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MS4 - Endocrine > Thyroid > Flashcards

Thyroid Flashcards

1
Q

Thyrotoxicosis definition

A

Clinical effect of ↑T4

Usually from gland hyperfunction

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2
Q

Sx of thyrotoxicosis

A
  • Diarrhoea
  • ↑ appetite but ↓ wt.
  • Sweats, heat intolerance
  • Palpitations
  • Tremor
  • Irritability
  • Oligomenorrhoea ± infertility
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3
Q

Signs of thyrotoxicosis in the hands

A
  • Fast / irregular pulse
  • Warm, moist skin
  • Fine tremor
  • Palmer erythema
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4
Q

Signs of thyrotoxicosis in the face

A
  • thin hair
  • lid lag
  • lid retraction
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5
Q

Signs of thyrotoxicosis in the neck

A

goitre or nodules

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6
Q

Signs specific to Graves

A
  1. Exophthalmos
  2. Pre-tibial myxoedema
  3. Thyroid acropachy
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7
Q

Thyroid acropachy definition

A

Clubbin and swelling of digits

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8
Q

Ix for thyrotoxicosis

A

High T4

Low TSH

Autoantibodies

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9
Q

Most common cause of thyrotoxicosis?

A

Graves’ disease

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10
Q

Triggers of Graves disease

A
  • stress
  • infection
  • child-birth
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11
Q

Conditions associated to Graves disease

A

T1DM

Vitiligo

Addison’s

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12
Q

Other causes of thyrotoxicosis

A

Toxic multinodular goitre
Toxic adenoma
Thyrotoxic phase of thyroiditis
Drugs

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13
Q

Drugs causing thyrotoxicosis

A

Thyroxine

Amiodarone

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14
Q

Medical treatment for thyrotoxicosis

A

Beta blocker - sx relief
Carbimazole

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15
Q

Action of carbimazole

A

Anti-thyroid

Inhibits TPO

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16
Q

Use of carbimazole in Graves’ disease

A

Rx 12-18 mo

Then withdraw

~ 50% relapse (→ surgery or radioiodine)

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17
Q

SE of carbimazole

A

Agranulocytosis

18
Q

Radiological treatment for thyrotoxicosis

CI

A

Radioactive iodine

CI in pregnancy

19
Q

Surgical treatment for thyrotoxicosis

A

Thyroidectomy

20
Q

Thyroid storm definition

A

Thyrotoxic crisis

Acute life-threatening hypermetabolic state

Induced by excessive release of thyroid hormones

21
Q

Features of thyroid storm

A
  • ↑ temp
  • Agitation, confusion, coma
  • Tachycardia, AF
  • Acute abdomen
  • Heart failure
22
Q

Precipitants to thyroid storm

A

Recent thyroid surgery

Radioactive iodine

Infection

MI

Trauma

23
Q

Mx of thyroid storm

A
  1. Fluid resuscitation + NGT
  2. Bloods: TFTs + cultures
  3. Propranolol
  4. Digoxin may be needed
  5. Carbimazole
  6. Hydrocortisone
  7. Rx cause
24
Q

Sx of hypothyroidism

A
  • Lethargy
  • Cold intolerance
  • ↓ appetite but ↑wt.
  • Constipation
  • Menorrhagia
  • ↓ mood
25
Q

Signs of hypothyroidism

A
  • Cold hands
  • Bradycardic
  • Slow-relaxing reflexes
  • Dry hair and skin
  • Goitre
  • Myxoedema
26
Q

Myxoedema definition

A
  • SC tissue swelling in severe hypothyroidism
  • Typically around eyes and dorsum of hand
27
Q

Causes of hypothyroidism

A
  • Atrophic thyroiditis
  • Hashimoto’s thyroiditis
  • Post De Quervain’s thyroiditis
  • Iodine deficiency
  • Drugs
  • Congenital thyroid agenesis
  • Hypopituitarism
28
Q

Drugs causing hypothyroidism

A

Carbimazole

Amiodarone

Lithium

29
Q

Most common cause of hypothyroidism in UK

A

Atrophic thyroiditis

30
Q

Most common couse of hypothyroidism worldwide

A

Iodine deficiency

31
Q

Ix for atrophic thyroiditis

A

Anti-TSH antibody positive

32
Q

Features of atrophic thyroiditis

A

Lymphocytic infiltrate → atrophy

No goitre

33
Q

Ix for Hashimoto’s thyroiditis

A

TPO positive

(Thyroid peroxidase antibody)

34
Q

Features of Hashimoto’s thyroiditis

A
  • Atrophy + regeneration → goitre
  • May go through initial thyrotoxicosis phase
  • May be euthyroid or hypothyoid
35
Q

Ix for hypothyroidism

A

High MCV

High TSH

Low T4

Antibodies

36
Q

Mx of hypothyroidism

A

Levothyroxine

Follow up for other autoimmune diseases

37
Q

Features of myxoedema coma

A
  • Looks hypothyroid
  • Hypothermia
  • Hypoglycaemia
  • Heart failure: bradycardia and ↓BP
  • Coma and seizures
38
Q

Precipitants to myxoedema coma

A
  • Radioiodine
  • Thyroidectomy
  • Pituitary surgery
  • Infection, trauma, MI, stroke
39
Q

Mx of myxoedema coma

A

Bloods

Correct any hypoglycaemia

T3/T4 IV slowly

Hydrocortisone

Rx hypothermia and heart failure

40
Q

Why give T3/T4 slowly in myxoedema coma?

A

May precipitate MI

MS4 - Endocrine (7 decks)

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