Hyper/Hypothyroidism and Thyroiditis

Question 1

What is primary hyper/hypothyroidism?

Answer 1

Affects the gland itself
+/- goitre
Autoimmune is the most common cause

Question 2

What is secondary hyper/hypothyroidism?

Answer 2

Hypothalamic or pituitary related

NO thyroid gland pathology

Question 3

What is another word used in TSH?

Answer 3

Thyrotropin

Question 4

What kind of cells release TSH and from where?

Answer 4

Thyrotroph cells

Anterior pituitary gland

Question 5

What are the blood results in primary hypothyroidism?

Answer 5

fT3/4 low

TSH high

Question 6

What are the blood results in primary hyperthyroidism?

Answer 6

fT3/4 high

TSH low

Question 7

What are the blood results in secondary hypothyroidism?

Answer 7

fT3/4 low

TSH low or normal

Question 8

What are the blood results in secondary hyperthyroidism?

Answer 8

fT3/4 High

TSH High

Question 9

What is myxoedema?

Answer 9

Severe hypothyroidism

Medical emergency

Question 10

What is pretibial myxoedema?

Answer 10

Clinical sign of graves disease

Hyperthyroidism

Question 11

What are causes of primary hypothyroidism with goitre?

Answer 11

Chronic thyroiditis- Hashimotos
Iodine deficiency
Drug induced - amiodarone
Maternally transmitted

Question 12

What are the causes of primary hypothyroidism without a goitre?

Answer 12

Atrophic thyroiditis
Post ablative therapy
Post radiotherapy
Congenital development failure

Question 13

What are some causes of self limiting hypothyroidism?

Answer 13

Withdrawal of antithyroid drugs
Subacute thyroiditis
Transient hypothyroidism
Post partum thyroiditis

Question 14

What are some causes of secondary hypothyroidism?

Answer 14

Infiltrative
Infectious
Malignant
Traumatic
Cranial radiotherapy
Drug induced

Question 15

What is the antibody specific in Hashimotos thyroiditis?

Answer 15

Thyroid peroxidase

TPO antibodies

Question 16

What happens in hashimotos thyroiditis?

Answer 16

Antibodies destroy the thyroid

T cell infiltration in inflammation

Question 17

How sensitive are TPO antibodies in Hashimotos thryoiditis?

Answer 17

95% sensitivity

Question 18

Why does hypothyroidism result in hyperprolactinaemia?

Answer 18

Increased TRH causes an increase in prolactin

Question 19

What is TRH?

Answer 19

Thyrotropin releasing hormone

Question 20

Clinical signs of hypothyroidism

Answer 20

Coarse sparse hair
Dull expressionless doughy face
Periorbital puffiness
Pale cool skin
Vitiligo
Deep hoarse voice
Sleep apnoea
Muscles aches and cramps

Question 21

Cardiac signs of hypothyroidism

Answer 21

Reduced heart rate
Cardiac dilation
Pericardial effusion
Heart failure

Question 22

Metabolic signs of hypothyroidism

Answer 22

Hyperlipidaemia
Decreased appetite
Weight gain

Question 23

Reproductive signs of hypothyroidism

Answer 23

Menorrhagia

Hyperprolactinaemia

Question 24

In the lab what will hypothyroidism look like?

Answer 24

Macrocytosis
Increased Creatine Kinase
Increased LDL cholesterol

Question 25

What is the drug of choice in hypothyroidism?

Answer 25

Levothyroxine

Question 26

What is rule with starting hypothyroidism drugs?

Answer 26

Especially in the old start low and incrementally increase. | Too high a does can lead to arrhythmias and death

Question 27

In the young what is the usual dose of levothyroxine?

Answer 27

50-100 μg

Question 28

In the old what is the usual dose of levothyroxine?

Answer 28

25-50 μg

Question 29

How is the treatment plan slightly different in secondary hypothyroidism?

Answer 29

Titrate the dosage according to fT4 not the TSH levels

Question 30

In pregnancy how is the dose affected?

Answer 30

As soon as pregnancy is suspected increase dosage by between 25-50%

Question 31

What is a myoexedema coma?

Answer 31

Severe hypothyroidism resulting in coma and medical emergency 60% mortality

Question 32

What is present on ECG in myoexedema coma?

