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Endocrine > Thyroid > Flashcards

Thyroid Flashcards

1
Q

Symptoms of hypothyroidism

A 
(Moms so tired) 
Memory loss
Obesity
Menorrhagia
Slowness
Skin and hair dry 
Onset is gradual 
Tiredness
Intolerance to cold
Raised BP
Energy levels are low
Depressed
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2
Q

Signs of hypothyroidism

A 
(bRADYCARDIC) 
Reflexes relax slowly 
Ataxia 
Dry thin hair/skin 
Yawning
Cold hands 
Ascites/non putting oedema 
Round puffy face
Defeated demeanour 
Immobile 
C-CCF
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3
Q

Investigations of hypothyroidism

A 
TFTs - free T4, TSH
1. Diagnose low T3,T4
2. Where is the problem? 
1o - low T4, and High TSH 
2o - low T4, and no compensatory increase in TSH
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4
Q

Treatment for hypothyroidism

A

Healthy and the young - levothyroixine(T4) 75-100mcg per day

Elderly and ischaemic heart disease - 25ug/day

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5
Q

How long does treatment for hypothyroidism take?

A

Clinical improvement within two weeks

Adjust dose every 4-6 weeks, T4 increases quickly TSH will take around six weeks

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6
Q

Pathogenesis of hashimotos thyroiditis

A

Autoimmune disease characterised by progressive destruction of the thyroid parenchyma “hurthle cell change” and mononuclear infiltrates without or with extensive fibrosis. It is mediated by multiple auto antibodies against thyroidperoxidase and TSH receptor

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7
Q

Clinical progression of hashimotos

A

Initial destruction of the thyroid gland can release the thyroglobulin colloid causing temporary hyperthyroidism(hashitoxocis) then euthyroid then hypothyroid

Painless enlargement of the thyroid

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8
Q

Amiodarone induced hypothyroidism

A

Used to treat heart conditions, this drug has a high iodine content. Inhibits the synthesis and release of the thyroid hormone and also conversion of t4 and t3

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9
Q

Other drugs that can cause hypothyroidism

A

Anti-thyroid medication, interferon-alpha and interleukin 2( malignancy), lithium (bipolar disorder)

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10
Q

Causes of hypothyroidism?

A

Autoimmune (hashimotos thyroiditis)
Primary(thyroidectomy, post radioactive iodine ablation, congenital biosynthesis defect, rare developmental abnormalities-thyroid dys genesis)
Secondary (pituitary, hypothalamic)

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11
Q

Antibodies in hypothyroidism

A

Anti-Tpo

Anti-Tg

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12
Q

Definition of hyperthyroidism

A

Over activity of the thyroid gland leading to excess thyroid hormone

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13
Q

Causes of hyperthyroidism

A 
Graves disease 
Toxic multinodular goitre 
Toxic adenoma 
Ectopic thyroid tissue 
Exogenous
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14
Q

Symptoms of hyperthyroidism (sweating)

A 
Sweating 
Weight loss
Emotional lability 
Appetite increased 
Tremor/tachycardia due to af
Intolerance to heat 
Nervousness 
Goitre and Gi upset(diarrhoea)
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15
Q

Signs of hyperthyroidism

A

Pulse is fast
Warm moist skin
Fine tremor
Lid lag(staring appearance)

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16
Q

TFTs for hyperthyroidism

A
  1. Diagnose high t3,t4
  2. Where is the problem ?
    Decreased TSH suggests thyroid
    Increased TSH suggests in or above pituitary
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17
Q

Other investigations for hyperthyroidism ?

A

Auto-antibodies for graves
ECG for AF
Radio-isotope scanning for “hot spots” –> toxic adenoma

18
Q

Autoantibodies for graves disease

A

Thyrotropin receptor antibodies (TRABS)

19
Q

Treatment for hyperthyroidism

A

B-blockers - rapid control of symptoms e.g anxiety and palpitations
Anti-thyroid medication
Partial thyroidectomy - thyroid gland is removed surgically leave some tissue plus parathyroid glands
Radioactive iodine - 131I is only absorbed by thyroid tissue, killing the cells and reducing thyroid hormone synthesis

20
Q

Method of drug treatment in hyperthyroidism

A
  1. Block and replace - give carbimazole and thyroxine simultaneously less risk of iatrogenic hypo
  2. Titration - give carbimazole for 4 weeks reduce according to TFTs every 1-2 months

6months -31% remission
24 months -82%remission

21
Q

Definition of graves disease

A

Autoimmune disease caused by circulating auto antibodies against TSH receptor so that thyroid hormones are produced in excess

22
Q

Epidemiology of graves disease

A

Women 40-60years

23
Q

Clinical features of graves disease

A

Thyrotoxicosis - classical signs of
Dysthyroid eye disease
Dermopathy - pretibial myxoedema (oedematous swelling above lateral malleolus)
Goitre- bruit as increased vasculature
Thyroid acropachy - clubbing, painful fingers

