Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Endocrinology > Lec8 - Thyroid Disease > Flashcards

Lec8 - Thyroid Disease Flashcards

1
Q

What is hypothyroidism?

A

An underproduction of thyroid hormone

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

What are the two main types of hypothyroidism?

A

Primary hypothyroidism

Secondary hypothyroidism

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

What is Primary hypothyroidism?

A

A problem with the thyroid gland itself

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

What is Secondary hypothyroidism?

A

A problem with the hypothalamus or pituitary leading to the thyroid gland being unable to function properly

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

What is hyPERthyroidism?

A

An overproduction of thyroid hormone

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

What else is hyperthyroidism known as?

A

Thyrotoxicosis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

What is goitre?

A

An enlargement of the thyroid gland

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

What does euthyroid mean?

A

Normal production of thyroid hormone

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Where is the thyroid gland?

A

Low in the neck, feel for the thyroid cartilage/ Adam’s apple and then inferior and laterally

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

What is a good sign of hyperthyroidism?

A

A bruit

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

What is a bruit?

A

A sound that is heard when the blood passing the thyroid is in some way obstructed

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

What is retrosternal extension/ goitre?

A

When the thyroid has moved down inferiorly from where it should be and now lies atop of the sternum

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

How can you tell if there is retrosternal extension?

A

If you can feel under the thyroid gland OR

if you percuss the sternum and get a dull sound

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

What do you check in thyroid function tests (TFTs)?

A 
Levels of:
TSH 
T3
T4 
Thyroid autoantibodies e.g. thyroid peroxidase auto-antibody (anti TPO AB)
TSH receptor autoantibody (TRAB)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

What is the best biomarker of thyroid status?

A

TSH

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

How else can you assess thyroid function?

A

By looking at a graph of density (y axis) against the TSH microlitreU/ml)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

What do you look for in the curve?

A

The shape of the area under the curve - if there is a tail from 3 onwards

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

If there is a tail in the curve from 3 onwards, what does this mean?

A

There there is an increased frequency of thyroid autoantibodies

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

What is the significance of the presence of autoantibodies

A

Likely to indicate autoimmune disease

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

If there is a negative autoAB result what does this mean?

A

It does not necessarily exclude autoimmune disease - they could still have an autoimmune disease
The presence of autoAB makes it easier to confirm the diagnosis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

Name the two types of thyroid autoAB:

A

Destructive autoAB

Stimulatory autoAB

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

What do destructive autoABs do?

A

They target the thyroid for autoimmune destruction and therefore cause hypothyroidism

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

What do stimulatory autoABs do?

A

They stimulate the TSH receptor and cause an overproduction of thyroid hormone

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

What are the symptoms of HYPOTHYROIDISM?

A 
Lethargy 
Mild weight gain 
Cold intolerance 
Constipation
Facial puffiness
Dry skin
Hair loss
Hoarseness
Heavy menstrual periods
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

What are the symptoms of severe HYPOTHYROIDISM?

A 
Change in appearance e.g. of the face 
Puffy and Pale 
Periorbital Oedema 
Bradycardia
Carpal tunnel i.e. signs of median nerve compression
Croaky voice 
Diffuse hair loss
Dry flaking skin
Effusions e.g. ascites, pericardial 
Goitre

Rarely: Coma/stupor

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

Causes of primary hypothyroidism

A 
Autoimmune hypothyroidism
Congenital hypothyroidism
Drugs e.g. lithium & amiodarone
Iatrogenic - after treatment for hyperthyroidism 
Iodine deficiency (not in the UK)
Thyroiditis
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
27
Q

What is the typical thyroid status of someone with primary hypothyroidism (thyroid dysfunction)?

A

HIGH TSH, Low T3, T4

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
28
Q

What is the typical thyroid status of someone with secondary hypothyroidism?

A

LOW TSH, Low T3, T4

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
29
Q

What investigations would you do for someone who came in with symptoms matching hypothyroidism?

A

Thyroid TFTs - TSH T3 and T4
Could also check thyroid autoantibodies
No imaging necessary

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
30
Q

What would be the treatment for primary hypothyroidism?

A

Thyroxine T4
Normal dose = 100-150micrograms a day
(depending on body weight and if they are elderly or have IHD then start with 25mcg daily with increments 4-6 weekly
Aim for normal FT4 without TSH suppression

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
31
Q

Why don’t you administer both T3 and T4?

