Thyroid Disease Flashcards
Name the 2 main causes of gland hyperfunction.
Tumour
Hyperplasia
Anything which increases cell number/function
Name 4 causes of gland hypofunction?
Infection
Autoimmunity
Ischemia
Tumour
Anything which decreses cell number/function
What are the 2 main pathologies of secondary hyper/hypothyroidism?
Hypothalmic disease
Pituitary disease
Name 5 causes of hyperthyroidism/thyrotoxicosis starting with the most common.
Grave’s disease
Toxic multinodular goitre
Tumours
Thyroiditis
High iodine intake
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
List general signs of hyperthyroidism.
Palpitations
Tremour
Weight gain
Anxiety
Heat intolerance
Eye disease
Pretibial myxoedema
Thyroid acropachy
Goitre
Brittle hair
Oligo/ame/polymenorrhea
How does hyperthyroidism present in teenage girls?
Behvioural, sleeping and eating issues
Name the drug used for hyperthyroidism in normal pateints vs 1st trimester pregnancy.
Carbimazole
Propylthiouracil (PTU)
How does carbimazole + PTU work?
Carbimazole = blocks TPO to stop T3/4 production
PTU = blocks DIO1
Name a side effect of PTU.
Liver failure
Name 4 side effects of carbimazole.
Agranulocytosis
Jaundice
Neutropenia
Aplasia cutis
Name 3 red flag signs for agranulocytosis.
Sore throat
Ulcer
Fever
Describe the 3 stepwise treatment of hyperthyroidism.
Beta-blockers + carbimazole or PTU
Radioiodine
Total thyroidectomy
Name 2 ways to administer anti-thyroid drugs.
Titrate and reduce carbimazole by TFTs every 1-2 months
Give carbimazole + levothyroxine together
Name 2 complications of thyroid surgery.
Recurrent laryngeal nerve damage
Hypothyroidisim
Name 4 signs of thyroid eye disease.
Exopthalmos/proptosis
Diplopia
Gritty eyes
Lid lag
What is the triad of thyroid acropachy?
Clubbing
Hands and feet swelling
Periosteal bone formation
What is Grave’s disease and who is it more common in?
Autoimmune hyperthyroidism
Women
Name 3 autoantibodies associated with Grave’s starting with the specific one + what letter they are.
Anti-TRAb
Anti-TPO
Anti-thyroglobulin
IgG antibodies
Explain how Grave’s disease works.
Anti-TRAb acts like TSH and activates T3/T4 production
Name 4 risk factors for Grave’s disease.
Smoking
Family history
Stress
Infection
Name 3 complications of Grave’s disease.
Osteoporosis
Hypercalcemia
Leukopenia
What does this show?
Normal thyroid
What does this show?
Grave’s disease
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
