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Thryoid Flashcards

1
Q

what eye problems can occur with graves disease?

A 
 Exophthalmos
 Ophthalmoplegia: esp. up-gaze palsy
 Eye discomfort and grittiness
 Photophobia and ↓ acuity
 Chemosis
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2
Q

what skin problem can occur with graves disease?

A

pre-tibial myxoedema

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3
Q

what is thyroid acropachy?

A

presents with digital clubbing, swelling of digits and toes, and periosteal reaction of extremity bones

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4
Q

what disease can thyroid acropachy occur/

A

graves disease

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5
Q

what antibodies are present with thyrotoxicosis?

A

TSH receptor, TPO

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6
Q

state three conditions graves is associated with?

A

T1DM
Vitiligo
addisons

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7
Q

what scan can be done for thyrotoxicosis?

A

isotope scan

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8
Q

what can trigger graves disease?

A

stress infection child birth

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9
Q

what is plummers disease?

A

toxic multinodular goitre

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10
Q

what does the iodine scan show for plummers disease?

A

hot nodules

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11
Q

does toxic adenoma have hot or cold nodules?

A

hot nodules

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12
Q

what drugs can cause thyrotoxicosis ?

A

thyroxine

amiodarone

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13
Q

what medication can be given for thyrotoxicosis?

A

beta blockers

carbimazole

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14
Q

what is the action of carbimazole?

A

inhibits TPO

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15
Q

what is a SE of carbimazole?

A

agranulocytosis

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16
Q

what is a CI of radio iodine ?

A

pregnancy, lactation

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17
Q

what are three complications of thyroidectomy?

A

recurrent laryngeal nerve damage
hypoparathyroidism
hypothyroidism

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18
Q

what are features of a thyroid storm?

A 
 ↑ temp
 Agitation, confusion, coma
 Tachycardia, AF
 Acute abdomen
 Heart failure
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19
Q

what is the medication treatment for thyroid storm?

A
  1. Propranolol PO/IV
  2. Digoxin may be needed
  3. Carbimazole then Lugol’s Iodine 4h later to inhibit thyroid
  4. Hydrocortisone
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20
Q

what is myxoedema?

A

SC tissue swelling in severe hypothyroidism

 Typically around eyes and dorsum of hand

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21
Q

does myxoedema occur in hypo/hyperthroidism?

A

hypothyroidism

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22
Q

what is the commonest cause of hypothyroidism in the UK?

A

atrophic thyroiditis

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23
Q

what is the commonest cause of hypothyroidism in the world?

A

iodine deficiency

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24
Q

what medication can cause hypothyroidism?

A

carbimazole
amiodarone
lithium

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25
Q

state some causes of hypothryoidism ?

A

Atrophic thyroiditis (commonest UK)
 Hashimoto’s thyroiditis
 Subacute thyroiditis (e.g. post-partum)
 Post De Quervain’s thyroiditis
 Iodine deficiency (commonest worldwide)
 Drugs: carbimazole, amiodarone, lithium
 Congenital: thyroid agenesis

Post-surgical
 Thyroidectomy
 Radioiodine

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26
Q

what antibodies are present in atrophic thyroiditis?

A

anti-TPO, anti-TSH

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27
Q

what three conditions is atrophic thyroiditis associated with?

A

Pernicious anaemia
Vitiligo
Endocrinopathies

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28
Q

what antibody is + for hashimotos thyroiditis?

A

TPO +ve

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29
Q

what is the treatment for hypothyroidism?

A

levothyroxine

30
Q

what is a myxoedema coma

A 
Looks hypothyroid
 Hypothermia
 Hypoglycaemia
 Heart failure: bradycardia and ↓BP
 Coma and seizures
31
Q

what is the management for myxoedema coma?

A

correct any hypoglycaemia
T3/T4 IV slowly
hydrocortisone 100mg IV

32
Q

what is a common virus to cause de Quervains ?

33
Q

what is the treatment for de Quervains?

A

self limiting

34
Q

what are the different types of malignant thyroid disease called/

A 
papillary 
follicular 
medullary 
anaplastic 
lymphoma
35
Q

what is the most common thyroid cancer?

36
Q

what are some complications of thyroid surgery?

A 
haematoma 
laryngeal oedema 
recurrent layrngeal nerve palsy 
hypoparathyroidism 
thyroid storm
37
Q

what recurrent laryngeal nerve is most common injuried?

