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BDS2 BAMS > Pituitary and thyroid disease > Flashcards

Pituitary and thyroid disease Flashcards

1
Q

What is endocrine disease?

A
  • Dysfunction of hormone secreting gland
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2
Q

What are the primary and secondary causes of endocrine disease?

A

Primary = GLAND failure (gland cannot make)

Secondary = CONTROL failure (gland can make but is not being asked to)

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3
Q

Do endocrine diseases have widespread, multisystem effect?

A
  • Yes
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4
Q

what does MEN stand for?

A
  • Multiple endocrine neoplasia
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5
Q

What does MEN 1 affect? (3 points)

A
  • Parathyroid, Pancreatic Islets, Pituitary (anterior)
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6
Q

What are the associated tumours with MEN 1? (3 points)

A
  • Adrenal cortex, Carcinoid, Lipoma
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7
Q

What does MEN 2a affect? (3 points)

A
  • Parathyroid
  • Medullary thyroid
  • Phaeochromocytoma
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8
Q

What does MEN 2b affect? (4 points)

A
  • MEdullary thyroid
  • Phaeochromocytoma
  • Mucosal neuromas (lump on nerve, on oral mucosa and tongue)
  • Marfanoid appearance
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9
Q

What is Phaeochromocytoma?

A
  • A tumour originating in cells of the adrenal gland that causes overproduction of certain hormones
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10
Q

What is Marfan syndrome?

A

A disorder of the body’s connective tissue, a group of tissues that maintain the structure of the body and support internal organs and other tissues

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11
Q

What does the pituitary do? (2 points)

A
  • Control of many gland activities

- Hypothalamic control - releasing hormones

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12
Q

How is endocrine disease regulated?

A

Negative feedback regulation

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13
Q

What hormones are secreted by the anterior pituitary? (6 points)

A
  • TSH (thyroid stimulating hormone)
  • ACTH (adrenocorticotrophic hormone)
  • GH (growth hormone)
  • LH
  • FSH
  • Prolactin
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14
Q

What does ACTH stand for?

A
  • Adrenocorticotrophic hormone
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15
Q

What hormones are secreted by the posterior pituitary? (2 points)

A
  • ADH (Anti-diuretic hormone for diabetes insipidus)

- Oxytocin

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16
Q

Why are pituitary tumours usually caused by?

A
  • Dysfunction from adenomas
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17
Q

Which hormones tend to be secreted in excess in a patient who is <40 and has a functional adenoma? (2 points)

A
  • Prolactin
  • ACTH

(Amenorrhoea-Galctorrhoea syndrome or Cushing’s syndrome)

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18
Q

What is Amenorrhoea-Galactorrhoea syndrome?

A

Unphysiological lactation of endocrinological origin or caused by a pituitary tumour

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19
Q

Which hormone tends to be secreted in excess in a patient who is >40 and has a functional adenoma? (2 points)

A
  • Growth hormone

- Acromegaly

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20
Q

What is acromegaly?

A
  • A rare condition resulting from excessive production of growth hormone by the pituitary gland
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21
Q

What does a non functional (space occupying) adenoma cause in patients over the age of 60? (2 points)

A
  • Visual field defects

- Other hormone deficiencies

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22
Q

What is the Sella Turcica?

A
  • A depression on the upper surface of the Sphenoid bone, lodging the pituitary gland
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23
Q

What is trans-sphenoidal surgery?

A

A surgical instrument is placed through the nostril and alongside the nasal septum to access the pituitary tumour

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24
Q

What does insufficient growth hormone in children cause?

A

Growth failure (reduced height - correct proportions but small)

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25
Q

What does insufficient growth hormone in adults cause? (2 points)

A

Metabolic changes in adults:

  • Increased fat
  • Reduced vitality
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26
Q

What does excessive growth hormone cause in children?

A
  • ‘Gigantism’
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27
Q

What does excess growth hormone case in adults?

A
  • Acromegaly
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28
Q

What is acromegaly?

A
  • A rare condition where the body produces too much growth hormone, causing body tissues and bones to grow more quickly
  • Over time, this leads to abnormally large hands and feet and a wide range of other symptoms
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29
Q

What do you measure to assess growth hormone?

A
  • Measure IGF-1 (Insulin-like growth factor 1)
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30
Q

Acromegaly has insidious onset. What does this mean?

A
  • It has a gradual or subtle development
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31
Q

At what age range is there a peak incidence of acromegaly?

