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MEH * > S11 Thyroid Disorders > Flashcards

S11 Thyroid Disorders Flashcards

1
Q

What is the importance of the pre-tracheal fascia?

A

Means the thyroid moves on swallowing, so if want to know if something is someone’s thyroid, ask them to swallow

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2
Q

What do thyroid hormones control?

A

Metabolic rate

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3
Q

What systems are affected in the body by thyroid hormone?

A
  • energy
  • weight
  • temperature
  • heart rate
  • nervous system
  • GI system
  • musculoskeletal
  • skin
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4
Q

In primary hypothyroidism, what do you measure in an investigation? What will the levels be?

A

Free T4 and TSH

T4 will be low, TSH will be high

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5
Q

In primary hyperthyroidism, what do you measure in an investigation? What will the levels be?

A

Free T4 and TSH

T4 low, TSH high

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6
Q

When can you feel the thyroid?

A

Only when it’s enlarged

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7
Q

How can you use imaging to see the thyroid?

A
  • ultrasound
  • radioisotope scan
  • CT can
  • plain x-ray scan
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8
Q

When do you know of someone has hyperthyroidism looking at radioisotope scans?

A

There will be a hot nodule
Toxic multinodular goitre - causing thyrotoxicosis
Lingual thyroid (hot nodule in neck/tongue)

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9
Q

What are symptoms of hypothyroidism?

A
  • tiredness
  • weight gain
  • cold intolerance
  • change in appearance
  • depression
  • psychosis
  • joint/muscle ache
  • dry hair and skin
  • constipation
  • puffy eyes
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10
Q

What are signs of hypothyroidism?

A
  • peri-orbital oedema
  • ‘peaches and cream’ skin colour
  • loss of eyebrows
  • dry, thin hair
  • bradycardia
  • slow-relaxing reflexes
  • carpal tunnel syndrome - oedema, etc causes median nerve compression
  • cold peripheries
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11
Q

What can cause hypothyroidism?

A
  • autoimmune strophic
  • autoimmune (results in goitre) Hashimoto’s thyroiditis
  • post-partum thyroiditis
  • dyshormonogenesis - babies with underactive thyroid, can’t make thyroxine
  • medication e.g. amiadarone
  • iodine deficiency
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12
Q

If a mother has iodine deficiency, how does it affect her unborn children?

A

They are born with cretinism - hypothyroidism

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13
Q

How do you treat hypothyroidism? What are the aims of treatment?

A
  • thyroxine replacement therapy - levothyroxine (synthetic T4) for life. Varying doses based on age and heart diseases etc

Resolution of symptoms, normalisation of blood tests (in 6-8 weeks)

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14
Q

How do you measure if you’re taking too much/too little thyroxine replacement therapy?

A

If you have high TSH, it’s under-replacement, need to take more

If you have low TSH, it’s over-replacement, need to take less

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15
Q

What is myxoedema coma?

A

Severe hypothyroidism usually seen in elderly (rare)

Occurring due to hypothermia and fluid overload in the heart (pericardial effusion)

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16
Q

What is borderline or subclinical hypothyroidism?

A

When a patient has fT4 and high TSH (very common)
It’s more common than having severe hypothyroidism

It can be monitored until symptoms need treatment

17
Q

What are the symptoms of hyperthyroidism?

A
  • weight loss
  • irritability
  • restlessness
  • insomnia
  • malaise
  • itching
  • sweating
  • palpitations
  • tremor
  • muscle ache
  • diarrhoea
18
Q

What are the signs of hyperthyroidism?

A
  • tremor
  • hyperkinesis
  • tachycardia
  • atrial fibrillation
  • warm peripheries
  • hypertension
  • proximal myopathy
  • lid lag
19
Q

What are causes of hyperthyroidism?

A
  • Graves’ disease - autoimmune (most common)
  • nodular thyroid disease (nodules secrete hormone continuously)
  • thyroiditis
20
Q

What happens in Graves’ disease?

A

Auto-antibodies bind to TSH receptor on thyroid cells and stimulate hormone synthesis

21
Q

What are some signs of Graves’ disease?

A
  • Graves’ opthalmopathy - optic nerve stretched
  • Pretibial myoedema (Graves’ dermopathy) - stretching of skin/swelling of legs
  • thyroid acropachy- thickening of extremities, looks like clubbing
22
Q

What types of nodular hyperthyroidism can you have?

A
  • a single toxic nodule - removed with surgery

* toxic multi-nodular goitre

23
Q

What is thyroiditis? What could cause it? Why does the thyroid start off overactive and end up underactive?

A

Inflammation of thyroid
* release of thyroxine into circulation

Could be due to viral infection (de quervain’s thyroiditis), after childbirth (post-partum), medication (amiodarone)

Increase due to sudden release of hormone (thyrotoxicosis), but decreases as the thyroid is damaged and then it can normalise

24
Q

How do you treat hyperthyroidism?

A
  • medication - carbimazole (beware of agranulocytosis - risk of infections), beta-blockers for symptom control
  • surgery - happens if side effects of medication - risk of damage to voice box (laryngeal nerve palsy) and hypocalcaemia due to parathyroid glands in close proximity
  • radioactive iodine - not used if pregnant, radiation restrictions after treatment
25
Q

What is thyroid crisis/‘thyroid storm’?

A

A rare condition with a 10% mortality

Presents as hyperpyrexia, tachycardia, cardiac failure, liver dysfunction

Urgent treatment on high dependency unit

26
Q

What do you need to be aware of if someone has hyperthyroidism and is pregnant?

A

In Graves’ disease, antibodies can cross the placenta so the baby can be born with hyperthyroidism

Need to closely monitor pregnancy

27
Q

What is goitre? Who is it more common in?

A

Thyroid swelling

Women

28
Q

What are 4 types of goitre?

A
  • diffuse goitre - simple, autoimmune thyroid disease, thyroiditis
  • nodular goitre - multinodular goitre, a solitary nodule is a red flag symptom
  • fibrotic goitre - Riedel’s thyroiditis (rare) or viral thyroiditis?
  • iodine deficiency - common worldwide but rare in the UK
29
Q

What are the red flag symptoms of thyroid cancer?

A

History

  • very young or old
  • rapid enlargement of lump in neck
  • hoarse once and dysphagia
  • family history of thyroid cancer

Examination

  • hard irregular thyroid mass
  • fixed to surrounding structures (doesn’t move when patient swallows)
  • cervical lymph nodes palpable
30
Q

How do you do investigations into suspected thyroid cancer?

A
  • ultrasound guidance
  • fine needle aspiration
  • CT scan thorax and mediastinum

If cytology suggests cancer, remove with surgery

MEH * (22 decks)

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