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endocrine > hypothyroidism > Flashcards

hypothyroidism Flashcards

1
Q

what is primary thyroid disease

A

disease affecting the thyroid gland itself

  • can occur with or without goitre
  • autoimmune usually
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2
Q

what is secondary hypothyroidism

A
  • hypothalamic or pituitary disease

- no thyroid gland pathology

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3
Q

what thyroid hormones can be measured

A
  • thyroid stimulating hormone (TSH)
  • free T4
  • free T3
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4
Q

what is the pathway of organs of the hypothalamic pituitary thyroid axis

A

hypothalamus > pituitary > thyroid > liver

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5
Q

hormone levels in primary hypothyroidism

A
  • free T3/4 low

- TSH high

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6
Q

hormone levels in primary hyperthyroidism

A
  • free T3/4 high

- TSH low

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7
Q

hormone levels in secondary hypothyroidism

A
  • free T3/4 low

- TSH low or normal

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8
Q

hormone levels in secondary hyperthyroidism

A
  • free T3/4 high

- TSH high or normal

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9
Q

what is hypothyroidism

A

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

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10
Q

what is myxoedema

A

severe hypothyroidism and is a medical emergency

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11
Q

what is pretibial myxoedema

A

rare clinical sign of Grave’s disease

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12
Q

goitrous causes of hypothyroidism

A
  • hashimoto’s
  • iodine deficiency
  • drug-induced
  • maternally transmitted
  • hereditary biosynthetic defects
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13
Q

non-goitrous causes of hypothyroidism

A
  • atrophic thyroiditis
  • post ablative therapy
  • post radiotherapy
  • congenital defects
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14
Q

self-limiting causes of hypothyroidism

A
  • withdrawal of antithyroid drugs
  • subacute thyroiditis
  • post-partum thyroiditis
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15
Q

secondary hypothyroidism causes

A

-infiltrative
-infectious
-malignant
-traumatic
-congenital
etc

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16
Q

what is the most common cause of hypothyroidism

A

hashimoto’s

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17
Q

what is hashimoto’s

A

autoimmune destruction of thyroid gland and reduced thyroid hormone destruction

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18
Q

what is hashimoto’s characterised by

A
  • antibodies against thyroid peroxidase

- T-cell infiltrate and inflammation microorganisms

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19
Q

clinical features of hypothyroidism

A
  • coarse, sparse hair
  • dull, expressionless face
  • periorbital puffiness
  • pale cool skin
  • vitiligo
  • hypercarotenaemia
  • cold intolerance
  • pitting oedema
  • hyperlipidaemia
  • decrease appetite
  • weight gain
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20
Q

cardiac features of hypothyroidism

A
  • reduced HR
  • cardiac dilatation
  • pericardial effusion
  • worsening of heart failure
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21
Q

GI features of hypothyroidism

A
  • constipation
  • megacolon and intestinal obstruction
  • ascites
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22
Q

resp features of hypothyoridism

A
  • deep hoarse voice
  • macroglossia
  • obstructive sleep apnoea
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23
Q

neurological features of hypothyroidism

A
  • decreased intellectual and motor activities
  • depression, psychosis
  • muscle stiffness, cramps
  • peripheral neuropathy
  • prolongation of tendon jerks
  • carpal tunnel syndrome
  • decreased visual acuity
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24
Q

gynae features of hypothyroidism

A
  • menorrhagia
  • later oligo- or amenorrhea
  • hyperprolactinaemia
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25
Q

antibodies present in hypothyroidism

A
  • anti TPO
  • anti thyroglobulin
  • TSH receptor antibody
26
Q

management of hypothyroidism

A

YOUNG
-start levothyroxine at 50-100 ug daily

OLD
-start levothyroxine at 25-50 ug daily, adjust every 4 weeks

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

27
Q

management for secondary hypothyroidism

A

titrate dose of levothyroxine to fT4 levels

28
Q

should thyroxine be taken after food?

