Hyper/hypothyroidism Flashcards
What are the levels of TSH and T3/4 in primary hyperthyroidism?
high T4/T3; low TSH
What are the levels of TSH and T3/4 in primary hypo?
high TSH and low T4/T3
What are the levels of TSH and T3/4 in seconandary hypo?
low TSH and low T3/4
What does myxoedema refer to?
severe hypothyroidism or pretibial myoxoesem
What is pretibial myxoedema?
a rash seen on the shins due to the accumulation of hydrophilic mucopolysaccharides in the ground substance of the dermis
What condition is pretibial myxoedema associated with?
Grave’s disease
What are the goitrous causes of primary hypothyroidism?
Hashimoto’s thyroiditis; iodine deficiency; drug induced
What drugs can cause hypothyroidism?
amiodarone; lithium
What can cause non-goitrous hypothyroidism?
atrophic thyroiditis; post-ablative; postradiation
What happens in Hashimoto’s thyroiditis
autoimmune destruction of thyroid gland resulting in reduced thyroid hormone production
What antibodies are foudn in the blood with Hashimoto’s?
thyroid peroxidase antibodies
What is seen on microscopy with Hashimotos?
Tcell infiltrate and inflammation
How does hypothyroidism affect the hair and skin?
coarse/sparse hair; dull expressionless face; periorbital puffiness; pale cool skin that feels doughy; vitiligo may be present (other AI disease)
What are the other signs of hypothyroidism?
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
What is seen on bloods with hypothyroidism?
macrocytosis; increased CK; LDL; hyponatraemia; hyperprolactinaemia
What antibodies are seen with Grave’s?
anti-TPO; anti-thryoglobulin; TSH receptor antibody
What antibodies are seen with autoimmune hypothyroidism?
anti-TPO and anti-thyroglobulin
Why should normal metabolic rate be restored gradually in hypothyroidism?
rapid restoration can precipitate cardiac arrhythmias
What is the treatment for hypothyroidism?
thyroxine (T4)
What is used to measure therapeutic success in primary hypothyroidism?
TSH
Who does myxoedema coma usually affect?
elderly women with long standing but unrecognised or untreated hypothyroidism
What is seen with myxoedema coma?
bradycardia; heart block; type 2 resp failure
What is seen in the eyes with hyperthyroidism?
lid retraction; double vision; eyes that protrude
Who gets graves disease?
20-50 year olds; females; high iodine intake; smoking; ?viral trigger
What is seen on scintigraphy or US with graves?
smooth symmetrical goitre
What is the prognosis of graves?
by 18 months 50% will have burnt out and 50% will relapse
What are the opthalmic features in graves?
lid retraction; lid lag; chemosis; proptosis; visual loss; diplopia
Who gets nodular thyroid disease?
older patients
What is seen on scintigraphy or US with nodular thyroid disease?
assymetrical goitre
What is a thyroid storm?
severe hyperthyroidism- medical emergency
What happens in a thyroid storm?
respiratory and cardiac collapse; exaggerated reflexes; hyperthermia
What is the treatment for a thyroid storm?
glucocorticoids; propylthiouracil; beta-blcokers; fluids
What causes the eye disease in graves?
mucles at the back of the eye are attacked by antibodies so become inflamed and swollen
What are the drugs for hyperthyroidism?
carbimazole; propylthiouracil
Which drug for hyperthyroidism is preferred in pregnancy?
propylthiouracil
What is a risk in treatment of graves?
agranulocytosis
What is used for symptomatic treatment of hyperthyroidism?
beta-blockers: propanolol
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
What is subacute thyroiditis/de Quervains associated with?
sore throat/fever over viral symptoms
Who gets de Quervains?
females; age 20-50
What is seen on scintigraphy scan?
low uptake
Approximately how many patients on amiodarone have abnormalities in thyroid function?
50%
Where does amiodarone induced hypothyroidism occur?
areas with high iodine intake
What are the levels of TSH and T3/4 in subclinical hyperthyroidism?
low TSH; normal T3/4
What are the levels of TSH and T3/4 in subclinical hypothyroidism?
high TSH; normal T3/4
