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Endocrinology > Thyroid > Flashcards

Thyroid Flashcards

1
Q

Where is the TSH receptor located?

A
  • surface of thyroid epithelial cells
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2
Q

What is used to control the production of T3 and T4?

A
  • Inhibitory feedback loops
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3
Q

Explain thyroiditis?

A
  • inflammation of the thyroid gland
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4
Q

Cause of thyroiditis?

A
  • Autoimmune (Hashimotos, Graves)
  • De Quervains
  • Infection
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5
Q

What causes the symptoms of hyperthyroidism?

A
  • Increased T3 and T4
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6
Q

Hyperthyroidism is also known as what?

A
  • Thyrotoxicosis
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7
Q

What are some causes of hyperthyroidism?

A
  • Graves
  • Adenoma
  • Thyroiditis
  • Ectopic production
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8
Q

What are some symptoms of hyperthyroidism?

A
  • anxiety
  • palpitations
  • weight loss
  • loose stool
  • heat intolerance
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9
Q

What investigations should be done for hyperthyroidism?

A
  • TSH

- T3 and T4

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10
Q

What investigation can be performed to test for Grave’s disease?

A
  • TSH receptor antibodies

TRAb

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11
Q

What is the first line treatment for hyperthyroidism?

A
  • carbimazole
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12
Q

What treatments can be used for hyperthyroidism?

A
  • carbimazole
  • propylthiouracil
  • radioactive iodine
  • b blockers
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13
Q

Grave’s disease is what type of condition?

A
  • autoimmune
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14
Q

What antibodies are associated with Grave’s disease?

A
  • TSH receptor antibodies
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15
Q

What triad of features of hyperthyroidism can be seen?

A
  • exophthalmos
  • pretibial myxoedema
  • acropathy
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16
Q

Symptoms of de quervain’s thyroiditis?

A
  • fever
  • neck pain
  • dysphagia
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17
Q

What is the phases of de quervains thyroiditis?

A
  • initial hyperthyroidism

- followed by hypothyroidism

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18
Q

What is a thyroid storm?

A
  • rare presentation
  • acute increased production of thyroid hormone
  • admission
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19
Q

Hashimoto’s thyroiditis is what condition?

A
  • autoimmune

- hypothyroidism

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20
Q

What are some causes of hypothyroidism?

A
  • Hashimotos
  • iodine deficiency
  • drugs for hyperthyroidism
  • post-surgery
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21
Q

Symptoms of hypothyroidism?

A
  • weight gain
  • fatigue
  • hair loss
  • oedema
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22
Q

Treatment for hypothyroidism

A
  • levothyroxine
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23
Q

What age group does Hashimoto’s thyroiditis typically effect?

A
  • 40-50
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24
Q

What autoimmune sign is seen in Hashimoto’s thyroiditis?

A
  • anti-thyroid antibodies
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25
Q

Hashimoto’s thyroiditis increases the risk of other auto-immune conditions? True or false

A
  • True
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26
Q

Goitre describes what?

A
  • any enlargement of the thyroid gland

- hyper or hypothyroidism can cause

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27
Q

What often causes a goitre?

A
  • lack of dietary iodine
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28
Q

Diffuse goitre?

A
  • iodine deficiency

- usually normal thyroid function

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29
Q

Multi-nodular goitre?

A
  • evolution from long standing simple goitre

- low risk of malignancy

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30
Q

What are the different carcinomas of the thyroid?

A
  • papillary
  • follicular
  • medullary
  • anaplastic
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31
Q

What is an example of a thyroid adenoma?

A
  • follicular adenoma
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32
Q

What may cause a papillary carcinoma?

A
  • ionising radiation
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33
Q

What may cause a follicular carcinoma?

A
  • iodine deficiency
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34
Q

What is the most common form of thyroid cancer?

A
  • papillary carcinoma
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35
Q

What does papillary carcinoma arise from?

A
  • follicular cells
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36
Q

What spread would papillary carcinoma tend to spread via?

A
  • lymphatic
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37
Q

What are symptoms of papillary thyroid carcinoma?

A
  • lesion
  • hoarseness
  • dysphagia
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38
Q

What is the 2nd most common type of thyroid cancer?

A
  • follicular carcinoma
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39
Q

What is the spread route of follicular carcinoma?

A
  • haematogenous
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40
Q

What cell type does medullary thyroid carcinoma arise from?

A
  • c-cells
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41
Q

Explain anaplastic carcinomas of the thyroid?

A
  • undifferentiated

- aggressive

42
Q

When does the thyroid gland begin to develop?

A
  • 4th week of embryogenesis
43
Q

Where does the thyroid gland originate?

A
  • thickening of the back of tongue

- foramen caecum

44
Q

Where does the thyroid gland descend down?

A
  • thyroglossal duct
45
Q

Remnant of the thyroglossal due can be called?

A
  • pyramidal lobe
46
Q

What spinal level does the thyroid gland sit?

A
  • C5-T1
47
Q

What is the arterial supply to the thyroid gland

A
  • superior and inferior thyroid artery
48
Q

Explain the steps in thyroid hormone synthesis

A
  • thyroglobulin synthesis
  • uptake and concentration of iodide
  • oxidation of iodide to iodine
  • iodination of thyroglobulin
  • formation of MIT and DIT
  • T3 and T4
49
Q

What is the most abundant thyroid hormone?

A
  • T4
50
Q

What is the most potent thyroid hormone?

A
  • T3

- 4 times more potent than T4

51
Q

What transports the thyroid hormones?

A
  • Thyroxine binding globulin

- TBG

52
Q

What is the role of de-iodinases?

A
  • derogates T3 and T4

- Mainly D3 and D1 involved

53
Q

Where would the de-iodinases enzyme D3 be found?

