Thyroid disease Flashcards
Of all the thyroid diseases, which doesn’t present with goitre?
Secondary to hypothalamic or ant. pituitary failure hypothyroidism
What would the plasma concentrations be for each of the following diseases?
Hyperthyroidism: Graves’ Disease, Primary, secondary, others (tumour)
Hypothyroidism: Primary, secondary, others (lack of iodine, drug-induced etc)
HYPOTHYROIDISM:
primary - down T3/T4, up TSH
secondary - down T3/4, down TSH
other - down T3/4, up TSH
HYPERTHYROIDISM:
Graves’- up T3/4, down TSH
secondary - up T3/4, up TSH
others - up T3/4, down TSH
What are the 2 types of goitre? What do each of them point to?
Diffuse - occur when there is over-stimulation of the thyroid gland by either TSH or thyroid stimulated immunoglobulins
Nodular - discrete area that is clearly different from surrounding thyroid gland
What is Hashimoto’s thyroiditis?
autoimmune disease that attacks the thyroid gland
Write at least 3 symptoms of the 8 symptoms of hypothyroidism
weight loss dry skin hoarse voice, slow speech menstrual changes cold intolerance constipation lowered HR/BP depression, confusion, poor memory
reduction in BMR and overall met activity
what’s a complication of hypothyroidism in newborns? What kind of facial appearance can you get from hypothyroidism?
cretinism - dwarfism and mental retardation
myxoedema - puffy appearance
facial - moon-like, round, puffy, pale, oedematous eye-lids
skin thickened and dry
How do you diagnose hypothyroidism? Primary? Secondary? Hashimoto’s
Thyroid function test
if hashimoto’s test for thyroid antibodies - TPO, anti-thyroglobulin
What are the treatment options? What’s first-line?
synthetic thyroid hormones
1st line - levo-thyroxine (T4)
What’s one contra-indication of levo-thyroxine? What’s the dosing interval usually like?
may worsen or uncover angina - beta-blocker may be prescribed
oral once a day
Why isn’t liothyronine used more commonly?
rapid onset can induce heart failure
only used in severe hypothyroid state
What’s the most common cause of hyperthyroidism?
Grave’s disease
Thyroid stimulating imminoglobulins (TSI) activate the thyroid gland to produce and release thyroid hormones
What are 3 of the 8 classic signs and symptoms of hyperthyroidism?
weight loss sweating heat intolerance palpitations tremor nervousness goitre exophthalmos
What’s something special that can happen to the eyes?
exophthalmos - pushing out the eyeballs
What also happens to adrenoceptors in hyperthyroidism?
enhancement, TH are synergistic with SNS
How do you test for hyperthyroidism? What do you do if you suspect Graves’ or a tumour?
thyroid function test
test for TS antibodies for Graves’
perform thyroid uptake test (iodine-123) for thyroid tumour
What are the 3 treatment options for hyperthyroidism?
anti-thyroid drugs
radioiodine (I-131)
surgery
What are the anti-thyroid drugs called?
How do they work?
Name 2 drugs
thionamides
decrease production of TH by inhibiting iodination and coupling processes (via TPO)
carbimazole and propylthiouracil (PTU)
What’s the first-line treatment for hyperthyroidism?
carbimazole
How long does it take for the drugs to work? Why?
several weeks as there is a lot stored
What are some rare side-effects of Carbimazole?
neutropenia and agranulocytosis (bone marrow suppression)
these are reversible
What can you give for symptomatic relief of hyperthyroidism?
non-selective beta-blockers
reduces actions of catecholamines -> rapid symptomatic relief of tremor, palpitations, anxiety
What are the 2 approaches to hyperthyroidism treatment?
‘dose titration’ - only use anti-thyroid drugs, adjust doses - gives lower side effects
‘block and replace’ anti-thyroid drugs + thyroxine replacement
What is radioactive iodide first-line for? (Which patient population group)
older patients with nodular goitres and hyperthyroidism
