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MD2 Ambulatory Care and Emergency Medicine > Thyroid Disease > Flashcards

Thyroid Disease Flashcards

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1
Q

What is the lifetime risk of thyroid disease in a woman?

A

20%

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2
Q

When is undiagnosed thyroid disease especially dangerous?

A

Pregnancy/peripartam

Cardiac disease

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3
Q

How often do ranges for thyroid function tests change during pregnancy?

A

Trimester to trimester

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4
Q

What blood test is a good screening test for hypothyroidism?

A

TSH

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5
Q

What blood tests do you do if you’re considering secondary hypothyroidism?

A

TSH and T4

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6
Q

What is sub-clinical hypothyroidism?

A

T4 normal, elevated TSH

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7
Q

What are the symptoms of hypothyroidism?

A 
Malaise
Tiredness
Myalgia
Depression
Cold intolerance
Constipation
Weight gain
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8
Q

What are the signs of hypothyroidism?

A 
Delayed tendon reflexes
Bradycardia
Myxoedema
Voice change
Myopathy
Hypothermia
Effusions
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9
Q

What are the most common causes of hypothyroidism?

A

Autoimmune
Iatrogenic
Drugs

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10
Q

What is thyroiditis?

A

Inflammation of thyroid gland

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11
Q

What is the natural history of thyroiditis?

A 
Initially hyperthyroid phase because some follicles rupture and release thyroid hormone
- 4-8 weeks
Then have hypothyroid phase
- 4-8 weeks
Transient and self-limiting
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12
Q

How is hypothyroidism diagnosed?

A

Check TSH and free T4
Correlate with symptoms and clinical exam
Anti-thyroid Abs can sometimes be helpful

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13
Q

What is the treatment for hypothyroidism?

A

Thyroxine

- 1.3-1.6 mg/kg

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14
Q

After how long do you adjust thyroxine dose?

A

6-8 weeks

- No hurry except in pregnancy

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15
Q

What medications may decrease thyroxine absorption?

A

Iron tablets
Calcium tablets
Antacids
Cholestyramine

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16
Q

Is a nuclear scan important in hypothyroidism?

A

No

17
Q

What are differential diagnoses for thyrotoxicosis?

A

Caffeine
Anxiety/panic disorder
Primary pulmonary/cardiac disorder

18
Q

What are the symptoms of hyperthyroidism?

A 
Heat intolerance
Weight loss
Increased appetite
Increased sweating
Tremulousness
Anxiety
Emotional lability
Hair loss
Increased frequency of bowel movements
Menstrual irregularity
19
Q

What are some of the causes of hyperthyroidism?

A 
Graves' disease
Toxic nodular goitre
Iodine-induced
- Radiographic
- Naturopathic remedies
- Amiodarone
Exogenous
Transient
20
Q

What are the possible signs of hyperthyroidism?

A 
Increased heart rate
Irregularly irregular rhythm
Tremor
Skin, nail and hair changes
Thyroid size, consistency, bruit
- May have diffuse, soft goitre
- May have bruit over thyroid
Pemberton's sign
21
Q

What eye signs may be present in Graves’ disease?

A

Redness and irritation
Staring appearance
Mild double vision on extreme lateral gaze

22
Q

What are the investigations for hyperthyroidism?

A

TSH
Free T3 and T4
Nuclear scan if unsure of cause
Abs against TSH receptor if suspect Graves’ disease

23
Q

What is the appearance of a nuclear scan in Graves’ disease?

A

Normal/increased uniform uptake

24
Q

What is the appearance of a nuclear scan in thyroiditis?

A

Decreased/no uptake

- Due to inflammation

25
Q

What is the appearance of a nuclear scan if one or more nodules are present?

A

Non-uniform uptake

26
Q

Which age group is particularly at risk of developing atrial fibrillation as a result of hyperthyroidism?

A

Elderly

27
Q

What are the treatment options for hyperthyroidism?

A 
Anti-thyroid drugs
- Carbimazole
- Propylthiouracil
Radioactive iodine
Surgery only if other reasons
- Adverse reactions to drugs
- Cosmetic/patient preference
- Risk of malignancy
28
Q

What is the pattern of disease in Graves’ disease?

A

Remitting-relapse

29
Q

What is the management of Graves’ disease?

A

Try anti-thyroid drugs, but they don’t often work

Need to remove thyroid, either via radiation/surgery

30
Q

Are anti-thyroid drugs safe to use in pregnancy and lactation?

A

Yes, but try and avoid use

- Propylthiouracil safer in first trimester

31
Q

What are the side effects of anti-thyroid drugs?

A

Commonly, rash

Very small risk of granulocytosis

32
Q

How long do you treat Graves’ disease for with anti-thyroid drugs?

A

12-18 months

33
Q

What medication can be used to help alleviate the symptoms of hyperthyroidism initially?

A

Beta-blockers

34
Q

What are the features of radioactive iodine as a treatment for hyperthyroidism?

A

Very effective and permanent
Permanent hypothyroidism frequent outcome
Small risk of thyroid eye disease
Must not be pregnant
Must not have had ordinary iodine for months

35
Q

What are the features of surgery for thyrotoxicosis?

A

Usually only considered if

  • Large goitre with obstructive/cosmetic concerns
  • Significant possibility of incidental thyroid malignancy
  • Intolerant of anti-thyroid drugs and radioactive iodine therapy refused/contraindicated
36
Q

What tests may be helpful in the confirmation of thyroiditis?

A

CRP
ESR
WCC

37
Q

If antibody testing is negative in the instance of hyperthyroidism, what test can be done, and what can it indicate?

A

Measure thyroglobulin levels
Elevated in thyroiditis
If normal, may indicate exogenous cause

38
Q

What is the management of sub-clinical hypothyroidism?

A

Observe/treat according to clinical circumstances

MD2 Ambulatory Care and Emergency Medicine (29 decks)

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