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2 Endocrine > Hyperthyroidism and Hypothyroidism > Flashcards

Hyperthyroidism and Hypothyroidism Flashcards

1
Q

what is the difference between primary and secondary thyroid disease?

A

primary affects thyroid gland itself, secondary is usually from hypothalamus/pituitary gland in brain

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2
Q

can you get goitre in secondary thyroid disease?

A

no

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3
Q

another word for TSH?

A

thyrotropin

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4
Q

where is TSH released and by what?

A

by thyrotroph cells in the anterior pituitary gland

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5
Q

what provokes TSH to be released?

A

release of TRH (thyrotropin releasing hormone)

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6
Q

what is T4?

A

thyroxine

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7
Q

what is T3?

A

lyrothyronine

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8
Q

which percentage of thyroid hormone secreted is T4?

A

80%

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9
Q

name the plasma proteins that T3 and T4 bind to

A

TBG (thyroid binding globulin)
albumin
pre-albumin

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10
Q

where is TRH made?

A

hypothalamus

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11
Q

what does TSH do?

A

stimulates thyroid gland to make T3 and T4

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12
Q

what do T3 and 4 do?

A

switch off TSH production

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13
Q

what does the liver do to T3 and 4?

A

T4 is converted to T3

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14
Q

what happens to T3/4 and TSH levels in primary hypothyroidism?

A

free T3/4 = LOW

TSH = HIGH

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15
Q

what happens to T3/4 and TSH levels in primary hyperthyroidism?

A

free T3/4 = HIGH

TSH = LOW

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16
Q

what happens to T3/4 and TSH levels in secondary hypothyroidism?

A 
T3/4wha = low
TSH = low
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17
Q

what happens to T3/4 and TSH in secondary hyperthyroidism?

A 
t3/4 = high
tsh = high
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18
Q

what is hypothyroidism?

A

insufficient secretion of thyroid hormones from the thyroid gland

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19
Q

what is myxoedema?

A

severe hypothyroidism

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20
Q

what SHOULD happen to TSH when T3/4 is low?

A

it should increase

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21
Q

intake of what chemical is linked to hypothyroidism?

A

iodine

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22
Q

goitrous causes of primary hypothyroidism?

A

chronic thyroiditis
iodine deficiency
drug induced
maternally transmitted

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23
Q

what drugs can cause hypothyroidism?

A

amiodarone

lithium

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24
Q

non goitrous causes of hypothyroidism?

A

atrophic thyroiditis
post ablative or radiotherapy
congenital

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25
Q

what is thyroperoxidase?

A

an enzyme involved in thyroid hormone synthesis

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26
Q

most common cause of hypothyroid in western world?

A

autoimmune hypothyroid eg hashimoto’s thyroiditis

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27
Q

histological appearance of autoimmune hypothyroid?

A

t cell infiltrates

inflammation

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28
Q

main pathological process in autoimmune hypothyroid?

A

antibodies made against thyroperoxidase (TPO)

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29
Q

which thyroid related substance is the most highly produced in hypothyroidism?

A

TSH

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30
Q

clinical facial features of hypothyroidism?

A 
thin hair
dull, expressionless face
periorbital puffiness
pale, cool skin that is doughy
vitiligo sometimes
hypocarotenaemia
patient is cold all the time
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31
Q

cardio clinical features of hypothyroidism?

A

bradycardia, cardiac dilatation, pericardial effusion, worse heart failure

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32
Q

GI features of hypothyroid?

A

constipation

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33
Q

metabolic features of hypothyroid?

A

weight gain
decreased appetite
hyperlipidaemia

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34
Q

why should you look at the legs in suspected hypothyroidism?

A

look for pitting oedema

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35
Q

respiratory features of hypothyroidism?

A

deep hoarse voice
macroglossia
obstructive sleep apnoea

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36
Q

neuro features of hypothyroid?

A 
confusion
depression
psychosis
muscle stiffness/pain
peripheral neuropathy
bad vision
carpal tunnel
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37
Q

what effect can hypothyroid have on periods?

A

can make them longer, not happen at all

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38
Q

effect of hypothyroid on MCV?

A

increase

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39
Q

effect of hypothyroid on:
CK
LDL

A

increase

increase

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40
Q

what electrolyte is particularly lost in hypothyroid?

A

hyponatraemia

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41
Q

what autoantibody is particularly sensitive in autoimmune hypothyroid?

A

anti-TPO

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42
Q

what is the main autoantibody involved in graves disease?

A

TSH receptors

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43
Q

what can rapid restoration of metabolic rate cause?

A

cardiac arrhythmias

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44
Q

treatment for younger patients with hypothyroid?

A

levothyroxine at 50-100 ug daily

45
Q

hypothyroid treatment for older patients with heart disease?

A

levothyroxine at 25-50 ug daily

46
Q

what should you do when you change the dose of thyroxine given for hypothyroid?

A

check TSH 2 months after

47
Q

why is TSH checked in hypothyroid?

A

can be used as a marker in PRIMARY only to see if treatment is working

48
Q

when should T4 be taken?

A

before breakfast

49
Q

is T4 or T3 more potent?

A

T3

50
Q

what drugs interfere with action of thyroxine?

A

PPIs

iron tablets

51
Q

how is dose of thyroxine changed in pregnant women with hypothyroid?

A

increase dose by 25-50%

52
Q

who does myxoedema coma affect?

A

elderly women with untreated hypothyroidism

53
Q

ECG findings of myxoedema coma?

A

varying heart block
T wave inversion
QT prolongation

54
Q

clinical presentation of myxoedema coma?

A 
type 2 resp failure
adrenal failure
bradycardia
heart block
low body temp
55
Q

treatment for myxoedema coma?

