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Endocrine > Hyper/hypo thyroid > Flashcards

Hyper/hypo thyroid Flashcards

1
Q

What is the commonest cause of a hypo/hyper thyroid?

A

Autoimmune thyroid disease

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2
Q

Are primary or secondary causes more common?

A

Primary

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3
Q

What does subclinical hypothyrodism look like, biochemically?

A

Normal T3/4 and raised TSH

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4
Q

What hormones are measured for thyroid issues?

A

TSH
T4
T3

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5
Q

In overt hyperthyroidism, describe the patterns of TSH and T3/4

A

TSH will be low.
T3/T4 will be high.
TSH low so negative feedback doesn’t turn off

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6
Q

Why is secondary pituitary gland failure different to primary in terms of hormone balance?

A

If TSH is high then T3/T4 are high e.g in TSHoma.

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7
Q

What is pre-tibial myxoedema?

A

Non-pitting oedema with discolouration over lateral malleoli.
Associated with Grave’s disease.

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8
Q

In which sex is hypothryoidism more common?

A

Females

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9
Q

What are the three types of primary hypothryoidism?

A

Goitrous
Non-goitrous
Self limiting

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10
Q

What kind of drugs can induce a goitrous hypothyroidism?

A

Amiodarone, stavudine(HIV)

lithium

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11
Q

A deficiency in what mineral can cause hypothyroidism?

A

Iodine

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12
Q

True or False

Hypothyroidism cannot be placentally transmitted

A

False.

Antithyroid agents or iodides can be transmitted

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13
Q

What is the main cause of primary goitrous hypothryroidism?

A

Hashimotos thyroiditis

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14
Q

What is the main cause of primary non- goitrous hypothryroidism?

A

Atrophic thyroiditis

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15
Q

True or False

Postpartum thyroiditis is transient

A

True

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16
Q

If Hashimotos thyroiditis is suspected which antibodies are present in blood?

A

Thyroid Peroxidase Ab

anti-TPO

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17
Q

What would be seen on microscopy with Hashimotos thyroiditis?

A

T cell infiltrate and inflammation

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18
Q

What signs can be seen on the skin in hypothyroidism?

A

Pale, cool skin
Hypercarotenaemia
Vitiligo
Pitting oedema

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19
Q

What changes are seen in hair?

A

Coarse and sparse hair

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20
Q

What CVS changes may be present?

A

Hyperlipidaemia
Reduced HR
Cardiac dilatation
Pericardial effusion

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21
Q

Is weight gain or weight loss more common in hypothryoidism?

A

Weight gain

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22
Q

True or False

Macroglossia is a sign of hypothyroidism

A

True

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23
Q

True or False

Carpal Tunnel syndrome may present in hypothryoidism

A

True

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24
Q

Which nerve is affected in carpal tunnel syndrome?

A

Median

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25
Q

What gynae changes may be present in hypothyroidism?

A

Menorrhagia

Oligo/amenorrhoea

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26
Q

What will the TSH be like in hypothyroidism?

A

High

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27
Q

What will the T4/3 levels be like in hypothryoidism?

A

Low

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28
Q

What is macrocytosis?

A

Large RBC.

MCV >100

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29
Q

What other changes may be seen in bloods?

A

Elevated CK
Elevated LDL
HYPOnatraemia
HYPERprolactinaemia

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30
Q

True or False

Younger patients with hypothyroidism should be started on lower doses of thyroxine

A

False.

Younger patients should be started on 50-100 micrograms

31
Q

How long after starting thyroxine should TSH levels be checked?

A

2 months.

4 weeks in elderly

32
Q

When should thyroxine be taken?

A

Before breakfast

33
Q

What consideration should be taken regarding thyroxine in pregnancy?

A

Dose should go up by half

34
Q

What is a myxoedema coma?

A

Occurs in severe hypothyroidism.

precipitated by stroke, MI, infection

35
Q

What signs are common in myxoedema coma?

