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Endocrine Y2 JC > Thyroid > Flashcards

Thyroid Flashcards

1
Q

Between what vertebral level is the thyroid gland found?

A

C5-T1

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2
Q

What arteries supplt the thyroid gland? Where do they branch from

A

External carotid artery

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3
Q

What molecule binds with thyroglobulin to produce thyroxine

A

Iodine

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4
Q

What enzyme is responsible for cleaving t4->t3

A

Deiodinase type II

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5
Q

Describe the feedback system that stimulates thyroxine release from thyroid and then inhibits it

A

Thyrotrophin is released from the hypothalamus-> acts on pituitary to release TSH (thyroid stimulating hormone) -> act on the thyroid gland to release T3/4.

T3/4 then act on the hypothalamus and pituitary to inhibit their secretions.

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6
Q

Give an example of a factor that increases TRH release? (Thyrotrophin releasing hormone)

A

Low temperatures

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7
Q

What effect does stress have on thyroxine release?

A

Stress inhibits TRH release from the hypothalamus therefore wont have thyroxine release from the thyroid.

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8
Q

What are the plasma proteins that t3 and T4 must be bound with to be transported in the plasma?

A

Thyroxine binding globulin or thyroxine binding prealbumin.

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9
Q

What are some of the physiological effects of thyroxine on the body?

A 
Increases metabolism (incresases mitochondria no.)
Loose bowel 
Lessen periods
Increase HR
Important in feotal development
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10
Q

What are some of the common causes of hypothyroidism?

A 
Iodine deficiency so unable to synthesis MIT or DIT
Hashimotos thyroiditis (autoimmune disease where antibodies attack thyroid peroxidase
Deficiency of hypothalamus or pituitary
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11
Q

What is the epidemiology of hypothyroidism?

A 
Other autoimmune conditions already like vitiligo and type 1 diabetes
Females
Lack of iodine in diet
45-60yrs incidence rises 
White populations
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12
Q

What are some of the symptoms of hypothyroidism?

A 
Goitre
Weight gain 
Slow pulse rate (bradycardia)
Constipation
Tired
Puffy hands/feet/face
Amenorrhoea (missed periods)
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13
Q

What is amenorrhoea?

A

Missing of periods

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14
Q

What is myoedema?

A

EMERGENCY

Diminished conscious level with bradycardia and hypertension

Common in the elderly

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15
Q

Blood results return for a patient
TSH 45 (0.4-4.0)
T3 0.03 ( 9.9-22)
FT4. 4. (0.9-2.6)

What type of thyroidism does this patient have?

A

Hypothyroidism

TSH high trying to stimiulate the thyroid gland to produce more thyroxine which is low

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16
Q

What is the treatment for hypothyroidism?

A

Thyroid hormone replacement with levothyroxine (T4) taken before breakfast

Start low then titrate up in 25micrograms
Recheck bloods every 4wks then once normal every 12-18months

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17
Q

What should you advise patients to avoid taking at the same time as their thyroxine tablets?

A

Calcium and iron tablets as they prevent absorption of the thyroxine

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18
Q

What are some of the pathological causes of hyperthyroidism?

A

Autoimmune where antibodies bind to thyroid gland to stimulate thyroxine production like in graves disease.

Multinodular goitre
Adenomas/ carcinomas
De quervains thyroiditis (acute inflammatory process from virus)
Postpartum thyroiditis (transient after pregnancy)

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19
Q

What are the epidemiological groups for hyperthyroidism?

A 
Middle aged WOMAN (20-40yrs)
Iodine deficiency (for toxic multinodular goitre)
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20
Q

What are some of the cardinal symptoms of hyperthyroidism?

A

Weight loss with increased appetite, tremor, heat intolerance, palpitations (can have AF), irregular periods (ammenorrhoea), goitre (leading to difficulty breathing/swallowing), diarrhoea

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21
Q

What are some specific symptoms of graves disease?

A

Exophthalmos (bulging eyes
Pretibial myxoedema
Blurred vision
Gritty eyes

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22
Q

What are some of the specific symptoms fo de quervains thyroidiitis?

A

Due to viral infection then symptoms of infection

Fever, malaise, local tenderness around thyroid, transient hypothyroidism before back to normal

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23
Q

What drug is known to cause distruption in thyroid fucntions?

A

Amiodarone for arrhythmia treatment

Can cause hyperthyroidism

24
Q

What would you expect to find on examination of someone with hyperthyroidism?

A 
Enlarged thyroid
Increased HR
Full pulse
Maybe AF
Tremor in hands
Bruits in graves
25
Q

If you suspect hyperthyroidism what investigations would you order?

A

Bloods;

  • antibodies; thyroid stimulating ig, thyroid growth stimulating ig, TSH binding inhibitor Ig.
  • TSH, T3 and fT4 levels
26
Q

You do bloods for a patient;

TSH <0.05 (0.4-4.0)
T3. 29. ( 9.9-22)
FT4. 79. (0.9-2.6)

What do they have?

A

Hyperthyroidism

27
Q

What are the treatment options for hyperthyroidism?

A

Inhibit thyroid hormone production within the thyroid- carbimazole or propylthiouracil (inhibit thyroid peroxidase)

Reduce sympathetic effects on heart and peripheral tissues so propranolol

28
Q

Before placing a patient with hyperthyroidism on carbimazole what side effect must you warn them of?

A

Can cause agranulocytosis causing a dry cough or sore throat

If get this then stop the medication and see GP

29
Q

What lifestyle advice should you give a person with hyperthyroidism?