A
  • 30-50 years of age (can take 10-15 years till changes are obvious enough)
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32
Q

What can acromegaly be caused by?

A

A benign pituitary tumour - MEN-1 a possibility

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33
Q

What are common features of acromegaly? (6 points)

A
  • Coarse features
  • Enlarged supra-orbital ridges
  • Broad nose, thickened lips & soft tissues
  • Enlarged hands (carpal tunnel syndrome, finger numbness)
  • Type 2 diabetes mellitus (insulin resistance from increased GH)
  • CV disease (Ischaemic heart disease, acromegalic cardiomyopathy)
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34
Q

What are possible intraoral changes of a person with acrom egaly? (4 points)

A
  • Enlarged tongue
  • Interdental spacing
  • ‘shrunk’ dentures
  • Reverse overbite
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35
Q

Acromegaly can give a patient visual field defects. Which cranial nerves can have possible palsies as well? (3 points)

A

III, IV, VI

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36
Q

One possible feature of acromegaly is hyperprolactinaemia. What is this?

A

Higher than normal levels of prolactin in the body

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37
Q

Is one possible feature of acromegaly hypopituitarism?

A
  • Yes
38
Q

Is primary hyperthyroidism by a gland common or rar e?

A

Common

39
Q

Is secondary hyperthyroidism as a result of loss of control of the process common or rare?

A

Rare

40
Q

What is another word for hypothyroidism?

A

Myxoedema

41
Q

Is the primary cause of hypothyroidism common or rare?

A

Common

42
Q

Is the secondary cause of hypothyroidism common or rare?

A
  • Less common than primary cause
43
Q

What is Grave’s disease a form of?

A

Hyperthyroidism - 70%-80% of cases

  • Autoantibodies stimulating the TSH receptor
44
Q

What are 2 things that can cause hyperthyroidism?

A
  • Toxic multi-nodular goitre

- Toxic adenoma

45
Q

Can a pituitary tumour cause hyperthyroidism?

A
  • Yes but this is rare (it is a secondary problem)
46
Q

What is an effect of hyperthyroidism?

A

Increased metabolism

47
Q

What are common symptoms of hyperthyroidism? (8 points)

A
  • Hot & excess sweating
  • Weight loss
  • Diarrhoea
  • Palpitations
  • Muscle weakness
  • Irritable, manic, anxious
48
Q

What are common signs of hyperthyroidism? (5 points)

A
  • Warm moist skin
  • Tachycardia & atrial fibrillation
  • Increased BP & heart failure
  • Tremor & hypeerflexia
  • Eyelid retraction & lid lag
49
Q

If someone has Grave’s disease what do they usually have a family history of?

A
  • Usually family history of autoimmune disease

- Vitiligo, PA, Type 1 DM, Coeliac, Myaesthenia gravis (if have one - more likely to have another)

50
Q

Grave’s disease can cause ophthalmopathy. What is this?

A

Ocular changes:

  • Scleral injection
  • Proptosis
  • Periorbital oedema
51
Q

Grave’s disease can cause conjunctival oedema. What is another name for this and what is it?

A
  • Chemosis

- Type of inflammation which occurs in the inner lining of the eyelid

52
Q

What is scleral injection?

A

Red eyes, caused by enlarged, dilated blood vessels

53
Q

What is proptosis?

A

Forward displacement or bulging of the eye

54
Q

What is periorbital oedema?

A

Swelling in the area around the eyes

55
Q

What are possible primary causes of hypothyroidism? (6 points)

A
  • Autoimmune (Hashimoto’s) thyroiditis (90% of cases)
  • Idiopathic atrophy
  • Radioiodine treatment/thyroidectomy surgery
  • Iodine deficiency
  • Drugs (carbimazole, amiodarone, lithium)
  • Congenital
56
Q

What are possible secondary causes of hypothyroidism?

A
  • Hypothalamic/pituitary disease
57
Q

What effect does hypothyroidism have on the metabolism?

A
  • Redced metabolism
58
Q

What are common symptoms of hypothyroidism? (6 points)

A
  • Tired
  • Cold intolerance, weight gain, constipation
  • Hoarse voice, goitre, puffed face & extremities
  • Angina
  • ‘slow’, poor memory
  • Hair loss (common lateral 1/3 of eyebrow)
59
Q

What are common signs of hypothyroidism? (5 points)

A
  • Dry course skin
  • Bradycardia, hyperlipidaemia
  • Psychiatric or confusion
  • Goitre (Hashimoto’s)
  • Delayed reflexes
60
Q

What age group and gender is usually affected by Hashimoto’s Thyroiditis?

