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Hospital Based Medicine And Surgery > L08: Thyroid Disease > Flashcards

L08: Thyroid Disease Flashcards

1
Q

What is the commonest hormone made in the thyroid gland

A

T4

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2
Q

What is the least common thyroid hormone

A

T3

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3
Q

What happens to t4

A

Becomes converted in the liver, kidney and thyroid into t3

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4
Q

What is the thyroid homeostasis

A
  1. Hypothalamus produced trh
  2. Trh acts on the pituitary gland to release tsh
  3. Tsh acts on the thyroid gland to produce t3 and t4
  4. When there is sufficient t3 and t4, this feedback negatively to the pituitary gland and hypothalamus to stop production of trh and tsh
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5
Q

What is primary hyperthyroidism

A

When there is high levels of t3 and t4, and low levels of tsh from the pituitary gland as it trying to decrease the amount

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6
Q

What is primary hypothyroidism

A

Low levels of t3 and t4 and high levels of tsh as its trying to stimulate the production of t3 and t4

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7
Q

What are the symptoms of primary hyperthyroidism

A 
Nervousness
Sweating
Palpitations
Weight loss
Increased appetite
Diarrhoea 
Eye signs

Everything in the body going fast

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8
Q

What are the causes of hyperthyroidism

A

Graves’ disease
Toxic Nodular goitre
Thyroiditis
Iodine induced

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9
Q

What investigations can be carried out in thyroid disease

A

Levels of free t3,4
TSH levels
Autoantibodies: thyroid peroxidase, TRAb (receptor antibodies)

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10
Q

What is Graves’ disease

A

An autoimmune disease that is common in females due to antibodies to tsh receptor thereby prevent tsh from doing its job

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11
Q

What are the 2 actions of antibodies

A

Stimulate the thyroid gland- hyperthyroidism

Inhibits the thyroid gland- hypothyroidism

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12
Q

What are the symptoms of Graves’ disease

A 
Exophthalmos 
Dermopathy (skin changes)
Diplopia 
Changes in vision 
Inability to close eyes
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13
Q

What is toxic Nodular goitre

A
  1. When there is an increased tsh drive which causes thyroid growth and formation of nodules
  2. The thyroid gland works on its own
  3. With time thyroid hormone increases
  4. In areas of thyroid deficiency, the thyroid is forced to make more t3 than t4 which results in t3 thyrotoxicosis
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14
Q

Where is toxic Nodular goitre common

A

In areas of iodine deficiency

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15
Q

What is the treatment of thyrotoxicosis

A

Destruction of thryoid tissue with radio iodine
Anti thyroid drugs e.g carbimazole
Surgical ablation

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16
Q

What is the treatment for Graves’ disease

A

Prolonged carbimazole

Radio iodine

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17
Q

In toxic Nodular goitre are there positive antibodies

A

No

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18
Q

What are the 2 main anti thyroid drugs

A

Carbimazole

Propylthiouracil

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19
Q

How do anti thyroid drugs work

A

Block the iodine uptake and organificaiton

20
Q

When can beta blockers be used

A

For symptomatic release due to everything going too fast

21
Q

What is the mechanism of action of radioactive iodine

A

Radioactive iodine gets taken up by the thyroid cells and causes follicular cell destruction

22
Q

What are the complications of surgery

A

Hypothyroidism
Haemmorhage
Recurrent laryngeal nerve palsy
Hypocalcaemia

23
Q

What is thyroditis

A

Temporary overactive thyroid gland

24
Q

How is thyroditis diagnosed

A

History of pain
Family history
Thyroid function is fast and has no antibodies
Radionuclides scan shows no uptake into the thyroid

25
Q

What is the treatment of thyroditis

A

Beta blockers: to relieve symptoms

Prednisolone (if very symptomatic)

26
Q

What is post partum thyroditis

A

Thyroditis seen after pregnancy, usually common in underlying auto immune thyroid disease

27
Q

What is the 2 phases seen in thyroditis

A
  1. Hyperthyroid phase

2. Hypothyroid phase

28
Q

What is iodine induced thyrotoxicosis

A

when there is an idoine load there will be a drive in t3 and t4

29
Q

What are the causes of hypothyroidism

A

Autoimmune disease:

  • Hashimoto thyroiditis
  • atrophic thyroiditis

Loss of functional tissue:
- post surgery or radio-iodine

Thyroiditis:
- Viral or post partum

Drugs

Hypopituitarism

30
Q

What are the features of hypothyroidism

A 
Fatigue, weakness, cold intolerance, weight grain, constipation
Dry skin, edema, hoarseness
Decreased hearing
Myalgia
Depression

Everything slowing down

31
Q

What is hypothyrodism treated with

A

Levothyroxine

32
Q

What is a goitre

A

Enlarged thyroid gland

33
Q

What are the worries of goitre

A 
New apperance 
Solitary nodule
Recent changes to size and pain
Male patient 
Mid line nodule 
Obstructive symptoms
34
Q

What is the first line test for a goitre

A

Ultrasound

35
Q

If the apperance of the goitre is u3 beyond what is the next step

A

Fine needle aspiration

36
Q

What are the outcomes of fine needle aspiration

A

Papillary cancer

Colloid nodule

37
Q

What is the management of thyroid cancer

A

Surgery
Radioactive iodine
Levothyroxine to suppress the tsh

38
Q

What is non thryoidal illness

A

When people are sick they can have abnormal thyroid test i.e inhibition of t4 to t3 conversion to conserve energy

39
Q

What is levothyroxine

A

A synthetic t4 hormone

40
Q

What is the mechanism of action of carbamazole

A

Reducing the production of t3 and t4

41
Q

What are the 3 main anti thyroid autoantibodies

A

Anti thyroid peroxidase (anti-too):

  • hashimoto thyroditis
  • graves

Tsh receptor antibodies:
90-100% Graves’ disease

Thyroglobulin:
70% of hashimoto thyroditis
30% Graves’ disease

42
Q

What antibodies are common in hashimoto thyroditis

A

Anti thyroid peroxidase (TPO) and anti thyroglobulin

43
Q

What is the long term prognosis of patients with Graves’ disease

A

Majority experience recurrent episodes in the future
10-20% experience full remission
Less than 10% experience hypothyroidism

44
Q

What other condition is patient with Graves’ disease at risk of

A

Pernicious anaemia (another autoimmune condition)

45
Q

What is the best treatment for Graves’ disease

A

Carbimazole, dosed on a reducing regimen over 18 months

Hospital Based Medicine And Surgery (30 decks)

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