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Endocrinology > Hypo/Hyperthyroidism and Thyroiditis > Flashcards

Hypo/Hyperthyroidism and Thyroiditis Flashcards

1
Q

define primary thyroid disease

A

disease affecting the thyroid gland itself

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2
Q

define secondary thyroid disease

A

hypothalamic or pituitary disease - no thyroid pathology

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3
Q

where is TSH secreted and in response to what?

A

TSH secreted from anterior pituitary in response to TRH from hypothalamus

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4
Q

what is 99% of T3 and T4 bound to?

A

TBG, albumin and pre-albumin

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5
Q

primary hypothyroidism - low or high:

(a) free T3/4
(b) TSH

A

primary hypothyroidism - low or high:

(a) free T3/4 - LOW
(b) TSH - HIGH

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6
Q

primary hyperthyroidism - low or high:

(a) free T3/4
(b) TSH

A

primary hyperthyroidism - low or high:

(a) free T3/4 - HIGH
(b) TSH - LOW

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7
Q

secondary hypothyroidism - low or high:

(a) free T3/4
(b) TSH

A

secondary hypothyroidism - low or high:

(a) free T3/4 - LOW
(b) TSH - LOW/NORMAL

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8
Q

secondary hyperthyroidism - low or high:

(a) free T3/4
(b) TSH

A

secondary hyperthyroidism - low or high:

(a) free T3/4 - HIGH
(b) TSH - HIGH/NORMAL

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9
Q

any disorder that results in insufficient secretion of thyroid hormones from the thyroid gland defines what?

A

hypothyroidism

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10
Q

define myxoedema

A

severe hypothyroidism and is a medical emergency

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11
Q

define oretibiyal myxoedema

A

a rare clinical sign of Graves’ disease, an autoimmune thyroid disease which results in hyperthyroidism!

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12
Q

name the 3 types of primary hypothyroidism

A

goitrous
non-goitrous
self-limiting

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13
Q

goitrous, non-goitrous or self-limiting:

Chronic thyroiditis (Hashimoto’s thyroiditis)

Iodine deficiency
Drug-induced (e.g. amiodarone, lithium)

Maternally transmitted (e.g. antithyroid drugs)

Hereditary biosynthetic defects

A

goitrous

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14
Q

goitrous, non-goitrous or self-limiting:

Atrophic thyroiditis

Post-ablative therapy (e.g. radioiodine, surgery)

Post-radiotherapy (e.g. for lymphoma treatment)

Congenital developmental defect

A

non-goitrous

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15
Q

goitrous, non-goitrous or self-limiting:

Following withdrawal of antithyroid drugs

Subacute thyroiditis with transient hypothyroidism

Post-partum thyroiditis

A

self-limiting

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16
Q

name the most common cause of autoimmune hypothyroidism

A

hashimoto’s thyrioditis

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17
Q

what is hashimoto’s thyroiditis characterised by the presence of?

A

antibodies against thyroid peroxidase (TPO)

T-cell infiltrate and inflammation microscopically

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18
Q

hypothyroidism clinical features:

hair and skin -

thermogenesis -

fluid retention -

A

hair and skin -

coarse, sparse hair
dull, expressionless face
pale, cool, dougy skin
vitiligo
hypercarotenaemia

thermogenesis -

cold intolerance

fluid retention -

pitting oedema

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19
Q

hypothyroidism clinical features:

cardiac -

metabolic -

A

cardiac -

reduced HR
cardiac dilatation
pericardial effusion
worsening of heart failure

metabolic -

hyperlipidaemia
decreased appetite
weight gain

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20
Q

hypothyroidism clinical features:

GI -

respiratory -

neurological -

A

GI -

constipation
megacolon
ascites

respiratory -

deep hoarse voice
macroglossia - large tongue
obstructive sleep apnoea

neurological -

decreased intelligence

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21
Q

hypothyroidism clinical features:

gynae/reproductive -

A

hypothyroidism clinical features:

gynae/reproductive -

menorrhagia
later oligo- or amenorrhoea
hyperprolactinaemia

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22
Q

laboratory investigations of primary hypothyroidism - increased or decreased:

TSH
fT3/4
CK
LDL

A

TSH INCREASED
fT3/4 DECREASED
CK INCREASED
LDL INCREASED

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23
Q

hypothyroidism in younger patients management?

A

levothyroxine 50-100μg

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24
Q

hypothyroidism in elderly with IHD patients management?

