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Endocrine > hyperthyroidism, hypothyroidism and thyroiditis > Flashcards

hyperthyroidism, hypothyroidism and thyroiditis Flashcards

1
Q

what does primary thyroid disease mean?

A

-a disease affecting the thyroid gland itself

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2
Q

what are the levels of T4, T3 and TSH like in primary hypothyroidism?

A 
T4/T3= too low
TSH= high
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3
Q

what are T3, T4 and TSH levels like in primary hyperthyroidism?

A

T3 + T4= high

TSH= low

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4
Q

what are T3, T4 and TSH like in secondary hypothyroidism?

A

T3 + T4= low

TSH= low (or ‘normal’)

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5
Q

what are T3, T4 and TSH like in secondary hyperthyroidism?

A

T3 + T4= high

TSH= high (or normal)

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6
Q

what is myxoedema?

A

-severe hypothyroidism and is a medical emergency

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7
Q

what is pretibial myxoedema?

A

a rare clinical sign of Graves’ disease (an autoimmune disease which results in hyperthyroidism)

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8
Q

who is hypothyroidism more common in?

A
  • women
  • white population
  • incidence is higher in areas of high iodine intake
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9
Q

what is the most common cause of hypothyroidism in western world?

A

autoimmune (hashimotos)

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10
Q

what increases risk of getting hashimotos?

A

-family history of autoimmune or thyroditis

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11
Q

what most common antibodies found in Hashimoto’s?

A

thyroid peroxidase antibodies

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12
Q

what can occur to hair and skin in hypothyroidism?

A
  • coarse, sparse hair
  • dull, expressionless face
  • periorbital puffiness
  • pale cool skin that feels doughy to touch
  • vitiligo may be present
  • hypercarotenaemia
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13
Q

how may a patients tolerence to temperature change if they have hypothyroidism?

A

-they may develop cold intolerance

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14
Q

what are some cardiac clinical features of hypothyroidism?

A
  • reduced heart rate
  • cardiac dilatation
  • pericardial effusion
  • worsening of heart failure
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15
Q

what affect does hypothyroidism have on lipidaemia?

A

it can cause hyperlipidaemia

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16
Q

what affect does hypothyroidism have on appetite and weight?

A
  • decreased appetite

- increased weight gain

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17
Q

what are some GI clinical features of hypothyroidism?

A
  • constipation
  • megacolon and intestinal obstruction
  • ascites
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18
Q

what are some resp clinical features of hypothyroidism?

A
  • deep hoarse voice
  • macroglossia
  • obstructive sleep apnoea
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19
Q

what are some neurological/CND clinical features of hypothyroidism?

A
  • decreased intellectual and motor activities
  • depression, psychosis and neuro psychiatric
  • muscle stiffness, cramps
  • peripheral neuropathy
  • prolongation of the tendon jerks
  • carpal tunnel syndrome
  • decreased visial acuity
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20
Q

what are some gynae/reproductive clinical features of hypothyroidism?

A
  • menorhagia
  • later oligo or amenorrhoea
  • hyperprolactaemia
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21
Q

what causes hyperprolactaemia?

A

high TRH (once TRH is lowered it can be reversed)

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22
Q

what is treatment for hypothyroidism in younger patients?

A

-start levothyroxine (T4) at 50-100 micrograms daily

check TSH 2 months after any dose change and once stabilised check TSH every 12-18 months

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23
Q

what is treatment for hypothyroidism in older patients?

A

in elderly patients with a history of IHD:
-start levothyroxine (T4) at 25 to 50 micrograms daily, adjust every 4 weeks according to response

-TSH should be checked 2 months after any dose change and once stabilised TSH should be checked every 12-18 months

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24
Q

when should levothyroxine (T4) be taken?

A
  • before breakfast (on empty stomach)

- doesn’t work if taken with PPI, iron tablets and calcium tablets as they impair the absorption

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25
Q

what should happen to dose of levothyroxine to a pregnant patient with hypothyroidism?