Answer 32

Bradychardia Low voltage complexs T wave inversion Prolonged QT

Question 33

What type of respiratory failure does someone with myoexedema present with?

Answer 33

Type 2 respiratory failure

Question 34

What is type 2 respiratory failure?

Answer 34

Hypoxia Hypercapnia Respiratory acidosis

Question 35

How else can someone in a myoexedema coma be affected?

Answer 35

Can have adrenal failure

Question 36

What is mainstay of treatment for a myoexedema coma?

Answer 36

``` ABC Passively rewarm Cardiac monitor IV thyroxine slowly infused Hydrocortisone if adrenal failure ```

Question 37

What is thyrotoxicosis?

Answer 37

Clinical and physiological state when tissues exposed to too many thyroid hormones

Question 38

Cardiac signs off hyperthyroidism?

Answer 38

Palpitations Atrial fibrillations Tachycardia

Question 39

Sympathetic affect of hyperthyroidism

Answer 39

Tremor | Sweating

Question 40

CNS affect of hyperthyroidism

Answer 40

Anxiety Nervousness Irritability Sleep disturbances

Question 41

Vision affects of hyperthyroidism

Answer 41

Lid Lag and retraction Proptosis (bulging eyes) Double vision

Question 42

Hair and skin affects of hyperthyroidism

Answer 42

Brittle thin hair | Rapid fingernail growth

Question 43

Reproductive affects of hyperthyroidism

Answer 43

Lighter less frequent periods

Question 44

What antibodies are involved in graves disease?

Answer 44

TRAb | TSH receptor antibodies

Question 45

Is graves genetically or environmentally driven?

Answer 45

Susceptible genes with environmental factors

Question 46

If an old patient presents with thyrotoxicosis what is the most likely cause?

Answer 46

Toxic multi nodular goitre

Question 47

What do blood tests usually show in graves?

Answer 47

``` Reduced TSH Increased fT3/4 Hypercalcaemia Increased alkaline phosphatase Leucopenia ```

Question 48

Clinical presentation in graves?

Answer 48

Pretibial myxoedema Thyriod acropachy - Clubbing Thyroid bruit - only seen in graves

Question 49

What is the cause of the bruit in graves?

Answer 49

Increased vascularity of the thyroid

Question 50

What is the driving force behind eye pathology in graves?

Answer 50

TRAb | Smoking consolidates damage

Question 51

In mild eye disease associated with graves what is the treatment?

Answer 51

Lubrication

Question 52

In severe eye disease associated with graves what is the treatment?

Answer 52

Steroid Radiotherapy Surgery

Question 53

In multi nodular goitre what do blood tests show?

Answer 53

Increased fT3/4 Reduced TSH TRAb negative

Question 54

What is a thyroid storm?

Answer 54

Severe hyperthyroidism | Usually triggered by infection or surgery with concordant hyperthyroidism

Question 55

What happens in a thyroid storm?

Answer 55

Respiratory and cardiac collapse Hyperthermia Exaggerated reflexes

Question 56

What is the 1st line drug in hyperthyroidism?

Answer 56

Carbimazole

Question 57

What is used in pregnancy?

Answer 57

Propylthiouracil

Question 58

Why is carbimazole 1st line?

Answer 58

As it has less risk of side effects

Question 59

What is used in symptomatic treatment of hyperthyroidism?

Answer 59

B2 Antagonist | Propanolol

Question 60

If drug treatment fails what is next step in treatment of hyperthyroidism?

Answer 60

Radioiodine | No increased risk of cancer

Question 61

When in radio iodine treatment avoided?

Answer 61

If eye disease is present | If patient is pregnant

Question 62

What is the main risk of radioiodine treatment?

Answer 62

Hypothyroidism

Question 63

What can amiodarone cause?

Answer 63

Hyper and hypothyroidism

Question 64

What is amiodarone?

Answer 64

Anti arrhythmic drug

Question 65

If all else fails what can be used to treat hyperthyroidism?

Answer 65

Thyroidectomy

Question 66

What are the risks associated with surgery in hyperthyroidism?

Answer 66

Hypothyroidism Hypoparathyroidism Damage to recurrent laryngeal nerve