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INTERNAL MEDICINE 5TH > thyroid > Flashcards

thyroid Flashcards

1
Q

causes of hypothyroidism

A
  1. congenital
  2. post operative
  3. radiation
  4. thyroidectomy (due to reistant graves or a toxic multi nodular goitre)
  5. de quervenains
  6. iodine deficiency - endemic goitre
  7. iodine excess - amiodrone, factitita (great intake of thyroid hormones)
  8. radioactive iodine therapy used for graves disease
  9. riedal (rare)
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2
Q

sub acute thyroiditis is a.ka

A

DE quervains

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3
Q

what is dequerveins

A

begin with hyperthyroidism and then hYPO

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4
Q

thyrotoxicosis facttitiica

A

too much intake of thyroid horses (overdoes)

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5
Q

ECG findins in hypo

A

low voltage

AV black

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6
Q

other symptoms of hypo

A 
effusions 
diastolic hypertension 
alpaca 
droopy eyelids 
lateral 1/3rd eyebrow- hertoghe  sign
menstraul cycle disturbances 
hyperprolactinemia
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7
Q

diastolic hypertension is associated with

A

hypothyroidism

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8
Q

what is myxoedema

A

Myxedema is a term generally used to denote severe hypothyroidism. Myxedema is also used to describe the dermatologic changes that occur in hypothyroidism and occasionally hyperthyroidism.

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9
Q

most serious complication of hypo

A

myxoedema crisis

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10
Q

subclinical hypothyroidism

A

high levels of TSH and normal levels of t3 , t4

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11
Q

antibodies for hashimotos

A

anti TPO

antithyroglobulin

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12
Q

labs for hypothyroidism

A

look for antibodies and in CBC anaemia is common

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13
Q

tx for hypothyroidism

A

levothyroxine 1.6 micro grams given TAKE 1 H B4 BREAKFAST VERY IMPORTANT FOR THE ABSORPTION ( start with lower doses and then you gradually increase unlike in graves )

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14
Q

what imaging studies for hypothyroidism

A
  1. US 2. radioactive uptake - allows you to differentiate autoimmune
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15
Q

classiccation of hyperthyroidism

A

with hyperthyroidism

w/o hyperthyroidism

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16
Q

hyperthyroidism causes

A
  1. de queervien (initial stage)
  2. iodine excess
  3. graves
  4. toxic multi nodular/adenoma
  5. hashimotos
  6. silent thyrodiits
  7. post partum thyroidits
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17
Q

neurological findings of hyperthyroidism

A

hyperfrelxia
tremor
muscle weakness
psychiatric : anxious, anxiety

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18
Q

triangle of graves

A
  1. TAO
    2, MYXOEDEMA ( even though most common in graves)
  2. ACROPATHY
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19
Q

subclinal hyperthyroidism

A

TSH will be low

thyroid levels are normL

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20
Q

OVERT hypothyroidism

A

TSH will be low and Thyroid hormones high

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21
Q

antibodies in graves

A

TSH receptors

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22
Q

tx medication for graves

A

metamizaole + propuylthiouracil - start at 300 /400 and then decrease - try for 18 months and then if not successful then we do surgery

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23
Q

what kind of myxedma is associated with hyper

A

pretibial

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24
Q

thyroid storm management

A

IV propranolol
IV digoxin
Propylthiouracil through NG tube followed by Lugol’s iodine 6 hours later
Prednisolone/hydrocortisone- 100mg/24 lecture says methyprednisolne

lithium is second line tx

lecture says endoyodin?

25
Q

whats lithium more associated with

A

hypothyroidism but causes both , random (should be avoided in pregnancy anomalies to fetus)

26
Q

what is the cause of exophthalmus in graves

A

the immune system attacks the muscles and fatty tissues around and behind the eye, making them swollen.

