Thyroid Disease Flashcards by Abby Lang

Name the 2 main causes of gland hyperfunction.

Tumour

Hyperplasia

Anything which increases cell number/function

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Name 4 causes of gland hypofunction?

Infection

Autoimmunity

Ischemia

Tumour

Anything which decreses cell number/function

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What are the 2 main pathologies of secondary hyper/hypothyroidism?

Hypothalmic disease

Pituitary disease

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Name 5 causes of hyperthyroidism/thyrotoxicosis starting with the most common.

Grave’s disease

Toxic multinodular goitre

Tumours

Thyroiditis

High iodine intake

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What is primary and secondary hyperthyroidism profile in terms of TSH and T3/T4?

Primary = low TSH and high T3/T4

Secondary = normal or raised TSH and high T3/4

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List general signs of hyperthyroidism.

Palpitations

Tremour

Weight gain

Anxiety

Heat intolerance

Eye disease

Pretibial myxoedema

Thyroid acropachy

Goitre

Brittle hair

Oligo/ame/polymenorrhea

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How does hyperthyroidism present in teenage girls?

Behvioural, sleeping and eating issues

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Name the drug used for hyperthyroidism in normal pateints vs 1st trimester pregnancy.

Carbimazole

Propylthiouracil (PTU)

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How does carbimazole + PTU work?

Carbimazole = blocks TPO to stop T3/4 production

PTU = blocks DIO1

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Name a side effect of PTU.

Liver failure

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Name 4 side effects of carbimazole.

Agranulocytosis

Jaundice

Neutropenia

Aplasia cutis

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Name 3 red flag signs for agranulocytosis.

Sore throat

Ulcer

Fever

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Describe the 3 stepwise treatment of hyperthyroidism.

Beta-blockers + carbimazole or PTU

Radioiodine

Total thyroidectomy

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Name 2 ways to administer anti-thyroid drugs.

Titrate and reduce carbimazole by TFTs every 1-2 months

Give carbimazole + levothyroxine together

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Name 2 complications of thyroid surgery.

Recurrent laryngeal nerve damage

Hypothyroidisim

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Name 4 signs of thyroid eye disease.

Exopthalmos/proptosis

Diplopia

Gritty eyes

Lid lag

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What is the triad of thyroid acropachy?

Clubbing

Hands and feet swelling

Periosteal bone formation

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What is Grave’s disease and who is it more common in?

Autoimmune hyperthyroidism

Women

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Name 3 autoantibodies associated with Grave’s starting with the specific one + what letter they are.

Anti-TRAb

Anti-TPO

Anti-thyroglobulin

IgG antibodies

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Explain how Grave’s disease works.

Anti-TRAb acts like TSH and activates T3/T4 production

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Name 4 risk factors for Grave’s disease.

Smoking

Family history

Stress

Infection

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Name 3 complications of Grave’s disease.

Osteoporosis

Hypercalcemia

Leukopenia

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What does this show?

Normal thyroid

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What does this show?

Grave’s disease

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Which 2 groups is toxic multinodular goitre commonly seen in?

Eldery Iodine-deficient

What is toxic multinodular goitre?

Autonomous nodules acting independently of TSH

What does this show?

Toxic multinodular goitre

What is a thyroid storm?

Medical emergency of severe hyperthyroidism

Name 3 causes of severe hyperthyroidism.

Infection Post-surgery Post-radioiodine

Name 3 signs of a thyroid storm.

Respiratory/cardaic collpase Hyperthermia Excessive reflexes

What are the 4 main part to thyroid storm treatment?

PTU Lugol's iodine Steroids Beta-blockers

What is subclinical hyperthyroidism and what is it commonly seen with?

Decreased TSH with normal T3/4 Multinodular goitre

What is the risk of subclinical hyperthyroidism + name 2 associations.

Hyperthyroidism Osteoporosis and AF

Treatment indications for subclinical hyperthyroidism?

Treat if TSH \< 0.1, AF or osteoporosis

What is subclinical hypothyroidism?

Increases TSH with normal T3/T4

What is the risk of subclinical hypothyroidism + risk factor?

Hypothyroidism Anti-TPO +ve

Treatment indications for subclinical hypothyroidism?

Treat if TSH \> 10 but ALWAYS if pregnant

What is sick euthyroid illness, who is it seen in and what is the characteristic biochemical trend?

Non-thyroidal ilness causing suppressed TSH Unwell patients TSH rises during recovery

Should you regularly check TFTs if suspected sick euthryoid syndrome?

No - avoid checking TFTs

What is primary and secondary hypothyroidism profile in terms of TSH and T3/4?

Primary = high TSH with low T3/4 Secondary = normal or low TSH with low T3/4

Name 4 causes of hypothyroidism starting with the most common

Hashimoto's thyroiditis Iodising radiation Surgery Iodine deficiency

Name 3 examples of each of goitrous, non-goitrous and self-limiting primary hypothyroidism.

Goitrous = Hashimoto's thyroiditis, iodine deficiency, drugs Non-goitrous = atrophic thyroiditis, post-surgery, irradiation Self-limiting = subacute thyroiditis, post-partum, drug withdrawal

What is the most common cause of secondary hypothyroidism?

Hypothalamic or pituitary disease

List general signs of hypothyroidism.

Bradycardia Fatigue Depression Cold intolerance Myxoedema Weight gain Hair loss Vitiligo Oligo/ame/polymenorrhea

What is the effect of hypothyroidism in children?

Cretinism

What effect does hypothyroidism have on lipids and CK?

Increases them

What is a myxoedema coma, who is it seen in + treatment?

Medical emergency of sever hypothyroidism Elderly pateints with history of illness IV T3 + steroids

Treatement regime for young and elderly with hypothyroidism?

Young = levothyroxine 50-100 micrograms Elderly = levothyroxine 25-50 micrograms adjusted every month

Monitoring for hypothyroidism?

Check TSH every 2 months after starting medication Check TSH ever 12-18 months when stable

What does this show?

Hypothyroidism (thyroiditis)

Treatment regime for secondary hypothyroidism?

Titrate levothyroxine to T4 levels Build up gradually to prevent ischaemia

What is the antibody specfic to Hashimoto's thyroiditis?

Anti-TPO

Who is subactute/De Quervain's thyroiditis seen in?

Younger patients with viral illness

Name 2 drugs which cause thyroiditis and explain how they do so?

Amiodarone and lithium Inhibits DIO1 to reduce T3/T4 production

What is Hashimoto's thyroiditis + 2 genetic links + main antibody?

Autoimmune failure of thyroid gland DR3 and DR5 genes Anti-TPO

Who is Hashimoto's thyroiditis seen in most?

Middle-aged women

What is the main risk of Hashimoto's thyroiditis?

B cell Non-Hodkin lymphoma

What is Hashitoxicosis?

Transient hyperfunction of thyroid followed by Hashimoto's thyroiditis

How is congenital hypothyroidism screened for?

Guthrie test (heel prick on day 5)

Name 2 causes of congenital hypothyroidism.

Abnormal thyroid site Pituitary dysfunction

Name 3 signs of congenital hypothyroidism.

Delayed jaundice Poor feeding Hypotonia

What is dyshormonogenesis?

AR genetic defect in T3/4 metabolism