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Year 5 Endocrine > Thyroid > Flashcards

Thyroid Flashcards

1
Q

How does the thyroid feedback loop work?

A

1) Hypothalamus detects low blood level of T3/T4
2) Releases TRH to stimulate anterior pituitary
3) Anterior pituitary releases TSH to stimulate thyroid gland
4) Thyroid produces T3 & T4 (inactive)

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2
Q

What are the functions of T3?

A

↑Basal metabolic rate → ↑production of proteins ↑use of sugar + fats
↑Cardiac output
↑Bone resorption → thins bones
↑sympathetic nervous system

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3
Q

What is primary hypothyroidism?

A

Insufficient release of thyroid hormones from thyroid

↓T3/T4 and ↑TSH

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4
Q

What are the causes of primary hypothyroidism?

A

Iodine deficiency
Hashimoto
Drug induced: Amiodarone, Li, Contrast, Iodine
Riedel thyroiditis: Parenchyma replaced by fibrous tissue
Subacute de-Quervain’s thyroiditis: Post-virus
Congenital

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5
Q

What is Hashimoto’s?

A

Autoimmune destruction of thyroid T-cells
Causes hypertrophy & hyperplasia
Leads to more follicular damage
Eventual complete loss of function

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6
Q

What are the causes of secondary hypothyroidism?

A

Tumour of ant. pituitary

Damage to hypothalamus (trauma, tumour)

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7
Q

What is secondary hypothyroidism?

A

Insufficient production of TSH

↓TSH → ↓T3/4

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8
Q

What are the signs & symptoms of hypothyroidism?

A 
↑weight/ oedema
Fatigue, lethargy
Constipation
Menorrhagia
Hoarse voice
Cold
↓Memory + ↓Cognition 
Dry skin & coarse hair
↓HR (bradycardia) ↑BMI, ↓Reflexes
Ataxia, Ascites, Effusion (lung & cardiac)
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9
Q

In which conditions would you have a non-painful & painful goitre?

A

Non-painful: Hashimoto & Riedel

Painful: De-Quervain’s

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10
Q

What are the signs of congenital hypothyroidism?

A 
Excessive sleeping
Mental retardation
Intellectual disability
Delayed physical growth
Short height
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11
Q

How is hypothyroidism investigated?

A

TFTs: 1o: ↓T4 ↓T3; TSH high , 2o: ↓T4 ↓T3; TSH low/n
Thyroid Ab: Anti-TPO = Hashimoto’s
Lipids

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12
Q

How is hypothyroidism managed?

A

TSH <4 = TREATMENT

Levothyroxine: Adjust every 3-4w according to TSH

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13
Q

What are the SE of levothyroxine?

A

Hyperthyroidism
↓bone density (osteoporosis)
Worsening angina
AF

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14
Q

What are the complications of hypothyroidism?

A

Amiodarone SE

Myxoedema coma: Infection/surgery → ↓GCS + hypothermia, bradycardia, hypoglycaemia, unconscious

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15
Q

What is hyperthyroidism?

A

Excess release of T3/T4

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16
Q

What are the causes of hyperthyroidism?

A 
Grave's
Toxic multi nodular goitre
Toxic adenoma
Exogenous
De Quervain's thyroiditis
17
Q

What is Grave’s disease?

A

Circulating IgG auto-ABx
Bind to & activate G-protein thyrotropin receptors
Smooth muscle hyperplasia
↑T3 production

18
Q

How does a toxic multi-nodular goitre cause hyperthyroidism? How is it Tx?

A

Autonomous secretion of T3/T4
Nuclear scintigraphy shows patchy uptake
Tx: Radioiodine

19
Q

What are the signs & symptoms of hyperthyroidism?

A 
↓weight
Muscle wasting → Proximal myopathy 
Diarrhoea
Oligomenorrhoea +/- infertility
Sweating + heat intolerance
Palpitations (AF)
Tremor &amp; hyperreflexia
Thin hair
Lid lag + lid retraction
Palmar erythema
20
Q

What are the signs of Grave’s disease?