24
Q

Graves Dysthyroid eye disease features

A
  • exophthalmosis = bulging eyes
  • upper lid retraction
  • proptosis- eyes protruding from the orbit
  • Diplopia- double vision
  • nerve compression
  • peri-orbital oedema
25
Q

Definition of a goitre

A

A goitre is a swelling in the neck caused by an enlarged thyroid gland

26
Q

Toxic goitre

A

Associated with hyperthyroidism

27
Q

Non toxic goitre

A

Secrete normal or reduced levels of thyroid hormones

28
Q

Two types of goitres

A

Diffuse - entire thyroid gland is enlarged caused by TSH induced hypertrophy and hyperplasia resulting in symmetrical enlargement of thyroid gland
Nodular- a thyroid nodule is a small lump in the neck

29
Q

Types of nodule goitres

A

Multinodular- many lumps
Single nodule
-cyst- non cancerous like swelling
- adenoma- solid cancerous tumour

30
Q

Diffuse non toxic goitre

A

Female : make = 7.1
Increased in pregnancy and adolescence
Often no thyroid dysfunction
Thyroid enlargement with inspiration strider and dysphasia

31
Q

Management of diffuse non toxic goitre

A

Surgery - obstructive symptoms
Thyroxine suppression- if TSH>1, 58% of goitres smaller at 9 months
131- may reduce thyroid volume by 40% at one year

32
Q

Features of benign nodules

A

FH hashimotos
FHA benign nodule/ goitre
Hypo/hyper symptoms
Sudden increase in size with pain

33
Q

Features of malignant nodule

A 
70 
Male 
History of external neck radiation 
Recent changes in speech/ breathing/ swallowing 
Family history of thyroid cancer/ Men2
34
Q

Clinical tools for recognising thyroid nodules

A

Palpable or impalpable
Consistency hard or soft
Motility fixed or mobile
Cervical lymph nodes

35
Q

Investigations for thyroid nodules

A 
Biochemistry 
FNAB- fine needle aspiration biopsy 
Scintigraphy- if TSH low, technetium 99m or 123 iodine, defines hot and cold areas, most malignant nodules cold 
Autoantibodies status 
Cxr
Flow volume loop 
Thyroid ultrasound 
- suspicious features- solid hypoechoic, microcalcifications, absence of halo
36
Q

Thyroid cancer two types

A 
Differentiated (good prognosis) 
- papillary 17%
- follicular 13-20% 
-mixed 50% 
Undifferentiated (poor prognosis) 
- anaplastic 
- small cell
37
Q

Post op for thyroid cancer ?

A

Start t3 or t4 long term

Check calcium within 24 hr (fall predicts need for therapy add alpha calcidol if persists)

38
Q

Maternal hypothyroid disease

A 
T4 is important in Neurodevelopment 
T4 crosses the placenta but T3 doesn't 
Causes: 
- thyroid dysgenesis 85% (TSH receptor) 
-dyshormonogenesis
Thyroid peroxidase, thyroglobulin, sodium iodide symporter
39
Q

Jod basedow phenomenon

A

Hyperthyroidism following administration of iodine or iodide either as a supplement or contrast medium
Presents in patients with an endemic goitre(iodine deficiency) who move to iodine-abundant areas. Therefore does not occur in normal individuals

40
Q

Wolf chaikoff effect

A

Hypothyroidism cause by ingestion or administration of large amounts of iodine

Used for treatment against hyperthyroidism to shut down hyper functioning gland or as an unpleasant effect of Amiodarone

41
Q

Types of Amiodarone thyroid disease

A

Type 1 - Autoimmune Thyrotoxicosis tbx is high dose of carbimazole
Type 2 destructive thyroiditis tbx is glucocorticoids

42
Q

Synthesis of thyroid hormone

A
  1. Accumulation of iodide ions
    - absorbed as dietary inorganic iodine and absorbed through the na+ I- symporter on the basal membrane of they thyroid follicular cell
    - pump is stimulated by TSH and inhibited by thiocyanate and nitrate
  2. Oxidation of iodide
    Iodide is oxidised to iodine by thyroid peroxidase
  3. Iodisation of thyroglobulin
    - the follicular cells are continuously synthesising glycoproteins called thyroglobulin
    Rer-Golgi-vesicles- exocytosis into the lumen of the follicles
    -Thyroglobulin is attached to tyrosine AAs
    - Free iodine atoms are then incorporated into tyrosine residues
    Binding of 1 atom to c3 = monoiodotyrosine (MIT)
    Binding of 1 atom to c5 = diiodityrosine (DIT)
  4. Coupling reactions
    DIT + MIT. = alanine + thyroxine (t4)
    DIT + MIT = alanine + 353 triiodothyronine (t3)
  5. Modified thyroglobulin molecules are stored in colloid

Endocrine (7 decks)

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