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Endocrine > Hypo/hyperthyroidism > Flashcards

Hypo/hyperthyroidism Flashcards

1
Q

What is the difference between primary and secondary thyroid disease?

A

Primary - disease is of the thyroid gland

Secondary - disease is of the hypothalamus/pituitary

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2
Q

What tests can measure thyroid function?

A

TSH
Free T4/T3
T4/T3 bound to proteins

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3
Q

What three proteins can T3/T4 be bound to?

A

TBG, albumin & pre-albumin

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4
Q

Is the thyroid axis positive or negative feedback?

A

Negative

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5
Q

What are the lab results in hypothyroidism?

A

primary - low T3/T4, high TSH

secondary - low T3/T4, low TSH

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6
Q

What are the lab results in hyperthyroidism?

A

primary - high T3/T4, low TSH

secondary - high T3/T4, high TSH

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7
Q

Describe subclinical hypothyroidism

A

TSH high, T3/T4 normal

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8
Q

State the two main types of hypothyroidism

A

Goitrous & Non-goitrous

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9
Q

Name four causes of goitrous hypothyroidism

A
  • Hashimoto’s
  • Iodine deficiency
  • Drug induced
  • Maternal transmission
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10
Q

State two causes of non-goitrous hypothyroidism

A
  • Atrophic thyroiditis

- Iatrogenic

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11
Q

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

A

Hashimoto’s thyroiditis

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12
Q

Describe Hashimoto’s

A

TPO antibodies (thyroid peroxidase) cause T cell infiltrate & inflammation of the thyroid gland

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13
Q

What are the clinical features of hypothyroidism?

A
  • cold skin, puffy eyes, hypercarotenaemia
  • cold intolerance
  • pitting oedema
  • bradycardia
  • decreased appetite, increased weight
  • constipation
  • sleep apnoea
  • low mood
  • oligo/ammenorrhoea
  • hyperprolactinaemia
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14
Q

In hypothyroidism what will happen to sodium?

A

It will decrease

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15
Q

What is the treatment for hypothyroidism?

A

Levothyroxine (T4)

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16
Q

What is the medical emergency associated with hypothyroidism?

A

Myxoedema Coma

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17
Q

Describe the typical presentation of myxoedema coma

A

Older women with undiagnosed/untreated hypothyroidism - severe medical emergency (60% mortality)

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18
Q

What does myxoedema coma lead to?

A

Accumulation of mucopolysaccharides in the dermis & other tissues which attract water and cause swelling

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19
Q

How can myxoedema coma be managed?

A

ABCDE

  • identify & treat concurrent illness
  • passively rewarm
  • cardiac monitoring for arrhythmias
  • antibiotics
  • thyroxine & hydrocortisone
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20
Q

Define thyrotoxicosis

A

clinical, physiological & biochemical state arising when tissues are exposed to excess thyroid

21
Q

Define hyperthyroidism

A

conditions which overactivity of thyroid gland leads to thyrotoxicosis

22
Q

What are the clinical features of thyrotoxicosis?

A
  • palpitations, AF
  • tremor, sweating
  • anxiety, nervousness, irritability
  • frequent, loose bowel movements
  • increased appetite, weight loss
  • proptosis. lid retraction
  • brittle, thin hair and skin
  • intolerance to heat
  • lighter, less frequent periods
  • muscle weakness
23
Q

State three things that can cause excess thyroid stimulation

A
  • Graves Disease
  • Hashitoxicosis
  • Cancer
  • Thyroid Nodules
24
Q

State three causes of thyrotoxicosis not associated with thyroid disease

A
  • Thyroid inflammation
  • Exogenous thyroid hormones
  • Ectopic thyroid tissue
25
Q

What is the most common cause of hyperthyroidism in young people?

A

Grave’s Disease

26
Q

Describe Grave’s Disease

A

TSH receptor antibodies (TRAb) act by stimulating thyroid hormone production

27
Q

How does Grave’s Disease arise?

A

susceptible genes + environmental factors

28
Q

What lifestyle factor significantly increases risk of Grave’s disease & treatment failure?

A

Smoking

29
Q

What investigations should be carried out on a patient with suspected Grave’s disease?

A

TSH, T3/T4

Calcium, WCC, TRAb

30
Q

Name four specific signs of Grave’s disease

A
  • pretibial myxoedema
  • thyroid acropachy
  • thyroid bruit
  • eye disease
31
Q

What is the more common cause of hyperthyroidism in older patients?

A

Nodular disease - insidious onset asymmetrical goitre

32
Q

Name the medical emergency associated with hyperthyroidism

A

Thyroid storm/crisis

33
Q

How does thyroid storm present?

A

Severe systemic disease - respiratory/cardiac collapse & hyperthermia

34
Q

How do you treat thyroid crisis?

A

Lugol’s iodine/potassium iodide
Glucocorticosteroids
Beta blockers
Fluids

35
Q

What is first line treatment for hyperthyroidism?

A

Carbimazole

36
Q

What is second line treatment for hyperthyroidism?

A

Propylthiouracil (inhibits DID1 to decrease conversion of T4 to T3 in the liver, less potent & may cause liver failure)

37
Q

What is the potentially fatal side effect associated with drugs for hyperthyroidism?

A

Agranulocytosis - highest risk in first 6 weeks, in the event of the patient developing a fever the drug must be stopped immediately. Patient must be warned verbally & in writing

38
Q

Name the beta blocker used in hyperthyroidism

A

Propanolol - useful for symptomatic relief

39
Q

When is radio iodine used?

A

Relapsed Grave’s, nodular thyroid disease

40
Q

What is the key risk of radio-iodine?

A

Hypothyroidism

41
Q

State the treatment used when radio-iodine is contraindiciated

A

Thyroidectomy - surgical & anaesthetic risks

42
Q

What is thyroiditis?

A

Inflammation of thyroid

43
Q

State the causes of thyroiditis

A
  • virus/bacteria
  • hashimoto’s
  • post partum
  • drugs/radiation
44
Q

Describe the disease progression of subacute thyroiditis

A

Triggered by viral infection, associated with neck tenderness, fever or viral symptoms. Usually self-limiting

45
Q

What is a normal thyroid level called?

A

euthyroid

46
Q

How does amiodarone relate to thyroid?

A

Drug has a high concentration of iodine.
Hypothyroidism can occur in iodine rich areas
Hyperthyroidism tends to occur in iodine deficient areas

47
Q

How does hypothyroidism arise due to amiodarone?

A

High iodine content may inhibit thyroglobulin iodination and thyroid synthesis & release causing hypothyroidism

48
Q

How does hyperthyroidism arise due to amiodarone?

A

Iodine excess can increase hormone synthesis or alternatively (type 2) due to toxicity of amiodarone thyroiditis occurs

49
Q

What happens to thyroid physiologically during illness?

A

TSH is suppressed initially but rises during recovery

Endocrine (17 decks)

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