A

dose of levothyroxine should be increased by 25-50%

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26
Q

who does myxoedema coma usually affect?

A

-elderly women with long standing but frequently unrecognized or untreated hypothyroidism

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27
Q

what are the signs of a myxoedema coma?

A

ECG: bradycardia, low voltage complexes, varying degrees of heart block, T wave inversion, prolongation of the QT interval

Type 2 respiratory failure: hypoxia, hypercarbia, respiratory acidosis

In 10% of patients there is co existing adrenal failure

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28
Q

what is the treatment for myxoedema coma?

A
  • ICU
  • passive rewarm (aim for slow rise in body temp)
  • cardiac monitoring for arrhythmias
  • close monitoring of urine output. fluid balance, central venous pressure, blood sugars, oxygenation
  • broad spectrum antibiotics
  • thyroxine cautiously (hydrocortisone)
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29
Q

what is thyrotoxicosis?

A

-a clinical, physiological and biochemical state arising when tissues are exposed to excess thyroid hormone

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30
Q

what are cardiac signs/symptoms in thyrotoxicosis?

A
  • palpitations
  • AF
  • cardiac failure (very rare)
  • tremor
  • sweating
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31
Q

what are CNS signs/symptoms in thyrotoxicosis?

A
  • anxiety
  • nervousness
  • irritability
  • sleep disturbances
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32
Q

what are GI signs/symptoms in thyrotoxicosis?

A

-frequent, loose bowel movements

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33
Q

what are vision signs/symptoms in thyrotoxicosis?

A
  • lid retraction
  • double vision
  • proptosis
34
Q

what are hair and skin signs/symptoms in thyrotoxicosis?

A

brittle, thing hair

rapid fingernail growth

35
Q

what are reproductive signs/symptoms in thyrotoxicosis?

A

-menstrual cycle changes (including lighter bleed and less frequent periods)

36
Q

what are the changes in muscles in thyrotoxicosis?

A

-muscle weakness (especially in thigha and upper arms)

37
Q

what are the changes in weight in someone with thyrotoxicosis?

A

weight loss even though there’s increased apetite

38
Q

what is a patients with thyrotoxicosis tolerance to temperature like?

A

-they have an intolerance to heat

39
Q

who does Grave’s disease usually affect?

A

younger 20-50 years

40
Q

what are some clinical signs/features of Grave’s?

A
  • pretibial myxoedema
  • thyroid acropachy
  • thyroid bruit
  • Grave’s eye disease
41
Q

who does nodular thyroid disease typically affect?

A

-older patients

42
Q

what tests are done if a patient has suspected nodular thyroid disease?

A
  • increase T4/3
  • decrease TSH
  • antibody negative (TRAb)
  • thyroid US
  • scintigraphy: high uptake
43
Q

what is the first line treatment for hyperthyroidism?

A

1st line= Carbimazole once daily

44
Q

what is the first line treatment for someone in their first trimester of pregnancy?

A

Propylthiouracil (PTU) twice daily

45
Q

side effects of using carbimazole in pregnancy?

A

-risk of aplasia cutis in early pregnancy

46
Q

side effects of propylthiouracil (PTU)

A

1:10,000 risk of liver failure

47
Q

what type of drug is carbimazole?

A

ATD (antithyroid drug)

48
Q

what are side effects of ATDs (carbimazole)?

A
  • 1 to 5% will develop allergic reaction (rash, urticaria, arthralgia)
  • cholestatic jaundice, increase liver enzymes, fulminant hepatic failure (PTU)
  • agranuloytosis
49
Q

what is agranulocytosis?

A

-a life-threatening blood disorder when the body cannot make enough of a type of white blood cell called neutrophils

50
Q

what should the patient be warned about and how before starting carbimazole?