A

Right because of oblique ascent

38
Q

what happens when one and both laryngeal nerves are damaged ?

A

 Damage to one → hoarse voice

 Damage to both → obstruction needing trachyostomy

39
Q

what happens to Ca after hypoparathryoidism?

40
Q

what thyroid cancers have thyroglobulin tumour marker?

A

papillary

follicular

41
Q

what tumour markers does medullary tumour have?

A

CEA and calcitonin markers

42
Q

what cells are affected by papillary and follicular cancers?

A

follicular cells

43
Q

where does papillary cancer spread?

A

lung and nodes

- JDG node (jugulodiagastric node = lateral aberrant thyroid)

44
Q

what does lateral aberrant thyroid mean?

A

when thyroid tissue is found in a distant location than normal (due to spread of cancer)

45
Q

what cells are the origin of medullary cancer?

A

parafollicular C cells

46
Q

what is the treatment of thyroid cancer?

A

total thyroidectomy
node excision
radio iodine
T4 to suppress TSH

47
Q

what are the two clinical signs seen in hypocalcemia ?

A

Chvosteks and trousseaus

48
Q

state some indications of thyroid surgery ?

A

Pressure symptoms
􏰀 Relapse hyperthyroidism (>1 failed drug Rx)
􏰀 Cosmesis
􏰀 Carcinoma

49
Q

where is the incision for thyroid surgery?

A

collar incision

50
Q

what is the commonest cause of primary hyperparathyroidism?

A

solitary adenoma

51
Q

what investigations should be done for primary hyperparathyroidism ?

A

Ca, PTH, ALP, PO4 levels
ECG
Xray
DEXA

52
Q

what ECG changes would be seen in hypercalcaemia?

A 
decreased QTc (bradycardia) 
- 1st degree heart block
53
Q

what changes would be seen on Xray for hypercalcaemia ?

A

osteoitis fibrous cystica

54
Q

what changes would be seen on DEXA scan for hypercalcaemia?

A

osteoporosis

55
Q

apart from solitary adenoma what is another cause of hyperparathyroidism?

A

hyperplasia

56
Q

what is the treatment for hyperparathyroidism ?

A

increase fluid intake
avoid dietary Ca and thiazides

excision of adenoma

57
Q

what are some causes of secondary hyperparathyroidism ?

A

vitamin D deficiency

chronic renal failure

58
Q

is phosphate increased or decreased with primary hyperparathyroidism ?

A

decreased

- decreased reabsorption at the kidney due to increased PTH

59
Q

is phosphate increased or decreased with secondary hyperparathyroidism ?

60
Q

does primary hyperparathyroidism lead to hyper/hypocalcaemia?

A

hypercalcaemia

- more PTH to increase Ca

61
Q

does secondary hyperparathyroidism lead to hyper/hypocalcaemia?

A

hypocalcaemia

- less Vit D

62
Q

is ALP increased or decreased with hyperparathyroidism ?

63
Q

what is the treatment for secondary hyperparathyroidism ?

A

correct cause
phosphate binders
vitamin D
cinacelcet (increases parathyroid Ca sensitivity)

64
Q

what ECG changes can be seen on hypoparathyroidism? (hypocalcaemia)

A

increased QTc which can develop into TdP (Torsades de pointes)

65
Q

what are three causes of hypoparathyroidism?

A

autoimmune
DiGeorge
Iatrogenic (surgery/radiation)

66
Q

what are the features of DiGeorge syndrome?

A 
Cardiac abnormality: Fallot’s 􏰁 Abnormal facies
􏰁 Thymic aplasia
􏰁 Cleft palate
􏰁 Hypocalcaemia
􏰁 Chr 22

CATCH 22

67
Q

is the level of ALP increased/decreased or normal with hypoparathyroidism?

68
Q

what is the treatment for hypoparathyroidism?

A

Ca supplements

calcitriol

69
Q

what causes pseudohypoparathyroidism?

A

Failure of target organ response to PTH

70
Q

what is a characteristic features of pseudohypoparathyroidism?

A

Short 4th and 5th metacarpals, short stature

71
Q

what is the treatment for pseudohypoparathyroidism?

A

calcium

calcitriol

72
Q

what is Pseudopseudohypoparathyroidism?

A

Normal (maternal) receptor in kidney → normal biochem

Abnormal (paternal) receptors in body → pseudohypoparathyroidsm phenotype

Y4 Endo (5 decks)

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