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Endocrinology > Thyroid > Flashcards

Thyroid Flashcards

1
Q

Does thyroid disease affect men or women more?

A

Women

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2
Q

What is the single most common presentation of thyroid disease?

A

Goitre: thyroid gland enlargement

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3
Q

What is goitre?

A

Thyroid gland enlargement

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4
Q

What is hypothyroidism?

A

Low levels of thyroid hormones in the blood

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5
Q

What causes hypothyroidism?

A

Primary:

  • autoimmune: Hashimoto’s + Atrophic
  • drugs
  • iodine deficiency

Secondary:
- problem with pituitary or hypothalamus

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6
Q

Clinical features of hypothyroidism?

A 
Fatigue
Weight gain
COLD intolerance
Bowels slow down
Menorrhagia
Mental slowness
Oedema: periorbital and generalised
Delayed reflexes
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7
Q

Investigations of thyroid disorders?

A

Check levels of TSH, T3, T4

Look for thyroid antibodies

Isotope uptake scan: the bright bits indicate an area of increased activity

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8
Q

What would you see on blood tests of primary hypothyroidism?

A

Raised TSH

Low T3 and T4

Anti-thyroid antibodies will be present if autoimmune cause

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9
Q

What would you see on blood tests of secondary hypothyroidism?

A

TSH is low

Low T3 and T4

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10
Q

Management of hypothyroidism?

A

Synthetic Levo-thyroxine
- doses depend on cause and size of person

Monitor the patient carefully on this drug

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11
Q

Which hypothyroidism patients should you NOT give L-thyroxine to? Why?

A

Patients with ischaemic heart disease, it can trigger angina and MI

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12
Q

What is autoimmune thyroiditis?

A

When the body creates antibodies against the thyroid and the hormones it produces (T3 +T4)

Damaging and impairing the function of the thyroid

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13
Q

Which autoimmune thyroiditides cause hypothyroidism?

A

Atrophic hypothyroidism

Hashimoto’s thyroiditis

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14
Q

Presentation of Hashimoto’s thyroiditis? Explain?

A

Hypothyroid symptoms

Goitre

Caused by lymphocytic and plasma cell infiltration of the thyroid

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15
Q

What is atrophic hypothyroidism?

A

Atrophy (no goitre)

Caused by lymphocytic infiltration of thyroid

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16
Q

What would autoimmune hypothyroidism look like histologically?

A

Many lymphocytes, small blue cells

Not many follicles seen and not much colloid

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17
Q

Which autoantibodies are commonly seen in autoimmune hypothyroidism?

A

Antibodies against:

  • thyroglobulin
  • thyroid peroxidase (anti-TPO) (an enzyme found in colloid)

Rarely: antibodies against TSH, will prevent TSH stimulating the thyroid to work

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18
Q

Does iodine deficiency cause hyper or hypothyroidism?

A

Hypothyroidism

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19
Q

What are the signs of iodine deficiency?

A

Massive goitre

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20
Q

What is hyperthyroidism?

A

Excess of thyroid hormones in the blood

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21
Q

What 3 mechanisms cause hyperthyroidism?

A
  1. Over production of thyroid hormones
  2. Leakage of pre-formed thyroid hormones
  3. Ingestion of excess thyroid hormone
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22
Q

Causes of hyperthyroidism?

A

Grave’s disease

Toxic multi-nodular goitre
Toxic adenoma
Drugs

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23
Q

Clinical features of hyperthyroidism?

A 
Weight loss
Tachycardia
HEAT intolerance
Increased bowel movements
Lid lag and stare
Menstrual slowing and stopping
Anxiety
Increased appetite
Tremor
24
Q

What would you see on blood tests of primary hyperthyroidism?

A

Raised T3 and T4, low TSH

25
Q

What would you see on blood tests of secondary hyperthyroidism?

A

Raised T3 and T4, high TSH

26
Q

What are some Grave’s disease specific clinical features?

A

Diffuse goitre
Thyroid eye disease
Pretibial myxoedema
Acropachy

27
Q

What is pretibial myxoedema?

A

Waxy discolouration of skin
Peau d’orange

Of anterior lower legs, spreading to dorsum of feet

28
Q

What is Arcopachy?

A

Swelling of hands and clubbing of fingers

29
Q

Management of hyperthyroidism?

A

Anti-thyroid drugs

Radioiodine

Surgery to remove part or all of thyroid

30
Q

Name the most common group of anti-thyroid drugs?
Name one?
How does it work?

A

Thionamides

Carbimazole

Reduces synthesis of new thyroid hormones
Doesn’t treat the underlying cause, however

31
Q

Which hyperthyroidism patients tend to have worse prognoses?

