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2.2 T1: The endocrine system > T1 L8: Thyroid disease > Flashcards

T1 L8: Thyroid disease Flashcards

1
Q

What is a Goitre?

A

An enlarged thyroid gland

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2
Q

What does Euthyroid mean?

A

Normal production of thyroid hormones

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3
Q

What is a bruit?

A

An extreme amount of blood flow

You listen for it during a thyroid examination

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4
Q

What hormones do thyroid function tests look at?

A

TSH, FT4, FT3, and thyroid autoantibodies like anti-TPO AB and TRAB

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5
Q

Which hormone is the best biomarker of thyroid status?

A

TSH

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6
Q

How long does it take for TSH to respond to change?

A

About 6 weeks

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7
Q

What do thyroid autoantibodies indicate?

A

They’re not pathogenic but indicate risk of autoimmune disease

Negative autoantibodies don’t exclude autoimmune disease but a positive result confirms disease

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8
Q

What are the 2 types of thyroid autoantibodies?

A

Destructive - target thyroid for autoimmune destruction

Stimulatory - stimulates TSH receptor (TRAB)

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9
Q

What are some symptoms of hypothyroidism?

A 
Lethargy
Mild weight gain
Cold intolerance
Constipation
Facial puffiness
Dry skin
Hair loss
Hoarseness
Heavy menstrual periods
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10
Q

What are some symptoms of severe hypothyroidism?

A 
Change is appearance Eg. puffiness or pale skin 
Periorbital oedema
Dry flaking skin
Diffuse hair loss
Bradycardia
Signs of median nerve compression (carpal tunnel)
Effusions Eg. Ascites, pericardial
Delayed relaxation of reflexes
Croaky voice
Goitre
Rarely stupor or coma
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11
Q

What is a myxoedema coma?

A

Patients exhibit multiple organ abnormalities and progressive mental deterioration

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12
Q

What are some causes of primary hypothyroidism?

A
  • Autoimmune hypothyroidism
  • Iatrogenic
  • Thyroiditis
  • Drugs like lithium or amiodarone which contains lots of iodine
  • Congenital
  • Iodine deficiency
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13
Q

What are the levels of TSH, T4, and T3 in primary hypothyroidism?

A

High TSH, low T3 and T4

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14
Q

What are the levels of TSH, T4, and T3 in secondary hypothyroidism?

A

All are low

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15
Q

What causes secondary hypothyroidism?

A

Diseases of the hypothalamus or the pituitary

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16
Q

What investigations are done to confirm primary hypothyroidism?

A

Blood results but thyroid autoantibodies could also be checked. No imaging is needed

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17
Q

What is the treatment for hypothyroidism?

A

Start by giving thyroxine (T4) but give a smaller dose to those >65 or those with ischaemic heart disease

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18
Q

What is Hashimoto’s disease?

A

A chronic autoimmune thyroiditis

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19
Q

What is Myxoedema?

A

An accumulation of glycosaminoglycans in the interstitial spaces of tissues

20
Q

Is hyperthyroidism the same as thyrotoxicosis?

A

Yes

21
Q

What are some symptoms of hyperthyroidosis?

A 
Weight loss
Lack of energy
Heat intolerance
Anxiety/irritability
Increased appetite
Increased sweating
Thirst
Palpitations
Pruritus
Weight gain
Loose bowels
Oligomenorrhoea
22
Q

What is Pruritus?

A

Itchy skin

23
Q

What is Oligomenorrhoea?

A

Sparse periods

24
Q

What are some signs of Thyrotoxicosis?

A 
Tremor
Warm, moist skin
Tachycardia
Wye signs
Thyroid bruit
Muscle weakness
Atrial fibrillation
Brisk reflexes
25
Q

What are some symptoms of thyroid eye disease (TED), thyroid associated ophthalmopathy (TAO)?

A 
Itchy, dry eyes
Prominent eyes/ change in their appearance 
Diplopia
Loss of sight
Loss of colour vision
Redness/ swelling conjunctiva
Unable to fully close eyes
Ache, pain, tightness in or behind the eye
26
Q

What is proptosis?