A
  • fetal tissue
  • placenta
  • brain (except pituitary)
54
Q

What investigations should be performed for a solitary thyroid nodule?

A
  • TSH

- USS fine needle aspiration

55
Q

What is the treatment for a low risk differentiated thyroid cancer?

A
  • lobectomy
56
Q

What is the treatment for a high risk differentiated thyroid cancer?

A
  • total thyroidectomy

- also consider radioactive iodine

57
Q

What tumour cell marker can be used for follow up patients with previous thyroid cancers?

A
  • thyroglobulin (Tg)
58
Q

What is the frequency of TSH measurements for patients with previous thyroid cancer?

A
  • TSH every 6 months for 5 years

- TSH every year for a further 5 years

59
Q

What puts an increased risk of thyroid lymphoma?

A
  • hashimoto’s thyroditis
60
Q

What is the diagnostic tool for thyroid lymphoma?

A
  • core biopsy
61
Q

Treatment of thyroid lymphoma?

A
  • steriods
  • r-chop chemo
  • radiotherapy
62
Q

What cells are involved in medullary thyroid carcinoma?

A
  • c-cell
63
Q

What investigations are done for multinodular goitre?

A
  • TSH

- CT scan

64
Q

Treatment for a multinodular goitre?

A
  • leave alone?
  • radioactive iodine
  • surgery
65
Q

Describe primary thyroid disease

A
  • disease affecting the thyroid gland itself
66
Q

Describe secondary thyroid disease?

A
  • hypothalamic or pituitary disease

- no thyroid pathology

67
Q

What thyroid hormones are measured?

A
  • TSH
  • Free T3
  • Free T4
68
Q

What does TSH levels reflect?

A
  • reflects tissue thyroid hormone action
69
Q

Where is T4 deionised to T3?

A
  • liver
70
Q

Explain the blood results you would expect with primary hyperthyroidism?

A

Free T3/4 = high

TSH = low

71
Q

Explain the blood results you would expect with secondary hyperthyroidism?

A

Free T3/4 = high

TSH = high or normal

72
Q

Explain the blood results you would expect with primary hypothyroidism?

A

Free T3/4 = low

TSH = High

73
Q

Explain the blood results you would expect with secondary hypothyroidism?

A

Free T3/4 = low

TSH = normal or low

74
Q

Define myxoedema

A
  • severe hypothyroidism

- medical emergency

75
Q

Explain pretibial myxoedema?

A
  • rare clinical sign of Grave’s disease
76
Q

What are some primary causes of hypothyroidism

A
  • Hashimotos
  • iodine deficiency
  • post-radiotherapy
77
Q

What are some secondary causes of hypothyroidism?

A
  • infection
  • malignancy
  • trauma
78
Q

Clinical features of hypothyroidism?

A
  • weight gain
  • decreased appetite
  • constipation
  • depression
  • reduced heart rate
79
Q

Treatment of hypothyroidism?

A

young pt - levothyroxine 50-100ug daily

elderly pt - levothyroxine 25-50ug daily

80
Q

Once commencing levothyroxine when should you check TSH levels?

A
  • after 2 months
81
Q

In secondary hypothyroidism what blood result is unreliable?

A
  • TSH

- use free t4/3

82
Q

Hashimoto’s thyroiditis is associated with what autoantibody?

A
  • TPO antibodies
83
Q

Symptoms of a myxoedema coma?

A
  • bradycardia
  • heart block
  • type 2 resp failure
84
Q

Treatment of myxoedema coma

A
  • rewarm
  • antibiotics
  • thyroxine
85
Q

Define thyrotoxicosis?

A
  • cels exposed to excess thyroid hormones
86
Q

Symptoms of thyrotoxicosis

A
  • palpitations, AF
  • Tremor
  • sweating
  • heat intolerance
  • weight loss
87
Q

Causes of thyrotoxicosis which are not associated with hyperthyroidism?

A
  • de quervains
  • postpartum thyroditis
  • over treatment of levothyroxine
88
Q

What autoantibody is associated with Grave’s disease

A
  • TSH receptor antibody (TRAb)
89
Q

Symptoms of Grave’s disease

A
  • pretibial myxoedema
  • thyroid acropachy
  • thyroid bruit
  • eye disease
90
Q

Symptoms of thyroid storm?

A
  • resp and cardiac collapse

- exaggerated reflexes

91
Q

What antithyroid drug should be used in the 1st trimester of pregnancy?

A
  • propylthiouracil
92
Q

What is a side effect of anti-thyroid drugs?

A
  • agranulocytosis
93
Q

Explain agranulocytosis?

A
  • low WCC
  • side effect of anti-thyroid drugs
  • warn patient if fever, oral ulcer or oropharyngeal infection STOP DRUG
94
Q

What is the beta-blocker of choice in hyperthyroidism?

A
  • propranolol
95
Q

When might radio iodine be used?

A
  • relapse of Grave’s disease
96
Q

What is radioactive iodine contraindicated in?

A
  • pregnancy
97
Q

Risk during thyroidectomy?

A
  • recurrent laryngeal nerve palsy
  • hypothyrodism
  • hypoparathyroidism
98
Q

Explain subacute thyroiditis?

A
  • may be triggered by viral infection

- self-limiting

99
Q

What is the affect of amiodarone on the thyroid?

A
  • abnormal TFTs
  • high free T4
  • low free t3
  • normal TSH
100
Q

Explain subclinical thyroid disease?

A
  • abnormal TSH

- normal T4/3

101
Q

Indication of a high risk subclinical hypothyroidism?

A
  • TPO antibody postitive
102
Q

Post operative checks after thyroidectomy?

A
  • calcium levels

- whole body iodine scanning

Endocrinology (16 decks)

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