Thyroid Flashcards
De Quervains
Hyperthyroidism Self limiting Viral Painful goitre Temp High ESR Low isotope uptake on scan Tx - NSAIDs
Grave’s Disease
hyperthyroidism
> females
40–60yrs (younger if maternal family history
Increased production thyroid hormones, enlarge thyroid
Signs Grave’s
Eye disease exophthalmos, ophthalmoplegia.
Pretibial myxoedema: oedematous swellings above lateral malleoli
Thyroid acropachy: extreme manifestation, with
clubbing, painful finger and toe swelling, and periosteal reaction in limb bones.
Graves autoantibodies
TSH receptor stimulating antibodies (90%)
anti-TPO antibodies (75%)
Toxic multinodular goitre:
elderly
in iodine-deficient areas
compressive symptoms > surgery
Toxic adenoma
solitary nodule producing T3
Hot nodule on isotope scan
Ectopic thyroid tissue
Metastatic follicular thyroid cancer
Struma ovarii: ovarian teratoma with thyroid tissue.
Treatment hyperthyroidism
B-blockers
Carbimazole
SE: agranulocytosis (neutrophils, can lead to dangerous sepsis; rare (0.03%))
Radioiodine
Thyroidectomy - recurrent laryngeal nerve (hoarse
voice) and hypoparathyroidism
Hypothyroidism associations
Autoimune - T1DM, Addison’s, PA
Turner’s and Down’s syndromes
Cystic fibrosis,
PBC
OHSS
POEMS syndrome—
poly neuropathy, organomegaly, endocrinopathy, m-protein band (plasmacytoma) +
skin pigmentation/tethering
Genetic:
Dyshormonogenesis: genetic (often autosomal
recessive) defect in hormone synthesis, eg Pendred’s syndrome (with deafness):
there is increased uptake on isotope scan, which is displaced by potassium perchlorate
Hashimoto’s thyroiditis:
Goitre due to lymphocytic and plasma cell infiltration.
> women aged 60–70yrs
May be hypothyroid /euthyroid; rarely initial period of hyperthyroid (‘Hashitoxicosis’).
Autoantibody titres are very high.
Ass w MALT lymphoma
Complications of hypothyroidism Pregnancy
Eclampsia, anaemia, prematurity, low birthweight, stillbirth, PPH.
Treatment hypothyroidism
Thyroxine - 50-100 ug, adjust 6/52
25 ug if elderly/ CV disease
Papillary thyroid ca
60%
Often younger patients.
Spread: lymph nodes & lung (jugulodigastric
node metastasis is the so-called lateral aberrant thyroid).
Treatment:
total thyroidectomy to remove non-obvious tumour ± node excision ± radioiodine to ablate
residual cells.
Give thyroxine to suppress TSH.
Follicular
≤25%
Occur in middle-age & spreads early via blood (bone, lungs).
Well-differentiated- total thyroidectomy + T4 suppression + radioiodine ablation.
Medullary
(5%) Sporadic (80%) or part of MEN May produce calcitonin Perform a phaeochromocytoma screen pre-op. : thyroidectomy + node clearance. External beam radio therapy should be considered to prevent regional recurrence.
