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
What is the drug of choice in hypothyroidism?
Levothyroxine
26
What is rule with starting hypothyroidism drugs?
Especially in the old start low and incrementally increase. | Too high a does can lead to arrhythmias and death
27
In the young what is the usual dose of levothyroxine?
50-100 μg
28
In the old what is the usual dose of levothyroxine?
25-50 μg
29
How is the treatment plan slightly different in secondary hypothyroidism?
Titrate the dosage according to fT4 not the TSH levels
30
In pregnancy how is the dose affected?
As soon as pregnancy is suspected increase dosage by between 25-50%
31
What is a myoexedema coma?
Severe hypothyroidism resulting in coma and medical emergency 60% mortality
32
What is present on ECG in myoexedema coma?
Bradychardia Low voltage complexs T wave inversion Prolonged QT
33
What type of respiratory failure does someone with myoexedema present with?
Type 2 respiratory failure
34
What is type 2 respiratory failure?
Hypoxia Hypercapnia Respiratory acidosis
35
How else can someone in a myoexedema coma be affected?
Can have adrenal failure
36
What is mainstay of treatment for a myoexedema coma?
``` ABC Passively rewarm Cardiac monitor IV thyroxine slowly infused Hydrocortisone if adrenal failure ```
37
What is thyrotoxicosis?
Clinical and physiological state when tissues exposed to too many thyroid hormones
38
Cardiac signs off hyperthyroidism?
Palpitations Atrial fibrillations Tachycardia
39
Sympathetic affect of hyperthyroidism
Tremor | Sweating
40
CNS affect of hyperthyroidism
Anxiety Nervousness Irritability Sleep disturbances
41
Vision affects of hyperthyroidism
Lid Lag and retraction Proptosis (bulging eyes) Double vision
42
Hair and skin affects of hyperthyroidism
Brittle thin hair | Rapid fingernail growth
43
Reproductive affects of hyperthyroidism
Lighter less frequent periods
44
What antibodies are involved in graves disease?
TRAb | TSH receptor antibodies
45
Is graves genetically or environmentally driven?
Susceptible genes with environmental factors
46
If an old patient presents with thyrotoxicosis what is the most likely cause?
Toxic multi nodular goitre
47
What do blood tests usually show in graves?
``` Reduced TSH Increased fT3/4 Hypercalcaemia Increased alkaline phosphatase Leucopenia ```
48
Clinical presentation in graves?
Pretibial myxoedema Thyriod acropachy - Clubbing Thyroid bruit - only seen in graves
49
What is the cause of the bruit in graves?
Increased vascularity of the thyroid
50
What is the driving force behind eye pathology in graves?
TRAb | Smoking consolidates damage
51
In mild eye disease associated with graves what is the treatment?
Lubrication
52
In severe eye disease associated with graves what is the treatment?
Steroid Radiotherapy Surgery
53
In multi nodular goitre what do blood tests show?
Increased fT3/4 Reduced TSH TRAb negative
54
What is a thyroid storm?
Severe hyperthyroidism | Usually triggered by infection or surgery with concordant hyperthyroidism
55
What happens in a thyroid storm?
Respiratory and cardiac collapse Hyperthermia Exaggerated reflexes
56
What is the 1st line drug in hyperthyroidism?
Carbimazole
57
What is used in pregnancy?
Propylthiouracil
58
Why is carbimazole 1st line?
As it has less risk of side effects
59
What is used in symptomatic treatment of hyperthyroidism?
B2 Antagonist | Propanolol
60
If drug treatment fails what is next step in treatment of hyperthyroidism?
Radioiodine | No increased risk of cancer
61
When in radio iodine treatment avoided?
If eye disease is present | If patient is pregnant
62
What is the main risk of radioiodine treatment?
Hypothyroidism
63
What can amiodarone cause?
Hyper and hypothyroidism
64
What is amiodarone?
Anti arrhythmic drug
65
If all else fails what can be used to treat hyperthyroidism?
Thyroidectomy
66
What are the risks associated with surgery in hyperthyroidism?
Hypothyroidism Hypoparathyroidism Damage to recurrent laryngeal nerve