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Endocrine > Thyroid Disease > Flashcards

Thyroid Disease Flashcards

1
Q

What activates the thyroid to release hormones?

A

TRH is released from the hypothalamus, leading to TSH being secreted by the anterior pituitary. The TSH then travels to the thyroid, bringing about the release of thyroid hormones.

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2
Q

What are potential causes of thyroiditis?

A

Autoimmune
Infection
Subacute
Lymphocytic
Palpation

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3
Q

What is the most prevalent cause of hyperthyroidism?

A

Grave’s disease

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4
Q

What causes Grave’s disease?

A

The presence of autoantibodies that act on TSH receptors, stimulating function.

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5
Q

What are the 3 main features in Grave’s disease?

A

Hyperthyroidism, with enlarged thyroid gland
Eye changes (exophthalmos)
Pretibial myxoedema

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6
Q

What is the most common cause of hypothyroidism?

A

Hashimoto’s thyroiditis

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7
Q

Besides Hashimoto’s thyroiditis, what other causes exist for hypothyroidism?

A

Iodine deficiency
Drugs
Congenital abnormalities

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8
Q

What is a goitre?

A

Any enlargement of the thyroid gland.

Often, this is a result of a lack of dietary iodine.

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9
Q

What is the most common form of thyroid cancer?

A

Papillary thyroid carcinoma

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10
Q

What are common benign causes of thyroid nodules?

A

Cysts
Colloid nodules
Benign follicular adenomas
Hyperplastic nodules

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11
Q

What type of thyroid cancer is associated with MEN type 2b syndrome?

A

Medullary thyroid carcinomas

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12
Q

Following an examination and history, how should a thyroid nodule be investigated?

A

Measure TSH levels
Ultrasound

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13
Q

What is the biggest risk factor for thyroid lymphoma?

A

Hashimoto’s thyroiditis

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14
Q

How is thyroid lymphoma treated?

A

R-CHOP chemotherapy
Radiotherapy
Steroids

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15
Q

How can bothersome toxic multinodular goitres be managed?

A

Radioactive iodine

If structural issues, or patient finds it unsightly, then surgery can be used.

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16
Q

Where do secondary thyroid diseases occur?

A

Pituitary or hypothalamus.

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17
Q

How do thyroid hormones present in primary hypothyroidism?

A

Low free T3
Low free T4
Raised TSH

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18
Q

How do thyroid hormones present in primary hyperthyroidism?

A

High free T3
High free T4
Low TSH

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19
Q

How do thyroid hormones present in secondary hypothyroidism?

A

Low T3
Low T4
Low TSH (no response to low T3/T4)

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20
Q

How do thyroid hormones present in secondary hyperthyroidism?

A

High T3
High T4
High TSH (no response to elevated T3/T4 levels)

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21
Q

What is the difference between myxoedema and pretibial myxoedema?

A

Myxoedema is a severe form of hypothyroidism.

Pretibial myxoedema is a rare complication of hyperthyroidism.

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22
Q

Name a drug that can cause hypothyroidism?

A

Amiodarone

23
Q

Which antibodies are linked to Hashimoto’s thryoiditis?

A

anti-TPO

24
Q

How is primary hypothyroidism diagnosed?

A

TFT (low T3/T4, and raised TSH)
Look for presence of anti-TPO (seen in 95% of people)

25
Q

Should dose of levothyroxine differ depending on age?

A

Yes, younger patients get 50-100ug whereas elderly patients get 25-50ug.

Often the initial dose is changed - these are just beginning values for treatment.

26
Q

Why do pregnant patients need a higher dose of levothyroxine?

A

As there are greater TBG levels in pregnancy, meaning less free T4 available.

27
Q

What is the main treatment of hypothyroidism?

A

Levothyroxine

28
Q

What drugs can impair the efficacy of levothyroxine?

A

PPIs
Iron tablets
Calcium tablets

29
Q

What is myxoedema coma?

A

A severe form of hypothyroidism in which significant bradycardia and type 2 respiratory failure develop. There may also be adrenal failure.

It is associated with a high mortality rate (60%).

30
Q

What is thyrotoxicosis?

A

The clinical state of hypothyroidism - the latter refers only to the condition which produces thyrotoxicosis.

31
Q

If TSH antibodies are found, do you need to carry out thyroid imaging to diagnose Grave’s disease?

A

No, antibody presence is sufficient.

32
Q

What is thyroid storm?

A

A severe form of hyperthyroidism, in which there is significant respiratory and cardiovascular collapse.

Will have hypothermia, and exaggerated reflexes.

33
Q

In which types of patients does thyroid storm present?

A

Acutely unwell hyperthyroid patients

Recent thyroid surgery

34
Q

What is the first-line treatment of hyperthyroidism?

A

Carbimazole

35
Q

In which trimester of pregnancy should propylthiouracil be used over carbimazole?

A

1st trimester of pregnancy.

36
Q

What antithyroid medication may cause agranulocytosis?

A

Carbimazole

37
Q

What does normal thyroid levels, but abnormal TSH levels indicate?

A

Subclinical hypothyroidism/hypethyroidism

38
Q

What is sick euthyroid syndrome?

A

When an intercurrent illness affects the thyroid, commonly seen in hospitalised patients.

As a result, avoid thyroid testing in hospital unless it appears as a thyroid disease specifically.

39
Q

What are the 5 types of thyroid cancer?

A

Papillary (most common)
Follicular
Medullary
Anaplastic
Other

40
Q

What forms of thyroid cancer belong to the differentiated sub-set?

A

Papillary
Follicular

41
Q

What are differentiated thyroid cancers dependent on to grow?

A

TSH

These cancers take up iodine and release thyroglobulin (like normal thyroid tissue).

42
Q

How do papillary and follicular thyroid cancers differ?

A

Papillary thyroid cancers favour lymphatic spread, whereas follicular spread more via haematogenous routes.

43
Q

How are differentiated thyroid cancers treated?

A

Surgery

This may be a thyroid lobectomy with isthmusectomy, sub-total thyroidectomy, or a total thyroidectomy.

44
Q

What form of thyroid cancer is associated with Hashimoto’s thyroiditis?

A

Papillary carcinoma

45
Q

Alongside surgery, what is used in the management of thyroid cancer?

A

Whole body iodine scanning

Only after sub-total/total thyroidectomy - as this shows whether any thyroid tissue remains within the body. Thus, will identify remnants, normal thyroid and metastasis.

46
Q

If whole body iodine scanning detects metastasis, what is the remaining treatment option?

A

Thyroid remnant ablation

This acts to make cells hungry through administration of high TSH, before giving radioactive iodine - which kills them off.

47
Q

What can be used as a marker in TRA?

A

Thyroglobulin

If treatment was successful, none will present in blood (as only produced within thyroid tissue).

48
Q

Can recurrent differentiated thyroid cancers be treated?

A

Yes, if the cells continue to take up iodine, then TRA can be used.

If resistant to iodine, try tyrosine kinase inhibitors.

49
Q

What is the first-line investigation for a new thyroid lump?

A

Thyroid function test

50
Q

Following TFTs, how is a new thyroid lump investigated?

A

USS, if inconclusive perform a FNA.

51
Q

What is pretibial myxoedema?

A

A rash that occurs in hyperthyroidism.

52
Q

What treatment is contraindicated in thyroid eye disease?

A

RAI (radioactive iodine)

53
Q
A

Endocrine (11 decks)

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