laryngeal nn

46
Q

Mx haematoma post thyroidectomy

A

ER removal of sutures

47
Q

Prevelance hypothyroidism

A

1-2%

48
Q

F:M hypothyroidism

A

10:1

49
Q

common causes hypothyroidism (3)

A

Hashimoto’s thyroiditis
Atrophic thyroiditis (autoimmune)
Prev Tx for hyperthyroidism

50
Q

What is Hashimoto’s thyroiditis

A

T cell destruction of gland

+ B cell secretion of inhibitory TSH receptor ab

51
Q

Appearance goitre Hashimoto’s thyroiditis

A

Symmetrical, bosselated goitre

52
Q

Appearance goitre atrophic thyroiditis

A

NOT associated with goitre ;)

53
Q

Less common causes hypothyroidism (5)

A 
Drugs 
Iodine deficiency 
Thyroiditis 
2' causes e.g.: 
Hypothalamic disorders 
Pituitary disorders
54
Q

Drugs causing hypothyroidism (3)

A

Amiodarone
Iodine XS
Lithium

55
Q

Sx hypothyroidism (7)

A 
Tiredess 
W gain 
Cold intolerance
Goitre
Depression 
Myalgia 
Constipation
56
Q

Signs hypothyroidism

A 
Mental slowness 
Dry thin hair 
Dry skin 
Slow relaxing reflexes 
bradycardia 
myxoedema
57
Q

What is myxoedema

A

The accumulation of mucopolysaccarides in SC tissue

58
Q

Ix hypothyroidism

A 
FBC
TFTs 
TPO antibodies 
Cholesterol 
CK
59
Q

Why do we check Cholesterol + CK when investigation for hypothyroidism

A

Cholesterol -raised in hepatic hypothyroidism

CK - raised in mm hypothyroidism

60
Q

TFT values hypothyroidism (1’ vs 2’)

A

1’ raised TSH, reduced T4

2’ - low TSH + T4

61
Q

Mx hypothyroidism

A

Levothyroxine for life
Low starting dose
reassess ev 4-6w until TSH in lower 1/2 norm

62
Q

What does acute thyroiditis follow

A

URTI

63
Q

PS acute thyroiditis (4)

A

Fever
Malaise
Thyroid swelling + tenderness

64
Q

Appearance acute thyroiditis Tc scan

A

Low/no take up

65
Q

Tx acute thyroiditis

A

propranolol + simple analgesia

66
Q

Most common type of thyroid cancer

A

Papillary carcinoma

67
Q

Who gets: papillary carcinoma

A

40-50y/o

68
Q

Spread: papillary carcinoma

A

Local mostly

Rarely –> lung/bone

69
Q

Prognosis: papillary carcinoma

A

Good

70
Q

RF papillary carcinoma

A

Previous neck irradiation

71
Q

Tx papillary carcinoma

A

Surgical resection

72
Q

Freq - follicular carcinoma

A

20%

73
Q

Which sex gets more follicular carcinoma

A

Females

74
Q

Spread: follicular carcinoma

A

Blood –> bone

75
Q

Prognosis follicular carcinoma

A

Good if resectable

76
Q

Tx follicular carcinoma

A

Surgical resection

77
Q

% medullary cell carcinoma

A

5%

78
Q

Who gets medullary cell carcinoma

A

Familial
Edlerly or
Children w/ MEN IIa/IIb

79
Q

What cells do medullary cell carcinomas arise from

A

Parafollicular C cells

80
Q

Spread medullary cell carcinoma

A

Local nodes + mets

Slow growing

81
Q

Prognosis medullary cell carcinoma

A

Poor

82
Q

% anaplastic cell carcioma

A

<5%

83
Q

Who gets anaplastic cell carcinoma

A

Elderly

84
Q

Spread anaplastic cell carcinoma

A

Rapid, aggressive

Locally invasive –> tracheal/SVC obstruction

85
Q

Prognosis anaplastic cell carcinoma

A

Poor

86
Q

Mx anaplastic cell carcinoma

A

External radiotherapy as palliation

87
Q

PS thyroid cancer

A

Mostly asymp
May be hoarseness/dysphagia
usually euthyroid

CP3 Medicine (29 decks)

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