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Endocrine > Hyperthyrodism, hypothyrodism and thyroditis > Flashcards

Hyperthyrodism, hypothyrodism and thyroditis Flashcards

1
Q

What can cause secondary thyroid disease?

A

Hypothalamic or pituitary disease

No thyroid gland pathology

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2
Q

When and where is TSH released?

A

Released by thyotroph cells in the anterior pituirary in response to thyrotropin releasing hormone (THR)

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3
Q

What percentage of thyroxine in T4 and T3?

A

80% T4

20% T3

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4
Q

What will the thyroid function tests look like in primary hypothyrodism?

A

Free T3/4 low

TSH high

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5
Q

What will the thyroid function tests look like in primary hyperthyrodism?

A

Free T3/4 high

TSH low - often falls to 0

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6
Q

What will the thyroid function tests look like in secondary hypothyrodism?

A

Free T3/4 low

TSH low

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7
Q

What will the thyroid function tests look like in secondary hyperthyrodism?

A

Free T3/4 high

TSH high

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8
Q

What is myoxedema?

A

Severe hypothyrodism

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9
Q

What is pretibial myxodeme?

A

Rare clinical sign of graves disease

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10
Q

What can cause goitrous hypothyrodism?

A 
Hashimoto's 
Iodine deficiency
Drug induced - amiodarone, lithium
Maternally transmitted - antithyroid drugs 
Heriditary biosynthetic defects
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11
Q

What can cause non-goitrous hypothyrodism?

A

Atrophic thyroditis
Post-ablative therpy (radioiodine, surgery)
Post-radiotherapy (lymphoma treatment)
Congenital developmental defect

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12
Q

What can cause self-limiting hypothyrodism?

A

Withdrawel of antithyroid drugs
Subacute thyrodidis
Post-partum thyroditis

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13
Q

What antibodies characterise hashimotos thyroditis?

A 
Thyroid peroxidate (TPO) 
T-cell infiltrate and inflammation microscopically
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14
Q

What are the hair and skin features associated with hypothyrodism?

A 
Coarse, sparse hair
Dull face
Periorbial puffiness
Pale skin
Vitiligo
Hypercarotenaemia
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15
Q

What are the thermogenesis features associated with hypothyrodism?

A

Cold intolerance

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16
Q

What fluid retention can occur with hypothyrodism?

A

Pitting oedema

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17
Q

What are the cardiac features associated with hypothyrodism?

A

Bradycardia
Dilation
Pericardial effusion
Worsening of heart failure

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18
Q

What are the metabolic features associated with hypothyrodism?

A

Hyperlipidaemia

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19
Q

What are the metabolic rate features associated with hypothyrodism?

A

Decreased appetite

Weight gain

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20
Q

What are the GI features associated with hypothyrodism?

A

Constipation

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21
Q

What are the resp features associated with hypothyrodism?

A

Deep hoarse voice
Macroglossia
Obstructive sleep apnoea

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22
Q

What are the neurological features associated with hypothyroidism?

A 
Decreased intellectual and motor activities 
Depression, psychosis
Muscle stiffness
Peripheral neuropathy 
Prolongation of tendon jerks 
Carpal tunnel syndrome
Reduced visual acuity
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23
Q

What gynae features associated with hypothyroidism?

A

Mennorhagia
Amenorrhoea
Hyperprolactinaemia

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24
Q

What are the lab features associated with hypothyroidism?

A

Increased TSH and redueced fT4/3
Increased LDL
Hyponatraemia
Hyperprolactinaemia

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25
Q

What is the management of hypothyrodism?

A

Metabolic rate restored GRADUALLY as rapid restoration may precipitate cardiac arrhythmias
Levothyroxine 50-100 micrograms

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26
Q

How should the management of hypothyrodism be monitored?

A

Check TSH 2 months after any dose change

Once stabilised, TSH should be checked every 12-18 months

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27
Q

When should levothyroxine be taken?

A

Before breakfast

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28
Q

What adjustments need to be made to levothyroxine in pregnancy?

A

Dose requirements may increase by 25-50% in pregnancy due to incresaed TBG

29
Q

Who does myxoedema coma affect?

A

Typically affects elderly women with long standing but frequently unrecognized or untreated hypothyrodism

30
Q

What are the common findigns in a myxoedema coma?

A

ECG: bradycardia, heart blocks, T wave inversion, prolonged QT
Type 2 resp failure: hypoxia, hypercarbia, resp acidosis
Co-exising adrenal failure

31
Q

How is myxoedema coma treated?

A 
ICU
Passive rewarm 
Cardiac monitoring 
Monitor urine, fluid, CVP, surgars and oxygenation 
Broad spectrum antibiotics 
Thyroxine cautiousl
32
Q

What is the difference between thyrotoxicosis and hyperthyroidism?

A

Thyrotoxicosis: clinical, physiological and biochemical state arising when tissues are exposed to excess thyroid
Hyperthyroidism: refers specifically to conditions in which overactivity of the thyroid gland leads to thyrotoxicosis

33
Q

What are the cardiac features of hyperthyroidism?