A

Severe hyperthyroidism
Large goitre
Men more than women
Young at age of onset

32
Q

What is a serious side effect of taking thionamides?

Precautions?

A

There is a high risk of agranulocytosis, this manifests as a sore throat, fever, mouth ulcers

It is very serious, you must warn patients to stop the drug if they get any of these symptoms

33
Q

How does radioiodine work?

A

It is a radioactive isotope, which damages the thyroid, preventing it from functioning as well, reducing thyroid hormone levels

34
Q

What is Grave’s disease?

A

An autoimmune condition that causes production of IgG antibodies that bind to the TSH receptor

This stimulates thyroid hormone production

Leading to hyperthyroidism

35
Q

What is the name of the antibodies involved in Grave’s disease?

A

Thyroid stimulating antibodies

36
Q

What would a thyroid affected by Grave’s disease look like histologically?

A

Hypertrophy of thyroid follicular cells
Less colloid
Pinker

37
Q

List some risk factors for getting autoimmune thyroiditis?

A 
Genetics, certain HLAs
Environmental
Female
Postpartum
Smoking, high iodine intake, stress
38
Q

Which autoimmune disorders have strong associations with autoimmune thyroiditis?

A

Diabetes M type I
Pernicious anaemia
Coeliac disease
RA, SLE, Sjorgen’s

39
Q

What is thyroid associated ophthalmopathy?

A

Swelling of intra-ocular muscles caused by an auto-antigen attacking them

Associated with autoimmune thyroiditis

40
Q

Clinical features of thyroid associated ophthalmopathy?

A

Inflammation of eyes

Proptosis: bulging eye

41
Q

Why does proptosis occur in thyroid associated ophthalmopathy?

A

Swelling of intra-ocular muscles makes the optic nerve, which is usually slack, become taut

The eye pushes forward and bulges out

42
Q

Which drugs are associated with thyroid disorders?

A

Amiodarone: an ant-arrhythmic

Lithium: bi-polar disorder drug

43
Q

What effect does amiodarone have on the thyroid?

A

Hyperthyroidism:
Because the pills contain a lot of iodine, meaning the person is ingesting more iodine than they need

Hypothyroidism:
Due to damage caused by iodine overload

44
Q

How do you treat hyperthyroidism caused by amiodarone?

A

Stop amiodarone

If you can’t, consider steroids, anti-thyroid drugs
Surgery

45
Q

How do you treat hypothyroidism caused by amiodarone?

A

Give thyroxine

No need to stop amiodarone

46
Q

What effect does lithium have on the thyroid?

A

Causes hypothyroidism

47
Q

Patient presents with puffy eyelids and bulging eyes, she has lost weight and gets hot and sweaty easily.
OE you see a diffuse goitre.

What does she likely have?

A

Hyperthyroidism

Caused by Grave’s disease

48
Q

Patient presents with constipation, and complains he feels the cold far more than he used to. His wife has noticed he appears blank and stares a lot.

OE you see no goitre

What does he likely have?

A

Hypothyroidism

Caused by atrophic autoimmune disease

49
Q

Patient presents with anxiety, more loose and frequent bowel movements and oedema on her face and legs.

She is known to be having treatment for atrial fibrillation.

What does she likely have?

A

Hyperthyroidism

Caused by amiodarone she is taking for her AF

50
Q

Patient presents with weight gain, constipation and complains her periods have been particularly heavy and painful over the last few months.

What does she likely have?

A

Hypothyroidism

51
Q

A new mum presents complaining of loose bowel movements, excess sweating and anxiety.

OE you see she has goitre

What does she likely have?

A

Hyperthyroidism

52
Q

What is thyrotoxicosis?

A

High levels of thyroid hormones
(caused by anything, not just thyroid disease)

So its basically the same thing as hyperthyroidism

53
Q

What is a thyroid storm?

Which thyroid diseases are at risk?

Precipitating factors?

A

An extreme manifestation of hyperthyroid due to overproduction of thyroid hormones

Graves, toxic adenoma, toxic multinodular goitre

Precipitated by surgical, trauma, childbirth, hypo, DKA, MI, drugs (amiodarone)

54
Q

Clinical features of thyroid storm.

A 
Tremor
Tachycardia (+/- AF)
Fever (over 41)
Agitation, delirium, confusion
Abdo pain, nausea and vomiting
55
Q

Management of thyroid storm?

A

Resuscitate (IV fluids, oxygen)

Cool down: cold towels, paracetamol

Antithyroid treatment:

  • Carbimazole
  • Lugol’s solution (iodine)
  • B blockers (propranolol)
  • hydrocortisone

If no improvement:

  • plasma exchange
  • thyroidectomt

Endocrinology (19 decks)

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