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Chemical Pathology > Thyroid > Flashcards

Thyroid Flashcards

1
Q

What is the normal range of TSH?

A

0.33-4.5mu/l

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2
Q

What is the normal range of free T4?

A

10.2-22.0pmol/l

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3
Q

What is the normal range of free T3?

A

3.2-6.5pmol/l

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4
Q

What does an elevated serum TSH but low T4 mean?

A

Hypothyroidism

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5
Q

What does an elevated serum TSH but normal T4 mean?

A

Treated hypothyroidism or subclinical hypothyroidism

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6
Q

What does an elevated serum TSH and elevated T4 mean?

A

TSH secreting tumour or thyroid hormone resistance

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7
Q

What does a decreased serum TSH but increased T4 mean?

A

Hyperthyroidism

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8
Q

What does a decreased serum TSH but normal T4 mean?

A

Subclinical hyperthyroidism - this may progress to primary hypothyroidism, especially if the patient is anti-TPO antibody positive

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9
Q

What does a decreased serum TSH and decreased T4 mean?

A

Central hypothyroidism (hypothalamic or pituitary disorder)

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10
Q

What does an increased serum TSH but decreased T4, followed by a decreased TSH and T4 mean?

A

Sick euthyroidism

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11
Q

What does a normal TSH but abnormal T4 mean?

A

Assay interference, changes in thyroxine binding globulin, or SE of amiodarone

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12
Q

Name three causes of hyperthyroidism with high uptake on a radioactive iodine uptake test

A

Graves disease, toxic multinodular goitre, toxic adenoma

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13
Q

Name two causes of hyperthyroidism with low uptake on a radioactive iodine uptake test

A

Subacute De Quervains thyroiditis, postpartum thyroiditis

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14
Q

Name two autoimmune causes of hypothyroidism

A

Primary atrophic hypothyroidism, Hashimotos thyroiditis

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15
Q

State three non-autoimmune causes of hypothyroidism

A

Iodine deficiency, thyroidectomy, radio-iodine, drug-induced (carbimazole, lithium, amiodarone)

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16
Q

What is the female to male ratio of Graves disease?

A

9:1

17
Q

What is de Quervain’s thyroiditis?

A

Self-limiting post-viral goitre, painful, initially causes hyperthyroidism then hypothyroidism

18
Q

Which group are most commonly affected by Hashimotos thyroiditis?

A

Elderly females

19
Q

Name the two autoantibodies which may be found in Hashimotos thyroiditis

A

anti-thyroid peroxidase (anti-TPO), anti-thyroglobulin (anti-TG)

20
Q

How is hyperthyroidism treated?

A

Carbimazole as an anti-thyroid
Beta blockers for symptom relief, topical steroids for dermopathy
If carbimazole fails, radio-iodine

21
Q

What are the side effects of carbimazole?

A

Rashes (common), agranulocytosis (rare)

22
Q

State the six indications for hemi or total thyroidectomy

A

Hyperthyroidism in a woman intending to become pregnant in the next 6 months, oesophageal or tracheal compression by thyroid goitre, cosmetic removal of thyroid goitre, suspected thyroid cancer, co-existing hyperparathyroidism, hyperthyroidism refractory to medical therapy

23
Q

Describe the presentation of a thyroid storm

A

Shock, pyrexia, confusion, vomiting

24
Q

How is a thyroid storm managed?

A

ITU admission, cooling, high dose anti-thyroid medications, corticosteroids, circulatory and respiratory support

25
Q

Name the five types of thyroid neoplasia

A

Papillary, follicular, medullary, lymphoma, anaplastic

26
Q

Describe the appearance of papillary thyroid cancer on histology

A

May see psammoma bodies

27
Q

What is the most common age range for developing papillary thyroid cancer?

A

30-40

28
Q

How is papillary thyroid cancer treated?

A

Surgery, radio-iodine, thyroxine to decrease TSH

29
Q

Which type of thyroid cancer is linked to MEN2?

A

Medullary thyroid cancer

30
Q

What is the main risk factor for thyroid lymphomas?

A

Chronic Hashimotos thyroiditis

31
Q

Where does medullary thyroid cancer originate?

A

Parafollicular C cells which produce calcitonin

32
Q

Which endocrine cancers does MEN1 predispose to?

A

Pituitary, pancreatic (e.g. insulinoma), parathyroid

33
Q

Which endocrine cancers does MEN2a predispose to?

A

Parathyroid, phaeochromocytoma, medullary thyroid

34
Q

Which endocrine cancers does MEN2b predispose to?

A

Phaeochromocytoma, medullary thyroid, mucocutaneous neuromas

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