A
  • warned about the side effect of agranulocytosis
  • warn patient verbally and in writing to stop drug and have urgent FBC checked in event of fever, oral ulcer or oropharyngeal infection
51
Q

when should a patient get an urgent FBC and stop taking carbimazole?

A

in event of :

  • fever
  • oral ulcer
  • oropharyngeal infection
52
Q

when is risk of getting agranulocytosis highest when on carbimazole?

A

-in first 6 weeks

53
Q

what treatment is good for immediate symptomatic relief of thyrotoxic symptoms in patients with hyperthyroidism?

A

BB (propanolol)

54
Q

what is 1st line treatment of relapsed Graves’ disease ?

A

radioiodine

55
Q

what is 1st line treatment of nodular thyroid diseases?

A

radioiodine

56
Q

when is radioiodine contraindicated?

A
  • in pregnancy

- relatively in active thyroid eye disease

57
Q

what is a high risk when treating Grave’s patients with radioiodine?

A

-high risk of hypothyroidism

58
Q

when is a thyroidectomy the choice of treatment in hyperthyroidism?

A

-when radioiodine is contraindicated

59
Q

what risks does a thyroidectomy bring?

A
  • recurrent laryngeal nerve palsy
  • hypothyroidism
  • hypoparathyroidism
60
Q

what is thyroiditis?

A

inflammation of the thyroid

61
Q

who is subacute thyroiditis typically found in?

A

-females ages 20-55

62
Q

what may trigger subacutre thyroitisis?

A

-viral infection

63
Q

what are some associated symptoms of subacute thyroiditis?

A
  • neck tenderness
  • fever
  • and/or other viral symptoms
64
Q

what are the investigations for subacute thyroiditis?

A

scintigraphy scan (low uptake throughout)

65
Q

what are some causes of thyroiditis?

A
  • hashimotos
  • de quervain’s/subacute
  • post partum
  • drug induced (amiodarone, lithium)
  • radiation
  • acute suppurative thyroiditis (bacterial)
66
Q

what is the treatment for subacute thyroiditis?

A

-its usually self limiting (few months)

67
Q

what is subclinical al thyroid disease?

A

-abnormal TSH with normal thyroid hormone levels

68
Q

what would T3, T4 and TSH be like in subclinical hypothyroidism?

A 
TSH= increase
T4/T4= the same
69
Q

what would T3, T4 and TSH be like in subclinical hyperthyroidism?

A 
TSH= lower
T3/T4= the same
70
Q

when is treatment advised in subclinical hypothyroidism?

A
  • when TSH>10

- if pregnancy

71
Q

when is treatment advised in subclinical hyperthyroidism?

A
  • when TSH<0.1

- or if there’s coexisting osteoporosis/fracture or AF

72
Q

what increases risk of getting sunclinical hypothyroidism?

A

-if TPO antibody positve

73
Q

what increases risk of getting sunclinical hyperthyroidism?

A
  • multinodular goitre

- if patient has Afib or osteoporosis

74
Q

what is non thyroidal illness also known as?

A

sick euthyroid syndrome

75
Q

who is non thyroidal illness commonly seen in?

A

-unwell, hospitalised patients

76
Q

what are TSH levels like in non thyroidal illness ?

A

TSH typically supressed initially and then rises during recovery

77
Q

who os postpartum thyroiditis more common in?

A

-type 1 diabetic women

78
Q

how does postpartum thyroiditis present?

A
  • temporary overactive thyroid and after a few weeks becomes under active
  • occurs after birth
  • however not all women with postpartum thyroiditis will go through both phases
79
Q

what is De Queverain’s thyroiditis?

A

-thyroiditis caused by a viral infection such as mumps or flu

80
Q

how does De Queverain’s thyroiditis present?

A
  • initially hyperthyroidism and then after a couple weeks can become hypo
  • this can resolve spontaneously or hypothyroidism may become permenant
  • fever
  • pain in neck, jaw or ear

Endocrine (53 decks)

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