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EndocrineJaz > Thyroid > Flashcards

Thyroid Flashcards

1
Q

vertebral level that thyroid sits at

A

C5-T1

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2
Q

thyroid sits infront of tracheal rings __+__

A

2nd-4th

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3
Q

thyoid increases in size physiologically in __/__

A

pregnancy

menstruation

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4
Q

innervation of the thyroid

A

parasympathetic from CNX

sympathetic from superior, middle and inferior ganglia of sympathetic trunk

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5
Q

blood supply of thyroid from

A

superior and inferior thyroid arteries (ECA)

+/- thyroidea ima

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6
Q

veins that drain from thyroid and where they drain to first

A

sup and middle thyroid - IJV

inferior - brachiocephalics

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7
Q

posteromedial aspect of thyroid is attached by ___ which the ___ travels near to/through

A

the Berry ligament

recurrent laryngeal n

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8
Q

tyrosine containing thyroglobulin filled spheres in thyroid

A

colloid

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9
Q

cells that line colloid in the thyroid

A

follicular cells

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10
Q

cells in thyroid that secret calcitonin

A

parafollicular C cells

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11
Q

synth and release of thyroid hormones:

___ from blood > ___ cells > ___ thyroglobulin>pinocytosis into ___ cell > lysosome > released into blood

A

I-
follicular cells
colloid
follicular cell

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12
Q

iodine attaches to ___ on thyroglobulin
1 = __
2 = __

A

tyrosine residues
MIT (monoiodotyrosine)
DIT

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13
Q

T3 is composed of __+__

A

MIT and DIT

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14
Q

T4 is composed of __

A

2x DIT

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15
Q

T3 and T4 are stored in

A

colloid thyroglobulin

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16
Q

__+___ prevent iodine from binding to form MIT and DIT

A

carbimazole and propylthiouracil

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17
Q

90% of thyroid hormon secreted is

A

T4

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18
Q

4x more potent thyroid hormone that is the major biologically active one

A

T3

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19
Q

T4 is converted to T3 by the __+__

A

liver kidney

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20
Q

TSH binds to a receptor on ___

A

follicular cell

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21
Q

T4 and T3 are ___ and so travel bound 70% to __, 20% ___, 5% to ___
inactive when bound

A

lipophilic
70 - TBG (thyroxine binding globulin)
20 - TBPA (thyroxine binding prealbumin)
5 - albumin

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22
Q

T3 bind __ less avidly to TBG and not significantly to TTR so

A

10-20x

more rapid onset/offset of action

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23
Q

conditions that can increase TBG levels (doesnt affect free T4 levels)

A 
pregnancy
neonate
OCP/oestrogens
tamoxifen
Hep A, biliary cirrhosis
porphyria
heroin
clofibrate
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24
Q

decreases level of TBG

A 
androgens
Cushing's - steroids
acromegaly
liver disease
nephrotic syndrome
phenytoin
carbamezepine
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25
Q

The effects T4 and T3 that cause an increased BMR

A

increase no. and size of mitochondria
increase O2 use and rate of ATP synth
increase synth of resp chain enzymes

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26
Q

T4 and T3 __ thermogenesis, __ bg, ___ insulin dependent glucose uptake into cells, mobilise fat from ___, ___ FA oxidation, ___ protein synthesis

A

increase

adipose tissue

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27
Q

GHRH production and secretion requires ___

slucocorticoid-induced GHRH release depends on __ and GH need __ presence for activity

A

Thyroid hormones

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28
Q

__+___ in foetal and neonatal brain requires thyroid hormones

A

myelinogenesis and axonal growth

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29
Q

thyroid hormones increase responsiveness to ___+___+__ by increasing __

A

adrenaline, noradrenaline, sympathetic NS neurotransmitters

increasing number of receptors

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30
Q

hypothalamus = __ > anterior pituitary = __ > thyroid =

A

TRH
TSH
T4+T3

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31
Q

in babies and young kids __ envnt stimulates TRH release

A

cold

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32
Q

circadian rhythm of thyroid hormones = increased at __ and decreased at __

A

up at night and down morning

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33
Q

___ enzymes activate and deactivate thyroid hormones by adding/removing I- from outer ring

A

delodinase

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34
Q

delodinase 2 function

A

activates T4 > T3 in tissues

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35
Q

Delodinase 1 is found in __+__

A

liver and kidney

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36
Q

delodinase 2 is found in (6)

