thyroid disease Flashcards

1
Q
  1. Hyperthyroidism- DDX

Hypothyroidism - DDx

A

Hyperthyroidism- DDX

  1. Grave’s disease
  2. subacute thyroiditis- painful
  3. postpartum thyroiditis- painless
  4. toxic nodular goiter
  5. toxic multinodular goiter
  6. infectious thyroiditis - painful
  7. haemorrhage in thyroid nodule- painful

Hypothyroidism - DDx

  1. Hashimoto’s thyroiditis
  2. iodine deficiency
  3. Li+ induced thyroiditis
  4. Amiodarone induced thyroiditis
  5. radiation and surgery
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2
Q
  1. hyperthyroidism- C/F and physical exam
A

C/F

  1. Increase energy
  2. insomnia
  3. heat intolerance
  4. increase appetite and wt loss
  5. diarrhoea

Physical examination

  1. tremor
  2. tachycardia
  3. hypertension
  4. hyperreflexia
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3
Q
  1. Hypothyroidism- C/F and Physical examination
A

C/F

  1. tiredness/lethargy
  2. sleeping, depression
  3. cold intolerance
  4. decrease appetite, weight gain
  5. constipation
  6. huskiness of voice
  7. hair loss

Physical examination

  1. bradycardia
  2. hypotension
  3. hyporeflexia
  4. thin hair
  5. hypercholesterolaemia- xanthoma, xanthelasma
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4
Q

Thyroid investigations - thyroid Ab

A
  1. TOP: Thyroid peroxidase enzyme
    - Hashimoto’s thyroiditis
    - subacute thyroiditis
    - postpartum thyroiditis
  2. TRAB: thyroid receptors Ab –> Grave’s disease
  3. anti- TG: anti-thyroglobulin –> for thyroid cancer
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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
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6
Q

name of test to rule out thoracic outlet obstruction

A

Pemberton sign

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7
Q

Grave’s disease treatment

A
  1. propranolol 10mg BD
  2. Carbimazole 10-45mg/day in 2-3 doses

if 1st trimester pregnant: PTU 200-6600 mg/day in 2-3 doses

  1. surgery: thyroidectomy
  2. 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
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8
Q

Subacute Thyroiditis - treatment

A
  1. Propranolol 10mg BD
  2. Aspirin 300mg daily OR Ibuprofen 400mg PO TDS
  3. prednisolone 40mg daily, tapering over 4 weeks
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9
Q

Hypothyroidism treatment and follow up

A
  1. 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 hypothyroidism
      In IHD, Thyroxine 25mcg daily 
  2. Repeat TSH for follow up when comence thyroxine
    - 6 weeks after starting thyroxine
    - Then every 3 months for 1st year
    - Then annual follow up
  3. If aiming to increase:
    - increase by 30-50% of total daily dose
    - In IHD, increase 25mcg every 6 weeks
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10
Q

Hypothyroidism- indication for referral

A
  1. Age < 18 years
  2. pregnant
  3. IHD
  4. nodule
  5. no response to treatment
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11
Q

Grave’s disease- eye manifestation

A
  1. exophthalmos
  2. ophthalmoplegia
  3. pretibial myxoedema
  4. clubbing
  5. lid lag retraction
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12
Q

hyperthyroidism - associated other diseases

A
  1. T1DM
  2. Addision disease
  3. vitiligo
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13
Q

Hypothyroidism - associated other diseases

A
  1. Turner disease
  2. down syndrome
  3. cystic fibrosis
  4. primary biliary cirrhosis
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