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Endocrine > Thyroid Disease > Flashcards

Thyroid Disease Flashcards

1
Q

What is Thyroid Disease?

A

When your thyroid doesn’t make the right amount of hormones

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2
Q

Where is the thyroid gland located and what does it do?

A

The thyroid gland is highly vascularized and is located just under the larynx.
It regulated the secretion and actions of thyroid hormones.

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3
Q

Where is the thyroid gland located and what does it do?

A

The thyroid gland is highly vascularized and is located just under the larynx.
It regulated the secretion and actions of thyroid hormones.

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4
Q

What are the different thyroid function test (TFTs) that can be done?

A

Thyroid releasing hormone (TRH), thyroid stimulating hormone (TSH), T3 and T4. Thyroid receptor antibodies can also be measured.

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5
Q

Explain the control and feedback of thyroid hormones?

A
  1. Low blood levels of T3 and T4 or low metabolic rate stimulates the release of TRH.
  2. TRH is then carried by hypophyseal portal veins to anterior pituitary, which stimulates the release of TSH by thyrotrophs.
  3. TSH is then released into the blood and stimulates thyroid follicular cells
  4. T3 ad T4 is then released into the blood by follicular cells
  5. Elevated t3 inhibits the release of TRH and TSH (negative feedback).
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6
Q

What are the actions of Thyroid Hormones?

A
  • Increased basal metabolic rate
  • Stimulate synthesis of Na+ / K+ ATPase
  • Increases body temperature
  • Stimulates protein synthesis
  • Increases the use of glucose and fatty acids for ATP production
  • Stimulates lipolysis
  • Enhance some actions of catecholamines
  • Regulate development and growth of nervous tissues and bones
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7
Q

What is an essential requirement for thyroid hormone synthesis?

A

Iodine

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8
Q

What are the causes of thyroid disease?

A
  • Thyroid neoplasia
  • Hypothalamic-pituitary disease
  • Thyroid disease in children - congenital
  • Iodine deficiency
  • Peripheral resistance to thyroid hormone
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9
Q

What is Goitre?

A

The swelling of the neck as a result of the thyroid gland being enlarged and not functioning properly. It is a feature of thyroid disease.

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10
Q

What is hypothyroidism?

A

A decreased population of thyroid hormones or tissue resistance to thyroid hormones.
The diagnosis of primary hypothyroidism is confirmed by symptoms and TFTs - serum TSH and free T4.

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11
Q

What are the causes of primary hypothyroidism?

A

 Congenital
 Infective
 Autoimmune e.g. Hashimoto’s thyroiditis, postpartum thyroiditis,
 Defects of hormone synthesis e.g. iodine deficiency
 Post-surgery
 Post-irradiation
 Infiltration e.g. tumour

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12
Q

What are the causes of secondary hypothyroidism?

A

Things like hypothalamic-pituitary disease or side effects to medications

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13
Q

What are the signs and symptoms of Hypothyroidism?

A

 Mental slowness, poor memory, poverty of movement, depression

 Peaches and cream complexion, loss of eyebrows, dry brittle unmanageable hair, dry skin, coarse thickened skin, puffy eyes, deep voice

 Hypertension, heart failure, bradycardia

 Anaemia

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14
Q

What are the two types of primary hypothyroidism?

A

Subclinical hypothyroidism and overt hypothyroidism

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15
Q

What is the first line treatment for primary hypothyroidism?

A

Levothyroxine sodium for maintainance therapy.

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16
Q

What should be done before starting levothyroxine?

A

A baseline ECG should be taken before initiation of levothyroxine because changes induced by hypothyroidism can be confused with ischaemia

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17
Q

What should happen is a patient’s metabolism increases too rapidly?

A

The initial dosage of levothyroxine should be reduced or levothyroxine can be withheld for one to two days before restarting at a lower dose.

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18
Q

What dose of levothyroxine should be given to patients?

A

Adults under 65 years of age with no history of cardiovascular disease; initially 1.6 micrograms/kg
once daily, rounded to the nearest 25 micrograms. Adjust dose according to response.

In adults over 65 years of age or with a history of cardiovascular disease; initially 25-50 micrograms
once daily, adjusted in steps of 25 micrograms every four weeks according to response.

The usual maintenance dose is 50 – 200 micrograms once daily.

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19
Q

What should be done if a patient is taking medication prior to the treatment of levothyroxine?

A

Consider adjusting the dose of the said medication as the patient responds to treatment of hypothyroidism.

20
Q

What other medication an be used for hypothyroidism?

A

Liothyronine sodium.

21
Q

What is the difference between Liothyronine and Levothyroxine?

A

Liothyronine is more rapidly metabolised and has a more rapid effect than levothyroxine.

Its effects develop after a few hours and disappear within 24 – 48 hours of discontinuing treatment. Liothyronine sodium 20 - 25 micrograms is equivalent to 100 micrograms of levothyroxine.

It is usually used in severe hypothyroid when a rapid response is desired.

22
Q

What counselling should be said to patients who are newly prescribed levothyroxine?

A

 Treatment is likely to be lifelong
 Take tablets regularly each day
 Take on an empty stomach to maximise absorption
 Avoid taking levothyroxine at the same time of day as medications that can affect its absorption

 It will take at least 2 – 3 weeks for them to see a symptomatic improvement.

 It can take at least 6 - 8 weeks treatment at full dose for TSH to return to normal or may take longer.

 They will need blood tests as appropriate for the measurement of TSH and free T4 levels

 They are eligible for a medical exemption certificate for prescription charges

 If a patient is taking other medications, doses of some of these medications may need reviewing as the thyroid hormones take effect.

