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Human development > Thyroid - clinical > Flashcards

Thyroid - clinical Flashcards

1
Q

Specific clinical manifestations of hypothyroidism?

A 
Coarse hair
Coarse skin
Puffy facies
Macroglossia
Hoarse voice
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2
Q

What is macroglossia?

A

Unusually large tongue

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3
Q

Non-specific clinical manifestations of hypothyroidism

A 
Bradycardia
Constipation
Cold intolerance
Weight gain
Tired
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4
Q

Hypothyroidism is usually…

A

Primary autoimmune

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5
Q

Primary AI causes of hypothyroidism?

A

Atrophic thyroiditis

Hashimoto’s thyroiditis

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6
Q

What blood test result do both atrophic thyroiditis and Hashimoto’s thyroiditis share?

A

Presence of thyroid peroxidase antibodies (TPO abs)

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7
Q

Differential diagnosis between atrophic thyroiditis and Hashimoto’s thyroiditis?

A

Hashimoto’s causes enlargement of the thyroid

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8
Q

Cause of primary hypothyroidism?

A

Lack of thyroid hormones causing a slowing of metabolic processes

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9
Q

Features of atrophic thyroiditis?

A

Fibrosis of thyroid gland and myxoedema

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10
Q

What is central hypothyroidism?

A

Hypothyroidism arising from a lack of TSH

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11
Q

What other investigations should be done in the case of central hypothyroidism?

A

Measure other pituitary hormones as well as testosterone
MRI/CT of the head (pituitary and hypothalamus)
Gene analysis

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12
Q

Treatment for hypothyroidism?

A

Levothyroxine

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13
Q

Thyrotoxicosis is…

A

Hyperthyroidism

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14
Q

Symptoms of thyrotoxicosis

A 
Restlessness
Warmth intolerance
Diarrhoea
Sweating
Palpitations and breathlessness
Mood and behaviour change
Muscle stiffness and weakness
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15
Q

Clinical signs of hyperthyroidism?

A

Lid retraction

Lid lag

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16
Q

Causes of hyperthyroidism?

A

Grave’s disease

Toxic thyroid nodule

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17
Q

Cause of Grave’s disease?

A

Stimulating antibodies to the TSH receptor

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18
Q

Associated findings in Grave’s disease?

A

Orbitopathy (25%)
Dermopathy (orange peel) and acropachy (rare)
Elephantitis
Myxoedema

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19
Q

Why does the thyroid enlarge in Hashimoto’s?

A

Lymphocytic infiltration and destruction of thyroid tissue with secondary antibodies to TPO

20
Q

Treatment for hyperthyroidism?

A

Carbimazole and Propylthiouracil
Radio-iodine (avoid in thyroid eye disease)
Surgery

21
Q

Painless thyroiditis:

A

Hashimoto’s
Lymphocytic (post-partum)
Reidel’s (fibrous)

22
Q

Painful thyroiditis:

A

Granulomatous (De Quervain’s)

Radiation-induced thyroiditis

23
Q

Lump but TFTs normal and Abs not found?

A

Nodule: cytology and Ultrasound scan

24
Q

Thyroid cancers

A

Papillary (PTC) - 85%
Medullary (linked with MEN2) - tumour marker is calcitonin
Anaplastic (lymphoma) - very aggressive

25
Q

Hormone profile of primary hyperparathyroidism?

A

PTH: elevated
Ca: elevated
Phosphate: low
Urine Ca:Creatinine clearance > 0.01

26
Q

Hormone profile of secondary hyperparathyroidism?

A

PTH: elevated
Ca: low or normal
Phosphate: elevated
Vitamin D: low

27
Q

Hormone profile of tertiary hyperparathyroidism?

A 
PTH: elevated
Ca: normal or high
Phosphate: low or normal
Vitamin D: low or normal
Alkaline phosphatase: elevated
28
Q

What causes primary hyperparathyroidism?

A

Adenoma (mainly solitary)

Carcinoma

29
Q

What causes secondary hyperparathyroidism?

A

Parathyroid hyperplasia due to low calcium almost always in the context of chronic renal failure

30
Q

What causes tertiary hyperparathyroidism?

A

Continual hyperplasia (all 4 glands) despite correction of the underlying renal problem

31
Q

Clinical signs of primary hyperparathyroidism?

A

Can be subtle or asymptomatic
Recurrent abdominal pain (renal colic, pancreatitis)
Changes in cognition/emotional state

32
Q

Clinical signs of secondary hyperparathyroidism?

A 
Few symptoms
Eventually may develop:
Bone disease
Osteitis fibrosa cystica
Soft tissue calcifications
33
Q

Clinical signs of tertiary hyperparathyroidism?

A

Metastatic calcification
Bone pain and/or fracture
Nephrolithiasis
Pancreatitis

34
Q

Finding of calcium:creatinine clearance < 0.01

A

Benign familial hypocalciuric hypercalcaemia

35
Q

Histological finding in muscle cells of Thyroid disease myopathy

A

Checkerboard appearance due to areas of necrosis and regeneration

36
Q

Causes of hypothyroidism:

A 
Hashimoto's
de Quevain's
Postpartum thyroiditis
Riedel's
Iodine deficiency
Lithum
(Amiodarone - both)
37
Q

Causes of hyperthyroidism:

A

Grave’s disease
Toxic multi nodular goitre
(Amiodarone - both)
(Postpartum and de Quervain’s both have an initial hyperthyroid phase before becoming hypo)

38
Q

Investigation of thyrotoxicosis will reveal…

A 
TSH down
T3 and T4 up
Thyroid autoAbs
(Can do isotope scan)
39
Q

Major active thyroid hormone:

A

T3

40
Q

Plasma thyroid hormone (less potent):

A

T4

41
Q

Lowers plasma calcium:

A

Calcitonin

42
Q

What is associated with Hashimoto’s?

A

MALT lymphoma

43
Q

High TSH
Low T3, T4
Anti-TPO +ve
Anti-Tg +ve

A

Hashimoto’s

44
Q

Hashimoto’s increases your risk of:

A

Other AI conditions:

e.g. Addison’s, LE, Grave’s, T1DM, pernicious anaemia, RA, thrombocytopenic purpura, vitiligo

45
Q

Features of Hashimoto’s thyroiditis?

A

Hypothyroid features
Firm, non-tender goitre
Anti-TPO and anti-Tg +ve

46
Q

Signs of hypoparathyroidism:

A

Tetany: muscle cramping, twitching and spasm
Perioral paraesthesia
Trosseau’s sign: carpal spasm if brachial artery occluded by raising and holding pressure over systolic
Chvostek’s sign: tapping over the parotid causes facial muscle twitching
Chronic: depression, cataracts
ECG: prolonged QT interval

47
Q

Treatment for primary hypoparathyroidism:

A

alfacalcidol

Human development (7 decks)

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