hyper/hypothyroidism

Question 1

what genes are associated with autoimmune thyroiditis

Answer 1

HLA, CTLA4, PTPN22

Question 2

what is primary hypothyroidism

Answer 2

low free T3/4 –> raised TSH

Question 3

what is secondary hypothyroidism

Answer 3

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

Question 4

what is subclinical hypothyroidism and when do you treat it

Answer 4

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

Question 5

what is primary hyperthyroidism

Answer 5

high free T3/4 –> low TSH

Question 6

what is secondary hyperthyroidism

Answer 6

pit problem –> high TSH –> high T3/4

Question 7

what is subclinical hyperthyroidism

Answer 7

low TSH and normal T3/4

Question 8

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

Answer 8

osteoporosis and AF, treat if TSH <0.1

Question 9

what are normal TSH levels

Answer 9

0.4-4

Question 10

what is the definition of hypothyroidism

Answer 10

any disorder that causes insufficient secretion of thyroid hormones

Question 11

who is most likely to develop hypothyroidism

Answer 11

older white women

Question 12

what causes hypothyroidism

Answer 12

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

Question 13

what causes goitres in hypothyroidism

Answer 13

hashimotos, iodine deficiency, drugs

Question 14

what causes non-goitrous hypothyroidism

Answer 14

atrophic thyroiditis - common from radiotherapy

Question 15

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

Answer 15

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

Question 16

what antibodies are associated with hashimoto’s thyroiditis

Answer 16

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

Question 17

what are symptoms of hypothyroidism

Answer 17

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

Question 18

what is a sign of extreme hypothyroidism

Answer 18

myxoedema - puffy hands and face

Question 19

what effect can hypothyroidism have on newborns

Answer 19

cretinism: dwarfism and limited mental function

Question 20

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

Answer 20

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

Question 21

what is the treatment of hypothyroidism

Answer 21

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

Question 22

what is myxoedema coma and who is likely to get it

Answer 22

v. severe hypothyroidism - elderly women with untreated hypothyroidism

Question 23

what are symptoms of myxoedema coma

Answer 23

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

Question 24

what is hyperthyroidism

Answer 24

overactive thyroid leading to excess thyroid hormones

Question 25

what is thyrotoxicosis

Answer 25

clinical signs and biochem when excess thyroid hormone present

Question 26

what are the main causes of hyperthyroidism

Answer 26

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

Question 27

what can cause thyrotoxicosis without hyperthyroidism

Answer 27

thyroid inflamm, ectopic thyroid tissue

Question 28

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

Answer 28

autoimmune disease, young women, smoking risk factor

Question 29

what antibodies are associated with graves disease

Answer 29

TSH receptor antibody (TRAb)

Question 30

what is the triad of Grave's disease

Answer 30

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

Question 31

what are symptoms of hyperthyroidism

Answer 31

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

Question 32

how to antithyroid drugs work (ATDs)

Answer 32

inhibit TPO and block thyroid hormone synthesis

Question 33

what is the first line ATD

Answer 33

carbimazole

Question 34

why should carbimazole be avoided in pregnancy

Answer 34

can cause aplasia cutis

Question 35

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

Answer 35

propylthiouracil (PTU) - less potent

Question 36

how do PTUs work

Answer 36

stops T4 being converted to T3

Question 37

what are the side effects of ATDs

Answer 37

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

Question 38

what is the first choice of treatment in graves

Answer 38

radioiodine

Question 39

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

Answer 39

contraindicated in pregnancy and high risk of hypothyroidism

Question 40

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

Answer 40

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

Question 41

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

Answer 41

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

Question 42

how do you treat thyroid storm/ crisis

Answer 42

iodine, glucocorticoids, beta-blockers, fluids

Question 43

what is DeQuervain thyroiditis

Answer 43

viral cause of subacute thyroiditis

Question 44

what happens to thyroid hormone levels in DeQuervain thyroiditis

Answer 44

causes hyperthyroid phase followed by hypothyroid phase

Question 45

what are symptoms and treatment of DeQuervain thyroiditis

Answer 45

tenderness and fever - is self-limiting