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0Finals Revision > Thyroid > Flashcards

Thyroid Flashcards

1
Q

TSH ↑

T4 ↓

A

Hypothyroidism

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2
Q

TSH ↑

T4 -

A

Subclinical hypothyroidism

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3
Q

TSH ↑

T4 ↑

A

TSH-secreting tumour
OR
Thyroid hormone resistance

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4
Q

TSH ↓
T4 ↑
T3 ↑

A

Hyperthyroidism

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5
Q

TSH ↓
T4 -
T3 -

A

Subclinical hyperthyroidism

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6
Q

TSH ↓
T4 ↓
T3 ↓

A

Central hypothyroidism (hypothalamic or pituitary cause)

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7
Q

Thyroid-stimulating hormone is sometimes known as…

A

Thyrotropin

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8
Q

Which structure produces TSH?

A

The anterior pituitary gland

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9
Q

How is T3 produced?

A
  • 85% is formed from peripheral conversion of T4

- 15% is produced directly by the thyroid gland

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10
Q

How do thyroid hormones travel in the plasma?

A

Thyroid hormones are mainly protein bound, e.g. to thyroxine-binding globulin (TBG)

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11
Q

Which is more useful: free T3 and T4; or total T3 and T4? Why?

A
  • free T3 and T4 is more useful

- total T3 and T4 rises and falls in line with TBG levels

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12
Q

What affects TBG levels?

A 
Increase TBG:
- pregnancy
- oestrogen therapy
- hepatitis
Decrease TBG:
- nephrotic syndrome
- malnutrition
- drugs (androgens, corticosteroids, phenytoin)
- chronic liver disease
- acromegaly
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13
Q

What antibody is commonly screened for when autoimmune thyroid disease is suspected?

A

Antithyroid peroxidase (TPO)

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14
Q

Which groups of patients should be screened for abnormalities in thyroid function?

A 
Patients with:
- AF
- hyperlipidaemia
- diabetes
- Down's syndrome
- Turner's syndrome
- Addison's disease
- Gestational diabetes
Patients treated with:
- Amiodarone
- Lithium
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15
Q

Symptoms of hypothyroidism

A
  • tiredness
  • cold intolerance
  • constipation
  • depression
  • bradykinesia
  • slow thoughts, depression and memory problems
  • muscle aches, weakness or cramps
  • decreased libido
  • carpal tunnel syndrome
  • irregular or heavy periods
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16
Q

Symptoms of hyperthyroidism

A
  • irritability and anxiety
  • hyperactivity
  • labile emotions
  • insomnia
  • feeling tired all the time
  • heat intolerance
  • palpitations
  • muscle weakness
  • polyuria
  • polydipsia
  • diarrhoea
  • pruritus
  • oligomenorrhoea (+/- infertility)
  • loss of interest in sex
17
Q

Signs of hyperthyroidism

A
  • goitre
  • arrhythmia (AF or SVT, VT is rare)
  • tachycardia
  • fine tremor
  • warm, moist skin
  • palmar erythema
  • urticaria
  • hair loss or thinning
  • weight loss (often despite and increased appetite)
  • lid lag
  • eye redness and dryness
  • exophthalmos
  • ophthalmoplegia
  • pretibial myxoedema
18
Q

Causes of hyperthyroidism

A
  • graves disease
  • toxic multinodular goitre
  • toxic adenoma
  • ectopic thyroid tissue
  • exogenous
  • subacute de Quervain’s thyroiditis
  • drugs e.g. amiodarone
  • postpartum
  • TB (rare)
19
Q

What is the ratio of men and women affected by Grave’s disease?

A
  • 9:1

- more women than men

20
Q

What age group is typically affected by Grave’s disease?

A

40-60 years old

21
Q

What are the potential complications of thyrotoxicosis?

A
  • heart failure
  • angina
  • AF
  • osteoporosis
  • ophthalmopathy
  • gynaecomastia
  • thyroid storm
22
Q

Signs of hypothyroidism

A
  • dry and scaly skin
  • weight gain
  • pallor
  • brittle hair and nails
  • reflexes relax slowly
  • cerebellar ataxia
  • cold hands
  • ascites
23
Q

Causes of primary hypothyroidism

A
  • primary atrophic hypothyroidism
  • Hashimoto’s thyroiditis
  • iodine deficiency
  • thyroidectomy
  • radioiodine treatment
  • drug induced
24
Q

What is secondary hypothyroidism?

A
  • not enough TSH due to hypopituitarism

- very rare

25
Q

What is the treatment for hypothyroidism?

A

Levothyroxine (T4)

26
Q

What is myxoedema coma?

A

The ultimate hypothyroid state before death

27
Q

What is the typical picture of myxoedema coma?

A
  • patient looks hypothyroid
  • often >65years
  • hypothermia
  • hyporeflexia
  • hypoglycaemia
  • bradycardia
  • sometimes psychosis
  • seizures
  • coma
28
Q

What could precipitate myxoedema coma?

A
  • infection
  • MI
  • stroke
  • trauma
29
Q

What is thyroid storm?

A

A hyperthyroid crisis

30
Q

What is the typical picture of a thyroid storm?

A
  • female patient
  • agitated and confused
  • tachyarhythmia
  • D&V
  • goitre
  • thyroid bruit
  • acute abdomen
  • heart failure
31
Q

What are the treatments available for hyperthyroidism?

A
  • Beta blockers may help control symptoms initially
  • Carbimazole (~50% will relapse and need definitive treatment)
  • Radioiodine therapy
  • Thyroidectomy (usually total)

0Finals Revision (21 decks)

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