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Endocrine > Thyroid 2 > Flashcards

Thyroid 2 Flashcards

1
Q

What is the AMES risk system?

A

Age, Metastases, Extend of primary tumour, Size of primary tumour

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2
Q

When would a Thyroid lobectomy with isthmusectomy be used?

A

Papillary microcarcinoma (less than 1cm in diameter), minimally invasive follicular carcinoma with capsular invasion only, patients in AMES low risk group

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3
Q

When would a sub total or total thyroidectomy be used?

A

DTC with extra-thyroidal spread, bilateral/multifocal DTC, DTC with distant mets, DTC with nodal involvement

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4
Q

What is done post surgery in sub total/total thyroidectomy patients?

A

Radioiodine ablation I131, T3 and T4 stopped beforehand to ensure TSH is elevated to produce best result.

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5
Q

What happens if uptake in the thyroid bed following radioiodine ablation is >0.1%?

A

Thyroid Remnant Ablation

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6
Q

What will patients following TRA be discharged on?

A

T3 or T4

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7
Q

What should be measured pre-op in suspected thyoid carcinoma patients as it can be a tumour marker?

A

Anti-thyroglobulin antibodies

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8
Q

What is the commonest cause of hypo/hyperthyroidism?

A

AI thyroid disease

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9
Q

What laboratory results would you expect in primary overt hypothyroidism?

A

Raised TSH, decreased fT4, normal or decreased fT3

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10
Q

What laboratory results would you expect in primary subclinical hypothyroidism?

A

Slightly raised TSH, normal fT4 and fT3

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11
Q

What laboratory results would you expect in secondary hypothyroidism?

A

Decreased or normal TSH, decreased fT4, decreased or normal fT3

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12
Q

What is myxoedema?

A

Either refers to severe hypothyroidism e.g. Myx coma, or accumulation of hydrophilic mucopolysaccharide in subcutaneous tissues

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13
Q

What is the cause of Atrophic AI hypothyroidism?

A

Antithyroid antibodies leading to lymphoid infiltration of the gland and eventual atrophy and fibrosis.

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14
Q

What is the cause of goitrous chronic thyroiditis (Hashimoto’s)

A

Type of AI hypo, hereditary defects and maternally transmitted causes (antithyroid agents, iodides)

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15
Q

A deficiency of what causes a goitrous hypothyroidism and why?

A

Iodine deficiency due to borderline hypot leading to TSH stimulation and thyroid enlargement

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16
Q

What are some causes of non-goitrous hypot?

A

Congenital defect, atrophic thyroiditis, post-ablative (radioiodine, surgery), postradiation

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17
Q

What are some causes for self limiting hypot?

A

Withdrawal of suppressive thyroid therapy, subacute and chronic thyroiditis with transient hypot, postpartum thyroiditis

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18
Q

Why does Hashimoto’s thyroiditis reduce thyroid hormone production?

A

AI destruction of thyroid gland

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19
Q

What sex is affected more so by AI hypot?

A

Females

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20
Q

What is Hashimoto’s characterised by?

A

Thyroid Peroxidase Antibodies in blood, T-cell infiltrate and inflammation on microscopy

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21
Q

What are the symptoms of hypothyroidism?

A

Lethargic, decreased mood, cold-intolerance, weight increase, constipation, menorrhagia, hoarse voice, decreased memory/cognition, dementia, myalgia, cramps, weakness

22
Q

What are the signs of hypothyroidism?

A

Think BRADYCARDIC- Bradycardic, Reflexes relax slowly, Ataxia, dry thin hair/skin, yawning, cold hands, ascites +-non-pitting oedema +- pericardia/pleural effusion, round puffy face, defeated demeanour, immonile +ileus, CCF. Also neuro/myopathy, goitre

23
Q

What lab results would you expect in hypothyroidism other than TFTs?

A

Macrocytyosis typical (rule out B12 deficiency, elevated CK, increased LDL cholesterol, hyponatraemia, hyperprolactinamia

24
Q

What antibody levels would you expect in AI hypot versus Graves?

A

Anti-TPO-95% vs70-80, anti-thyroglobulin 60 vs 30-50, TSH receptor antibody 10-20 (blocking) vs 70-100 (stimulating)

25
Q

What is the management of hypothyroidism?

A

Normal metabolic rate should be restored gradually. Levothyroxine in young, same in elderly but smaller dose adjusted every 4 weeks. Check after 2/12.