A

levothyroxine 25-50μg

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25
what should you check every 2 months after any dose change in hypothyroidism?
TSH
26
once stabilised on levothyroxine, what should be checked every 12-18 months?
TSH
27
levothyroxine is T3/T4
levothyroxine is T4
28
when should levothyroxine be taken?
before breakfast
29
in what situation is levothyroxine dose increased by 25-50%?
pregnancy as TBG increases
30
typically affects elderly women with long standing but frequently unrecognized or untreated hypothyroidism mortality up to 60% despite early diagnosis and treatment 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 diagnosis
myxoedema coma
31
myxoedema coma treatment?
ABCDE | passively rewarm
32
the clinical, physiological and biochemical state arising when the tissues are exposed to excess thyroid hormone defines what?
thyrotoxicosis
33
conditions in which overactivity of the thyroid gland leads to thyrotoxicosis defines what?
hyperthyroidism
34
thyrotoxicosis symptoms and signs? ``` CVS sympathetic CNS GI vision hair and skin reproduction muscles metabolism thermogenesis ```
palpitations, AF, tremor, sweating, anxiety, nervousness, irritability, sleep disturbance, frequent loose bowels, lid retraction, double vision, proptosis, brittle thin hair, rapid fingernail growth, lighter and less frequent periods, muscle weakness, weight loss and increased appetite, heat intolerance
35
name the most common condition associated with hyperthyroidism
graves disease also hashitoxicosis, thyrotopinoma, cancer etc
36
name the 2 different types of thyroid nodule
toxic solitary nodule | toxic multinodular goitre
37
is thyroiditis like subacute thyroiditis, post-arum thyroiditis and amiodarone induced thyroiditis associated with hyperthyroidism?
no
38
is smoking important in graves disease?
yes graves is inflammatory disease so smoking doesn't help
39
in graves disease, increased or decreased: ``` TSH fT4/3 ALP calcium WBC ```
``` TSH - DECREASED fT4/3 - INCREASED ALP - INCREASED calcium - INCREASED WBC - DECREASED ```
40
what bone disease is graves associated with?
osteoporosis
41
name the antibody found in graves disease
TRAb
42
name the condition of the legs seen in graves disease
pretibial myxoedema
43
fingernail condition associated with graves?
thyroid acropachy
44
large goitres in graves can result in a thyroid _____
large goitres in graves can result in a thyroid BRUIT
45
name the main clinical finding of graves seen on the face
thyroid eye disease - TED graves ophthalmopathy - GO associated with smoking TRAb driven treated topically and with steroids in severe
46
is TRAb positive or negative in nodular thyroid disease?
negative
47
fT3/4 and TSH in nodular thyroid disease?
fT3/4 INCREASED | TSH DECREASED
48
state the medical emergency associated with severe hyperthyroidism
thyroid storm resp and cardio collapse hyperthermia
49
who is thyroid storm seen in?
hyperthyroid patients with an acute infection/illness or recent thyroid surgery
50
thyroid storm treatment?
``` Lugol’s Iodine glucocorticoids PTU β-blockers fluids monitoring ```
51
drug treatment of hyperthyroidism?
antithyroid drugs - ATDs carbimazole - once daily betablockers - propranolol for immediate symptomatic relief caution in asthma so CCB instead radioiodine - relapsed graves and nodular thyroid disease, contraindicated in pregnancy and high risk of hypothyroidism when used in graves
52
drug treatment of hyperthyroidism in 1st trimester of pregnancy?
propylthiouracil | twice daily
53
side effects of ATDs?
agranulocytosis - ATDs cannot be used again rash, urticaria, jaundice, hepatic failure
54
treatment of hyperthyroidism when radio iodine is contraindicated?
thyroidectomy
55
what is subacute thyroiditis usually triggered by?
viral infection
56
findings in subacute thyroiditis on scintigraphy scan?
low uptake throughout
57
TSH is __________ and normal fT3/4 in ___________ hypothyroidism TSH is __________ and normal fT3/4 in ___________ hyperthyroidism
TSH is INCREASED and normal fT3/4 in SUBCLINICAL hypothyroidism TSH is DECREASED and normal fT3/4 in SUBCLINICAL hyperthyroidism
58
``` 68 year old female tired weight gain slow goitre ``` diagnosis?
primary hypothyroidism
59
``` 68 year old female FHx of thyroid disease tired goitre TSH high T4 normal TPO high ``` diagnosis?
subclinical hypothyroidism
60
``` 52 year old male headache visual field defect dizzy and weak TSH low T4 low ``` diagnosis?
pituitary tumour causing secondary hypothyroidism

Endocrinology (31 decks)

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