Thyroid Flashcards

1
Q

What is in the Graves triad?

A

Exopthalmos, thyroid acropachy and pretibial myxoedema

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2
Q

Causes of hyperthyroidism?

A

Graves (most common) (TSHRAbs)
Toxic multinodular goitre
Toxic adenoma
De Quervains thyroiditis = increased release

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3
Q

What are toxic multinodular goitre features?

A

Autonomously functioning thyroid that secretes excess

In Elderly and iodine deficient areas

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4
Q

Features of De Quervains thyroiditis?

A

Post-viral infection, transient hyper->hypo->Euthyroid

Painful goitre, fever and raised ESR

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5
Q

Hyperthyroid investigations?

A

Thryoid exam and ECG
Bloods
Radioisotope scan for uptake

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6
Q

Thyroiditis management?

A

Usually self limiting, NSAIDS for thyroid pain and may require additional if very hyper/hypothyroid

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7
Q

Graves management?

A

Beta blockera
Anti-thyroid drugs e.g. cRBIMAZOLE OR PROPYLTHIOURACIL
rADIOIODINE THERAPY
tHYROIDECTOMY

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8
Q

Complications of hyperthyroidism?

A

Thyroid storm : fever, tachycardia, confusion and agitation, nausea and HTN
Management: 4Ps (propylthiouracil, poatssium iodine (lugols), propanolol, prenisolone (steroids)

Atrial fibrillation

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9
Q

Breakdown of thyroid cancer?

A
Papillary = 80% (young females and good prognosis)
Follicular = 10%
Medullary = 4% (carcinoma of parafollicular cells), secrete calcitonin and part of MEN 2a/b syndromes
Anaplastic = elderly women and not responsive to treatment. Compression = dysphagia and hoarsness
Lymphoma = associated with Hashimotos thyroiditis
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10
Q

Thyroid cancer signs and symptoms?

A

palpable thryoid nodule, most are cold nodules. COmpression symptoms = hoarsness, dyspnoea and dysphagia and cervical lymphadenopathy

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11
Q

Investigations for thyroid cancer?

A

TSH, USS neck, FNA biopsy and laryngoscopy

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12
Q

What are the MEN 1 conditions?

A

Autosomnal dominant 3 P’s

Pituitary tumour (prolactinoma/GH)
Parathyroid hyperplasia 
Pancreatic tumours (gastrinoma, insulinoma, zollinger-ellsion)
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13
Q

What are the MEN 2a conditions?

A

Mutation in RET
Parathyroid hyperplasia
Phaeochromocytoma (headaches, palpitations,sweating)
Medullary thyroid cancer (increased calcitonin)

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14
Q

What are the MEN2B conditions?

A

Phaeochromocytoma
Medullary thyroid cancer
Marfinoid habitus
Neuroma

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15
Q

Other tumour markers?

A
CEA for colon
CA15-3 in Breast
CA19-3 - pancreatic
Calcitonin = medullary thyroid cancer
Metenephrines = phaeochromocytoma
5-HIAA in carcinoid tumours
alpha-fetoprotein is HCC
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16
Q

WHat is carcinoid syndrome?

A

Neuroendocrine tumours of the GIT or lungs which secrete serotonin and other vasoactive peptides

17
Q

Signs and symptoms of carcinoid syndrome?

A

CARCinoid

Cutaneous flushing
Asthmatic wheeze
Right sided murmur
Cramps + diarrhoea

Palpitations, hypotension and telangiectasia

18
Q

Investigations for Carcinoid syndrome?

A

24hr urine collection shows increased 5-HIAA levels (serotonin metabolite)

CT/MRI to localise the tumour

19
Q

WHat does phaeochromocytoma show in urine?

A

Increased urinary metanephrones and catecholamines

20
Q

Signs and symptoms of acromegaly?

A

Increased GH production secondary to pituitary adenoma.

I look different in photos, my rings and shoes dont fit, headaches.

SPade like hands, clubbed nailes, Carpal tunnels syndrome and high BP

Coarse facial features (bossing, prognathism, diaphoresis, pituitrary enlargmenet signs, macroglossia

Deep voice and sleep apnoea

21
Q

Complications of acromegaly?

A

Diabetes, HTN, cardiomyopathy and colorectal cancer. Impaired gluocse tolerance

22
Q

Ix for Acromegaly?

A

Serum IGF-1 (1st line)

ral glucose suppresion test

Pituitary MRI

23
Q

Mx for acromegaly?

A

Surgery = trans-spenoidal hypophysectomy (1st line)

Medical if sugery unseccessful/inoperable
Medical = 1) somatostatin analogi=ue (octreotide)
2) GH receptor antagonist (pegvisomant)
3) Dopamine agonist (bromocriptine/cabergoline)

Radiotherapy

24
Q

Hypogonadism Presentation in females?

A

Delayer puberty, amenorrhoea, infertility, decreased libido, night sweats, hot flushes and dysparenuia, symptoms of cause

25
Q

Causes of primary female hypogonadism?

A

Gonadal dysgenesis = Turners
Gonadal damage = radiotherapy, chemo, suergeyr, autoimmune damage
Primary ovarian failure
PCOS

26
Q

Causes of secondary female hypogondism?

A

Problem with hypothalamus/pituitary/secondary

Kallmans (failure of GnRH neurone migration = GnRH secretion decrease)
pITUITARY/HYPOTHALMIC PROBLEM E.G. ADENOMA OR HAEMOCHROMOTOSIS
hYPERPROLACTINAEMA
Functional = stress, weight loss and eating disorders
Post OCP

27
Q

Female signs of hypogonadism and underlying cause?

A
Pre-pubertal = primary amenorrhoea, no secondary sexual characteristics
Post-pubertal = regression of sexual characteristics
Kallmans = anosmia
Turners = webbed neck and short stature
Hyperprolactinaemia = galactorrhoea, visual field defects
28
Q

Hypogonadism female Ix?

A

Pregnancy test

Bloods for decreased oestradiol
Primary = increased LH and FSH
Secondary = decreased LH and FSH
Prolactin and TFTS

primary = genetic testing and pelvic MRI/USS
secondary = pituitary funtion tests and MRI
29
Q

Hypogonadism in Males presentation?

A

Delayed puberty, erectile dysfunction, infertility, decreased libidio and symptoms of cause

30
Q

Primary hypogonadism in males causes?

A
Gonal dysgnesis = Klinefelters
Gonadal damage (torsion, irridation, trauma)
Post-orchitis (mumps and autoimmune)
31
Q

Secondary hypogonadism males causes?

A

Kallmans
Pituitary.hypothalamic lesions
Hyperprolactinaemia
Prader-willi syndrome

32
Q

Signs of male hypogonadism?

A
Pre-pubertal = no secondary sex charactersitc
Post = hynaecomastia and hair loss
Klinefeleters = low IQ and behavioural
Kallmans = anosmia
33
Q

UIx for male hypogonadism?

A

Bloods = serum testosterone, SHBG, LH and FSH amnd prolactin

Genetic testing and MRI pituitary