A
  • Middle aged and elderly women
61
Q

What are the presenting features of Hashimoto’s disease? (2 points)

A
  • Goitre

- Hypothyroid features

62
Q

What is Hashimoto’s Thyroiditis associated with? (2 points)

A
  • Often a family history of autoimmune disease
  • Vitiligo, PA, Type 1 DM, Addison’s disease
  • Downs syndrome
63
Q

Is idiopathic atrophy more likely in males or females?

A

10x more likely in females

64
Q

Does idiopathic atrophy incidence increase or decrease with age?

A

Increases

65
Q

Idiopathic atrophy is likely an autoimmune cause. What dies this mean (2 points)

A
  • Lymphocyte infiltrate

- Associated with organ specific autoimmune disease

66
Q

How can you investigate thyroid disease via the blood?

A

By testing for TSH, T3 and T4

67
Q

How can you investigate for thyroid disease via imaging? (2 points)

A
  • Ultrasound scan (cysts)

- Radioisotope scans - gland uptake

68
Q

How can you investigate for thyroid disease via tissues? (2 points)

A
  • Fine needle aspirate/biopsy (FNA & FNB)
69
Q

In hyperthyroid disease caused by a pituitary cause (rarer). What will the levels of TSH and T3 be?

A
  • Raised TSH

- Raised T3

70
Q

In hyperthyroid disease caused by a Grave’s or an adenoma (Common). What will the levels of TSH and T3 be?

A
  • Low TSH
  • Raised T3

(as autoantibody signalling)

71
Q

In hypothyroid disease caused by a pituitary cause rarer). What will the levels of TSH and T4 be?

A
  • Low TSH

- Low T4

72
Q

In hypothyroid disease caused by gland failure (common). What will the levels of TSH and T4 be?

A
  • High TSH

- Low T4

73
Q

What are 2 drugs that can be used to treat hyperthyroidism?

A
  • Carbimazole (titration, block and replace - T4 as required)
  • Beta-blockers
74
Q

Radioiodine can be used to treat hyperthyroidism. What is the problem with this?

A
  • There is a hypothyroidism risk with time - review
75
Q

What surgery option can be used to treat hyperthyroidism?

A
  • Partial thyroidectomy

- Usually follows drug therapy to stabilise it

76
Q

How can we treat Grave’s ophthalmopathy?

A

-none/simple measures

77
Q

What is the treatment method for hypothyroidism? (3 points)

A
  • Give T4 tablets (thyroxine) - slow response - weeks
  • Increase dose slowly - IHD
  • Recheck using TSH as a guide if gland failure
78
Q

How does Goitre cause Thyroid enlargement? (4 points)

A
  • Diffuse enlargement of the thyroid gland
  • Often iodine deficient
  • Diffuse, nodular
  • Drug related?
79
Q

How does Solitary nodule enlargement cause Thyroid enlargement? (2 points)

A
  • Adenoma, carcinoma, cyst formation possible

- Low cancer risk - suspicious in children or elderly

80
Q

Is there usually thyroid swelling when someone has thyroid cancer?

A
  • Yes
81
Q

What is thyroid cancer like in children?

A

Papillary (80%) or follicular in children

82
Q

What is thyroid cancer like in adults?

A
  • Undifferentiated in the elderly
83
Q

What are the nodules like on radioisotope scans of thyroid cancer?

A

‘cold’

84
Q

People with thyroid cancer are often TSH sensitive. What should they be given post surgery?

A

T4

85
Q

What is the prognosis of thyroid cancer in the young?

A
  • Generally good
  • 5% 10 year mortality in papillary BUT
  • 80% 10 year mortality in follicular
86
Q

Is Goitre detectible to a dentist?

A

yes - if find it in an exam refer to GP immediately

87
Q

How can patients with hyperthyroidism present in a dental setting?

A
  • Pain, anxiety and psychiatric problems
88
Q

Should you do dental treatment on patients who have untreated hyperthyroid?

A
  • Caution for treatment until controlled

- Can do emergency treatment whilst waiting to settle

89
Q

What should a dentist avoid the use of if a patient had severe (untreated) hyperthyroidism?

A

Avoid sedatives

90
Q

If a patient has a thyroid problem but are on the correct treatment, should they be treated any different to a normal patient?

A
  • No, they are normal

BDS2 BAMS (57 decks)

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