PBL 6 - Hypothyroidism Flashcards

1
Q

Name the two hormones secreted by the cuboidal cells of the thyroid gland
follicles. No abbreviations

A

1) Triiodothyronine (T3)

2) Thyroxine (T4)

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2
Q

Name two consequences of hyperthyroidism on glucose metabolism.

A

Hyperthyroidism leads to Insulin resistance [1], mainly associated with increased
hepatic gluconeogenesis [1

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3
Q

Explain why the thyroid gland is enlarged in Hashimoto thyroiditis and why TSH
is elevated

A

Thyroid enlargement is induced by an inflammatory infiltrate of immunocytes that
replace the parenchyma and subsequent fibrosis [1]
Thyroid hormones have a negative feedback action on secretion of TSH by the
anterior pituitary Low plasma levels of T3 / T4 remove this ‘brake’ on TSH
production/release, resulting in high plasma levels of the hormone

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4
Q

What do coeliac disease and Hashimoto disease have in common?

A

They are both autoimmune disease [1].
Both involve CD4 T cells and B cells, producing auto-immune antibodies targeting
epithelial cells to undergo apoptosis/necrosis [1

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5
Q

) What treatment was Maria given and explain why it was probable the dose
would need adjusting. [

A

Hormone replacement therapy with thyroxine (tetraiodothyronine, T4), for life [1].
Normally patients started on low dose which is gradually increased [1], the aim
being to reverse S & S of hypothyroidism without causing predictable adverse
effects, especially cardiac [

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6
Q

What is TPO (thyroid peroxidase)

A

enzyme that oxidises iodide on tyrosine of thyroglobulin –> T3/T4 synthesis.

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7
Q

How are T3 and T4 stimulated

A

Hypothalamus secretes thyrotropin-releasing hormone –> AP secretes TSH –> Thyroid secreates triiodothyronine + thyroxine
= Negative feedback - too much T3 and T4 –> TRH inhibited

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8
Q

Effects of thyroid hormone

A

Increase BMR
Enhance fatty acid oxidation and mobilation
Thermogenesis
Insulin effects

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9
Q

How do thyroid hormones enhance FA oxidation and mobilisation

A

= Increases no LDL receptors
= Breaks down cholesterol
= Increases lipolysis –> removing triglycerides from chylomicrons and VLDL + depositing fat in tissue

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10
Q

How does thyroid hormone affect glucose metabolism

A

1) Synergistic with insulin - increases uptake of glucose via GLUT4 upregulation in muscles
2) Opposes insulin in the liver- gluconeogenesis/glycogenolysis in liver

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11
Q

How does TH increase thermogenesis

A

Increases uncoupling by increasing capacity to do more oxidative phosphorylation by increasing the no of mitochondria

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12
Q

TH effects on cardiac myocytes

A

Increase contractility by increasing no of beta adrenergic receptors

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13
Q

Symptoms of hypothyroidism

Skin, CV, GI, Nerves, renal, endocrine

A

= Myxoedema, brittle nails, hair falls out, wounds heal slowly
= reduced cutaneous circulation, sensitivity to cold, sinus bradyacrdia,LDL cholesterol up
= Reduced appetite, weight gain, constipation
= Hyponatraemia
= Decreased GLUT 4 stimulation, reduced libido

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14
Q

What is cretinism

A

Congenital hypothyroidism

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15
Q

What is hashimotos syndrome

A

Autoimmune disease where the thyroid gland is gradually destroyed

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16
Q

What are autoantibodies against in hashimotos

A

= Thyroid peroxidase, thyroglobulin, TSH receptors

17
Q

How can you diagnose hashimotos

A

Elevated TPO antibodies

18
Q

Why does a goitre form

A

Low thyroxine –> Stimulates TSH (Type IV hs)
Hypertrophy/hyperplasia of epithelial cells of follicles
Increased colloid accumulation
Lymphoid filtration + accumulation –> inflammatory cytokines attract more immunocytes –> replace parenchyma –> fibrosis of gland

19
Q

Cause of goitre

A

Hashimotos

I2 deficiency

20
Q

Diagnosis + ant Tx of hypothyroidism

A

High TSH
Low t4
Give levothyroxine or Iiothyronine

21
Q

Hyperthyroidism symptoms

A

Weight loss
intolerance to heat
bone reabsorption
tachycardia
Insulin resistance - hepatic gluconeogenesis
Decreased levels of LDL, ApoB, total cholesterol

22
Q

Why does the pt have high TSH

A

Due to positive feedback, low TH would increase the anterior pituitary to release more TSH to compensate for the hypothyroidism

23
Q

Why high HbA1c in pt

A
  • TH oppose insulin so increase blood sugar by increasing hepatic gluconeogenesis, glycogenolysis (in liver) Work with insulin in muscle, there is insulin resistance and TH dec GLUT4
24
Q

Why high LDL cholesterol

A

• Need TH to regulate lipoprotein lipase needed to remove triglycerides from chylomicrons and VLDL as well as depositing fat in adipose → Patient has a lack of TH→ Increase in LDL cholesterol

25
Q

Why patient weight gain

A

Decreased BMR

Doesnt burn as many calories per day

26
Q

Why memory loss in pt

A

lack of TH slows down neural processes (brain depends on glucose, glucose metabolism affected by low TH)

27
Q

Why does the pt feel cold

A

– Decreased BMR due to lack of TH production, less uncoupling –> less thermogenesis

28
Q

How is levothyroxine given

A

Orally or via IV

29
Q

Long term use of levothyroxine

A

Hyperthyroidism, cardiac failure, angina

30
Q

Why can levothyroxine not be used as a diet pill

A

Only help to lose weight if you have hypothyroidism

Can be toxic as can cause hypertension in normal people - sweating, angina, cardiac failure, dysrhythmias

31
Q

What can trigger hypothalamus to produce TRH

A

Cold
Acute psychosis
Circaidian rhythm

Severe stress can inhibit

32
Q

In cells, what receptors do thyroid hormones interact with

A

Neuclear

33
Q

What are HbA1c levels

A

Measure of glycosation of haemoglobin over past 3 months if high