A 
heart
skeletal muscle
CNS
fat 
thyroid
pituitary
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37
Q

delodinase 3 is found in ++_

A

foetal tissue
placenta
brain (except pituitary)

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38
Q

2ndry hypothyroidism is/not associated with a goitre

A

isnt

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39
Q

s+s of hypothyroidism

A 
slow relaxing reflexes
lethargy
weight gain
cold intolerance
decreased appetite
slow pulse
mentally sluggish
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40
Q

puffy face in hypothyroidism =

A

myxoedema

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41
Q

if hypothyroid in baby may cause ___

A

cretinism - dwarfism and mental retardation

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42
Q

auto anti body in Graves -

causes __thyroidism

A

TSI

hyperthyroidism

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43
Q

exophthalmos is caused by

A

water retaining carbohydrates building up behind the eye in Graves disease

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44
Q

s+s of hyperthyroidism

A 
heat intolerance
tremor
palpitations
nervous/v emotional
lose weight
increased appetite
insomnia
sweaty
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45
Q

in primary hyperthyroidism T4/3 = and TSH =

A 
T4/3 = high
TSH = low
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46
Q

in primary hypothyroidism T4/3 = and TSH =

A 
T3/4 = low
TSH = high
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47
Q

2ndry hyperthyroidism T4/3 = TSH =

A

both high

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48
Q

2ndry hypothyroidism T4/3 = TSH =

A

both low

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49
Q

subclinical hypothyroidism T4/3 = TSH =

A 
TSH = high
T4/3 = normal
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50
Q

myxoedema coma =

A

severe hypothyroidism

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51
Q

what is myxoedema?

A

accumulation of hydrophilic mucopolysaccharides in ground substance of dermis and other tissues > doughy induration of the skin (usually shins) seen in Graves

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52
Q

primary causes of goitrous primary hypothyroidism

A

Hashimoto’s thyroiditis - AI
iodine deficiency
amiodarone
lithium

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53
Q

non goitrous primary causes of hypothyroidism

A

congenital developmental defect, atrophic thyroiditis, post-ablative, postradiation

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54
Q

selflimiting causes of primary hypothyroidism =

A

after withdrawal of suppressive thyroid therapy, subacute thyroiditis, postpartum thyroiditis

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55
Q

2ndry causes of hypothyroidism

A

hypothalamic - encephalitis, sarcoid, malig

panhypopituitarism or isolated TSH deficiency

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56
Q

most common cause of hypothyroidism in Western world and in developing countries

A 
western = hashimotos
dev = iodine deficiency
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57
Q

Ig present in Hashimotos

A

TPO (thyroid peroxidase)

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58
Q

on microscopy of hashimotos =

A

T cell infiltrate and inflammation

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59
Q

fT4 is a better indication of hypothyroidism as __

A

there is preferential conversion to T3

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60
Q 
s+s of hypothyroid:
hair =
face =
periorbital \_\_\_
skin =
hyper\_\_\_
A 
coarse and sparse hair
dull expressionless face
periorbital puffiness
pale cool doughy skin - maybe vitiligo and hypercarotenaemia
hyperlipidaemia
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61
Q

gynae symptoms of hypothyroidism

A

menorrhagia > later = oligo/amennorhoea

hyperprolactinaemia as increased TRH causes increased PRL

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62
Q

other blood results for hypothyroidism other than hormones

A

macrocytosis
increased CK and LDL
hyponatraemia
hyperprolactinaemia

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63
Q

starting dose of thyroxine in young and in elderly with HD

A 
young = 50-100microg/day
elderly = 25-50microg/day
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64
Q

TSH receptor Ig inGraves : Hashimotos % and its effect in both

A 
Graves = 70-100% - stimulating
Hashimotos = 10-20% - blocking
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65
Q

3 Igs in Graves and Hashimotos

A

anti TPO
anti thyroglobulin
TSH receptor

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66
Q

check TSH every __ after thyroxine dose change and ___ once stabilised

A

2mnths

12-18mnths

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67
Q

in pregnancy dose of thyroxine =

A

can increase by 25-50% as TBG increased

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68
Q

if secondary hypothyroidism treated with levothyroxine then monitor __ not __

A

fT4 not TSH (as it stays low)

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69
Q

ECG and resp signs of myxoedema coma

A

bradycardia, low voltage complexes, heart block, T wave inversion, QT interval prolonged
Type 2 resp failure - hypoxia, hypercarbia, resp acidosis

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70
Q

myxoedema coma is typically in

A

elderly F with longstanding but freq unrecognised and untreated hypothyroidism

71
Q

Rx for myxoedema coma

A 
ICU
passively rewarm
cardiac monitor
fluids and electrolytes
Abx broad spectrum
thyroxine cautiously posssibly with hydrocortisone
72
Q 
hyperthyroidism s+s
arrhythmia
GI
visual 
hair
nail
gynae
muscles
A

AF
diarrhoea
chemosis, lid lag, lid retraction, diplopia, exophthalmus
brittle thinning hair
fast growing nails
lighter periods and less frequent
muscle weakness esp thighs and upper arms

73
Q

causes of hyperthyroidism =

A 
Graves
multinodular goitre
toxic nodule (adenoma)
subacute/postpartum thyroiditis
kelp
amiodarone/lithium
74
Q

Graves tends to fluctuate/stay constant

50% __ at 18m and 50% __

A

fluctuate
burn out
relapse

75
Q

graves goitre is ___

A

smooth and symmetrical

76
Q

scintigraphy result in graves

A

diffuse increased uptake

77
Q

Rx for grave eye disease

A 
lubricants
steroids short term inflam decrease
radiotherapy
Sx
stop smoking
78
Q

age range typical of graves and gender split

A

F2:1M

20-50yo

79
Q

demographic of nodular thyroid disease

A

older patient

80
Q

nodular thyroid disease goitre -

A

asymmetrical

81
Q

scintigraphy result for nodule thyroid disease goitre

A

patchy increased uptake

82
Q

Signs of Thyroid storm

A 
sever hyperthyroidism
respiratory and CV collapse
hyperthermia
exaggerated reflexes
need ventilation
83
Q

Rx for thyroid storm

A 
lugols iodine (stuns thyroid)
steroids
PTU
beta blockers
fluids and monitor
84
Q

can cause agranulocytosis this drug can

A

carbimazole

85
Q

hyperthyroid drug preferred in pregnancy

A

PTU

86
Q

in Graves start carbimazole __ and __ over 12-18 months

A

high dose

taper

87
Q

symptomatic control in hyperthyroidism =

A

beta blockers

88
Q

if have had radioiodine what precautions must you take?

A

no close prolonged contact with kids/preg F
dont share bed with partner for 2-3days
avoid preg for 6 months
ensure not preg

89
Q 
subacute thyroiditis aka
F:M
age range 
triggered by a 
phases
A 
De Quervain's thyroiditis
F>M
20-50yo
virally
hyper>hypo>eu
90
Q

scintigraphy results for De Quervains thyroiditis

A

reduced uptake

91
Q

2% of patients on amiodarone get __
13% get ___
each more common if __ iodine intake

A 
2 = thyrotoxicosis - low iodine intake
13 = hypo - high iodine intake
92
Q

thyroid embryology:

develops from evagination of ___ -descends through ___ along the ___

A

pharyngeal epithelium
foramen caecum
thyroglossal duct

93
Q

embryology: if thyroid fails to descend =

A

lingual thyroid

94
Q

if thyroid descends excessively =

A

retrosternal in mediastinum

95
Q

can occur anywhere along the path of descent of the thyroid

A

thyroglossal duct cyst

96
Q

the histology of cells that make up the thyroid

A

flat to cuboidal follicular epithelial cells

97
Q

struma ovarii =

A

monodermal teratoma that is composed of thyroid tissue = ectopic production

98
Q

on microscopy of graves =

A

scalloping and paling of colloid

99
Q

HLA gene associated with Hashimoto’s

A

HLA DR3+5

100
Q

polymorphisms in these 2 immune regulation associated genes are a component of Hashimotos

A 
CTLA 4 (-ve regulator of T cell responses)
PTPN-22 (inhibits T cell function)
101
Q

Hashimotos increases risk of __ and of developing ___ in affected gland

A

other AI conditions

B cell NHL

102
Q

diffuse goitre - usual cause =
F:M
age
eu/hyper/hypo?

A

idiopathic
F>M
young adults
euthyroid usually - T3/4 normal but TSH increased/ULN

103
Q

follicular adenoma description of its appearance =

A

discrete solitary mass - encapsulated by a collagen cuff

104
Q

follicular adenoma are usually ___ but can lead to TSH independent ___

A

non-functional

thyrotoxicosis

105
Q

__+___ mutations in a follicular adenoma can lead to it being functional

A

TSHR

G protein

106
Q

Thyroid carcinomas: age, gender

4 types

A 
F>M, early adulthood
papillary (75-85%)
follicular (10-20%)
medullary (5%)
anaplastic (<5%)
107
Q

5 causes of papillary thyroid carcinoma

A 
ionising radiation
active MAP kinase pathway
rearrangements of RET/NTKR1
activating point mutation in BRAF
ras mutation
108
Q

the appearance of papillary thyroid carcinoma

A

usually solitary nodule, can be multifocal, often cystic

may be calcified = psammoma bodies

109
Q

10 yr survival rate for papillary thyroid carcinoma

A

95%+

110
Q

cause of follicular thyroid carcinoma (3)

A

iodine deficiency
P13K/AKT pathway mutations
ras (usually N-ras) mutations

111
Q

age and gender of follicular thyroid carcinoma

A

F>M

40-50yo

112
Q

Describe follicular thyroid carcinoma

A

usually single nodule (slowly enlarging painless non-functional , may be part capsule, vascular/capsular invasion distinguishes it from adenoma)

113
Q

spread of follicular thyroid carcinoma

A

not usually lymphatic - usually haematogenous

114
Q

spread of papillary thyroid carcinoma

A

usually lymph nodes

115
Q

mortality of follicular thyroid carcinoma at 10yrs

A

high stage = 50%

minimally invasive = >90%

116
Q

medullary thyroid carcinoma marker =

A

calcitonin

117
Q

MTC is associated with this genetic condition

A

MEN2 - germline RET mutations - can be very young patient

118
Q

If familial then MTC =__/__

A

bilateral/multicentric

119
Q

70% of MTC are sporadic and these usually develop at age ___ and are a ___

A

40-50yo

solitary nodule

120
Q

MTC derived from ___

A

C cells

121
Q

describe appearance of MTC -

A

spindle/polygonal cells in nests, trabeculae or follicles

associated with amyloid deposition (of calcitonin)

122
Q

MTC are usually ___ and need a total ___

A

aggressive

thyroidectomy

123
Q

paraneoplastic syndromes (2) associated with MTC

A

diarrhoea (VIP)

Cushing’s (ACTH)

124
Q

2 mutations associated with anaplastic thyroid carcinoma

A

p53 and beta catenin mutations

125
Q

Anaplastic thyroid carcinoma: __+___

age, in patients with a Hx of ____,

A

undifferentiated and aggressive
older patient
differentiated thyroid carcinoma

126
Q

anaplastic thyroid carcinoma grows ___ and can involve ___

A

rapidly

other neck structures

127
Q

Thy1 on FNA means

A

insufficient/uninterpretable

128
Q

Thy2 on FNA means

A

benign

129
Q

Thy3 on FNA means

A

atypia probably benign

130
Q

Thy4 on FNA means

A

suspicion of malignancy

131
Q

Thy 5 on FNA =

A

malignant

132
Q

most differentiated thyroid cancers take up ___ and secrete ___
they are ___ driven

A

I-
thyroglobulin
TSH

133
Q

factors associated with increased risk of differentiated thyroid cancers

A 
Female (2/3:1M)
not afro-caribbean
radiation (strong link)
increased TSH or parity
thyroid adenomata
134
Q

majority of differentiated thyroid cancers present with __

some =

A

palpable nodules

chance finding on histology

135
Q

differentiated thyroid cancers = __+__

A

follicular and papillary variants

136
Q

commonest histological type of thyroid cancer (76%) =

A

papillary thyroid cancer

137
Q

papillary thyroid cancer tends to spread via

A

lymphatics

138
Q

thyroid cancer associated with Hashimotos

A

Papillary thyroid cancer

139
Q

2nd commonest histological type of thyroid cancer (17%) =

A

follicular

140
Q

follicular carcinoma of thyroid tends to spread via

A

haematogenous spread

141
Q

incidence of follicular carcinoma is slightly increased in areas with ___

A

low iodine intake

142
Q

Ix for differentiated thyroid cancers =

A

US FNA
may involve an excision biopsy of lymph node
if suspect vocal cord palsy = pre-op laryngoscopy

143
Q

6 clinical predictors of malignancy in thyroid cancers

A 
Male
new nodule age <20 or >50
increasing size of nodule
>4cm diameter
Hx of head and neck irradiation
vocal cord palsy
144
Q

risk stratification used in post-op for thyroid cancers = ___ which stands for +++

