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Year 2 Endocrine > Hyper/Hypothyroidism and Thyroiditis > Flashcards

Hyper/Hypothyroidism and Thyroiditis Flashcards

1
Q

What is primary hyper/hypothyroidism?

A

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

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2
Q

What is secondary hyper/hypothyroidism?

A

Hypothalamic or pituitary related

NO thyroid gland pathology

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3
Q

What is another word used in TSH?

A

Thyrotropin

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4
Q

What kind of cells release TSH and from where?

A

Thyrotroph cells

Anterior pituitary gland

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5
Q

What are the blood results in primary hypothyroidism?

A

fT3/4 low

TSH high

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6
Q

What are the blood results in primary hyperthyroidism?

A

fT3/4 high

TSH low

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7
Q

What are the blood results in secondary hypothyroidism?

A

fT3/4 low

TSH low or normal

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8
Q

What are the blood results in secondary hyperthyroidism?

A

fT3/4 High

TSH High

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9
Q

What is myxoedema?

A

Severe hypothyroidism

Medical emergency

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10
Q

What is pretibial myxoedema?

A

Clinical sign of graves disease

Hyperthyroidism

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11
Q

What are causes of primary hypothyroidism with goitre?

A

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

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12
Q

What are the causes of primary hypothyroidism without a goitre?

A

Atrophic thyroiditis
Post ablative therapy
Post radiotherapy
Congenital development failure

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13
Q

What are some causes of self limiting hypothyroidism?

A

Withdrawal of antithyroid drugs
Subacute thyroiditis
Transient hypothyroidism
Post partum thyroiditis

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14
Q

What are some causes of secondary hypothyroidism?

A 
Infiltrative
Infectious
Malignant
Traumatic
Cranial radiotherapy
Drug induced
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15
Q

What is the antibody specific in Hashimotos thyroiditis?

A

Thyroid peroxidase

TPO antibodies

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16
Q

What happens in hashimotos thyroiditis?

A

Antibodies destroy the thyroid

T cell infiltration in inflammation

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17
Q

How sensitive are TPO antibodies in Hashimotos thryoiditis?

A

95% sensitivity

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18
Q

Why does hypothyroidism result in hyperprolactinaemia?

A

Increased TRH causes an increase in prolactin

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19
Q

What is TRH?

A

Thyrotropin releasing hormone

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20
Q

Clinical signs of hypothyroidism

A 
Coarse sparse hair
Dull expressionless doughy face
Periorbital puffiness
Pale cool skin
Vitiligo
Deep hoarse voice
Sleep apnoea
Muscles aches and cramps
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21
Q

Cardiac signs of hypothyroidism

A

Reduced heart rate
Cardiac dilation
Pericardial effusion
Heart failure

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22
Q

Metabolic signs of hypothyroidism

A

Hyperlipidaemia
Decreased appetite
Weight gain

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23
Q

Reproductive signs of hypothyroidism

A

Menorrhagia

Hyperprolactinaemia

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24
Q

In the lab what will hypothyroidism look like?

A

Macrocytosis
Increased Creatine Kinase
Increased LDL cholesterol

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25
Q

What is the drug of choice in hypothyroidism?

A

Levothyroxine

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26
Q

What is rule with starting hypothyroidism drugs?

A

Especially in the old start low and incrementally increase.

Too high a does can lead to arrhythmias and death

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27
Q

In the young what is the usual dose of levothyroxine?

A

50-100 μg

28
Q

In the old what is the usual dose of levothyroxine?

A

25-50 μg

29
Q

How is the treatment plan slightly different in secondary hypothyroidism?

A

Titrate the dosage according to fT4 not the TSH levels

30
Q

In pregnancy how is the dose affected?

A

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

31
Q

What is a myoexedema coma?

A

Severe hypothyroidism resulting in coma and medical emergency
60% mortality

32
Q

What is present on ECG in myoexedema coma?

A

Bradychardia
Low voltage complexs
T wave inversion
Prolonged QT

33
Q

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

A

Type 2 respiratory failure

34
Q

What is type 2 respiratory failure?

A

Hypoxia
Hypercapnia
Respiratory acidosis

35
Q

How else can someone in a myoexedema coma be affected?

A

Can have adrenal failure

36
Q

What is mainstay of treatment for a myoexedema coma?

A 
ABC
Passively rewarm
Cardiac monitor
IV thyroxine slowly infused
Hydrocortisone if adrenal failure
37
Q

What is thyrotoxicosis?

A

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

38
Q

Cardiac signs off hyperthyroidism?

A

Palpitations
Atrial fibrillations
Tachycardia

39
Q

Sympathetic affect of hyperthyroidism

A

Tremor

Sweating

40
Q

CNS affect of hyperthyroidism

A

Anxiety
Nervousness
Irritability
Sleep disturbances

41
Q

Vision affects of hyperthyroidism

A

Lid Lag and retraction
Proptosis (bulging eyes)
Double vision

42
Q

Hair and skin affects of hyperthyroidism

A

Brittle thin hair

Rapid fingernail growth

43
Q

Reproductive affects of hyperthyroidism

A

Lighter less frequent periods

44
Q

What antibodies are involved in graves disease?

A

TRAb

TSH receptor antibodies

45
Q

Is graves genetically or environmentally driven?

A

Susceptible genes with environmental factors

46
Q

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

A

Toxic multi nodular goitre

47
Q

What do blood tests usually show in graves?

A 
Reduced TSH
Increased fT3/4
Hypercalcaemia
Increased alkaline phosphatase
Leucopenia
48
Q

Clinical presentation in graves?

A

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

49
Q

What is the cause of the bruit in graves?

A

Increased vascularity of the thyroid

50
Q

What is the driving force behind eye pathology in graves?

A

TRAb

Smoking consolidates damage

51
Q

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

A

Lubrication

52
Q

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

A

Steroid
Radiotherapy
Surgery

53
Q

In multi nodular goitre what do blood tests show?

A

Increased fT3/4
Reduced TSH
TRAb negative

54
Q

What is a thyroid storm?

A

Severe hyperthyroidism

Usually triggered by infection or surgery with concordant hyperthyroidism

55
Q

What happens in a thyroid storm?

A

Respiratory and cardiac collapse
Hyperthermia
Exaggerated reflexes

56
Q

What is the 1st line drug in hyperthyroidism?

A

Carbimazole

57
Q

What is used in pregnancy?

A

Propylthiouracil

58
Q

Why is carbimazole 1st line?

A

As it has less risk of side effects

59
Q

What is used in symptomatic treatment of hyperthyroidism?

A

B2 Antagonist

Propanolol

60
Q

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

A

Radioiodine

No increased risk of cancer

61
Q

When in radio iodine treatment avoided?

A

If eye disease is present

If patient is pregnant

62
Q

What is the main risk of radioiodine treatment?

A

Hypothyroidism

63
Q

What can amiodarone cause?

A

Hyper and hypothyroidism

64
Q

What is amiodarone?

A

Anti arrhythmic drug

65
Q

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

A

Thyroidectomy

66
Q

What are the risks associated with surgery in hyperthyroidism?

A

Hypothyroidism
Hypoparathyroidism
Damage to recurrent laryngeal nerve

Year 2 Endocrine (21 decks)

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