27
Q

tx of subacute thyroiditis

A

usually not antithyroid medications as its preformed !

nsaids, CS

28
Q

what would you advise a patient with TAO on life advice

A

stop smoking its a big risk factor

29
Q

when is thyrotocisosis without hyperthryoridsm seen

A

exogenous intake of
thyroid hormones or inflammatory and neoplastic disease with destruction of
thyroid cells

30
Q

what happens if proptosis is unilateral

A

rule out malignancy as usually exophthalmus is bilateral

31
Q

device for measuring prothesis

A

Hertel exophthalmometer

32
Q

tx for the TAO

A

Sunglasses, apply artificial tears, eye protectors during sleep and keep your head
elevated when in bed to decrease oedema of eyes
Glucocorticoids (in severe cases)
External X-RAY therapy on retrobulbar area
surgery can help too- decompression of optic nerve

remember TAO can also cause very wet eyes too

33
Q

antibodies for Graves

A

TPO
microsomal
TSH

34
Q

on a thyroid scan what is the uptake like for subacute

A

low uptake is charactaeirsitc

35
Q

side effect of carbimazole

A

agranulocytosis so look out for mouth ulcers, sore throat

36
Q

CI of radioactive iodine

A

CI - Children, age <30, pregnancy, (destroy fetal gland) lactation and leukopenia AND TA0 as makes it worse

37
Q

hyperthyroidism in pregnancy

A

Anti-thyroid medications - these drugs cross placenta hypoplasia of fetal thyroid
gland (fetal hypothyroidism) so its CI during 1st trimester as risk of congenital hypothryodisa - we manage symptomatically with small doses of propel

Anti-thyroid drugs given in 2nd/3rd trimester but the lowest possible doses
Propylthiouracil - preferred as it crosses placenta to a lesser extent
Small doses of propranolol given to control symptoms for mother
Sub-total thyroidectomy can be done in mid-trimester, but you want to delay as much ss possible to improve fetal survival (premature

38
Q

Hyperthyroidism in breast-feeding period

A

Anti-thyroid drugs can pass into breast milk - If possible stop taking medications
after birth/during breast feeding period
Propylthiouracil is not concentrated in milk

39
Q

rf far thyroid cancer

A

deficiency in iodine, head and neck radiation , having hashimotos/grvaes

40
Q

most common thyroid

A

papillary - remember more local spread so LN’S

41
Q

where do thyroid cancers typically metasitse too

A

lungs and bone

42
Q

which cancer freuqnely spread to ln

A

paiallry

43
Q

signs of cancer

A

dyspahgia
trouble breathing
hoarseness of voice if spread

44
Q

which cancer associated with iodine deficiency

A

follicular

45
Q

which cancers are graves and hashimotos more likely to get

A

papally

46
Q

whats associated with medullary carcinoma

A

raised calcintotn , which is associated with diarrhoea too .

Secretes bioactive substances: ACTH, CTRH, VIP (like neuroblastoma so diarrhoea)

bushings syndrome and + diarrhoea syndrome

47
Q

which cancer is sensitive to iodine

A

follicular

48
Q

tx of lymphoma radiation

A

RADIATION

49
Q

thyroid scan for thyroid cancer is most likely o shw

A

‘Cold nodules’ but some follicular Ca

take up the radioiodine and appear hyperactive

50
Q

LYMOHAMA

A

Almost always Non-Hodgkins lymphoma
Highly associated with Hashimoto’s thyroiditis

responds to radiotherapy

51
Q

tumoru markers

A

Elevated Thyroglobulin- papillary or follicular
Elevated calcitonin- medullary carcinoma
citokeratin - anaplastic carcinoma

52
Q

whats descriptive of a thyroid mass

A

lump that moves on swallowing but not on tongue protrusion

53
Q

ANTITHYROID DRUGS

A

nhibit synthesis of thyroid hormones.

Main monotherapy or an adjunctive therapy before surgery or radioactive iodine therapy.

54
Q

WHAT DO We typicallly use radioactive iodine for what is the proecedure

A

certain types of thyroid cancer (P+F)( higher does)
hyperthyroidosim (

RAI is taken in an oral capsule form. You don’t need to be hospitalized unless the dose is very high, which is rarely needed. You will be prompted to drink lots of water after taking the pill to flush the remaining radioactive iodine out of your system.

Most patients need only one dose before their hyperthyroidism is resolved, which may take a few weeks to several months.

55
Q

what’s the procedure for RAI tx in thyroid cancer

A

usually after surgery to catch any stray cancer cells

56
Q

gold standard diagnosis of graves

A

US

57
Q

relationship between hyperthyroid gland and diabetes

A

increased risk as metabolism in increased clearance of insulin and thyroid hormones are contrainsular

58
Q

j

A

INTERNAL MEDICINE 5TH (12 decks)

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