A

Hypothyroid, hypoglycaemic, hypothermic, bradycardia

36
Q

What changes are present on ECG in myxoedema coma?

A

Low voltage complexes
?heart block
T wave inversion
QT elongation

37
Q

What respiratory changes would you be worried about in myxoedema coma?

A

Type 2 resp failure with hypoxia, hypercarbia –> acidosis

38
Q

What cardiac changes are present in HYPERthryoidism?

A

Palpitations

AF

39
Q

What nervous system changes are present in hyperthyroidism?

A

Irritability
Nervousness
Anxiety

40
Q

What GI changes are present in hyperthyroidis?

A

Frequent loose stools

41
Q

What is the bulging of eyes called?

A

Exopthalmus
Proptosis
Exorbitism

42
Q

What changes are present in hair and skin in hyperthyroidism?

A

Brittle and thinning hair

Fast growing nails

43
Q

What is the autoimmune causation for hyperthryoidism called?

A

Graves disease

44
Q

What age does Graves disease normally affect?

A

20-50

45
Q

In which sex is Graves disease more common?

A

Female

46
Q

Is there a genetic link in Grave’s disease?

A

Yes

47
Q

Which antibody is positive in Graves?

A

TRAbs

48
Q

What are the thyroid hormone patterns in Graves?

A

High T3/4

low TSH

49
Q

How is the goitre described in Graves?

A

Smooth
Symmetrical
High uptake

50
Q

What is chemosis?

A

Conjuctival swelling

51
Q

True or False

Smoking is a recommended treatment for proptosis

A

true

Eye disease may improve

52
Q

In who does nodular thyroid affect?

A

Older patients

53
Q

What are the test results for nodular thyroid disease?

A

High T3/4
low TSH
Ab neg
Assymetrical goitre w high uptake

54
Q

Which eponymously annoyingly named condition is a subacute thyroiditis and may be associated with viral symptoms?

A

De Quervains

55
Q

What is the treatment for De Quervains?

A

No treatment. Will resolve in 18 months

56
Q

When does a thyroid storm occur?

A

Severe hyperthyroidism

Underlying infection

57
Q

What are the symptoms of a thyroid storm?

A

Resp and cardiac collapse
Hyperthermia
Exaggerated reflexes

58
Q

What is the Tx for thyroid storm?

A 
Lugols iodine
steroids
PTU
B blockers
Fluids
59
Q

How is hyperthyroidism treated?

A

Carbimazole

Propylthiouracil (PTU)

60
Q

What drug can be given for the sympathomimetic symptoms?

A

Beta blockers specifically propanolol

61
Q

How does radio-iodine work?

A

Radioactivity destroys thryoid gland over a few weeks and then pee it out.

62
Q

What precautions need to be taken with radio-iodine?

A

No sharing bed
Not pregnant
No contact with pregnant women

63
Q

When is surgery indicated in hyperthroidism?

A

Only after drugs and radioiodine have failed

64
Q

In Graves disease which is the best antibody to check?

A

TSH receptor antibody

65
Q

When is scintigraphy used?

A

In hyperthyroid only

66
Q

What test is done at 5 days after birth?

A

Guthrie’s test

67
Q

What is Guthrie’s test for?

A

Heel prick test to check TSH/ T4

68
Q

What symptoms would be present in newborns with congenital thyroid disease?

A

Delayed jaundice
Poor feeding but normal weight gain
Hypotonia

69
Q

What is cretinism?

A

Developmental delay due to absence of thyroxine

70
Q

What is the normal range for TSH?

A

0.4-4.0

71
Q

What is the normal range for T3?

A

9.9-22

72
Q

What is the normal range for T4?

A

0.9-2.6

73
Q

What side effect of carbimazole means the medication must stop?

A

Agranylocytosis.

74
Q

What is agranylocytosis and how might it present?

A

Lack of granulocytes in blood leading to infection

Cough or sore throat

Endocrine (20 decks)

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