A

1) Eye disease: Ophthalmoplegia
2) Pretibial myxoedema
3) Thyroid acropatchy: Clubbing, painful finger, toe swelling
Bruits

21
Q

How is hyperthyroidism investigated?

A

TFTs: 1o = ↓or normal TSH ↑T4/T3 2o = ↑TSH ↑T4/T3
AutoAbx: TRAB (TSH receptor stimulating Abx), TPO
USS
Isotope scan: If antibodies negative (Cancer)

22
Q

What is the management of hyperthyroidism?

A

1) B-blocker (Propanolol) for rapid Sx control
2) Carbimazole: Start high and titrate down
- Carbimazole + Thyroxine = Block & Replace
- Pregnant = propylthiouracil
3) Radioiodine 131i: Drink, often 1st line in teenagers
4) Thyroidectomy

23
Q

What are the SE of carbimazole?

A

Agranulocytosis
Sepsis
Cholestatic jaundice

24
Q

What are the complications of hyperthyroidism?

A

Thyrotoxic crisis/storm: Hyperthermia, mental disturbance, thyrotoxic Sx
Thyroid eye disease: Eye discomfort, diplopia, proptosis, afferent pupillary defect

25
Q

What is the mechanism of thyroid eye disease in hyperthyroidism?

A

Huge RF w/SMOKING!
AutoAb cause retro-orbital inflammation & lymphocyte infiltration
Leads to swelling of orbit (exophthalmos)

26
Q

How is a thyrotoxic crisis treated?

A 
IV fluids &amp; NG
Sedate- Chlorpromazine
Propanolol
Digoxin- Slow HR
Carbimazole
Hydrocortisone/Dexamethasone- stop peripheral conversion of T4- T3
Co-Amoxiclav- if infection
27
Q

What are the main types of thyroid cancer?

A 
Papillary 70%
Follicular adenoma/carcinoma
Medullary 
Lymphoma
Anaplastic- POOR prognosis
28
Q

What are the features of a papillary carcinoma?

A

Young patients
Spread via lymph nodes & lungs
Pale empty nuclei
Tx: Thyroidectomy +/- node excision +/- radioiodine, Thyroxine to suppress TSH

29
Q

What are the features of a follicular adenoma/carcinoma?

A

Middle-aged patients
Spreads early
Via blood to bone & lungs
Presents as solitary thyroid nodule
Adenoma= well-differentiated
Carcinoma= encapsulated w/capsular invasion
Tx: Thyroidectomy +/- node excision +/- radioiodine

30
Q

What are the features of a medullary tumour?

A 
80% sporadic
MEN syndrome
Can produce Calcitonin
Phaeochromocytoma screen required
Tx: Thyroidectomy &amp; nodal clearance
31
Q

What is a thyroid lymphoma associated with?

A

Hashimoto’s

Female w/stridor or dysphagia

32
Q

What is a simple goitre? Does it need treating?

A

Enlarged palpable thyroid gland that moves on swallowing
Normal hormone levels
No treatment required

33
Q

What are the causes of a goitre?

A
  • Problem w/thyroid function (hyper/hypo)
  • Endemic: Iodine deficiency, usually diffuse becoming nodular w/age
  • Sporadic: Female, diffuse → multi nodular. Comes from entire follicle, no Tx needed unless painful/compressing
34
Q

What are the different types of thyroiditis?

A 
Hashimoto's
De Quervain's (subacute)
Postpartum
Silent
Infectious
Drug/RT induced
35
Q

What is De Quervain’s thyroiditis?

A

Painful swelling of thyroid
Triggered by viral infection (flu, mumps)
Around 20-50yo women
Sx: Fever, neck/jaw/ear pain, Sx of hyperthyroidism

36
Q

How is De Quervain’s investigated?

A

↓TSH
↑T3
↑T4
↑CRP & ↑ESR

37
Q

How is De Quervain’s treated?

A

Supportive: Analgesia/ Prednisolone
Tachy = Beta blocker/CCB
Thyrotoxicosis = KI + Prednisolone 40mg OD 2-3w

38
Q

Which drugs can lead to thyroiditis?

A

Interferons
Amiodarone
Lithium
RT

Year 5 Endocrine (6 decks)

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