A

no should be taken on an empty stomach

29
Q

what should be done to the dose of levothyroxine in pregnancy

A

increased by 25-50%

30
Q

who gets myxoedema coma

A

elderly women with long standing but frequently unrecognised or untreated hypothyroidism

31
Q

ECG findings of myxoedema coma

A
  • bradycardia
  • low voltage complexes
  • varying degrees of heart block
  • T wave inversion
  • prolongation of QT interval
32
Q

resp findings of myxoedema coma

A

type 2 respiratory failure

33
Q

how do you treat myxoedema coma

A
  • ABC
  • rewarm
  • cardiac monitoring
  • monitor urine output
  • broad spectrum antibiotics
  • thyroxine cautiously
34
Q

what is thyrotoxicosis

A

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

35
Q

what is hyperthyroidism

A

conditions in which overactivity of the thyroid leads to thyrotoxicosis

36
Q

cardiac symptoms of hyperthyroidism

A
  • palpitation , AF

- cardiac failure

37
Q

sympathetic symptoms of hyperthyroidism

A
  • tremor

- sweating

38
Q

CNS hyperthyroidism symptoms

A
  • anxiety
  • nervousness
  • irritability
  • sleep disturbances
39
Q

other symptoms of hyperthyroidism (GI, vision, hair, skin)

A
  • frequent loose bowel movements
  • lid retraction
  • double vision
  • proptosis
  • brittle thin hair
  • rapid fingernail growth
40
Q

reproductive symptoms of hyperthyroidism

A
  • menstrual cycle changes

- lighter bleeding and less frequent periods

41
Q

msk symptoms of hyperthyroidism

A

muscle weakness

-especially in thighs and upper arms

42
Q

metabolism symptoms of hyperthyroidism

A

weight loss despite increased appetite

43
Q

thermogenesis symptom of hyperthyroidism

A

intolerance to heat

44
Q

causes of hyperthyroidism

A
  • Graves disease
  • hashitoxicosis
  • thyrotropinoma
  • thyroid cancer
  • choriocarcinoma
  • thyroid nodules with autonomous function
  • thyroid inflammation
  • over treatment with levothyroxine
  • thyrotoxicosis factitia
  • metastatic thyroid carcinoma
45
Q

lab findings of Grave’s disease

A
  • decreased TSH

- increase free T4/3

46
Q

clinical signs specific to Grave’s disease

A
  • pretibial myxoedema
  • thyroid acropachy
  • thyroid bruit
  • Grave’s eye disease
47
Q

how is mild grave’s eye disease treated

A

topically with lubricants

48
Q

how is severe grave’s eye disease treated

A
  • steroids
  • radiotherapy
  • surgery
49
Q

who gets nodular thyroid disease

A

older patients

50
Q

tests for nodular thyroid disease

A
  • increase fT4/3
  • decrease TSH
  • high uptake of scintigraphy
  • thyroid US
  • antibody NEGATIVE (TRAb)
51
Q

what happens in thyroid storm

A
  • severe hyperthyroidism
  • resp and cardiac collapse
  • hyperthermia
  • exaggerated reflexes
  • typically seen in hyperthyroid patients with an acute infection/illness
52
Q

treatment for thyroid storm

A
  • Lugol’s iodine
  • glucocorticoids
  • PTU
  • beta blockers
  • fluids
  • monitoring
53
Q

treatment for hyperthyroidism

A

carbimazole
-1st line, once daily

Beta blockers
-propanolol

prophylthiouracil
-1st line only in 1st trimester of pregnancy, twice daily

Radioiodine

  • 1st choice for relapse of Grave’s disease and nodular thyroid disease
  • contraindicated in pregnancy
54
Q

side effect of Carbimazole

A

risk of aplasia cutis in early pregnancy

55
Q

Grave’s disease treatment

A

Carbimazole for 4-8 weeksOnce the patient has normal thyroid hormone levels, they continue on maintenance carbimazole and either:

  • The dose is carefully titrated to maintain normal levels (known as “titration-block”)
  • The dose is sufficient to block all production and the patient takes levothyroxine titrated to effect (known as “block and replace”)
56
Q

side effects of ATDs

A
  • cholestatic jaundice
  • rash, urticaria
  • fulminant hepatic failure
  • agranulocytosis (life threatening blood disorder)
57
Q

causes of thyroiditis

A
  • Hashimoto’s
  • De Quervain’s
  • post partum
  • drug induced
  • radiation
  • acute suppurative thyroiditis
58
Q

subacute thyroiditis trigger and symptoms

A
  • triggered by viral infection
  • neck tenderness
  • fever
  • other viral symptoms
59
Q

what is subclinical thyroid disease

A

abnormal TSH with normal thyroid hormone levels

60
Q

when is treatment advised in subclinical hypothyroidism

A

when TSH is >10

61
Q

when is treatment advised in subclinical hyperthyroidism

A

if TSH < 0.1

62
Q

what are non-thyroidal issues

A

refers to the impact of intercurrent illness (e.g. infection) on the HPT axis
-TSH typically suppressed initially then rises during recovery

endocrine (40 decks)

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