A

Because T4 is converted to T3 in the target tissues anyway and there is no evidence to suggest that combination therapy works

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
32
Q

Name the types of AUTOIMMUNE HYPOTHYROIDISM

A

Chronic autoimmune thyroiditis/ Hashimoto’s disease

Myxoedema

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
33
Q

What is Hashimoto’s disease or chronic autoimmune thyroiditis?

A

Autoimmune disease causing hypothyroidism
with a goitre
with lymphocytic infiltration

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
34
Q

What is a myxoedema?

A

accumulation of glycosaminoglycans in the interstitial spaces of tissues causing very severe hypothyroidism (any cause) and coma

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
35
Q

What are the symptoms of thyrotoxicosis/hyperthyroidism?

A 
Anxiety/ irritability
Heat intolerance  
Increased sweating
Increased appetite 
Lack of energy
Loose bowels
Oligomenorrhoea
Palpitations driven into arrhythmia 
Pruritus
Thirst 
Weight loss with increased appetite 
Weight gain
36
Q

What are the signs of thyrotoxicosis?

A 
Atrial fibrillation
Brisk reflexes
Eye signs 
Muscle weakness
Tachycardia
Tremor
Thyroid bruit 
Warm, moist skin
37
Q

What is Thyroid Eye Disease (TED)?

A

Inflammation of all the tissues surrounding the eye except the eye itself e.g. fat, conjunctiva, muscles, eyelids

38
Q

What is another name for TED?

A

Thyroid Associated Ophthalmopathy (TAO)

39
Q

What is TED/TAO associated with?

A

Autoimmune hyperthyroidism e.g. Grave’s disease

20% puts with Grave’s have TED but not always at the same time or even at all

40
Q

What is an increased risk of TED?

A

Smoking

41
Q

What are the ‘mild’ symptoms of TED?

A

Dry or itchy eyes - artificial tears help

Prominent eyes/ change in appearance

42
Q

What are the worrisome symptoms of TED?

A 
Diplopia/ loss of sight 
loss of colour vision - grey or blurred patches 
Redness/ swelling of conjunctiva 
Unable to close eyes fully 
Ache/ pain/ tightness in or behind eye
43
Q

What is one way of confirming TED?

A

T2 weight MRI with STIR sequencing shows the inflammatory activity of the extra ocular muscles

44
Q

What are the hand signs associated with thyrotoxicosis?

A

Fine tremor

Warm/ sweaty hands

45
Q

What are the pulse signs of thyrotoxicosis?

A

Sinus tachycardia

Atrial fibrillation

46
Q

What are the neck signs of thyrotoxicosis?

A

Goitre
Movement when swelling
Smooth/ not
Bruit/ not

47
Q

Eye signs of thyrotoxicosis

A

Eyelid retraction/ lag
Proptosis/ exopthalmos
Opthalmoplegia - abnormal eye movements causing diplopia
Inflammation of the conjunctiva

48
Q

What is autoimmune hyperthyroidism also known as?

A

Grave’s disease

49
Q

What is the pathophysiology of Grave’s disease?

A

The autoantibodies stimulate the TSH receptor causing overproduction of the thyroid hormone and thyroid growth (goitre)

50
Q

How common is Grave’s?

A

Accounts for 75% of cases

51
Q

Who does it often effect?

A

Women between 30-50

52
Q

What are the other causes of thyrotoxicosis?

A

Toxic multinodular goitre
Toxic adenoma - single cancerous nodule
Thyroiditis
Drugs e.g. amiodarone

53
Q

Gestational thyrotoxicosis

A

Placental human chorionic gonadotrophin hormone is structurally similar to TSH and has TSH-like action on the thyroid
Increased if hyperemesis/twin pregnancy
Usually settles after 1st trimester of pregnancy

54
Q

What are the helpful diagnostic features of Grave’s disease?

A

Personal/ FHx of Grave’s disease
Goitre with a bruit
Thyroid eye disease (20% Grave’s disease)
Positive thyroid autoantibody titre

55
Q

When is Grave’s more common and more likely?

A

If the pt also has another autoimmune disease

56
Q

What type of imaging can you do?

A

Thyroid uptake scan (uptake scan)

Functional scan: darker areas of increased activity

57
Q

What are the types of treatment options for Grave’s disease?

