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Year 3- Medicine > Thyroid and Parathryoid disease > Flashcards

Thyroid and Parathryoid disease Flashcards

1
Q

What are the hormones responsible serum Ca2+ and PO4- levels? What is their role?

A

Vit D - increase
PTH- increase
Calcitonin - decrease

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2
Q

What are the various forms of vit D found and where do the conversions happen?

A

Cholecalciferol (converted in the liver to) calcidiol
Calcidiol (converted in the kidney to) calcitriol
Calcitriol is the activated form of vitamin D

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3
Q

What effect does low serum Ca2+ levels have on the parathyroid gland?

A

Stimulates PTH and decreases calcitonin

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4
Q

What is the effect of PTH on the body?

A

It stimulates bones to release Ca2+ and PO4-

It stimulates the kidney to convert calcidiol to calcitriol and increases reabsorption from tubules

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5
Q

What effect does Vit D have on the body?

A

It stimulates the bones to release Ca2+ and PO4-
It stimulates reabsorption of Ca2+ from the nephrons
It stimulates absorption of Ca2+ from the gut
It negatively feedbacks to the parathyroid gland to prevent PTH release

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6
Q

Give some causes of high Ca2+ (7)

A 
High osteoclasts activity
High PTH
High PTHrP
Drugs
Endocrinopathy
High vitamin D action
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7
Q

In what situations might you get increase osteoclasts activity?

A

Metastic cancer to bone
Paget’s disease
Immobility

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8
Q

What would cause raised PTH?

A

Primary hyperparathyroidism

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9
Q

Why might there be high levels of PTHrP

A

Malignancy

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10
Q

What drugs cause raised serum calcium?

A

Thiazides
Lithium
Excess dietary Ca2+

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11
Q

Give some examples of endocrinopathies that cause raised calcium levels

A

Raised T4 (hyperthyroidism)
Addison’s disease
Phaeochromocytoma

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12
Q

What would cause a raised Vit D level ?

A

Excess dietary vit D

Sarcoidosis

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13
Q

What action does T3 and T4 have on the body?

A

Increase cell metabolism via nuclear receptors and are thus vital for growth and mental development

Also increase catecholamine effects

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14
Q

When might total T3/4 levels be raised and why?

A

When thyroxine binding globulin (TBG) is high

This can rise in pregnancy, oestrogen therapy (HRT, contraception) and hepatitis

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15
Q

When might total T3/T4 be low due to TBG and not the true values?

A

Nephrotic syndrome, Malnutrition (protein loss)
Drugs (androgens, corticosteroids, phenytoin)
Chronic liver disease
Acromegaly

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16
Q

In what situations would you want to screen for thyroid dysfunction?

A
  • AF
  • hyperlipidaemia (up to 14% have hypothyroidism)
  • diabetes (annual review)
  • women with T1DM during T1 of pregnancy and post delivery
  • pt on amiodarone and lithium (6 monthly)
  • pt with Down’s or Turner’s syndrome or Addison’s disease (yearly)
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17
Q

What is thyrotoxicosis?

A

Clinical effect of XS thyroid hormone, usually from gland hyperfunction

18
Q

What are the symptoms of thyrotoxicosis?

A 
Diarrhoea
Reduced weight 
Increased appetite 
Heat intolerance
Sweating
Palpitations 
Tremor 
Irritability 
Oligomenorrhoea
19
Q

What are the signs of thyrotoxicosis?

A 
Tachycardia
(AF)
Warm moist skin
Fine tremor 
Palmar erythema 
Thin hair 
Lid retraction 
Potentially a goitre
20
Q

What are some specific signs of Graves’ disease?

A 
Eye disease (exophthalmos)
Pretibial myxoedema (lipopolysaccharides deposits in the skin causing swelling)
Thyroid acropachy (clubbing)
21
Q

What tests would you do in suspected thyrotoxicosis? What would be the expected results?

A 
TFT: low TSH, high T4,T3
FBC: mild normocytic anaemia, raised ESR
U+E: raised Ca2+
LFT: raised 
Thyroid autoantibody screen
22
Q

What are the causes of thyrotoxicosis?

A

Graves’ disease: IgG autoantibodies binding to and activating thyrotropin receptors- causing thryoid enlargement and increased hormone production

Toxic multinodular goitre: seen in elderly/iodine deficient areas. Nodules secreting T3/4. Surgery may be needed for compressive symptoms of enlarged gland

Toxic adenoma: solitary nodule secreting T3/4

Ectopic thyroid tissue: potentially ovarian teratoma

Exogenous: iodine XS, levothyroxine XS, decreased TBG

23
Q

How do you treat thyrotoxicosis?

