Thyroid Disease Flashcards
Bruit?
Extreme amounts of blood flowing through thyroid
Retrosternal goitre causes?
Deviation of trachea
How many people have thyroids checked?
1 in 4
Thyroid autoantibodies?
Anti TPO AB thyroid peroxidase- adds iodine to thyroglobulin.
TSH receptor TRAB
Symptoms of hypothyroidism?
Lethargy, mild weight gain, cold intolerance, constipation, facial puffiness, dry skin, hair loss, hoarseness and heavy menstrual periods
Severe hypothyroidism?
Stupor or coma, median nerve compression, ascites etc
Causes of hypothyroidism?
- Autoimmune
- Iatrogenic
- Iodine deficiency
- Congenital hypothyroidism
- Drugs
- Thyroditis
Addict
Secondary hypothyroidism hormone level?
TSH, T3 and T4 low
Treat of hypothyroidism?
T4 100 micro gram daily
If old and ishchaemic heart disease, start at 25 to 50
Myxedema?
Accumulation of glycosaminoglycans in interstitial space of tissues, severe hypothyroidism
Symptoms of thyrotoxicosis, hyperthyroidism?
Weight loss, increased appetite, lack of energy, thirst, palpitations, heat intolerance, anxious irritable, oligomenorrhoea
Signs of thyrotoxicosis?
Tremor, warm moist skin, tachycardia, brisk reflex, eye signs, thyroid bruit, muscle weakness and atrial fibrillation
Thyroid eye disease?
20% of people with Graves’ disease
TED symptoms?
Itchy, dry eyes, prominent eyes.
Diplopia (double vision), loss of colour vision, redness and swelling of conjunctival unable to close eyes, tightness behind eye
Inflammation of all orbital tissues except eye
Proptosis?
Pushing forward of eyes
Opthamolplegia?
When eyes don’t move smoothly
Causes of thyrotoxicosis?
- Graves- accounts for 75%
- Toxic multinodular goitre
- Toxic adenoma
- Thyroiditis
- Drugs (amiodarone )
What % of hyperthyroidism is graves?
75
Gestational thyrotoxicosis?
Placental beta human chorionic gonadotrophin act like TSH
Symptom control for graves?
Beta blockers, propranolol, not in asthmatics
Medical therapy for hyperthyroidism
Carbimazole or propylthiouracil
18 months to 2 year.
Rare side effect- agranulocytosis
Long term cure medication?
1/3
Severe thyroid eye disease?
Worsens with radioiodine
Which hormone takes longer to re-equilibrium?
TSH, monitor T4
Thyroid eye disease treatment?
Radiotherapy, immunosuppressive steroid-sparing agents, pulsed iv methylpred oral prednisolone, orbital decompression, eyelid surgery, stop smoking
Thyroid storm causes?
Multisystem condition
Surgery childbirth
Acute severe illness: PE, stroke, diabetic ketoacidosis, infection trauma
Thyroiditis?
Mild thyrotoxicosis, may use beta blockers
Then long hypothyroid phase, may use thyroxine.
Triggered by viral or pregnancy
Drugs that affect thyroid function?
Lithium- inhibits thyroid hormone secretion synthesis
and amiodarone
Thyroid nodule, cancer percentage?
5
How to treat toxic adenoma or toxic multinodular goitre?
Short term medical therapy then radioiodine
Causes of hypothyroidism?
- Graves
- Toxic Multinodular goitre
- Toxic Adenoma
- Thyroiditis
- Drugs
Thyroid eye disease may be graves in what percent of the cases?
20
Goitre with a bruit is?
Graves
To test for graves what scan should you do and what would you find?
Thyroid uptake scan, darker areas where increased activity
What percent after radioiodine risk hypothyroidism?
40%
When cant you use radioiodine?
Not in pregnant, breast feeding, in severe thyroid eye disease
In order to do thyroidectomy patient must first be?
Euthyroid
Treatment for a toxic adenoma or toxic multinodular goitre?
Short term medical therapy and then radioiodine
Features of thyroid storm?
Graves Thyroid eye disease Goitre 140 bpm< High pyrexia Atrial dysrhytmias Ventricular dysfunction Heart failure CNS agitation/delirium Vomiting Diarrhoea Heaptocellular dysfunction
Consider thyroiditis in following patients?
If pregnant/ within 1 year post partum- increase risk of t1d
Very tender thyroid
Thyroid status does not fit lab
Not graves
Current/recurrent treatment of immunomodulatory meds
How long does TSH take to change?
6 weeks
Further investigations for graves?
Thyroid autoantibodies
Thyroid uptake scan
Radioactive iodine treatment?
Radiation kills thyroid cells,
First do medical therapy until euthyroid
How many people after radioactive iodine risk hypothyroidism?
40%
What are the risks with thyroid surgery?
Anaesthetic Neck scar Hypothyroidism Hypoparathyroidism Vocal cord palsy