A 
Medical
Radioiodine (radiation therapy)
Surgery 
Symptom control - Beta blockers e.g. propanolol
No treatment
58
Q

What is the medical treatment for Grave’s

A

Carbimazole or propylthiouracil (PTU)
18 months to 2 year
Titrate or block replace

59
Q

What is a rare side effect of carbimazole and propylthiouracil?

A

Agranulocytosis

60
Q

What is the long term cure rate with medical treatment of Grave’s?

A

1/3

61
Q

What is the relapse rate with medical treatment of Grave’s?

A

2/3 - usually within the first year

62
Q

What is radio iodine treatment?

A

Oral treatment with radio iodine concentrated in the thyroid
The radiation kills the thyroid cells

63
Q

What do you have to ensure before radio iodine therapy?

A

That the pt is euthyroid with medical therapy

64
Q

What are the precautions that need to be taken?

A

Pt need to are not to try for children for 6 months if women 4 months if man
Not to be given if pregnant or breast feeding
Not to be given if there is severe thyroid eye disease
Warn pt about airplane security systems
Need to avoid close contact with others for 1-2 weeks post treatment - tricky with young kids

65
Q

What is the risk of radio iodine treatment?

A

40% chance of permanent hypothyroidism after treatment

66
Q

What is the surgery treatment for Grave’s?

A

Thyroidectomy - almost total

67
Q

What must be ensured before pts have thyroidectomy?

A

That they are euthyroid from medical treatment first

68
Q

What is the risk of surgery

A 
The neck scar
Anaesthetic 
Hypoparathyroidism
Hypothyroidism
Vocal cord palsy - from recurrent laryngeal nerve damage
69
Q

What is the treatment for a toxic adenoma or toxic multi nodular goitre?

A

Short term medical therapy

Subsequent curative therapy e.g. radioiodine

70
Q

What must patients know about treatments for thyroid?

A

They do not help eye disease

71
Q

What are the TED treatment options?

A

Active

Burnt out

72
Q

What are the active TED treatment options?

A

Encourage smoking cessation
Steroids - IV methylpred or oral prednisolone
Other immunosuppressive/ steroid sparing agents
Radiotherapy

73
Q

What are the burnt out TED treatment options

A

Surgery
Orbital decompression
Eyelid surgery

74
Q

What are the risks of surgery for TED?

A

May be left with disfigurement leading to impaired quality of life and social avoidance

75
Q

What is a thyroid storm?

A

A thyrotoxicosis crisis

76
Q

Who usually gets it?

A

Usually people with secondary Grave’s

77
Q

Why do people get it?

A

If their hyperthryoidism is unrecognised and untreated or incompletely treated

78
Q

What triggers a thyroid storm?

A

Surgery - GA
Childbirth
Acute severe illness e.g. infection, DKA, trauma, stroke, PE

79
Q

What does a thyroid storm involve?

A 
Multi system 
Hyperpyrexia 
CNS - delirium/ agitation
CArdiovascular - tachycardia, atrial dysrhythmias, ventricular dysfunction, heart failure 
GI - nausea and vomiting
80
Q

What can a thyroid storm result in?

A

Because the degree of elevation of thyroid hormone concentration does not distinguish uncomplicated thyrotoxicosis from thyroid storm
High mortality rate
ITU level care

81
Q

What is the risk of not treating thyrotoxicosis?

A

Symptoms worsening
Atrial fibrillation
Stroke
Osteoporosis - Fractures

82
Q

What is thyroiditis

A

Usually self limiting thyroid disease

83
Q

What is transient mild thyrotoxicosis?

A

Always resolves in 1-2months
Beta blockers if required
Anti thyroid drugs won’t work but if lasts 4-6 months may require thyroxine treatment

84
Q

Associations of autoimmune disease with other diseases:

A 
Other autoimmune endocrine disease 
e.g. 
Type 1 diabetes
Pernicious anaemia 
Coeliac disease 
Premature ovarian failure 
Addison's disease

Syndromes
Turner syndrome
Downs syndrome

85
Q

What medications are associated with thyroid disease?

A

Hypothyroidism:
Lithium - inhibits thyroid hormone synthesis and secretion
Hypothyroidism and hyperthyroidism:
Amiodarone

Endocrinology (11 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions