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TCD Cases > Thyroid Disease > Flashcards

Thyroid Disease Flashcards

1
Q

Suggest 4 drugs of abuse that can potentially lead to significant weight loss

A
  1. Alcohol
  2. Cocaine
  3. Amphetamines
  4. Cannabis
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2
Q

Give 8 potential physical signs that are commonly associated with hyperthyroidism

A
  1. Tremor
  2. Agitation
  3. Acropachy
  4. Conjunctival oedema
  5. Opthalmoplegia
  6. Pretibial myxoedema
  7. Proximal myopathy
  8. Hyperreflexia
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3
Q

Define and describe the position of the thyroid gland

A

A soft endocrine gland found in the lower neck, anterior to the trachea, below the thyroid cartilage of the larynx

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4
Q

Which cell type produce thyroglobulin?

A

Thyroid follicular cells

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5
Q

Which thyroid cell type produces calcitonin?

A

Thyroid C-Cells

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6
Q

What hormones are produced by the hypothalamus and pituitary gland respectively as part of the hypo-pituitary-thyroid axis

A

Hypothalamus - TRH

Pituitary - TSH

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7
Q

Give 2 scenarios that can lead to an artificially elevated levels of thyroid binding globulin (TBG)

A
  1. Pregnancy

2. OCP

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8
Q

Name a drug that can lead to deranged TFT results

A

Amiodarone as it contains high levels of iodine

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9
Q

What are the 3 main causes of thyrotoxicosis?

A
  1. Grave’s disease
  2. Multinodular goitre
  3. Solitary toxic nodule
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10
Q

What is the pathophysiology of Grave’s disease?

A

Antibody stimulation of the TSH receptors

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11
Q

Name 2 drugs that can potential cause thyrotoxicosis

A
  1. Amiodarone

2. Interferon

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12
Q

Name the 3 potential forms of eye disease that can be precipitated by thyrotoxicosis

A
  1. Exophthalmos
  2. Chemosis
  3. Peri-orbital oedema
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13
Q

What are the 3 main risk factors associated with thyroid eye disease?

A
  1. Raised intraocular pressure
  2. Optic nerve damage
  3. Corneal ulceration
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14
Q

Symptoms control of thyrotoxicosis can be achieved by which drug class?

A

Beta-adrenergic blockers

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15
Q

What are the 3 main treatment options for thyrotoxicosis?

A
  1. Antithyroid drugs
  2. Radioactive iodine
  3. Surgery
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16
Q

Give 2 examples of anti-thyroid drugs

A
  1. Carbimazole

2. Propylthiouracil

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17
Q

Name the 2 possible drug regimes for the treatment of thyrotoxicosis

A
  1. Titration

2. Block and replace

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18
Q

What are the 5 main side effects associated with antithyroid drugs?

A
  1. Rash/ itching
  2. Arthralgia
  3. Nausea and vomiting
  4. Mild leukopenia
  5. Agranulocytosis
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19
Q

Define agranulocytosis

A

Severe acute deficiency in neutrophil production as a result of damage to the bone marrow by toxic drugs/chemicals

20
Q

What is the main consequence of treatment with radioactive iodine?

A

Permanently damages the thyroid follicular cells and thus the patient becomes at risk of developing hypothyroidism.

21
Q

What are the 4 main risks of thyroid surgery that a patient should be informed of?

A
  1. Damage to the parathyroid glands
  2. Damage to the recurrent laryngeal nerve
  3. Bleeding
  4. Keloid scaring
22
Q

Give 4 clinical features often seen in hyperthyroidism due to Grave’s disease

A
  1. Opthalmoplegia
  2. Exopthalmos
  3. Pretibial Myxoedema
  4. Thyroid acropachy
23
Q

What triad of symptoms are associated with acropachy?

A
  1. Digital clubbing
  2. Soft tissue swelling of the hands and feet
  3. Periosteal new bone formation
24
Q

What is the mechanism in neonatal hyperthyroidism?

A

Thyroid stimulating antibodies (in Grave’s disease) can cross the placenta and excessively stimulate the thyroid gland of the foetus

25
Q

Name the thyroid cell type that secretes calcitonin

A

Parafollicular C cells

26
Q

What is the ratio of T4 to T3 released by the thyroid gland?

A

Approximately 10 times as much T4 is released

27
Q

In what state is 99% of circulating thyroid hormone found in?

A

Inactively bound to plasma proteins

28
Q

Name 2 peripheral tissues that deiodinate T4 to T3

A
  1. Liver

2. Kidneys

29
Q

What is the blood supply to the thyroid gland?

A

Superior and inferior thyroid arteries; branches of the External carotid artery and thyrocervical trunk respectively.

30
Q

Which intracellular structure within the thyroid follicular cells produce thyroglobulin?

A

Endoplasmic reticulum

31
Q

Where does the synthesis of thyroid hormones occur?

A

Within the colloid lobules that are surrounded by follicular cells

32
Q

Name the transported that transports iodide from the follicular cell into the colloid

A

Pendrin transporter

33
Q

Name 2 possible early complications of radioactive iodine therapy

A
  1. Grave’s opthalmopathy

2. Neck discomfort

34
Q

Give 4 symptoms that can help identify hypothyroidism

A
  1. Hoarse voice
  2. Constipation
  3. Myalgia and muscle weakness
  4. Cold intolerance
35
Q

What is the most common cause of primary hypothyroidism in the UK?

A

Hashimoto’s thyroiditis

36
Q

Outline the TFT results one would expect to see in cases of secondary hypothyroidism

A

Low levels of TSH and low free T4

37
Q

Give 2 possible consequences of thyroid hormone over-replacement

A
  1. Atrial Fibrillation

2. Osteoporosis

38
Q

List 5 red flag symptoms when investigating a new onset neck swelling

A
  1. Dysphagia
  2. Neck pain
  3. Hoarseness
  4. History of radiation to the neck
  5. Family history of thyroid cancer
39
Q

What is the investigations of choice for a neck lump?

A

Ultrasound followed by a fine needle aspirate

40
Q

What are the main histological types of thyroid carcinoma?

A
  1. Papillary carcinoma (70%)
  2. Follicular carcinoma (20%)
  3. Anaplastic carcinoma (3%)
  4. Lymphoma (2%)
  5. Medullary cell carcinoma (5%)
41
Q

From which cell type do medullary cell carcinomas of the thyroid gland arise from?

A

Calcitonin producing C cells

42
Q

What are the 4 main potential causes of a diffuse goitre?

A
  1. Grave’s disease
  2. Hypothyroidism (e.g. Hashimoto’s)
  3. Colloid goitre (euthyroid)
  4. Iodine deficiency
43
Q

Name a drug that can cause a diffuse goitre

A

Lithium

44
Q

Outline the 4 ‘pressure symptoms’ to consider when assessing a goitre

A
  1. Mobility
  2. Skin tethering
  3. Lymphadenopathy
  4. Recurrent laryngeal nerve palsy
45
Q

Name 2 other conditions that are commonly associated with medullary cell carcinoma

A
  1. Phaeochromocytoma

2. Hyperparathyroidism

46
Q

Briefly define Sheehan syndrome

A

A form of secondary hypothyroidism due to pituitary infarction postpartum.

47
Q

In addition to hypothyroidism, give 3 other hormones that a patient with Sheehan syndrome is likely to be deficient in

A
  1. ACTH
  2. Gonadotrophins
  3. Prolactin

TCD Cases (25 decks)

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