A

Stop smoking as it increases your chances of developing eye disease

30
Q

Baby of 2 days presents with jaundice, poor feeding, floppy. He had guthries test which pulled up an abnormality. What is the likely diagnosis? His mother has known autoimmune diseaes.

A

Paediatric hypothyroidism

31
Q

If paediatric hypothyroidism is left untreated past 3 months, what are the possible consequences?

A

Permanent developmental delay

32
Q

What is lid lag? What condition does it suggest present?

A

When the eye moves down and the movement of the upper eyelid is delayed

Hyperthyroidism specifically graves

33
Q

What are some of the causes of hyperthyroidism?

A 
Graves disease
Toxic multinodular goitre
Adenomas or carcinomas
De quervains thyroiditis
Postpartum thyroiditis
34
Q

Women with hyperthyroidism presents to clinic wanting to get pregnant. She is currently on carbimazole. What advice would you give her?

A

Stop the carbimazole and switch to propylthiouracil. Must wait 3 months to clear from her system before getting pregnant

For the 1st trimester propylthiouracil
2nd trimester carbimazole
3rd trimester propylthiouracil

35
Q

Young boy 7 years presents with frequent agitation, waking up in the night, and recently been wetting the bed at night. His mom mentions shes had to get new school trousers as they’ve been falling down. Likely diagnosis?

A

Paediatric hyperthyroidism

36
Q

Women presents with polydipsia, polyuria, tired, and abdominal pain. She mentions going up stairs has become difficult. She is currently on thiazide like diuretics. Likely diagnosis? Investigations?

A

Hyperparathyroidism

Bloods of raised serum calcium, raised serum PTH, increased urine calcium excretion where 0.03 < considered low

37
Q

What is the acute treatment for hypercalcaemia?

A

Clinically dehydrated so high fluids 4-6L a day of saline and furosemide

Bisphosphonates to lower calcium over 2-3days

38
Q

What is the long term management for hyperparathyroidism?

A

Surgical resection, no medical management

39
Q

What are some of the complications of long term hyperparathyroidism?

A

Abnormal ECG

Kidneys stones
Arrhythmias
Osteoporosis

40
Q

People with MEN1 and 2 are likely to also get what condition?

A

Hyperparathyroidsim

41
Q

Man with known digeorge syndrome presents with pins and needles in his legs, and lips, difficulty breathing with stridor. On examination he is chvosteks sign positive. What is the likely diagnosis?

A

Hypoparathyroidism

Digeorge is a common predisposition
Chvosteks sign is percussion over the facial nerve in the face to see facial muscles twitch

42
Q

What are some of the causes of hypomagnesaemia? What can this lead to ?

A

Hypocalcaemia (hypoparathyroidism)

Alcohol, PPI, thiazides, diarrhoea, pancreatitis, IBD

43
Q

What are some of the complications of hypoparathyroidism?

A

Long QT syndrome
Asphyxia
Fractures due to disordered bone
Breathing problems

44
Q

What is the emergency treatment for hypocalcaemia?

A

IV calcium gluconate 10ml 10% over 10 minutes

Then

10ml 10% in 100ml over 10hrs
Vitamin D supplements

45
Q

What are the long treatments for hypoparathyroidism

A

Calcium suppleemtns 1-2g a day

1-alphacalcidol 0.5 mcg

Depot injection cholecalciferol 3x10^5 every 6 months

46
Q

Describe the pathology of vitamin D deficiency causing rickets and osteomalacia

A

Low vitamin D means low absorption of. Alcium aand phosphate int he intestine causes a high PTH secretion in oder to get a normal calcium level. This means more bone reabsorption to create calcium causing the weakened bones

47
Q

What is the treatment for vitamin D deficiency?

A

Vit D 400-800 units a day after 3200 load

48
Q

How would you differentiate between a thyroid swelling and a thyroglossal cyst?

A

Thyroglossal cyst will move upwards with protrusion of the tongue and swallowing

49
Q

Young women with hypothyroidism comes to clinic telling you she’s pregnant. What do you advise/ managamenet implemet?

A

During pregancy increased demand on thyroid so increase daily iintake by 25mcg.

HCG secreted from the fetus increaes thyroxine levels suppresses TSH so can cause hyperemesis gravidarum (extreme sickness and vomiting) try and bear with it dont want to treat in 1st trimester

Check thyroid levels for the first 20weeks every month, then 2 monthly until term. Aim for TSH below 3.

On average increase pills by 50% during pregnancy

50
Q

What are some of the complications to the fetus if mom has untreated hypothyroidism during pregnancy?

A 
Increased risk of abortions
Preeclampsia (high BP in mom)
placental Abruption (placenta coming away from wall of womb)
Post partum haemorrhage
Preterm labour
Risk of IQ <85
51
Q

What are some of the complications of untreated hyperthyrodism during pregnancy?

A

Still birth
Spontaneous miscarriage
Thyroid crisis in labour
Transient neonatal thyrotoxicosis

52
Q

Woemn with hyperthyroidism has to take antithyroid medication while pregnant. What medications should she be on during her pregnancy?

A

1st trimester; propylthiouracil

2…….

53
Q

What is the most common type of carcinoma found in the thyroid

A

Papillary carcinoma

54
Q

You find psammoma bodies in the lymph nodes in the neck. What is the diagnosis”?

A

Papillary carcinoma

Showing as solitary nodule in the thyroid

55
Q

What cell type is papillary carcinoma derived from ?

A

Follicular epithelium

56
Q

Man presents with diarrhoea, and progressive dysphagia. You do a congo stain on a sample from the thyroid and it comes back red. What is the diagnosis?

A

Medullary carcinoma

Treat with total thyroidectomy

Endocrine Y2 JC (8 decks)

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