A 
AMES
age (older = worse)
metastases
extent
size of primary tumour
145
Q

Sx given to low risk AMES patients with differentiated thyroid cancers,<1cm papillary cancers and minimally invasive follicular ca with capsular invasion only

A

lobectomy with isthmusectomy

146
Q

in differentiated thyroid cancer this is the Sx given if high risk AMES, extra thyroidal spread, multifocal, distant met.s, nodal involvement

A

sub/total thyroidectomy

147
Q

if a patient with differentiated thyroid cancer has macroscopic lymph node disease Rx =

A

nodal clearance (Sx)

148
Q

nodal clearance for papillary thyroid cancer with lymph node disease =

A

central compartment clearance and lateral lymph node sampling

149
Q

nodal clearance for follicular thyroid cancer with lymph node disease =

A

central compartment clearance

150
Q

check calcium within __ of thyroid Sx - replace if ___ and give IV if __/___

A

24hrs
<2mmol/l
<1.8/symptomatic

151
Q

whole body iodine scan is done in patients who have had ___
usually ___ post-op
stop T4 __ and T3 ___ before scan

A

sub/total thyroidectomy
3-6months
T4 - 4wks
T3 - 2 wks

152
Q

senstitivy of iodine body scan is determined by ___

A

the elevation of TSH

153
Q

long term affects of thyroid remnant ablation can be ___

A

small increase in AML incidence - mainly if cumulative I-131 doses >800mCi and repeated therapy does in 12months

154
Q

thyroid remnant ablation process

A

pre treat with rhTSH >
2/3GBq I-131 capsules >
discharge pt when <500cps at 1m count rate >
usually give levothyroxine long term post this

155
Q

rationale behind thyroid remnant ablation

A

to suppress TSH to <0.1mU/l and fT4 <25
ablate any microfoci in residual thyroid tissue and remove as source of Tg
permit predictably useful scanning in whole body scane

156
Q

C lymph node recurrence is more/less common in papillary over follicular thyroid cancer

A

more

157
Q

___ is a tumour marker in diferentiated thyroid cancers

A

thyroglobulin

158
Q

must measure ___ before thyroid remnant ablation because not everyone secretes it
also measure ___ as can affect titre

A

thyroglobulin

anti-Tg Igs

159
Q

if after Rx for differentiated thyroid cancer the Tg levels are rising but pt has a -ve whole body iodine scan what do you do?

A

possible PET scan to determine if Sx/radio appropriate + target specific tissue

160
Q

S+S of congenital hypothyroidism

A

delayed jaundice
poor feeding but “normal” wt gain
skin and hair changes
hypotonia (umbilical hernia, constipation)

161
Q

screening test for congenital hypothyroidism = __

done at day __

A 
Guthrie test (TSH and fT4)
5
162
Q

s+s of hyperthyroidism in kids

A 
behaviour problems
sleep disturbance
eating difficulties
goitre 
fast HR
precocious puberty
163
Q

treatment for hyperthyroidism in kids

A

beta blocker
carbimazole+/thyroxine for at least first 2 yrs
then Sx/radio-iodine

164
Q

causes of primary congenital hypothyroidism

A

gland dysplasia+/- abnormal site

inborn error of TH metabolism

165
Q

4 factors that cause T4 to be converted to inactive rT3

A

stress
fasting
illness
cortisol

166
Q

3 thyroid autoIgs

A

antiTPO
anti thyroglobulin
TRAb

167
Q

treatment of thyroid storm =

A 
high dose carbimazole
beta blockers
hydrocortisone
K+ iodide/lugol
IV fluids +/- inotropes
168
Q

one of the most common benign thyroid nodules =

A

colloid nodule

169
Q

most penetrant feature of MEN2

A

MTC

170
Q

MTC causes excess secretion of __ => present with___

A

calcitonin

diarrhoea

171
Q

Rx for TMNG =

A

radio-iodine unless occupation is a contraindication

172
Q

If have only taken carbimazole for few days before blood test (poor compliance) it will show =

A

normal fT4 but raised TSH as it has not had time to reduce yet

173
Q

carbimazole is a very effective drug and so if it is not working it is usually due to ___

A

non-compliance

174
Q

in hypopituitarism if give thyroxine before cortisol it may cause ___

A

Addison’s crisis as it increases the BMR

EndocrineJaz (15 decks)

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