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Endocrinology > Hypo/hyperthyroidism > Flashcards

Hypo/hyperthyroidism Flashcards

1
Q

Give 2 secondary causes of hypo/hyperthyroidism?

A

hypothalamic

pituitary

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2
Q

What would you want to measure if you thought a patient has hyperthyroidism?

A

thyroid function tests

also do ECG in case of AF

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3
Q

What is pretibial myoxoedema? When is it seen?

A

accumulation of mucopolysaccharides in ground substance of dermis on skin of shins
Grave’s disease

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4
Q

What is thyrotoxicosis?

A

hyperthyroidism

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5
Q

When does myoexedema occur?

A

Either refers to severe hypothyroidism eg myoexedema coma

OR pretibial myoxoedema in Grave’s disease - on skin

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6
Q

In areas of high iodine intake, is hypo or hyper more common?

A

hypo

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7
Q

What are the goitrous causes of primary hypothyroidism?

A 
Chronic thyroiditis (Hashimotos)
Iodine deficiency
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8
Q

What are the non goitrous causes of hypothyroidism?

A

atrophic thyroiditis
post ablative/radiotherapy
congenital

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9
Q

Most common cause of thyroiditis?

A

hashimoto’s

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10
Q

In Hashimotos, what is seen in blood?

A

thyroid peroxidase antibodies

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11
Q

In Hashimotos, what is seen on microscopy?

A

T cell infiltrate and inflammation

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12
Q

What type of hair can be seen in hypothyroidism?

A

sparse, coarse

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13
Q

What are other signs of hypothyroidism?

A 
dull expressionless face
periorbital puffiness
pale cool skin, doughy to touch
vitiligo
hypercarotenaemia/yellowing
fluid retention, pitting oedemia
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14
Q

Can vitiligo be associated with hypo or hyper?

A

hypo

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15
Q

What happens to heart rate in hypo?

A

reduced

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16
Q

What happens to lipids in hypo?

A

hyperlipidaemia

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17
Q

What respiratory signs may occur with hypo

A

deep hoarse voice, macroglossia, obstructive sleep apnoea

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18
Q

What GI symptoms may occur with hypo?

A

constipation

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19
Q

What is carpal tunnel more likely in, hypothyroid or hyperthyroid?

A

hypo

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20
Q

What can hypothyroidism do to periods?

A

menorrhagia

later oligo/amenorrhoea

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21
Q

What does hypothyroid do to prolactin?

A

increases

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22
Q

What happens to thyroid hormones in hypothyroid?

A

TSH high

T4/3 low

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23
Q

What happens to sodium in hypothyroidism?

A

low

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24
Q

Once stabilized, how often should TSH be checked?

A

every 12-18 months

25
Q

What is the main treatment of hypothy.

A

thyroxine

26
Q

Is there any benefit of combined T4 and T3 therapy?

A

no

27
Q

When is T4 preferabnly taken?

A

before breakfast

28
Q

Is T3 therapy used much in hypo?

A

no

29
Q

Who does myxoedema coma tend to affect?

A

elderly women with longstanding but untreated hypothyroidism

30
Q

Is there a high mortality in myxoedema coma?

A

yes

31
Q

What are the ECG findings of myxoedema coma?

A

bradycardia, low voltage complexes, varying degrees of heart block, t wave inversion, prolongation of QT interval

32
Q

Which drug can cause thyroid dysfuction?

A

amiodarone

33
Q

Is it more likely to get hypo or hyper on amiodarone?

A

hypo

34
Q

Cardiac signs of hyperth?

A 
palpatations/AF
cardiac failure (rare)
35
Q

What CNS symptoms may occur in hyperth?

A

anxiety, irritability, insomnia

36
Q

What GI symptoms may occur in hyperth?

A

frequent loose bowel movements

37
Q

What may happen to vision in hyperth?

A

lid retraction
double vision
eyes that bulge out

38
Q

What hair changes occur in hyperthyroidism?

A

brittle thinning hair

39
Q

What happens to nail growth in hyperthyroid?

A

rapid

40
Q

What happens to periods in hyperthyroidism?

A

lighter bleeding/less frequent

41
Q

What happens to muscles in hyperth?

A

weakness, especially in thighs and upper arms

42
Q

What happens to metabolism in hyper?

A

increased appetite but weight loss

43
Q

What are nodular thyroid causes of hyperthyroid?

A 
multi nodular goiter
toxic nodule (adenoma)
44
Q

What are inflammatory types of hyperthyroid?

A

subacute

post-partum

45
Q

What is seen on thyroid function tests in Grave’s?

A

high T3/4, low TSH

46
Q

What is Graves antibody positive for?

A

TRAbs

47
Q

What is seen on ultrasound in graves?

A

smooth symmetrical goitre

48
Q

In whom does nodular thyroid disease occur more?

A

older patients

49
Q

Are nodular thyroid disease patients antibody TRAbs positive?

A

NO

50
Q

What type of goiter is seen in in nodular thyroid disease?

A

assymetrical

51
Q

What is De Quervains?

A

sub acute thyroiditis

52
Q

What happens to T4 in sub acute thyroiditis?

A

high then low then normal

53
Q

What happens to TSH in sub acute thyroiditis?

A

low then high then normal

54
Q

What is Thyroid storm?

A

severe hyperthyroidism
resp and cardio collapse
hyperthermia
may be linked to infection

55
Q

What is treatment of thyroid storm?

A

lugols iodine, glucocorticoids, PTU, B blockers, fluids, monitoring

56
Q

Treatment of hyperthyroidism?

A

carbimazole

propylthiouracil (preferred in pregnancy)

57
Q

What else should be used in hyperthyroid to treat symptoms?

A

propranolol

58
Q

If a patient presents with tiredness/goiter and has a high TSH but a normal T4 what is the diagnosis?

A

subclinical hypothyroidism

Endocrinology (25 decks)

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