A
  1. Drugs: Beta blockers for symptoms and antithyroid medications ie carbimazole
  2. Radioiodine: CI: pregnancy/lactation
  3. Thyroidectomy: usually total, risks of hoarse voice+ hypoparathyroidism
24
Q

What is the worrying side effect of carbimazole?

A

Agranulocytosis, reduced neutrophils

Can lead to neutropenic sepsis

25
Q

What are the symptoms of hypothyroidism?

A 
Tiredness
Low mood
Cold intolerance
Constipation
Menorrhagia 
Hoarse voice
Weakness
26
Q

What are the signs of hypothyroidism?

A 
BRADYCARDIA:
Bradycardia 
Reflexes (slow)
Ataxia 
Dry thin hair/skin 
Yawning/drowsy 
Cold hands
Ascites (+_ oedema)
Round puffy face (obese)
Defeated demeanour (low mood)
Immobile 
CCF
27
Q

What tests would you do in suspected hypothyroidism and what would be the expected results?

A

TFT: TSH high, T3/4 low
Cholesterol and triglycerides high
Macrocytosis

28
Q

What are the two main autoimmune causes of hypothyroidism? And list some others

A

Primary atrophic hypothyroidism: diffuse lymphocytic infiltration of the thyroid leading to atrophy, hence no goitre

Hashimoto’s thryoiditis: goitre due to lymphocytic and plasma cell infiltration. Autoantibody titres are very high

Iodine deficiency: world wise biggest cause

Post thyroidectomy/ radioiodine treatment

Drug induced: antithryoid (carbimazole), amiodarone, lithium

29
Q

What is secondary hypothyroidism?

A

Hypothyroidism due to not enough TSH due to hypopituitarism

Rare.

30
Q

How would you treat hypothyroidism?

  1. healthy and young
  2. elderly or IHD
A
  1. Levothyroxine (review at 12/52)- want to adjust so no symptoms and normalises TSH (but dont want TSH suppression)
  2. levothyroxine but lower doses and monitor carefully as drug can precipitate MI or angina
31
Q

What is subclincial hypo-and hyper-thryoidism?

A

Hypo- TSH high but T4 normal

Hyper- TSH low but T4 normal

32
Q

What are some causes of primary hyperparathyroidism? (3)

A

Solitary adenoma
Hyperplasia of glands
Parathyroid cancer

33
Q

What are the signs and symptoms of hyperparathyroidism?

A

Subtle symptoms

Raised Ca2+ (symptoms relate to this):
Weak, Tired, Thirsty, Renal stones, Abdo pain

Bone reabsorption:
Pain, fractures, osteoporosis/osteopenia

Raised BP

34
Q

What are the test done to confirm hyperparathyroidism?

A

Calcium: high
PTH: high (or inappropriately normal)
Phosphate: low (except in renal failure)
ALP: raised (bone activity)

35
Q

What is the treatment for hyperparathyroidism?

A 
If mild: 
Fluids to prevent stones 
Avoid thiazides 
Lower Ca2+ and VitD intake
Excision of gland/adenoma (treat the cause)
36
Q

What effect would secondary hyperparathyroidism have on the Ca2+ and PTH levels?

A 
Calcium low
PTH high (appropriately)
37
Q

What are the causes of secondary hyperparathyroidism?

A

Reduced Vit D intake
Chronic renal failure

(Things lowering Ca2+ so PTH has to work harder)

38
Q

What is the treatment for secondary hyperparathyroidism?

A

Correct cause
Phosphate binders
Vit D

39
Q

What is cinacelcet?

A

Drug that is a ‘calcimimetic’- increased sensitivity of parathyroid gland to Ca2+

40
Q

What is tertiary hyperparathyroidism and what are the levels of Ca2+ and PTH seen in it?

A

Ca2+ high
PTH very high

Develops after prolonged secondary hyperparathyroidism because of parathyroid gland hyperplasia. This raises Ca2+ but the negative feedback is no longer working and PTH continues to rise.

Seen in chronic renal failure

41
Q

What is malignant hyperparathyroidism? What are the Ca2+ and PTH levels?

A 
Ca2+ high
PTH low (PTHrP is doing its job but is not detected in the assay)

Due to PTHrP being produced by a some squamous cell lung cancers, breast and renal cell carcinomas.

42
Q

Hypothyroidism

A

Need to make cue cards

Year 3- Medicine (12 decks)

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