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BDS2 BAMS Endocrinology > Thyroid and pituitary disease > Flashcards

Thyroid and pituitary disease Flashcards

1
Q

What is endocrine disease

A

dysfunction of hormone secreting glands

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2
Q

How are hormones regulated

A

negative feedback

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3
Q

What are the two ways hormone regulation goes wrong

A

PRIMARY
- gland failure (gland can’t make hormone)

SECONDARY
- control failure (gland isn’t being asked to make hormone)

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4
Q

what are the results of endocrine disease

A

widespread, multisystem effects

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5
Q

What is multiple endocrine neoplasia (MEN)

A

people prone to getting tumours in one gland are prone to getting completely difference cancer in another gland

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6
Q

What are the 3 different types of MEN

A

MEN1

  • parathyroid, pancreatic islets, pit gland (anterior)
  • associated tumours (adrenal cortex, carcinoid, lipoma)

MEN2a
- parathyroid, medullary thyriod, phaeochromocytoma

MEN2b
- medullary thyroid, phaeochromocytoma, mucosal neuromas, marfanoid apprearance

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7
Q

what is a mucosal neuroma

A

lumps forming on oral mucosa

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8
Q

what does the pituitary gland do

A
  • Control of many gland activities

- takes messages from the hypothalamus and fires them out to particular areas

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9
Q

What hormones are made in the anterior pituitary

A
  • TSH (thyroid stimulating hormone)
  • ACTH (adrenocorticotrophic hormone)
  • GH (growth hormone)
  • LH, FSH, prolactin
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10
Q

What hormones are made in the posterior pituitary

A
  • ADH (anti diuretic hormone)

- oxytocin

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11
Q

Why do pituitary tumours tend to be multi system

A

because they squash an enclosed space

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12
Q

What are the 2 kinds of pituitary tumour

A
  • Functional adenomas

- Non-functional adenomas

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13
Q

What is a functional adenoma

A

the tumour produces the hormone and keeps getting bigger. Problem is you can’t turn off the hormone as tumour doesn’t respond to normal signals

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14
Q

What disease is caused by a functional adenoma producing Prolactin/ACTH

A
  • amenorrhoea-Galctorrhoea syndrome

- cushing’s disease

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15
Q

What disease is caused by a functional adenoma producing growth hormone

A

acromegaly

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16
Q

What are non-functioning adenomas

A

tumour doesn’t make a hormone, it just squashes gland

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17
Q

How are pituitary tumours often first picked up

A

they get tunnel vision due to effect on the optic nerve path

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18
Q

How are pituitary tumours treated

A

Trans-sphenoidal surgery

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19
Q

What happens if you have insufficient growth hormone

A
  • growth failure in children

- metabolic changes in adults e.g. increased fat

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20
Q

What happens when you have excess growth hormone

A
  • ‘giantism’ (children)

- acromegaly (adults)

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21
Q

what is the difference between giantism and acromegaly

A

Giantism (children) people are in proportion just really big

Acromegaly (adults) people are out of proportion as anything which grows by apposition will grow but nothing else

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22
Q

With thyroid disease (both hyperthyroidism and hypothyroidism) what is the common reason for its dysfunction

