Thyroid Flashcards
who is hypothyroidism seen in?
Females over 50 that have DM and iodine deficiency
what group of people have Graves?
30-50
What group of people have hyperthyroidism but not graves?
Over 50 females
What is the change of voice in hypothyroidism?
Hoarseness
what happens to concentration in both hypo/hyperthyroidism?
Decreased
If someone has palpitations what is the condition that could be causing this?
Hyperthyroidism
What is the change oh hair in
a) hyper
b) hypo
a) Sweaty skin and coarse hair
b) dry flaky skin and hair loss outer 1/3rd of eyebrow
What is the heart changes and BP in
a) hyper
b) hypo
a) Tachycardia, palpitations and increase BP
b) Reduced HR and BP
What heart conditions are associated with
a) hyper
b) hypo
a) AF
b) Angina
Do you get a goitre in both hypo and hyper?
yes
What happens to the menstrual cycle in both hypo and hyper?
Disturbed and amenorrhoea
In which condition can you get oedema in the face and oedema in the wrist causing carpal tunnel syndrome?
Hyper
What are the key differentiation questions for a thyroid history?
Weight change Tolerance to heat or cold Activity levels Hair loss Palpitations Dry skin Bowels
What should you ask in PMH?
Any previous thyroid surgery ?
Any autoimmune conditions
What should you ask in drug history?
If they are taking: Amiodarone Lithium Iodine Any changes in how you are taking them
What social history questions should you specifically ask?
Diet that contains iodine
Work–> next to radation
In FMH what should you ask?
Any family with thyroid problem or autoimmune disease
On inspection in examination what are you looking for?
If they are hyperactive
Agitated, anxiety, fidgety (hyper)
What signs are you looking for in the hand? What do they indicate?
Dry skin (hypo) Sweaty hands (hyper) Phalangeal bone overgrowth (Graves) Palmar erythema (hyper)
What is the pulse like in:
a) hypo
b) hyper
a) bradycardia
b) tachycardia
If the pulse is irregular irregular what is the condition and the cause?
AF caused by thyrotoxicosis (hyper)
What general signs are you looking for in the face?
a) hypo
b) hyper
a) dry skin, coarse hair and outer 1/3rd of hair eyebrow low
b) sweaty, coarse hair
In the eyes what are you looking for and in what planes do you look at?
Exopthalmous and in all 3 planes
Front, side and back(top)
What eye test are you doing?
Lid lag
What is lid lag caused by?
Graves disease
What are you inspecting in thyroid gland inspection?
What instructions are you giving and why?
General look at the thyroid to see if there is any obvious mass/lump
Ask patient to swallow water–> movement will be either a mass or thyroglossal cyst not a lympth
Then ask for them to protrude their tongue which will cause a thyroglossal cyst to move upwards
What do you palpate? and from where?
First the trachea from the front
Then the thyroid from the back
Start at the adams apple and down to the isthmus
What actions do you ask the patient to do on palpation?
Protrude their tonuge and swallow water
What are you assessing in palpation?
Size Symettery Consistency --> smooth or nodular ( multinodular goitre) Masses Palpable thrills --> thyrotoxocosis
What else do you palpate in the neck as well as the thyroid and trache?
Lymph ( ask the examiner if they want you to do it)
What do you percuss in thyroid examination:?
Manubrium to top of the sternum
If resonant then normal but if dull indication of mass
On auscultation what instruction do you give to the patient?
Hold your breath
Use the bell side
Any sounds indication of Graves
What are your special tests?
Tibial myxedema–> Graves
Patella reflex
Proximal myopathy
What are the indications of increase or decreased patella reflex?
Increase –> hyper
Decreased –> hypo
How do you test for proximal myopathy?
Ask the patient to stand up without their hands
Indication of hyper
What are the end pieces?
Thyroid function test
ECG–> abnormal cardiac signs
US
Three cardinal signs of graves?
Exopthalmous
Tibial myxedema
Thyroid acropathy
What is the affect of weight in
a) hyper
b) hypo
a) reduction in weight without meaning to
b) gain in weight
What is the affect in appetite in
a) hyper
b) hypo
a) increased but still loss of weight
b) decreased but gain in weight
What is the affect in bowels for
a) hyper
b) hypo
a) frequent stools
b) constipation
What is the effect of hyper on
a) energy levels
b) sleep
c) mood
a) increased
b) reduced sleep
c) Anxious and irritable
What is the effect of hypo on
a) energy levels
b) sleep
c) mood
a) reduced energy
b) increased sleep
c) lethargy and depression
What would the blood results be for
a) hyper
b) hypo
a) Increase secretion of thyroid hormones= TSH ↓ → T4 ↑, T3 ↑ or normal.
b) decrease secretion of thyroid hormones= TSH ↑ → T4 ↓, T3 ↓
