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Endocrine > Thyroid > Flashcards

Thyroid Flashcards

1
Q

What are the developmental abnormalities of thyroid development?

A
  1. Wrong place: ectopic thyroid

2. Wrong connection: thyroglossal duct

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2
Q

What happens when TSH stimulates the thyroid?

A
  1. Iodine taken up by follicular cell
  2. T4 and T3 synthesized by follicular cell (done on thyroglobulin, stored in colloid)
  3. T4 (and thyroglobulin) released into circulation
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3
Q

What are the types of differentiated thyroid cancer?

A
  1. Papillary**

2. Follicular thyroid cancer

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4
Q

How can we stage thyroid cancer?

A

MACIS staging system is good for dynamic staging

TNM good for static staging

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5
Q

What kind of thyroid nodules are there?

A

Cold nodules- don’t take up tracer but may be malignant

Hot nodules- do take up tracer due to hyperthyroid mutation pattern. 98% benign

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6
Q

What features are suspicious for thyroid malignancy?

A 
Rapid growth
Hard nodules
Fixed
Hoarseness
Lymphadenopathy

Extremes of age
Large module
Compression SX

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7
Q

Where does follicular cancer metastasize to?

A

Lung and bone

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8
Q

If someone has a low TSH with a palpable nodule, what we do next?

A

Radio nuclear thyroid test, this will tell us if this is a hot nodule

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9
Q

What do we do for palpable nodules with high or normal TSH?

A

Do ultrasound- look for cancerous features like microcalcification, irregular borders, tall nodules, hypoechoic

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10
Q

What does thyroid suppression therapy do in the elderly?

A

May increase risk of osteoporosis and a fib

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11
Q

How do we monitor cancer recurrence?

A

Thyroglobulin levels

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12
Q

What is the marker of medullary thyroid cancer?

A

Calcitonin from c cell

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13
Q

What are the symptoms of hypothyroidism?

A 
Weight gain
Cold intolerance
Fatigue, lethargy, depression
Dry hair, coarse/puffy skin, possible goitre
Menstrual irregularities
Slow reflex relaxation*
Muscle weakness, bradycardia,
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14
Q

What are the clinical features of Graves’ disease?

A 
Weight loss despite appetite
Tremor
Heat intolerance and sweating 
Palpations, shortness of breath, a fib
Amenorrhea
Diarrhea
Hair loss
Muscle weakness and fatigue 
Graves orbitopathy
Pre tibial myxedema
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15
Q

Proptosis

A

Forward protrusion of the orbit due to graves

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16
Q

What features are common between pregnancy and hyperthyroid?

A 
Heat intolerance
Tachycardia
Wide pulse pressure
Flow murmur
Radiant hands and feet
Glitter (in I deficient areas)
17
Q

How do thyroid bio markers change over pregnancy?

A
  1. Initial decrease in TSH because of HCG
  2. Free T4 decreases in second and third trimesters
  3. Bound T3/4 increase as increase in thyroid binding globulin
18
Q

What is the main cause of hyperthyroid in pregnancy?

A

Graves’ disease

19
Q

What are the risks of untreated hyperthyroid in pregnancy?

A

Miscarriage
Preterm delivery
Low birth weight
Pre eclampsia

20
Q

What are the risks of untreated HYPO thyroid?

A 
Fetal loss
Hypertension
Placental abruption
Postpartum hemorrhage
Impaired neurodevelopmen to
21
Q

What do we use to treat post partum thyroiditis?

A

Hyper: beta blockers
Hypo: consider thyroxine replacement

22
Q

What causes transient hypothyroidism in the infant?

A
  1. Prematurity
  2. Maternal anti-thyroid drugs
  3. Maternal TSH blocking antibody
23
Q

What causes persistent hypothyroidism in the infant?

A
  1. Thyroid dysgenesis** (75%)
  2. Dyshormonogenesis
  3. Central hypothyroidism
  4. Maternal radio-iodine ablation (super duper stupid)
24
Q

How do we treat graves disease in pregnancy?

A
  1. Cannot radioablate- contraindicated in preg/breastfeed
  2. PTU anti-thyroid drug- best as crosses placenta least
  3. May abate slightly due to effect of pregnancy
25
Q

Who is at risk of post partum thyroiditis?

A
  1. Those wtih DM1

2. Hashimoto’s thyroiditis already

26
Q

What characterizes hashimoto’s thyroiditis?

A

lymphocytic infiltration of the thyroid, causing progressive thyroid tissue destruction

27
Q

Toxic adenoma

A

Least common cause of hyperthyroid
Low TSH, high t3/4
Palpable nodule with focal point of uptake on scan

28
Q

Multinodular goitre

A

Low TSH, high t3/t4
Nodules with radio iodine uptake
May have SX of thyroid enlargement

29
Q

Graves Disease

A 
Most common cause of hyperthyroid 
Caused by autoimmune attack on thyroid 
Presentation:
-occulopathy
-clubbing
-pretibial myxedema
-bruit over goiter
-firm, non tender goiter

Radioiodine scan shows diffuse uptake

30
Q

Thyroiditis

A

Thyroid releases preformed thyroxine, leading to hyper then hypo thyroid
Presentation
- painful thyroid (post viral)
- may be post partum or drug induced (amiodarone)

Scan shows no uptake of radio iodine.

31
Q

What is the most common cause of hypothyroid?

A

Hashimoto’s

32
Q

Myxedema coma

A

Rare, life threatening, hypothyroid state

Tx with IV thyroxine

33
Q

what antibodies do you have in Hashimotos?

A

Anti thyroid peroxidase

34
Q

What information do we get from an uptake study?

A

Quantitative- just get a number. Good for ruling in or out Thyroiditis and graves.
Not good for nodules

35
Q

What does a scan tell you?

A

Gives you a picture- good for differentiating toxic adenoma vs multinodular goiter

36
Q

Painful thyroid enlargement

A

Thyroiditis (subacute/ granulomatous) is painful- radiates into jaw and ears

Post partum is not painful

37
Q

What are the serious side effects of methimazole

A

Agranulocytosis
Hepatitis
Fetal abnormalities

38
Q

What effect does prematurity have on thyroid?

A

Will be hypothyroid because fetal t4s need a bit of time to catch up

39
Q

Causes of congenital hypothyroid?

A

Sick euthyroid
Maternal anti thyroid drugs
Maternal TSH blocking ab
Thyroid dysgenesis*

Endocrine (12 decks)

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