A

PRIMARY

i.e. the gland is the problem

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23
Q

what’s another word for hypothyroidism

A

myxoedema

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24
Q

what is the autoimmune disease which causes hyperthyroidism called

A

graves disease

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25
how does graves disease occur
- immune system makes antibody which fits the TSH receptor on the thyroid gland - gland makes more thyroid hormone - it therefore gets exercised and increases in size (goitre) - control system works fine but is overridden with TSH receptor protein
26
how common is a pituitary gland dysfunction being the cause of hyperthyroidism
uncommon
27
what is the effect of hyperthyroidism
increased metabolism
28
symptoms of hyperthyroidism
- hot & excess sweating, weight loss, diarrhoea - palpitations, muscle weakness - irritable, manic, anxious
29
signs of hyperthyroidism
- warm moist skin - tachycardia and atrial fibrillation - increased blood pressure and heart failure - tremor and hyperreflexia - eyelid retraction and lid lag
30
what is a goitre
increasing size of thyroid gland. Problems related to lack of iodine
31
what diseases are 'if you have one you're more likely to have another' related to hyperthyroidism
- grave's disease - vitiligo - pernicious aneamia - type 1 diabetes - coeliac - myaesthenia gravis - family history of autoimmune disease
32
are goitres physiological or pathogogical
can be either
33
What effects does hyperthyroidism have on your eyes
- ophthalmopthy | - conjuntival oedma
34
what causes the effects of hyperthyroidism on your eyes
Graves disease doesn't just affect they thyroid gland. Antibodies also bind to fat cells, triggers inflammatory cells, causes orbit volume to increase so get proptosis (eyeballs popping out at you)
35
How do you treat primary hyperthyroidism
steroids to stop immune response
36
why will giving a drug to block thyroid hormone not work for hyperthyroidism
is caused by antibody
37
what causes most cases of hypothyroidism
autoimmune disease (Hashimoto's thyroiditis)
38
what are the different ways you can get primary hypothyroidims
- atuoimmune (hashimoto's) thyroiditis (90% cases) - idiopathic atrophy - radioiondine treatment/thyroidectomy surgery - iodine deficiency - drugs (carbimazole, amiodarone, lithium) - congenital
39
how can you get secondary hypothyroidism
hypothalamic/pituitary disease
40
what is the effect of hypothyroidism
reduced metabolism
41
symptoms of hypothyroidism
- tired - cold intolerance - weight gain
42
signs of hypothyroidism
- dry coarse skin - bradycaridia, hyperlipidaemia - psychiatric or confusion - goitre (hashimoto's) - delayed reflexes
43
what are the presenting features of hashimoto's thyroiditis
- goitre | - hypothyroid features
44
what things are associated with hashimoto's thyroiditis
- a family history of autoimmune disease | - down's syndrome
45
who tends to get hashimoto's thyroiditis
middle aged and elderly women
46
What is idiopathic atrophy
we don't know why it happens but lymphocytes suggest it's autoimmune. Gland is attacked so can't produce thyroid hormone anymore (more common in women)
47
What are the effects of hypothyroidism
opposite of hyperthyroidism - hair loss common - can't smile (swelling)
48
How can you investigate thyroid disease
1. blood test - TSH, T3 and T4 2. imaging - ultrasound scan (cysts) - radioisotope scans 3. tissue - fine needle aspirate/ biopsy
49
what does a raised TSH and a raised T3 suggest
hyperthyroid caused by pituitary (rarer)
50
what does a low TSH with raised T3 suggest
hyperthyroid caused by graves or ademoma (common)
51
what does a low TSH with low T4 suggest
hypothyroid caused by pituitary cause (rarer)
52
what does a high TSH with a low T4 suggest
hypothyroid caused by gland failure (common)
53
what are the signs after investigation of hyperthyroid caused by pituitary cause (+ how common is this)
raised TSH raised T3 (rare)
54
what are the signs after investigation of hyperthyroid caused by graves or ademona (+ how common is this)
low TSH | raised T3
55
what are the signs after investigation of hypothyroid caused by pituitary (+ how common is this)
low TSH low T4 (rarer)
56
what are the signs after investigation of hypothyroid caused by gland failure (+ how common is this)
high TSH low T4 (common)
57
How do you treat hyperthyroidism
- carbimazole - beta-blockers - radioiodine - surgery - graves ophthalmopathy
58
how do you treat hypothyroidism
- give thyroxine tablets - increase dose slowly - recheck using TSH as a guide if gland failure
59
How do you get thyroid enlargement
Goitre - diffuse enlargement of the thyroid gland - often iodine deficient - diffuse, nodular - drug related? Solitary nodule enlargement - adenoma, carcinoma, cyst formation possible - low cancer risk - suspicious in children or elderly
60
How do you spot thyroid cancer
- usually with a thyroid swelling - young or elderly - 'cold' nodules on radioisotope scan - often TSH sensitive - give thyroxine post surgery - generally a good prognosis in young
61
what are the dentally relevant things to know about thyroid disease
- goitre detectable to the dentist - hyperthyroid = pain, anxiety and psychiatric problems, caution for treatment until controlled - hypothyroid = avoid the use of sedatives if severe - treated patient are normal
62
What usually causes acromegaly
benign pituitary tumour (MEN1 a possibility)
63
What are the general presenting features of someone with acromegaly
- coarse features - enlarged supra-orbital ridges - broad nose, thickened lips and soft tissues - enlarged hands - type 2 diabetes mellitus - cardiovascular diseases - often become class 3 (mandible grows) - large hands - visual field defects - hyperprolactinaemia - hypopituitarism
64
What intra-oral changes occur which acromegaly
- enlarged tongue - interdental spacing - 'shrunk' dentures - reverse overbite - do full cranial nerve check as they might be squashed

BDS2 BAMS Endocrinology (3 decks)

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