Hyper/hypothyroidism Flashcards

1
Q

What are the levels of TSH and T3/4 in primary hyperthyroidism?

A

high T4/T3; low TSH

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2
Q

What are the levels of TSH and T3/4 in primary hypo?

A

high TSH and low T4/T3

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3
Q

What are the levels of TSH and T3/4 in seconandary hypo?

A

low TSH and low T3/4

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4
Q

What does myxoedema refer to?

A

severe hypothyroidism or pretibial myoxoesem

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5
Q

What is pretibial myxoedema?

A

a rash seen on the shins due to the accumulation of hydrophilic mucopolysaccharides in the ground substance of the dermis

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6
Q

What condition is pretibial myxoedema associated with?

A

Grave’s disease

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7
Q

What are the goitrous causes of primary hypothyroidism?

A

Hashimoto’s thyroiditis; iodine deficiency; drug induced

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8
Q

What drugs can cause hypothyroidism?

A

amiodarone; lithium

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9
Q

What can cause non-goitrous hypothyroidism?

A

atrophic thyroiditis; post-ablative; postradiation

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10
Q

What happens in Hashimoto’s thyroiditis

A

autoimmune destruction of thyroid gland resulting in reduced thyroid hormone production

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11
Q

What antibodies are foudn in the blood with Hashimoto’s?

A

thyroid peroxidase antibodies

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12
Q

What is seen on microscopy with Hashimotos?

A

Tcell infiltrate and inflammation

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13
Q

How does hypothyroidism affect the hair and skin?

A

coarse/sparse hair; dull expressionless face; periorbital puffiness; pale cool skin that feels doughy; vitiligo may be present (other AI disease)

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14
Q

What are the other signs of hypothyroidism?

A

cold intolernace; pitting oedema; reduced HR; caridac dilatation; periocardial effucion; hyperlipidaemia; weight gain; decreased appetite; constipation; deep hoarse voice; sleep apnea; muscle stiffnesscramps; carpal tunnel syndrome

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15
Q

What is seen on bloods with hypothyroidism?

A

macrocytosis; increased CK; LDL; hyponatraemia; hyperprolactinaemia

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16
Q

What antibodies are seen with Grave’s?

A

anti-TPO; anti-thryoglobulin; TSH receptor antibody

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17
Q

What antibodies are seen with autoimmune hypothyroidism?

A

anti-TPO and anti-thyroglobulin

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18
Q

Why should normal metabolic rate be restored gradually in hypothyroidism?

A

rapid restoration can precipitate cardiac arrhythmias

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19
Q

What is the treatment for hypothyroidism?

A

thyroxine (T4)

20
Q

What is used to measure therapeutic success in primary hypothyroidism?

21
Q

Who does myxoedema coma usually affect?

A

elderly women with long standing but unrecognised or untreated hypothyroidism

22
Q

What is seen with myxoedema coma?

A

bradycardia; heart block; type 2 resp failure

23
Q

What is seen in the eyes with hyperthyroidism?

A

lid retraction; double vision; eyes that protrude

24
Q

Who gets graves disease?

A

20-50 year olds; females; high iodine intake; smoking; ?viral trigger

25
What is seen on scintigraphy or US with graves?
smooth symmetrical goitre
26
What is the prognosis of graves?
by 18 months 50% will have burnt out and 50% will relapse
27
What are the opthalmic features in graves?
lid retraction; lid lag; chemosis; proptosis; visual loss; diplopia
28
Who gets nodular thyroid disease?
older patients
29
What is seen on scintigraphy or US with nodular thyroid disease?
assymetrical goitre
30
What is a thyroid storm?
severe hyperthyroidism- medical emergency
31
What happens in a thyroid storm?
respiratory and cardiac collapse; exaggerated reflexes; hyperthermia
32
What is the treatment for a thyroid storm?
glucocorticoids; propylthiouracil; beta-blcokers; fluids
33
What causes the eye disease in graves?
mucles at the back of the eye are attacked by antibodies so become inflamed and swollen
34
What are the drugs for hyperthyroidism?
carbimazole; propylthiouracil
35
Which drug for hyperthyroidism is preferred in pregnancy?
propylthiouracil
36
What is a risk in treatment of graves?
agranulocytosis
37
What is used for symptomatic treatment of hyperthyroidism?
beta-blockers: propanolol
38
What are the precautions taken with radio-iodine treatmetn for hyperthyroidism?
avoid prolonged contact with young hildren/pregnant women; dont share a bed for x days; avoid pregnancy for 6 months; ensure not pregnany
39
What is subacute thyroiditis/de Quervains associated with?
sore throat/fever over viral symptoms
40
Who gets de Quervains?
females; age 20-50
41
What is seen on scintigraphy scan?
low uptake
42
Approximately how many patients on amiodarone have abnormalities in thyroid function?
50%
43
Where does amiodarone induced hypothyroidism occur?
areas with high iodine intake
44
What are the levels of TSH and T3/4 in subclinical hyperthyroidism?
low TSH; normal T3/4
45
What are the levels of TSH and T3/4 in subclinical hypothyroidism?
high TSH; normal T3/4