Hyper/hypothyroidism Flashcards
What is the commonest cause of hypo or hyperthyroidism
Autoimmne thyroid disease
What is meant by primary thyroidism
The problem is with the gland itself
What is meant by secondary thyroidism
The problem is with the hypothalamus or pituitary
What do we need to measure when measuring thyroid hormone
TSH
T4 and T3 (both free)
What would the thyroid hormones be like in hyperthyroidism
High level of T4 and T3 and low TSH
What would the thyroid hormones be like in hyperthyroidism
High TSH and low T3,T4
What is meant by primary subclinical hypothyroidism
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
In what kind of hypothyroidism is TSH normal
Secondary
In what kind of hypothyroidism is fT4 normal
Subclinical hypothyroidism
What is the name given to the skin on the shins in Grave’s disease
Pretibial myxoedema
In what population is the incidence higher for hypothyroidism
Hispanics or African-American populations or in those with a high iodine intake
What are the 3 main categories for causes of primary hypothyroidism
Goitrous
Non-goitrous
Self-limiting
What are the 2 main goitrous causes of primary hypothyroidism
chronic thyoiditis or iodine deficiency
What is Hashimoto’s thyroiditis
The most common cause of hypothyroidism in Western world - autoimmune destruction of thyroid gland resulting in reduced thyroid hormone production
What is Hashimoto’s thyroiditis characterised by
Presence of thyroid peroxidase antibodies
T cell infiltrate and inflammation on microscopy
What are some signs and symptoms of hypothyroidism
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
What antibody is the most sensitive in Grave’s disease
anti-TPO antibody
What is the management for hypothyroidism in young
start thyroxine at 50-100ug daily
What is the management for hypothyroidism in older
thyroxine 25-50ug adjust every 4 weeks according to response
When should TSH be checked after treatment has commenced
2 months after any dose change then when stable, every 12-18 months
What should the dose of thyroxine be increased by in pregnancy
25ug
Who is typically affected by a myxoedema coma
Elderly women with long standing but frequently unrecognised or untreated hypothyroidism
How is a myxoedema coma treated
Intensive care passively rewarm cardiac monitoring for arrhythmias monitor BP,CVP, O2, urine output, BMs Fluids / electrolyte balance / fluid restriction
What are some signs and symptoms of hyperthyroidism
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
What are some causes of hyperthyroidism
Auto-immune - Graves
Nodular - multi-nodular goitre or toxic nodule
Thyroiditis - subacute or postpartum
Iodine
Medication (lithium, amiodarone, thyroxine
Graves disease affects women more than men. True or false
True
What are some additional features in Grave’s disease
Lid retraction lid lag chemosis proptosis visual loss diplopia
What are the treatment options for opthalmopathy
Lubricants decompression surgery radiotherapy corrective surgery stop smoking
What may occur during a thyroid storm
Severe hyperthyroidism respiratory and cardiac collapse hyperthermia exaggerated reflexes ventilation underling infection
What is the treatment for a thyroid storm
Lugols Iodine Glucocorticoids PTU B blockers fluids monitoring
What is the treatment for hyperthyroidism
Carbimazole
Propylthiouracil
How do we treat Grave’s
Start oral medication at a high dose and reduce over 12-18 months and stop
What is thyroiditis
Inflammation of the their gland
What are some examples of thyroiditis
Graves Hashimotos DeQuervains Post partum drug induced Acute
Who is more likely to develop De Quervains
Females
20-50 years
may be associated with sore throat / fever/ other viral symptoms
Describe the fluctuation of T4 in De Quervains
High in early stage, low in late then normal
Describe the fluctuation of TSH in De Quervains
Low in early stage, high in late, then normal
