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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
Q

how does graves disease occur

A
  • 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
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26
Q

how common is a pituitary gland dysfunction being the cause of hyperthyroidism

A

uncommon

27
Q

what is the effect of hyperthyroidism

A

increased metabolism

28
Q

symptoms of hyperthyroidism

A
  • hot & excess sweating, weight loss, diarrhoea
  • palpitations, muscle weakness
  • irritable, manic, anxious
29
Q

signs of hyperthyroidism

A
  • warm moist skin
  • tachycardia and atrial fibrillation
  • increased blood pressure and heart failure
  • tremor and hyperreflexia
  • eyelid retraction and lid lag
30
Q

what is a goitre

A

increasing size of thyroid gland. Problems related to lack of iodine

31
Q

what diseases are ‘if you have one you’re more likely to have another’ related to hyperthyroidism

A
  • grave’s disease
  • vitiligo
  • pernicious aneamia
  • type 1 diabetes
  • coeliac
  • myaesthenia gravis
  • family history of autoimmune disease
32
Q

are goitres physiological or pathogogical

A

can be either

33
Q

What effects does hyperthyroidism have on your eyes

A
  • ophthalmopthy

- conjuntival oedma

34
Q

what causes the effects of hyperthyroidism on your eyes

A

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
Q

How do you treat primary hyperthyroidism

A

steroids to stop immune response

36
Q

why will giving a drug to block thyroid hormone not work for hyperthyroidism

A

is caused by antibody

37
Q

what causes most cases of hypothyroidism

A

autoimmune disease (Hashimoto’s thyroiditis)

38
Q

what are the different ways you can get primary hypothyroidims

A
  • atuoimmune (hashimoto’s) thyroiditis (90% cases)
  • idiopathic atrophy
  • radioiondine treatment/thyroidectomy surgery
  • iodine deficiency
  • drugs (carbimazole, amiodarone, lithium)
  • congenital
39
Q

how can you get secondary hypothyroidism

A

hypothalamic/pituitary disease

40
Q

what is the effect of hypothyroidism

A

reduced metabolism

41
Q

symptoms of hypothyroidism

A
  • tired
  • cold intolerance
  • weight gain
42
Q

signs of hypothyroidism

A
  • dry coarse skin
  • bradycaridia, hyperlipidaemia
  • psychiatric or confusion
  • goitre (hashimoto’s)
  • delayed reflexes
43
Q

what are the presenting features of hashimoto’s thyroiditis

A
  • goitre

- hypothyroid features

44
Q

what things are associated with hashimoto’s thyroiditis

A
  • a family history of autoimmune disease

- down’s syndrome

45
Q

who tends to get hashimoto’s thyroiditis

A

middle aged and elderly women

46
Q

What is idiopathic atrophy

A

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
Q

What are the effects of hypothyroidism

A

opposite of hyperthyroidism

  • hair loss common
  • can’t smile (swelling)
48
Q

How can you investigate thyroid disease

A
  1. blood test
    - TSH, T3 and T4
  2. imaging
    - ultrasound scan (cysts)
    - radioisotope scans
  3. tissue
    - fine needle aspirate/ biopsy
49
Q

what does a raised TSH and a raised T3 suggest

A

hyperthyroid caused by pituitary (rarer)

50
Q

what does a low TSH with raised T3 suggest

A

hyperthyroid caused by graves or ademoma (common)

51
Q

what does a low TSH with low T4 suggest

A

hypothyroid caused by pituitary cause (rarer)

52
Q

what does a high TSH with a low T4 suggest

A

hypothyroid caused by gland failure (common)

53
Q

what are the signs after investigation of hyperthyroid caused by pituitary cause (+ how common is this)

A

raised TSH
raised T3

(rare)

54
Q

what are the signs after investigation of hyperthyroid caused by graves or ademona (+ how common is this)

A

low TSH

raised T3

55
Q

what are the signs after investigation of hypothyroid caused by pituitary (+ how common is this)

A

low TSH
low T4

(rarer)

56
Q

what are the signs after investigation of hypothyroid caused by gland failure (+ how common is this)

A

high TSH
low T4

(common)

57
Q

How do you treat hyperthyroidism

A
  • carbimazole
  • beta-blockers
  • radioiodine
  • surgery
  • graves ophthalmopathy
58
Q

how do you treat hypothyroidism

A
  • give thyroxine tablets
  • increase dose slowly
  • recheck using TSH as a guide if gland failure
59
Q

How do you get thyroid enlargement

A

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
Q

How do you spot thyroid cancer

A
  • 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
Q

what are the dentally relevant things to know about thyroid disease

A
  • 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
Q

What usually causes acromegaly

A

benign pituitary tumour (MEN1 a possibility)

63
Q

What are the general presenting features of someone with acromegaly

A
  • 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
Q

What intra-oral changes occur which acromegaly

A
  • 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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