Thyroid Flashcards
Normal tsh
0-5 miu/l???
Serum t3
1.2-3.1 nmol/l
Serum thyroxine
55-150nmol/l
Free t3
0.3% 3to 9 pmol/l
Free t4
0.03% 8 to 26 pmol/l
Serum creatinine
Inc in hyper
De in hypo
Serum cholesterol
Inc in hypo
Dec in hyper
Causes of thyrotoxicosis without hyperthyroidism
Ectopic fn thyroid Struma ovarii Fn metastaticfollicular ca Trophoblastic tumour Thyrotoxicosis factitia
Drugs causing thyrotoxicosis
Amiodarone (str similr to t4)
Pecipitatng factors for thyrotoxicosis
Puberty preg emotion infection
histological graves disease
acinasr cell hypertrophy hyperplasia
absence of normal colloid
tall columnar epithelium
tshr observed in
graves disease only
toxic adenoma
benign fn monoclonal thyroid tumour>3cm
not tsh resp
no eye signs
t3>t4
rai shud not be used in
preg n lactation
thyrotoxicosis factitia
intake of l thyroxine without indications or overdose
jod basedow effect
hyper in goitre patient after administration of increased doses of iodide or iodine contrast agents or amiodarone
antibodies in graves disease
tsi nd lats
essential components of graves disease
diffuse goitre thyrotoxicosis autoimmune manifestations like infiltrative ophthalmopathy dermopathy myopathy
treatment of toxic adenoma
intially antithyroid drugs asftr 6 weeks hemithyroidectomy
rai?
subclinical hyperthyroidism may present as
cardiomyopathy nd arrythmias
neonatal thyrotoxicosis
born to mother with graves due to crossing of tsi across placventa
toxic for only 3to4 weeks
unexplained diarrhoea could be an affect of
thyrotoxicosis
diff btw primaryb and secondary thyrotoxicosis
symptoms frst diffuse thrill bruit more severe eye signs common hepatosplenomegaly younger age no prexisting goitre
symptoms of thyrotoxicosis
wt loss diarrhoea palpitations angina ccf fatigue muscole weakness trmor(?) increase in linear growth in children oligo or amenorrhoea hair loss gynaecomastia pruritus palmar erythmia irritability nervousness insomnia
what causes lid retraction?
sympathetic overactivity
spasm of mullers muscle(lps)
von grafes sign
lid lag
dalrymples sign
upper eyelid retractionm
stellwags
staring sign (retraction nd contraction so widening of palpebral fissure)
joffroys sign
no wrinkling
moebius sign
lack of convergence
lymphocytic infiltration of inferior oblique and rectus muscle
eventual diplopia nd ophthalmoplegia
naffzigers sign
…
jellineks
pigmentation
enroth
edema of eyelids nd conjunctiva
frst sign to appear
stellwags
order of appearance of signs
stellwags
von grafe
joffroys
moebius
exophthalmox due to
infiltration of retrobulbar tissues with fluid nd round cells with lid spasm
malignant exophthalmos
edema chemosis conj injection
diplopia ophthalmegia corneal ulcerations papilloedema loss of vision
treatment of severe exophthalmos
emergency`` iv steroid iv antibiotics diuretics gaunethidine steroid drops antibiotic drops lateral tarsorrhaphy orbital decompression dark spectacles protective eye patches local radiation? methylcellulose ....
exophthalmos nd ophthalmopathy may be worsened by
antithyroid drugs
thyroidectomy?
criles grading
sleeping pulse rate for three consecutive nights nad average
1 <90
90 to 110
>110
cardiac manifestations in thyrotoxicosis
ectopic pulsus paradoxus wide pp multiple extrasystoles paroxysmal atrial tachycardia
paroxysmal atrial fibrillation af not responding to digoxin
which muscles more affected?
proximal muscles
isometric contraction
pretibial myxoedema
hyper
bilateral symmetrical shiny red thickened sklin dry coarse hair feet nd vankles usually
myxomatous deposition like gag nd hyaluronic acid
thyroid dermopathy
pretibial myXEDEMA pruritus palmar erythema hair thinning dupuytren contracture
thyroid acropachy
clubbing of fingers and toes in primary thyrotoxicosis
hypertrophic pulmonary osteoarthropathy
investigations for thyrotoxicosis
thyroid fn test (esp free t3 nd t4) radioisotope study(hot?) iv 99mtc trh ecg total count nd neutrophil(y?) tsi estimation
tbg raised in
pregnancy
hyperestrogenism
cirrhosis
tbg decreases in
high androgen levels
hypopproteinimia
acromegaly
discordant nodule
warm in tc scan
cold in rai
malignancy?
treatment for thyrotoxicosis
bb ccb oral rehydration? lugols iodine 10 drops 3x methimazole carbimazole propylthiouracil steroids rai thyroidectomy
hormone dependent tumour
papillary carcinoma of thyroid
woolner classification
occult primary
intrathyroidal
extrathyroidal
variants of pct
micropapillary
encapsulated
diffusing sclerosant
papillofollicular?
microscopy pct
cystic spaces papillary projections
psammoma bodies orphan annie nucleus(not seen in fnac)
tall cell type columnar type
pct spread
slowly progressive less aggressive
usually no blood spread
..
clinical features pct
soft /hard/firm solid/cystic solitary/multinodular
lymph nodes
diagnosis of pct
fnac thyroid nd nodes radioisotope-cold tsh x ray\us neck mri
treatment of pct
total or near thyroidectomy with central node compartment dissection
suppressive dose of l thyroxine
lcnd or mrnd
rait
suppressive dose of l thyroxine
0.3 mg od life long
target level of tsh after surgery
<0.1 mU/L
side effects of lifelong l thyroxine
osteoporosis
ames score
pct
age40 met ext size4
ages score
age grade extent size
lymph node status does not alter the prognosis of
pct
thyroid paradox
cellular tumourws are soft cytic hard
in pct
psammoma bodies are seen in
pct
meningioma
serous cystadenoma of ovary
fnac is useful in
follicular carcinoma
thyroglobulin immunostaining is positive in
fct
typical features in fct
capsular invasion and angioinvasion
bone secondaries common in skull-warm vascular soft fluctuant localized non mobile pulsatile nd other flat bones
why bone sec in fct is pulsatile
outer and inner tables disrupted nd metastasis contains colloid pulsation is transmitted to scalp through fluid colloid
investigations fct
frozen section biopsy intial hemithyroidectomy? us abdomen cxr xray bones ct head body trucut biopsy(but..?
treatment fct
total thyroidectomy with central node compartment dissection lvl 6
lcnd or mrnd
post op rai
maintennce dose of l thyroxine .1mg od or t3 80ug /day
tsh level to be maintained for tissue uptake of iodine
30miu/l
Horners syndrome
Enophthalmos
Anhydrosis
Ptosis
Meiosis
5 cardinal signs of primary toxic goitre
Eye signs Tremor Tachycardia Moist skin Bruit
