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SM Endocrine > Hyper/hypothyroidism > Flashcards

Hyper/hypothyroidism Flashcards

1
Q

What is the commonest cause of hypo or hyperthyroidism

A

Autoimmne thyroid disease

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2
Q

What is meant by primary thyroidism

A

The problem is with the gland itself

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3
Q

What is meant by secondary thyroidism

A

The problem is with the hypothalamus or pituitary

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4
Q

What do we need to measure when measuring thyroid hormone

A

TSH

T4 and T3 (both free)

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5
Q

What would the thyroid hormones be like in hyperthyroidism

A

High level of T4 and T3 and low TSH

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6
Q

What would the thyroid hormones be like in hyperthyroidism

A

High TSH and low T3,T4

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7
Q

What is meant by primary subclinical hypothyroidism

A

on the way to developing primary hypothyroidism but have not quite got there yet but the pituitary is having to work harder to maintain normal levels

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8
Q

In what kind of hypothyroidism is TSH normal

A

Secondary

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9
Q

In what kind of hypothyroidism is fT4 normal

A

Subclinical hypothyroidism

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10
Q

What is the name given to the skin on the shins in Grave’s disease

A

Pretibial myxoedema

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11
Q

In what population is the incidence higher for hypothyroidism

A

Hispanics or African-American populations or in those with a high iodine intake

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12
Q

What are the 3 main categories for causes of primary hypothyroidism

A

Goitrous
Non-goitrous
Self-limiting

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13
Q

What are the 2 main goitrous causes of primary hypothyroidism

A

chronic thyoiditis or iodine deficiency

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14
Q

What is Hashimoto’s thyroiditis

A

The most common cause of hypothyroidism in Western world - autoimmune destruction of thyroid gland resulting in reduced thyroid hormone production

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15
Q

What is Hashimoto’s thyroiditis characterised by

A

Presence of thyroid peroxidase antibodies

T cell infiltrate and inflammation on microscopy

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16
Q

What are some signs and symptoms of hypothyroidism

A 
Coarse, sparse hair 
Dull expresiionaless face 
puffiness around the eyes 
pale, cool skin 
doughy touch to skin
vitiligo 
hypercarotenaemia 
cold intolerance 
constipation
reduced heart rate 
cardiac dilatation
pericardial effusion 
hyperlipidaemia 
decreased appetite 
weight gain 
ascites 
deep hoarse voice 
macroglossia 
obstructive sleep apnoea 
preipheral neuropathy 
muscle stiffness 
prolonged reactions 
depression, psychosis 
mental sluggishness
Menorrhagia hyperprolactinaemia
17
Q

What antibody is the most sensitive in Grave’s disease

A

anti-TPO antibody

18
Q

What is the management for hypothyroidism in young

A

start thyroxine at 50-100ug daily

19
Q

What is the management for hypothyroidism in older

A

thyroxine 25-50ug adjust every 4 weeks according to response

20
Q

When should TSH be checked after treatment has commenced

A

2 months after any dose change then when stable, every 12-18 months

21
Q

What should the dose of thyroxine be increased by in pregnancy

A

25ug

22
Q

Who is typically affected by a myxoedema coma

A

Elderly women with long standing but frequently unrecognised or untreated hypothyroidism

23
Q

How is a myxoedema coma treated

A 
Intensive care 
passively rewarm 
cardiac monitoring for arrhythmias 
monitor BP,CVP, O2, urine output, BMs
Fluids / electrolyte balance / fluid restriction
24
Q

What are some signs and symptoms of hyperthyroidism

A 
Palpatations/AF 
cardiac failure 
tremor 
sweating 
Anxiety
nervousness
irritability 
sleep disturbance 
loose bowel movements 
increased bowel movements 
lid retraction 
double vision 
brittle hair or thinning 
rapid fingernail growth 
menstrual changes 
muscle weakness
weight loss 
decreased appetite 
intolerance to heat
25
Q

What are some causes of hyperthyroidism

A

Auto-immune - Graves
Nodular - multi-nodular goitre or toxic nodule
Thyroiditis - subacute or postpartum
Iodine
Medication (lithium, amiodarone, thyroxine

26
Q

Graves disease affects women more than men. True or false

A

True

27
Q

What are some additional features in Grave’s disease

A 
Lid retraction 
lid lag 
chemosis 
proptosis 
visual loss 
diplopia
28
Q

What are the treatment options for opthalmopathy

A 
Lubricants 
decompression surgery 
radiotherapy 
corrective surgery 
stop smoking
29
Q

What may occur during a thyroid storm

A 
Severe hyperthyroidism 
respiratory and cardiac collapse 
hyperthermia 
exaggerated reflexes 
ventilation 
underling infection
30
Q

What is the treatment for a thyroid storm

A 
Lugols Iodine 
Glucocorticoids 
PTU 
B blockers 
fluids 
monitoring
31
Q

What is the treatment for hyperthyroidism

A

Carbimazole

Propylthiouracil

32
Q

How do we treat Grave’s

A

Start oral medication at a high dose and reduce over 12-18 months and stop

33
Q

What is thyroiditis

A

Inflammation of the their gland

34
Q

What are some examples of thyroiditis

A 
Graves 
Hashimotos 
DeQuervains
Post partum 
drug induced 
Acute
35
Q

Who is more likely to develop De Quervains

A

Females
20-50 years
may be associated with sore throat / fever/ other viral symptoms

36
Q

Describe the fluctuation of T4 in De Quervains

A

High in early stage, low in late then normal

37
Q

Describe the fluctuation of TSH in De Quervains

A

Low in early stage, high in late, then normal

SM Endocrine (27 decks)

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