A

Tachycardia
Palpitation
AF
Cardiac failure (v rare)

34
Q

What are the sympathetic symptoms of hyperthyroidism?

A

Tremor

Sweating

35
Q

What are the CNS features of hyperthyroidism?

A

Anxiety
Nervousness
Irritability
Sleep disturbance

36
Q

What are the GI features of hyperthyroidism?

A

Diarrhoea

37
Q

What are the vision features of hyperthyroidism?

A

Lid retraction
Double vision (diplopia)
Proptosis (graves)

38
Q

What are the hair and skin features of hyperthyroidism?

A

Brittle and thin hair

Rapid fingernail growth

39
Q

What are the reproductive features of hyperthyroidism?

A

Menstrual cycle changes - lighter bleeding and less frequent

40
Q

What are the metabolism features of hyperthyroidism?

A

Weight loss despite increased appetite

41
Q

What are the thermogenesis features of hyperthyroidism?

A

Heat intolerance

42
Q

What thyrotoxicosis causes are associated with hyperthyroidism?

A 
Graves
Thyroid nodules
Hashitoxicosis
Thyrotropinoma
Thyroid cancer 
Choriocarcinoma
43
Q

What thyrotoxicosis causes are not associated with hyperthyroidism?

A 
Thyroid inflammation: 
Subacute (de Quervain's) thyroiditis
Postpartum thyroiditis
Drug-induced thyroiditis 
Exogenous thyroid hormones: over-treatment with levothyroxine
Thyrotoxicosis factitia
Ectopic thyroid tissue: 
Metastatic thyroid carcinoma
Struma ovarii
44
Q

What are the lab investigations of graves disease?

A

Decreased TSH and increased fT4/3
Hypercalcaemia
Increased alk phos

45
Q

What antibody is commonly present in graves?

A

TSH receptor antibody

Anti-TPO

46
Q

What clinical signs are specific to graves?

A

Pretibial myxoedema
Thyroid acropachy
Thyroid bruit
TED/ Graves opthamology

47
Q

How is graves opthamology treated?

A

Mild: topical
Severe: steroids, radiotherapy, surgery

48
Q

Who is likely to get nodular thyroid disease?

A

Older patients

49
Q

What will nodular thyroid disease have biochemically?

A 
Increased fT4/3
Decreased TSH 
Antibody negative 
Scintigraphy: high uptake
Thyroid US
50
Q

What is a thyroid storm?

A

Severe hyperthyroidism

51
Q

What are the signs and symptoms of a thyroid storm?

A

Resp and cardiac collapse
Hyperthermia
Exaggerated reflexes

52
Q

How is a thyroid storm treated?

A 
Lugol's iodine
Glucocorticoids
PTU
Beta blockers
Fluids 
Monitoring
53
Q

How does carbimazole work?

A

Inhibits TPO therefore blocking thyroid hormone synthesis

54
Q

What is the first line drug in hyperthyroidism?

A

Carbimazole

55
Q

What is the first line drug for hyperthyroidism in the 1st semester of pregnancy?

A

Propylthiouracil

56
Q

How is graves treated?

A

Dose titrate for a year
OR
High dose for 6 months then treat with levothyroxine

57
Q

What are the side effects of anti-thyroid drugs?

A

Allergic type - rash, urticaria, arthralgia
Cholestatic jaundice, deranged LFTs, fulminant hepatic failure
Agranulocytosis

58
Q

What is agranulocytosis?

A

Bone marrow switches off the production of neutrophils

59
Q

What is the advice given for a patient starting on ATDs?

A

Stop drug and have urgent FBC in event of fever, oral ulcer or oropharyngeal infection esp within first 6 weeks

60
Q

When are beta blockers used in hyperthyroidism?

A

Immediate symptomatic relief of thyrotoxic symptoms

61
Q

What beta blocker is used in hyperthyroidism?

A

Propranolol

Additionally inhibits DIO1

62
Q

In what patients are beta blockers CI?

A

Asthma - use CCB (diltiazem) instead

63
Q

When is radioiodine used in hyperthyroidism?

A

1st choice treatment for relapsed graves’ disease and nodular thyroid disease

64
Q

Can radioiodine be used in pregnancy?

A

No

65
Q

Can radioiodine be used in active thyroid eye disease?

A

Preferably no

66
Q

When is a thyroidectomy utilised?

A

When radioiodine is CI or fails to work

67
Q

What conditions fall under thyroiditis?

A 
Hashimoto's 
De Quervain's (viral) 
Postpartum
Drug induced (amiodarone, lithium) 
Radiation
Acute suppurative thyroiditis
68
Q

What are the associated symptoms with subacute thyroiditis?

A

Neck tenderness, fever or other viral symptoms

69
Q

What is sick euthyroid syndrome?

A

Encountered in the unwell, hospitalised patient

Intercurrent infection has an impact on the HPT axis and TSH is typically suppressed and then rises during recovery

Endocrine (35 decks)

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