23
Q

What could be the cause of TSH levels remaining abnormal after treatment?

A
  • Malabsorption
  • Coeliac disease
  • Autoimmune gastritis
  • Other medications being taken
  • Laboratory assay interference or non-adherence to thyroid hormone medication.
24
Q

What are some signs and symptoms of hypothyroid coma? Aka myxoedema

A

 Severe cardiac failure
 Pericardial effusions
 Hypoventilation
 Hypoglycaemia
 Hyponatraemia
 Hypothermia
 Confusion

25
Q

What can be used to treat hypothyroid coma?

A

Liothyronine sodium by slow IV injection.

Other adjunctive treatment if necessary includes:
- intravenous fluids
- hydrocortisone
- treatment of infection if present
- assisted ventilation.

26
Q

What is hyperthyroidism?

A

An excessive production of thyroid hormones by the thyroid gland

27
Q

What is thyrotoxicosis?

A

Prolonged exposure to elevated levels of thyroid hormone (not always causes by excessive production of thyroid hormones, could also be excessive ingestion of thyroid hormones).

28
Q

What are some causes of hyperthyroidism?

A
  • Graves’ disease
  • Solitary toxic adenoma / nodule
  • Toxic multinodular goitre
  • de Quervain’s thyroiditis
  • Postpartum thyroiditis
  • Amiodarone-induced
29
Q

What are some signs and symptoms of hyperthyroidism / thyrotoxicosis?

A
  • weight loss
  • Increased appetite
  • Heat intolerance and sweating
  • Fatigue and weakness
  • Hyperactivity, irritability, dysphoria, insomnia, tremor, hyper-reflexia
  • Tachycardia, atrial fibrillation
  • Warm moist skin, hair loss, onycholysis
30
Q

How is primary hyperthyroidism / thyrotoxicosis diagnosed?

A

This is confirmed by TFTs: TSH, free T4, free T3 and as appropriate TPO and thyroglobulin antibodies,
TSH receptor antibodies and by radioactive iodine uptake and scan.

31
Q

What medications are used to treat hyperthyroidism?

A
  1. Carbimazole
  2. Propylthiouracil

Propylthiouracil is reserved for patients who are intolerant of carbimazole, suffer sensitivity reactions to carbimazole and for whom other treatments are inappropriate e.g. during pregnancy

32
Q

What dose of Carbimazole should be given?

A

The dose of carbimazole is 15 to 40 mg daily; higher doses can only be prescribed under specialist
supervision.

The dose is continued until the patient becomes euthyroid, usually after 4 – 8 weeks.
The dose is then gradually reduced to a maintenance dose of 5 to 15 mg. Therapy is usually given for 12 – 18 months.

33
Q

What dose of Propylthiouracil should be given?

A

Propylthiouracil is given in a dose of 200 to 400 mg daily in divided doses until the patient becomes
euthyroid, then the dose may be gradually reduced to a maintenance dose of 50 to 150 mg daily in
divided doses.

34
Q

What is given in a blocking-replacement regimen?

A

A combination of carbimazole 40 to 60 mg daily with levothyroxine 50 to 150 microgram daily may
be used in a blocking-replacement regimen which is usually given for 18 months.
Carbimazole is commenced initially and then levothyroxine therapy is added, usually after several weeks.
This regimen is not suitable for use during pregnancy.

35
Q

What are the side effects of anti-thyroid drugs?

A

Sore throat, rash, severe hepatic reactions,

36
Q

What can be done in the case of surgery - thyroidectomy?

A

Iodine has been used for 10 - 14 days prior to partial thyroidectomy, as an adjunct to anti-thyroid
drugs.
However, there is little evidence of a beneficial effect.

37
Q

When should Radioactive Iodine Therapy be considered?

A
  • If medical therapy or compliance is a problem
  • If patient had cardiac disease
  • If patient relapse after thyroidectomy
38
Q

What is done before starting radioactive iodine therapy?

A

Anti-thyroid drugs is withdrawn

39
Q

How is radioactive iodine therapy given?

A

It is administered by sodium ioidie and usually concentrates in the thyroid gland

40
Q

What are the contra-indications of radioactive iodine aka sodium ioidie?

A

Pregnancy
Breastfeeding

41
Q

What other treatment can be given for thyrotoxicosis?

A

Propranolol

42
Q

What is Thyrotoxic crisis / thyroid storm?

A

Rapid deterioration of hyperthyroidism

43
Q

What are the signs and symptoms of Thyrotoxic crisis / thyroid storm?

A
  • Hyperpyrexia
  • Severe tachycardia
  • Extreme restlessness
  • Cardiac failure
  • Liver dysfunction
44
Q

What are the emergency treatments for Thyrotoxic crisis / thyroid storm?

A
  • IV fluids
  • Propranolol (if not contra-indicated)
  • Hydrocortisone
  • Oral iodine
  • Carbimazole or propylthiouracil – may need administering by nasogastric tube
  • Other supportive measures and treatment
45
Q

What are the symptoms of Thyroid eye disease?

A

Visible swelling and redness of the eyelids and conjunctiva.

46
Q

What treatments can be given for Thyroid eye disease?

A
  • Steroids
  • Orbital irradiation with/without steroids
  • Lubricants – artificial tears
  • Prisms
  • Diuretics for lid swelling
  • Surgery
47
Q

What are the contra-indications of Propranolol?

A
  • Asthma
  • Hypotension
  • Diabetes.
  • Low blood sugar.
  • Depression
  • Complete heart block

Endocrine (8 decks)

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