26
Q

What is myxoedema coma?

A

Severe hypothyroidism presenting with confusion or coma, often in elderly women with untreated hypot

27
Q

What findings would you expect in myxoedema coma?

A

ECG-bradycardia, low voltage complexes, varying heart block, T wave inversion, prolongation of QT interval, type 2 resp failure, hypoxia, hypercarbia, resp acidosis, co-existing adrenal failure in 10%

28
Q

How would you treat Myxoedema coma?

A

ABCDE. Rewarm, cardiac monitoring, monitor bp, cvp ,oxygen, urine output, BM, fluids, electrolyte balance, broad spectrum antibiotics, caution with thyroxine (low doses) and hydrocortisone

29
Q

What are the symptoms of hyperthyroidism?

A

Diarrhoea, weight decrease, appetite increase, overactive, sweats, heat intolerance, palpitations, tremor, irritability, labile emotions, oligomenorrhoea +-infertility

30
Q

What are some signs of hyperthyroidism?

A

Fast/irregular pulse (AF or SVT), warm moist skin, fine tremor, palmar erythema, thin hair, lid lag, lid retraction, goitre, thyroid nodules or bruit depending on case

31
Q

What are signs of Graves disease?

A

Eye disease, pretibial myxoedema:oedematous swelling above lateral malleoli, thyroid acropachy:extreme with clubbing, painful finger and toe swelling, periosteal reaction in limb bones

32
Q

How is Graves disease caused?

A

Serum IgG antibodies bind to TSH receptors in the thyroid, stimulating thyroid hormone production, they behave like TSH. These antibodies are specific for Graves.

33
Q

What test results will you find for Graves?

A

High T3/4, low TSH. Antibody +ve (TRAbs), smooth symmetrical goitre (scintigraphy)

34
Q

What will happen by 18 months in Graves patients?

A

50% will have burnt out, 50 will relapse

35
Q

What opthalmopathys can be present in Graves?

A

Lid retraction/lag, chemosis, proptosis, visual loss, diplopia

36
Q

What is the treatment for opthalmopathys in Graves?

A

Lubricants, decompression surgery, radiotherapy, corrective surgery, stop smoking

37
Q

What are the defining features of Toxic multinodular goitre?

A

Older patients, more insidious onset, gland may feel nodular

38
Q

What test results would you expect on TMG?

A

High T3/4, low TSH, antibody -ve (TRAbs), assymetrical goitre on scintigraphy

39
Q

What are the features of thyroid storm?

A

Emergency-severe hyperthyroidism, resp/cardiac collapse, hyperthermia, exaggerated reflexes, maybe associated underlying infection

40
Q

What is the treatment of thyroid storm?

A

Lugols iodine, glucocorticoids, PTU, b-blockers, fluids, monitoring, may require ventilation

41
Q

What is the treatment of hyperthyroidism?

A

Carbimazole, propylthiouracil (preferred in pregnancy). To treat symptoms rapidly use b-blocker-propranolol. Risk of agranulocytosis

42
Q

What is the 2nd line treatment of hyperthyroidism?

A

Radio-iodine

43
Q

What are some precautions in taking radio-iodine for hyperthyroidism?

A

Most become hypothyroid post treatment. Avoid pregancy, don’t share a bed for x days, ensure not pregnant. Risk of thyroid storm

44
Q

What is the 3rd line treatment for hyperthyroidism?

A

Surgery-thyroidectomy

45
Q

What are some types of thyroiditis?

A

Graves, hashimotos, De Quervains/subacute (viral), post-partum, drug induced and radiation, acute/suppurative (bacterial)

46
Q

What is the cause of de Quervains?

A

Acute inflammatory process-likely viral origin.

47
Q

What may be associated with de Quervains?

A

Sore throat/fever, other viral symptoms

48
Q

How will de Quervains progress?

A

Usually self limiting (over few months)

49
Q

What test results will you see in de Quervains?

A

T4-high in early stage, low in late then normal, TSH- low in early, high in late, normal. Scintigraphy-low uptake

50
Q

What drug can often induce thyroid dysfunction-both hypo/hyper?

A

Amiodarone

51
Q

What pattern exists in amiodarone patients developing hyper or hypothyroidism?

A

In low iodine intake area thyrotoxicosis more likely, in high area hypothyroidism more likely

52
Q

Why does amiodarone cause adverse effects on the thyroid?

A

It’s high iodine content

Endocrine (14 decks)

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