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Endocrine > Hyperthyroidism/ hypothyroidism/thyroiditis > Flashcards

Hyperthyroidism/ hypothyroidism/thyroiditis Flashcards

1
Q

primary thyroid disease

A

disease affecting thyroid gland itself
can occur with or without goitre

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2
Q

secondary thyroid disease

A

hypothalamic or pituitary disease
no thyroid gland pathology

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3
Q

what is TSh released by

A

thyrotroph cells in anterior pituitary

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4
Q

what is TSH released in reponse to

A

TRH

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5
Q

what is another name for thyroid stimulating hormone

A

thyrotropin

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6
Q

hormone characteristiscs in primary hypothyroidism

A

free t3/t4 low
TSH high

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7
Q

hormone characteristics in primary hyperthyroidism

A

free t3/t4 high
TSH low

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8
Q

secondary hypothyroidism hormone characteristics

A

free t3/t4 low
TSH low or normal

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9
Q

secondary hyperthyroidism hormone charcateristcs

A

free t3/t4 high
TSH high or normal

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10
Q

myxoedema

A

severe hypothyroidism
medical emergency
when hypothyroidism goes untreated for a long time

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11
Q

pretibial myxoedema

A

localized skin condition associated with Graves’ disease

characterized by thickened, waxy, and discolored skin on the shins, though it can also occur on other areas like the feet or dorsa of the toes

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12
Q

goitrous primary hypothyroidism causes

A

Chronic thyroiditis (Hashimoto’s thyroiditis)
Iodine deficiency
Drug-induced (e.g. amiodarone, lithium)
Maternally transmitted (e.g. antithyroid drugs)
Hereditary biosynthetic defects

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13
Q

non goitrous primary hypothyroidism causes

A

Atrophic thyroiditis
Post-ablative therapy (e.g. radioiodine, surgery)
Post-radiotherapy (e.g. for lymphoma treatment)
Congenital developmental defect

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14
Q

self limiting primary hypothyroidism caueses

A

Following withdrawal of antithyroid drugs
Subacute thyroiditis with transient hypothyroidism
Post-partum thyroiditis

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15
Q

secondary hypothyroidism causes

A

Infiltrative
Infectious
Malignant
Traumatic
Congenital
Cranial radiotherapy
Drug-induced

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16
Q

hashimotos thyroiditis

A

autoimmune destruction of thyroid gland and reduced thyroid hormone production

Characterised by
Antibodies against thyroid peroxidase (TPO)
T-cell infiltrate and inflammation microscopically

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17
Q

hypothyroidism clinical features

A

Hair and skin
Coarse, sparse hair
Dull, expressionless face
Periorbital puffiness
Pale cool skin that feels doughy
to touch
Vitiligo may be present
Hypercarotenaemia

Thermogenesis
Cold intolerance

Fluid Retention
Pitting oedema

Cardiac
Reduced heart rate
Cardiac dilatation
Pericardial effusion
Worsening of heart failure

Metabolic
Hyperlipidaemia

Metabolic rate
Decreased appetite
Weight gain

GI
Constipation
(Megacolon and intestinal obstruction)
(Ascites)

Respiratory
Deep hoarse voice
Macroglossia
Obstructive sleep apnoea

Neurology/CNS
Decreased intellectual and motor activities
Depression, psychosis, neuro-psychiatric
Muscle stiffness, cramps
Peripheral neuropathy
Prolongation of the tendon jerks
Carpal tunnel syndrome
(Cerebellar ataxia, encephalopathy)
Decreased visual acuity

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18
Q

abnormslities in blood tests of primary hypothyroidism

A

Macrocytosis (↑MCV)
↑Creatine kinase (CK)
↑LDL-cholesterol
Hyponatraemia
↓renal tubular water loss
Hyperprolactinaemia
↑TRH leads to ↑PRL (often mild)

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19
Q

thyroid auto antibodies

A

anti-TPO
anti- thyroglobulin
TSH receptor antibody

20
Q

most common auto antibodies in autoimmu e hypothyroidism

A

anti-top= 95%
anti thyroglobulin= 60%
tsh receptor antibody= 10-20%

21
Q

hypothyroidism drug management

A

levothyroxine
children- 50-100
elderly- 25-50

22
Q

treatment of myxoedema coma

A

Intensive care, remember – A, B, C!
Passively rewarm: aim for a slow rise in body temperature
Cardiac monitoring for arrhythmias
Close monitoring of urine output, fluid balance, central venous pressure, blood sugars, oxygenation
Broad spectrum antibiotics
Thyroxine cautiously (hydrocortisone)

