thyroid disease Flashcards
1
Q
- Hyperthyroidism- DDX
Hypothyroidism - DDx
A
Hyperthyroidism- DDX
- Grave’s disease
- subacute thyroiditis- painful
- postpartum thyroiditis- painless
- toxic nodular goiter
- toxic multinodular goiter
- infectious thyroiditis - painful
- haemorrhage in thyroid nodule- painful
Hypothyroidism - DDx
- Hashimoto’s thyroiditis
- iodine deficiency
- Li+ induced thyroiditis
- Amiodarone induced thyroiditis
- radiation and surgery
2
Q
- hyperthyroidism- C/F and physical exam
A
C/F
- Increase energy
- insomnia
- heat intolerance
- increase appetite and wt loss
- diarrhoea
Physical examination
- tremor
- tachycardia
- hypertension
- hyperreflexia
3
Q
- Hypothyroidism- C/F and Physical examination
A
C/F
- tiredness/lethargy
- sleeping, depression
- cold intolerance
- decrease appetite, weight gain
- constipation
- huskiness of voice
- hair loss
Physical examination
- bradycardia
- hypotension
- hyporeflexia
- thin hair
- hypercholesterolaemia- xanthoma, xanthelasma
4
Q
Thyroid investigations - thyroid Ab
A
- TOP: Thyroid peroxidase enzyme
- Hashimoto’s thyroiditis
- subacute thyroiditis
- postpartum thyroiditis - TRAB: thyroid receptors Ab –> Grave’s disease
- anti- TG: anti-thyroglobulin –> for thyroid cancer
5
Q
Thyroid investigation- Thyroid nucleotide scan
A
only for hyperthyroidism
C/I in pregnancy
stop breastfeeding for 3 days post-test
interpretation
- cold nodule–> consider FNA
- hot nodule (heterogeneous uptake) –> toxic nodular/multinodular goiter
- diffuse homogenous uptake –> Grave’s disease
6
Q
name of test to rule out thoracic outlet obstruction
A
Pemberton sign
7
Q
Grave’s disease treatment
A
- propranolol 10mg BD
- Carbimazole 10-45mg/day in 2-3 doses
if 1st trimester pregnant: PTU 200-6600 mg/day in 2-3 doses
- surgery: thyroidectomy
- radiation: Radioactive iodine
- women: no pregnancy for 6 months
- men: no conception for 4 months (new sperm in 3 months)
- all: avoid contact with children and pregnant women for several days
8
Q
Subacute Thyroiditis - treatment
A
- Propranolol 10mg BD
- Aspirin 300mg daily OR Ibuprofen 400mg PO TDS
- prednisolone 40mg daily, tapering over 4 weeks
9
Q
Hypothyroidism treatment and follow up
A
- Thyroxine 50mcg daily, titrate up dose while follow up
a. Hashimoto’s thyroiditis
b. Subclinical hypothyroidism when TSH >10
c. Subclinical hypothyroidism when TSH 4-10 with TPO +ve
d. 1st trimester when TSH > 2.5 regardless of overt or subclinical hypothyroidismIn IHD, Thyroxine 25mcg daily
- Repeat TSH for follow up when comence thyroxine
- 6 weeks after starting thyroxine
- Then every 3 months for 1st year
- Then annual follow up - If aiming to increase:
- increase by 30-50% of total daily dose
- In IHD, increase 25mcg every 6 weeks
10
Q
Hypothyroidism- indication for referral
A
- Age < 18 years
- pregnant
- IHD
- nodule
- no response to treatment
11
Q
Grave’s disease- eye manifestation
A
- exophthalmos
- ophthalmoplegia
- pretibial myxoedema
- clubbing
- lid lag retraction
12
Q
hyperthyroidism - associated other diseases
A
- T1DM
- Addision disease
- vitiligo
13
Q
Hypothyroidism - associated other diseases
A
- Turner disease
- down syndrome
- cystic fibrosis
- primary biliary cirrhosis