A

Pushing forward of the eyes

27
Q

What are some signs of thyrotoxicosis?

A 
Hand tremor
Sinus tachycardia
Atrial fibrillation
Goitre
Lid retraction
Proptosis
Ophthalmoplegia
Inflammation of the conjunctiva
28
Q

What is Grave’s disease?

A

An autoimmune hyperthyroidism

29
Q

What are some causes of thyrotoxicsosis?

A 
Grave's disease
Toxic multinodular goitre 
Toxic adenoma
Thyroiditis
Drugs
30
Q

What is toxic adenoma?

A

A single nodule benign swelling

31
Q

What is a toxic thyroid?

A

One that is producing too much thyroid hormone

32
Q

What is Gestational thyrotoxicosis?

A

Occurs when the placental B-human chorionic gonadotrophin is structurally similar to TSH and TSH-like action on the thyroid

It’s more common in twin pregnancies and normally settles after the 1st trimester of pregnancy because then the levels of HCG go down

33
Q

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

A

-Personal or family history of any autoimmune thyroid/ endocrine disease
-Goitre with a bruit
Thyroid eye disease (20% Grave’s)
Positive thyroid autoantibody titre

34
Q

What are some investigations that can be done to prove hyperthyroidism?

A
  • Thyroid function blood tests
  • Thyroid autoantibody presence
  • Thyroid uptake scan to show increased activity
35
Q

How is Grave’s disease treated?

A

Radioiodine
Surgery
Symptoms control with Beta-blockers like Propranolol

36
Q

What risks are there is Grave’s disease is left untreated?

A

Symptoms will worsen
Atrial fibrillation leading to stroke
Osteoporosis

Some people may refuse treatment because they are happy with the weight loss

37
Q

What are some medical treatments for Grave’s disease?

A

Carbimazole or Propylthiouracil (PTU)
-For 18months-2 years

Rare complication: Agranulocytosis which can present as severe mouth ulcers

But 2/3 patients relapse (mostly men)

38
Q

What is Agranulocytosis?

A

Extremely low number of granulocytes

39
Q

How does radioiodine treatment work?

A

The radioiodine will be mostly taken up by the thyroid gland because it uses mostly of the iodine and this will kill the thyroid cells

40% risk of permanent hypothyroidism after treatment

People have to avoid contact with others for a prolonged period of time so not good for children
-Not to be used with pregnancy

40
Q

What are some of the risks associated with surgery to treat hyperthyroidism?

A 
Anaesthetic risks
Neck scar
Hypothyroidism
Hypoparathyroidism
Vocal chord Palsy (due to damage to the recurrent laryngeal nerve)
41
Q

What is the treatment for thyroid eye disease?

A
  • Smoking cessation
  • Steroids
  • Radiotherapy
  • Surgical treatment (Eg. orbital decompression or eyelid surgery)
42
Q

What is a Thyroid storm (Thyrotoxic crisis)?

A

It’s an acute excessive release of thyroid hormones

Usually secondary to Grave’s disease. It’s often triggered by surgery, childbirth, acute severe illness

43
Q

What are some features of a thyroid storm?

A
  • Multisystem
  • Hyperpyrexia
  • Cardiovascular issues like Tachycardia or heart failure
  • GI issues like nausea, diarrhoea, hepatocellular dysfunction

High mortality rate or ICU-level care

44
Q

What are some features of thyroditis?

A
  • Transient mild thyrotoxicosis that always resolves after a couple of months
  • Longer hypothyroid phase of 4-6 months
45
Q

When should a diagnosis of thyroiditis be considered?

A
  • Patient is pregnant/ within 1 year post-partum
  • Patient has very tender thyroid as this is not seen with Grave’s disease or a Goitre
  • Clinical thyroid status doesn’t fit the lab results
  • No diagnostic feature of Grave’s disease
  • Current/ recent treatment with immunomodulatory medication
46
Q

What are some diseases associated with Thyroiditis?

A

Autoimmune endocrine conditions like T1 diabetes, Pernicious anaemia, Coeliac disease, Premature ovarian failure, Addison’s disease

Syndromes like Turner’s or Down’s

2.2 T1: The endocrine system (23 decks)

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