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Endocrine MRCP > Thyroid > Flashcards

Thyroid Flashcards

1
Q

What would TFTs be in thyrotoxicosis?

A

Low TSH
High free T4

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2
Q

What are TFTs in primary hypothyroid?

A

TSH high
Free T4 low

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3
Q

What are TFTs in secondary hypothyroid?

A

TSH low
Free T4 low

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4
Q

What are TFTs in sick euthyroid?

A

Low/normal TSH
Low free T4
Low T3

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5
Q

What are TFTs with steroid therapy?

A

Low TSH
Normal T4

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6
Q

What causes secondary hypothyroid?

A

Pituitary failure - eg post surgery/RXT, pituitary adenoma

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7
Q

What is the initial management of Grave’s disease?

A

Symptomatic management - propranolol

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8
Q

What are the options for Grave’s disease?

A

Anti-thyroid drugs - carbimazole
Radioiodine treatment

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9
Q

What are the options for treatment with carbimazole?

A

Standard therapy
Block and replace therapy

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10
Q

How is standard carbimazole therapy delivered?

A

Commenced at 40mg and gradually reduced to maintain euthyroid over 12-18 months

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11
Q

How is block-and-replace treatment delivered?

A

Carbimazole commenced at 40mg and thyroxine added when patient euthyroid
lasts 6-9 months

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12
Q

What are the benefits of standard carbimazole therapy?

A

Fewer side effects

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13
Q

What is the main risk of carbimazole?

A

Agranylocytosis

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14
Q

What are indications for radio iodine treatment?

A

Relapse following anti-thyroid drugs or resistant to ATD treatment

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15
Q

What are contraindications for radioiodine?

A

Pregnancy
Age <16
Thyroid eye disease - relative contraindication

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16
Q

What are the long term implications of radioiodine treatment?

A

Most require thyroxine at 5 years post
Must avoid pregnancy for 4-6 months following treatment

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17
Q

What are indications for treatment with anti-thyroid drugs?

A

Symptoms of thyrotoxicosis
Significant risk of hyperthyroid complications eg elderly, cardiovascular disease

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18
Q

What antibodies are associated with Grave’s disease?

A

TSH receptor stimulating antibodies - 90%
Anti-thyroid peroxidase antibodies

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19
Q

What is seen on Thyroid scintigraphy in Grave’s?

A

Diffuse homogenous increase uptake

20
Q

What are signs specific to Grave’s disease?

A

Eye signs - 30% patients
Pretibial myxoedema
Thyroid acropachy - digital clubbing, soft tissue swelling of hands and feet, periostea new bone formation

21
Q

What are causes of hyperthyroid?

A

Grave’s
Toxic multi nodular goitre
Acute phase subacute thyroiditis
Acute phase post part thyroiditis
Acute phase Hashimoto’s
Amiodarone
Contrast

22
Q

What is toxic multi nodular goitre?

A

Multiple autonomously functioning thyroid nodules resulting in hyperthyroidism

23
Q

What is seen on scintigraphy in toxic multi nodular goitre?

A

Patchy uptake

24
Q

How is toxic multi nodular goitre managed?

A

Radioiodine therapy

25
Q

When is a thyroid storm normally seen?

A

Patients with known thyrotoxicosis following
- surgery
- trauma
- infection
- acute iodine load

26
Q

What are the features of thyroid storm?

A

fever >38.5C
Tachycardia
N&V
Confusion
HTN
Heart failure
Abnormal LFTs

27
Q

What is the management of thyroid storm?

A

Symptomatic - eg paracetamol
Treat cause
Beta blockers
Anti-thyroid drugs - methimazole, propylthiouracil
Ligol’s iodine
Dex 4mg IV QDS - blocks conversion of T4 to T3

28
Q

What is the timescale of subacute thyroiditis?

A

Phase 1 - hyperthyroid = 3-6 weeks
Phase 2 - euthyroid = 1-3 weeks
Phase 3 - hypothyroid = weeks to months

29
Q

How does subacute thyroiditis normally present?

A

Hyperthyroid
Painful goitre
Raised ESR

30
Q

What is seen on thyroid scintigraphy in subacute thyroiditis?

A

Globally reduced uptake

31
Q

What is the management of subacute thyroiditis?

A

Usually self limiting
Steroids if severe
Pain - NSAIDs

32
Q

What causes thyroid eye disease?

A

Autoimmune response to auto antigen causes retro-orbital inflammation, which causes glycosaminoglycan and collagen deposition

33
Q

What are the complications of thyroid eye disease?

A

Exposure keratopathy - most common
Optic neuropathy
Strabismus and diplopia

34
Q

What causes optic neuropathy in thyroid eye disease?

A

Extraocular muscles compress optic nerve

35
Q

What is the management of thyroid eye disease?

A

Steroids
Radiotherapy
Surgery
Avoid radioiodine - can cause worsening of inflammatory symptoms

36
Q

What is the biggest risk factor for thyroid eye disease?

A

Smoking

37
Q

What autoantibodies are associated with Hashimoto’s?

A

thyroid peroxidase
Anti-thyroglobulin

38
Q

What is Hashimoto’s associated with?

A

Other autoimmune conditions
MALT lymphoma

39
Q

What doses should levothyroxine be started at?

A

50-100micrograms
>50yo , cardiac disease or severe hypothyroid - 25 micrograms

40
Q

When are TFTs checked after starting levothyroxine?

A

8-12 weeks

41
Q

What adjustments should be made to levothyroxine in pregnancy?

A

Increase by minimum of 25-50micrograms

42
Q

What are the important interactions of levothyroxine?

A

Iron, calcium carbonate - reduce absorption of levothyroxine
- give at least 4 hours apart

43
Q

What are causes of hypothyroid?

A

Hashimoto’s
Subacute thyroiditis
Reidel thyroiditis
After thyroidectomy/radioiodine
Drugs
Dietary iodine

44
Q

What drugs cause hypothyroid?

A

Lithium
Amiodarone
Carbimazole

45
Q

What is Reidel’s thyroiditis?

A

Dense fibrois tissue replacing normal thyroid

46
Q

What are the features of Reidel’s thyroiditis?

A

Hard, fixed, painless goitre
Associated with retroperitoneal fibrosis
Middle aged women

Endocrine MRCP (4 decks)

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