A

rewarm
cardiac monitoring
broad spectrum antibiotics
thyroxine cautiously

56
Q

how is thyrotoxicosis different from hyperthyroidism?

A

tissues are exposed to excess thyroid hormone, doesnt mean there is a problem with the thyroid gland itself

57
Q

cardiac symptoms of thyrotoxicosis?

A

palpitations
AF
HF (Rare)

58
Q

sympathetic nervous effects of thyrotoxicosis?

A

tremor

sweating

59
Q

CNS effects of thyrotoxicosis?

A

anxiety
nervousness
irritability
sleep disturbance

60
Q

GI effects of thyrotoxicosis?

A

frequent, loose bowel movements

61
Q

vision effects of thyrotoxicosis?

A

lid retraction
double vision
proptosis

62
Q

hair and nail symptoms of thyrotoxicosis?

A

thin hair

rapid nail growth

63
Q

do you get weight loss or gain in thyrotoxicosis?

A

weight loss

64
Q

are you intolerant to cold or heat in thyrotoxicosis?

A

heat

65
Q

hyperthyroid causes of thyrotoxicosis?

A

excessive thyroid stimulation eg graves OR thyroid nodules with autonomous function

66
Q

non hyperthyroid causes of thyrotoxicosis?

A

thyroiditis
exogenous thyroid hormones
ectopic thyroid tissue

67
Q

what forms of thyroiditis can cause thyrotoxicosis?

A 
subacute thyroiditis (viral)
post partum thyroiditis
68
Q

is graves disease more common in younger or older publications?

A

younger

69
Q

most common cause of graves disease?

A

genetic factors plus environmental

70
Q

what would TSH and T3/4 look like in graves disease?

A

TSH- LOW

T3/4 = HIGH

71
Q

what does hypercalcaemia + increased ALP indicate?

A

increased bone turnover

72
Q

what thyroid condition is linked to osteoporosis

A

graves

73
Q

how low is the TSH levels in graves?

A

can be almost undetectable

74
Q

what autoantibody should be checked in graves?

A

TSH receptor antibody

75
Q

clinical signs on examination that suggest graves disease?

A

pretibial myxoedema
thyroid acropachy
thyroid bruit
graves eye disease

76
Q

when is the only time you would hear a thyroid bruit

A

graves disease if there was a large goitre

77
Q

lifestyle advice for graves disease?

A

STOP smoking, makes eyes worse

78
Q

treatment for mild graves eye disease?

A

topical lubricant

79
Q

treatment for severe graves eye disease?

A

steroids
radiotherapy
surgery

80
Q

is onset of graves insidious and slow or acute and severe?

A

acute/severe

81
Q

who gets nodular thyroid tdisease?

A

older patients

82
Q

how an you differentiate nodular thyroid disease from graves?

A

slower onset
in older people
thyroid feels nodular but is smooth in graves
goitre can be asymmetrical

83
Q

effect of nodular thyroid disease on T3/4 and TSH?

A

increases T3/4

decreases TSH

84
Q

what result will nodular thyroid disease get when checking TSH receptor antibody

A

negative

85
Q

tests for nodular thyroid disease?

A

TSH receptor antibody test
thyroid USS
thyroid hormone levels

86
Q

is thyroid storm severe?

A

yes, do ABC

87
Q

what is thyroid storm?

A

severe hyperthyroidism

88
Q

clinical features of thyroid storm?

A

resp and cardio collapse
hyperthermia
exaggerated reflexes

89
Q

most common cause of thyroid sorm?

A

hyperthyroid patients with an acute infection or recent thyroid surgery

90
Q

treatment for thyroid storm?

A 
ugol's iodine
glucocorticoids
beta blockers for tachycardia
fluids
propylthiouracil
91
Q

1st line drug for hyperthyroidism?

A

carbimazole OD

92
Q

1st line drug for 1st trimester of pregnancy in someone who is hyperthyroid?

A

propylthiouracil BD

93
Q

treatment for graves disease?

A

dose titration of carbimazole

94
Q

side effects of antithyroid drugs for hyperthyroidism?

A

allergy
jaundice
increased liver enzymes
agranulocytosis

95
Q

what is agranulocytosis?

A

absence of neutrophils

96
Q

what should you do if a patient on antithyroid drugs gets agranulocytosis?

A

take them off them; they cant be used again

97
Q

when is the risk of agranulocytosis highest in hyperthyroid patients?

A

first 6 weeks of starting antithyroid drugs

98
Q

what beta blocker is of particular use in hyperthyroidism and why?

A

propranolol, stops T3-T4 conversion in liver

99
Q

1st line treatment for relapsed graves disease?

A

radioiodine

100
Q

is radioiodine safe in pregnancy?

A

NO

101
Q

why can’t radioiodine be used in active graves disease?

A

cause hypothyroid

102
Q

what should you do in graves disease when radioiodine is contraindicated?

A

thyroidectomy

103
Q

surgical risks of thyroidectomy?

A

recurrent laryngeal nerve palsy
hypothyroidism
hypoparathyroidism

104
Q

clinical symptoms of subacute thyroiditis?

A

neck tenderness
fever
viral symptoms

105
Q

common cause of subacute thyroiditis?

A

viral infection

106
Q

what age group is most commonly affected by subacute thyroiditis?

A

20-50s

107
Q

what do the TFTs look like in patients with inhibited DIO1 receptors?

A

increased T4
decreased T3
normal TSH

108
Q

which type of thyroid disease occurs in iodine deficient areas?

A

hyperthyroidism

109
Q

what do you call mild thyroid disease that could progress to hypo/hyperthyroidism?

A

subclinical thyroid disease

2 Endocrine (35 decks)

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