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chem path > Thyroid > Flashcards

Thyroid Flashcards

1
Q

symptoms of hypothyroidism?

A

cold intolerace, everything slows down (constipation, weight gain)

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2
Q

what is thyroxine

A

T4

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3
Q

difference between T3 & T4

A

T3 is biologically active
-T4 (thyroxine) converted to T3

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4
Q

what are causes of hypothyrodism

A

1) autoimmune - hashimotos, primary atrophic, de quervains
2) iodine deficiency
3) amiodarone, carbimazole, lithium, surgery (thyrodectomy/radioidine), pituitary disease
4) riedels thyroiditis - dense fibrosis replacing normal tissue (painless, stony hard)

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5
Q

what is the most common cause of hypothyroidism in the UK

A

autoimmune (primary atrophic)

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6
Q

what is the most common cause of hypothyroidism worldwide

A

iodine deficiency

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7
Q

what is the role of thyroid hormone

A

regulated BMR and sensitises adrenergic receptors, increasing response to catecholamines

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8
Q

what features in hashimotos?

A

high TSH, low T3/4
goitre

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9
Q

what antibody present in hashimotos

A

anti-thyroid peroxidase (anti-TPO)

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10
Q

features of primary atrophic hypothyrodism

A

no goitre
high TSH, low T3/4

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11
Q

what TSH/T3/4 in secondary hypothyroidism (pituitary/hypothalamus issue)

A

low TSH, low T3/4

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12
Q

what is sick euthyroid syndrome

A

due to illness/inflammation, the body shuts down to conserve energy

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13
Q

levels of TSH/T3/4 i sick euthyroid syndrome

A

T3/4 low
-TSH initially high, then low

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14
Q

what would you expect to see in subclinical hypothyroidism?

A

normal T3/4
high TSH
(this is because pituitary gland can compensate at that stage to maintain normal T3/4)

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15
Q

do you treat subclinical hypothyrodiism

A

usually only if symptomatic or secondary hyperlipidaemia

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16
Q

what would you expect to see in medication non adherence in hypothyroidism?

A

T3/T4 normal
TSH high
(TSH lags behind)
-offer adherence counselling

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17
Q

how do you treat hypothyroidism

A

levothyroxine (T4)

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18
Q

what do you titrate levothyroxine treatment to?

A

titrate to normal TSH

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19
Q

what do you titrate levothyroxine to in secondary hypothyroidism?

A

titrate to normal fT4

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20
Q

when do you need a higher dose of levothyroxine

A

pregnancy, nephrotic syndrome (T4 bound to TBG which is lost)

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21
Q

what is the cause of primary atrophic hypothyroidism?

A

lymphocytic infiltration causing atropgy

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22
Q

difference between primary atrophic and hashimotos?

A

goitre in hashimotos
no goitre (small thyroid) in primary atrophic

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23
Q

what does hashimotos have a strong association with and is the most common concomitant autoimmune condition?

A

pernicious anaemia

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24
Q

what cell might be found in hashimots

A

hurthle cell

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25
Q

what is riedels thyroiditis

A

hard fibrosis replacing normal tissue - painless, stony hard

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26
Q

what drugs can cause hypothyroidism

A

amiodarone, lithium, thyroid drugs

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27
Q

features of myxoedema coma?

A

hypoglycaemia, low GCS, hypothermia
-due to really low T4/T3

28
Q

how do you treat myxoedemacoma?

A

IV liothyronine
+ IV corticosteroids (until adrenal insufficiency is excluded)

29
Q

how are the causes of hyperthyroidism divided?

A

1) high uptake - graves, toxic multinodular goitre, toxic adenoma
2) low uptake - subacute de quervains thyroiditis

30
Q

what features in graves

A

high uptake - all over - smoothly enlarged goitre
-painless goitre

31
Q

what antibody in graves

A

anti-TSH receptor antibody

32
Q

what features in toxic multinodular goitre (plummers)

A

patchy uptake (high uptake hot nodules)
painless
(multiple hyperfunctioning thyroid nodules)

33
Q

what features in toxic adenoma?

A

single hyperfunctioning nodule
-1 distinct solitary nodule on scan

34
Q

features of de quervains thyroditis

A

-painful goitre
-self-limiting
-inflammation cauwes release of thyroid hormones (hyperthyroid phase)
-depletion of thyroid hormone (hypothyroid phase)
-resolution (euthyroid)

35
Q

why does high hCG cause hyperthyrodisim?

A

HCG can stimulate thyroid by mimicking TSH
-can have ectopic tumour with excessive hcg

36
Q

graves disease specific features?

A

pretibial myxoedema
exopthalamos
goitre
(PEG)
acropachy (swelling & oedema of fingers)
-lid lag not specific to graves

37
Q

how to treat hyperthyrodisim?

A

symptom relief: beta blockers
carbimazole or prophythiouracil (inhibit TPO)
-either titrate to normal or block & replace
-radioiodine (not in pregnancy)

38
Q

can iodine be used for hypothyrodism?

A

yes, iodine 131 for treatment
-wolff-chaikoff -> lots of iodine inhibits TPO

39
Q

what iodine is used for treatment

A

iodine 131

40
Q

what iodine is used for nuclear imaging

A

iodine 123

41
Q

what is a serious side effect of carbimazole

A

agranulocytosis

42
Q

what is a thyroid storm?

A

acute state - shock, pyrexia, confusion, vomiting

43
Q

how is thyroid storm treated

A

requires ITU - IV beta blockers, anti thyroid medications, steroids

44
Q

order of thyroid tumours from most to least common?

A

Please feel my leng ass
papillary
follicular
medullary
lymphoma
anaplastic

45
Q

what is the prognosis for papillary cancer

A

very good, LN spread

46
Q

what cell can be seen in papillary cancer

A

psamomma body (P&P) - foci of calcification
-empty appearing nuclei with central clearing (orphan annie eyes)

47
Q

what marker for papillary cancer

A

thyroglobulin

48
Q

what marker for follicular cancer

A

thyroglobulin

49
Q

prognosis for follicular cancer

A

very good

50
Q

problem with follicular cancer?

A

spreads early from blood

51
Q

medullary cancer marker?

A

calcitonin

52
Q

where is medullary cancer derived from?

A

parafollicular C cells secreting calcitonin

53
Q

what genetic condition is associated with medullary cancer?

A

MEN2
(M&M - 2)

54
Q

prognosis in anaplastic cancer?

A

poor, most die within a year (elderly)

55
Q

what cell do you get in anaplastic cancer

A

spindle cells

56
Q

what lymphoma targets thyroid? what is it associated with?

A

MALToma
-associated with hashimotos
-good prognosis

57
Q

what do you monitor after treating thyroid cancers for recurrence?

A

thyroglobulin levels

58
Q

how do you treat thyroid cancer?

A

MDT
-surgery
-replace thyroixine to suppress TSH
-monitor recurrence with thyroglobulin

59
Q

MEN1 features ?

A

3 Ps
pituitary adenoma
PTH hyperplasia
Pancreas tumour (insulinoma)

60
Q

MEN2a features?

A

2Ps 1M
-PTH hyperplasia
-phaeochromocytoma
-medullary thyroid cancer

61
Q

MEN2b features?

A

-phaechromocytoma
-medullary thyroid cancer
-+ mucosal neuromas & marfanoid body habitus

(as we move on we get more Ms than Ps)

62
Q

inheritance of multiple endocrine neoplasia (MEN)

A

autosomal dominant

63
Q

what is schmitds syndrome

A

primary hypothyroidism + addisons disease

64
Q
A
65
Q
A

chem path (20 decks)

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