Thyroid Conditions Flashcards
What is postpartum thyroiditis?
It is a phenomenon observed following pregnancy and may involve hyperthyroidism, hypothyroidism or the two sequentially
What is the difference in investigation findings between Grave’s disease and subacute lymphocytic thyroiditis?
Radioactive Iodine Uptake (RAIU) test:
In Grave’s, there is increased iodine uptake.
But in the hyperthyroid phase of subacute lymphocytic thyroiditis, iodine uptake is suppressed. In the hypothyroid phase, iodine uptake is increased.
Lid lag is a sign of hypo or hyperthyroidism?
Hyperthyroidism
Proximal Myopathy is a sign of hypo or hyperthyroidism?
Hyperthyroidism
What are the symptoms defining Grave’s disease?
Smooth symmetrical goitre with bruit.
Thyroid associated orbitopathy: Exophthalmos
Thyroid associated dermopathy: Pretibial myxoedema
Thyroid acropachy (clubbing)
How long does postpartum thyroiditis affects women?
For 1 year.
In the first 2-6/12, there is hyperthyroid symptoms.
In the second phase, which is from 3-12/12, there is hypothyroid symptoms.
Euthyroid symptoms resumes after 1 year.
What is the cause of exophthalmos?
Secondary to retro-orbital swelling/inflammation of tissues and infiltration of lymphocytes.
What are the medications available for hyperthyroidism?
Beta-blockers such as propranolol. Can use Diltiazem/other calcium channel blockers as an alternative.
Iodide
Carbimazole OD 5-40MG
Propylthiouracil TDS 50-150MG
Which has a shorter half life: Carbimazole or Propylthiouracil?
Propylthiouracil
When is surgery considered?
- Large goitre or severe disease
- Patient choice: example if patient does not want radiation
- Medication failure
- Thyroid eye disease
How is radioactive iodine given? Is it for the treatment of hyperthyroidism or hypothyroidism?
Radioactive iodine is given as a capsule to be swallowed. It is a treatment for hyperthyroidism.
What is the advantage of radioactive iodine?
The treatment is permanent.
Patient with menorrhagia. Does she has hypothyroidism or hyperthyroidism?
Hypothyroidism.
Oligomenorrhoea occurs in hyperthyroidism.
Macroglossia could indicate hypothyroidism or hyperthyroidism?
Hypothyroidism
Pericardial effusion is a sign of hypothyroidism or hyperthyroidism?
Hypothyroidism
How is thyroxine manufactured and given?
Thyroxine is manufactured as sodium tablets, Levothyroxine Sodium, which are taken once daily.
In sizes of 25, 50 and 100 micro-grams.
What are the adjustments made to Levothyroxine Sodium in severe liver disease?
Less Levothyroxine Sodium may be needed in severe liver disease, as thyroxine is metabolised in the liver.
What is the amount of thyroxine produced in the body?
~100micrograms/day
What is the maintenance dose of Levothyroxine Sodium?
For adults 18-49yo, 100-200micrograms as maintenance dose
For adults >50yo, 50-200micrograms as maintenance dose.
Grave’s and Hashimoto’s are linked with which conditions?
Autoimmune conditions such as vitiligo, T1DM and Addison’s disease.
What are the conditions associated with hypothyroidism?
Cystic Fibrosis, Primary Biliary Cirrhosis, Turner’s syndrome and Down’s syndrome
Can Lithium cause hypothyroidism, hyperthyroidism or both?
Both hypo and hyperthyroidism, but more commonly, hypothyroidism
There is bruits detected in hyper or hypothyroidism?
Why?
Bruits are heard in Hyperthyroidism (Grave’s) as there is increased blood flow
Anti-TPO antibodies are used to diagnose hypo or hyperthyroidism?
TRAb are used to diagnose hypo or hyperthyroidism?
Anti-TPO antibodies are used to diagnose hypothyroidism (Hashimoto’s)
TRAb are used to diagnose hyperthyroidism (Grave’s)
MEN 2a and 2b are linked with?
Medullary thyroid carcinoma
What are the triggers of Grave’s disease?
Stress, Infection and childbirth
In which patients are thyroxine given with caution? Why?
Patients with liver disease or liver failure, and patients with ischaemic heart disease.
This is because thyroxine is metabolised in the liver. Thyroxine can also precipitate angina or MI. Hence, give thyroxine cautiously in lesser amounts.