23
Q

findings in 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
Co-existing adrenal failure is present in 10% of patients

24
Q

who does myxoedma usually affect

A

elderly women with long standing but frequently unrecognized/ untreated hypothyroidism

25
Q

thyrotoxicosis

A

clinical physiological and biochemical state arising when the tissues are exposed to excess thyroid hormone

26
Q

hyperthyroidism in compairson to toxicosis

A

conditions in which overactivity leads to thyrotoxicosis

27
Q

symptoms and signs of thyrotoxicosis

A

Cardiac
Palpitation, atrial fibrillation (AF)
Cardiac failure (very rare)

Sympathetic
Tremor
Sweating

CNS
Anxiety, nervousness, irritability, sleep disturbance

GI
Frequent, loose bowel movements

Vision
Lid retraction (not specific to Graves’)
Double vision (diplopia)
Proptosis (Graves’)

Hair and skin
Hair change – brittle, thin hair
Rapid fingernail growth

Reproductive
Menstrual cycle changes, including lighter bleeding and less frequent periods

Muscles
Muscle weakness, especially in the thighs and upper arms

Metabolism
Weight loss despite increased appetite

Thermogenesis
Intolerance to heat

28
Q

tests in nodular thyroid disease

A

↑fT4/3, ↓TSH
Antibody negative (TRAb)
Scintigraphy: high uptake
Thyroid US

29
Q

nodular thyroid disease

A

presence of one or more discrete lumps (nodules) within the thyroid gland

30
Q

first line drug for hyperthyroidism

A

carbimazole
ocne daily dosing

31
Q

propythiouracil

A

1st line only in 1st trimester of pregnancy
Twice daily dosing
10x less potent compared to carbimazole
Inhibits DIO1 (↓T4 to T3 conversion)

32
Q

side effcts of atds

A

Generally well tolerated drugs
1-5% will develop allergic type reactions – rash, urticaria, arthralgia
Cholestatic jaundice, ↑liver enzymes, fulminant hepatic failure (PTU)
Agranulocytosis
0.1-0.5% of patients
ATDs cannot be used again
Risk highest in first 6 weeks
No evidence for monitoring of FBC
Warn patient verbally and in writing to stop drug and have urgent FBC checked in event of fever, oral ulcer or oropharyngeal infection

33
Q

Useful drug for immediate symptomatic relief of thyrotoxic symptoms

A

beta blockers
propanolol is drug of choice

34
Q

first choice treatment for relapsed graves disease and nodular thyroid disease

A

radioiodine

35
Q

what is radiodine contraindicated in

A

pregnancy
active thyroi eye disease

36
Q

thyroiditis

A

inflammaton of thyroid
ashimoto’s
De Quervain’s/subacute (viral)
Post-partum
Drug-induced (amiodarone, lithium)
Radiation
Acute suppurative thyroiditis (bacterial)

37
Q

subacute thyroiditis

A

May be triggered by viral infection
May be associated with neck tenderness, fever, or other viral symptoms
Usually self limiting (over a few months)
Scintigraphy scan – low uptake throughout
ages 20-50

38
Q

where does hypothyroidism tend to occur

A

in iodine rich areas

39
Q

where does hyperthyroidism tend to occur

A

in iodine deficient areas

40
Q

subclinical thyroid disease

A

increased TSH with normal t3/t4
subtle, noticed in blood tests

41
Q

non thyroidal illness

A

in unwell patient
tsh typically suppressed initially then rises during recovery

42
Q

type 1 amiodarone induced thyroiditis

A

usually due to pre existing thyroid issue
amiiodarone consitss of lots of iodine so causes iodine overload leading to excessive thyroid hormone production

43
Q

type 2 amiodarone induced thyroiditis

A

direct damage to thyroid tissue
usually self limitting so managed with corticosteroids to reduce inflammation

44
Q

is carpal tunnel syndrome assoc with hypo or hyper

A

hypo

45
Q

thyrotoxicosis

A

thyroid storm
administer PTU as more rapid than carbimazole, prevents t4 into t3

46
Q
A

Endocrine (35 decks)

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