hyper/hypothyroidism Flashcards

1
Q

what genes are associated with autoimmune thyroiditis

A

HLA, CTLA4, PTPN22

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2
Q

what is primary hypothyroidism

A

low free T3/4 –> raised TSH

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3
Q

what is secondary hypothyroidism

A

pituitary problem –> low TSH –> low T3/4

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4
Q

what is subclinical hypothyroidism and when do you treat it

A

high TSH but normal T3/4, treat if pregnant or if TSH>10

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5
Q

what is primary hyperthyroidism

A

high free T3/4 –> low TSH

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6
Q

what is secondary hyperthyroidism

A

pit problem –> high TSH –> high T3/4

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7
Q

what is subclinical hyperthyroidism

A

low TSH and normal T3/4

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8
Q

what is subclinical hyperthyroidism associated with and when do you treat it

A

osteoporosis and AF, treat if TSH <0.1

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9
Q

what are normal TSH levels

A

0.4-4

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10
Q

what is the definition of hypothyroidism

A

any disorder that causes insufficient secretion of thyroid hormones

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11
Q

who is most likely to develop hypothyroidism

A

older white women

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12
Q

what causes hypothyroidism

A

low iodine (in developing countries), hasimotos autoimmune thyroiditis (developed), drugs eg lithium/ amiadarone, secondary causes eg hypopituitarism

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13
Q

what causes goitres in hypothyroidism

A

hashimotos, iodine deficiency, drugs

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14
Q

what causes non-goitrous hypothyroidism

A

atrophic thyroiditis - common from radiotherapy

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15
Q

1)what is hashimotis thyroiditis, 2)who gets it, 3)what is associated with it and 4)what can precede it

A

1)gradual autoimmune failure and destruction of thyroid, 2)middle aged women get it, 3)assoc with HLA and other AI diseases, 4)can be preceded by transinet hyperfunction

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16
Q

what antibodies are associated with hashimoto’s thyroiditis

A

TPO anti-thyroid antibodies, CD8 cells, anti-thyroglobulin

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17
Q

what are symptoms of hypothyroidism

A

everything slowed down: dry hair, bradycardia, tired, depressed mood, weight gain + decreased appetite, constipation, cold intolerance, non-pitting oedema, slow intellect

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18
Q

what is a sign of extreme hypothyroidism

A

myxoedema - puffy hands and face

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19
Q

what effect can hypothyroidism have on newborns

A

cretinism: dwarfism and limited mental function

20
Q

what TFT’s and other biochem tests are seen in hypothyroidism

A

TFT: high TSH low T3/4, Biochem: high CK/ LDL/ macryoctosis, antibodies: TPO, anti-thyroblobulin

21
Q

what is the treatment of hypothyroidism

A

levothyroxine (T4), start on low dose and work up - increase in pregnancy

22
Q

what is myxoedema coma and who is likely to get it

A

v. severe hypothyroidism - elderly women with untreated hypothyroidism

23
Q

what are symptoms of myxoedema coma

A

extreme bradycardia and heart block, resp failure, hypoxia, hypercarbia and acidosis

24
Q

what is hyperthyroidism

A

overactive thyroid leading to excess thyroid hormones

25
Q

what is thyrotoxicosis

A

clinical signs and biochem when excess thyroid hormone present

26
Q

what are the main causes of hyperthyroidism

A

excessive stimulation: grave’s, hasitoxicosis, cancer. functional nodules: toxic nodule and toxic multinodular goitre

27
Q

what can cause thyrotoxicosis without hyperthyroidism

A

thyroid inflamm, ectopic thyroid tissue

28
Q

what is Grave’s disease and who gets it and what is a big risk factor

A

autoimmune disease, young women, smoking risk factor

29
Q

what antibodies are associated with graves disease

A

TSH receptor antibody (TRAb)

30
Q

what is the triad of Grave’s disease

A

hyperthyroidism + goitre, expo-thalamus, pretibial myxoedema (rash on legs)

31
Q

what are symptoms of hyperthyroidism

A

diarrhoea, expo-thalamus, double vision, rapid nail growth, lighter/ infrequent periods, weight loss + appetite gain, heat intolerance + sweaty, nervous, heightened emotions, pretibial myxoedema

32
Q

how to antithyroid drugs work (ATDs)

A

inhibit TPO and block thyroid hormone synthesis

33
Q

what is the first line ATD

A

carbimazole

34
Q

why should carbimazole be avoided in pregnancy

A

can cause aplasia cutis

35
Q

what is the second line ATD (why is it second)

A

propylthiouracil (PTU) - less potent

36
Q

how do PTUs work

A

stops T4 being converted to T3

37
Q

what are the side effects of ATDs

A

allergy, jaundice + hepatic failure, agranulocytosis (rare and can be fatal)

38
Q

what is the first choice of treatment in graves

A

radioiodine

39
Q

when is radioiodine contraindicated for graves and what is a common side effect

A

contraindicated in pregnancy and high risk of hypothyroidism

40
Q

what other treatments are used in hyperthyroidism (excluding ATDs and RAI)

A

beta blockers eg propranolol (not in asthma), surgery if RAI contraindicated

41
Q

what is a thyroid storm/ crisis and what are common symptoms

A

severe hyperthyroidism: resp+cardiac collapse, hyperthermia, exaggerated reflexes

42
Q

how do you treat thyroid storm/ crisis

A

iodine, glucocorticoids, beta-blockers, fluids

43
Q

what is DeQuervain thyroiditis

A

viral cause of subacute thyroiditis

44
Q

what happens to thyroid hormone levels in DeQuervain thyroiditis

A

causes hyperthyroid phase followed by hypothyroid phase

45
Q

what are symptoms and treatment of DeQuervain thyroiditis

A

tenderness and fever - is self-limiting