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Y3 TCD CASES > THYROID DISEASE > Flashcards

THYROID DISEASE Flashcards

1
Q

Which type of thyroid dysfunction would produce the TFT pattern below?

LOW T4
HIGH TSH

A

primary HYPOthyroidism

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2
Q

Which type of thyroid dysfunction would produce the TFT pattern below?

LOW T4
NORMAL / LOW TSH

A

secondary HYPOthyroidism

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3
Q

Which type of thyroid dysfunction would produce the TFT pattern below?

HIGH T4
LOW TSH

A

primary HYPERthyroidism

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4
Q

Which type of thyroid dysfunction would produce the TFT pattern below?

HIGH T4
HIGH TSH

A

secondary HYPERthyroidism

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5
Q

name some common causes of primary hypothyroidism…

A

drugs e.g. amiodarone
thyroidectomy
autoimmune thyroiditis (hashimotos)
iodine derangement

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6
Q

name some common causes of hyperthyroidism (aka thyrotoxicosis)…

A

graves disease
toxic multinodular goitre
toxic adenoma

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7
Q

what are the symptoms of thyrotoxicosis?

A

INCREASED BASAL METABOLIC RATE

increased appetite
decreased weight
restless
anxious
heat intolerant
mood changes - irritable
frequent bowel actions
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8
Q

what are the signs of thyrotoxicosis?

A 
tachycardia
AF
warm/moist skin
tremor
goitre visible
hypertension
pretibial myxoedema
diplopia
decreased visual acuity
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9
Q

what signs of thyrotoxicosis can be seen in the eye?

A

lid lag / retraction (perceived stare)
exopthalmos / proctopsis (SPECIFIC TO GRAVES)
conjunctival oedema

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10
Q

as a clinician, what is the main worry if a patient has longstanding thyrotoxicosis?

A

huge increase in cardiovascular mortality

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11
Q

how can different eye signs help differentiate the cause of thyrotoxicosis?

A

exopthalmus + proctopsis = graves (graves IgG react with orbital autoantigens)

lid lag + lid retraction = increase in basal sympathetic tone

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12
Q

how does graves disease present in 25% of cases?

A

EYES!!!

think discomfort, grittiness, tear production, diplopia, decreased visual acuity

(i.e. mum!)

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13
Q

what is graves disease?

A

hyperthyroidism whereby IgG antibodies mistakenly active the thyrotrophin receptor in a molecular mimicry type reaction. This causes smooth thyroid enlargement and increased thyroid production

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14
Q

what is a toxic multinodular goitre? (plummers disease)

A

many autonomous nodules of the thyroid gland that abhorrently secrete T4, irrespective of TSH status

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15
Q

a smooth goitre could would make a clinician suspicious of which pathologies?

A

graves disease
hashimotos thyroiditis
sub-acute thyroiditis

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16
Q

a nodular goitre could would make a clinician suspicious of which pathologies?

A

solitary toxic adenoma (rare cause of hyperthyroidism)

17
Q

a multinodular goitre would make a clinician suspicious of which pathologies?

A

toxic multinodular goitre

18
Q

which drugs can cause hyperthyroidism?

A

amiodarone

interferon

19
Q

most thyroid nodules are benign, but a small amount are malignant. What is the most common type of thyroid cancer?

A

Papillary carcinoma

20
Q

which diagnostic test would provide confirmation of suspected thyroid cancer?

A

fine needle aspiration

21
Q

what are the red flags for thyroid cancer?

A 
dysphagia
neck pain
hoarseness of voice
radiation to neck
FH of thyroid Ca
22
Q

what drug is aimed at symptomatic relief for thyrotoxicosis?

A

propanolol

non selective beta blocker that reduces HR and helps with anxiety

23
Q

what are the two drugs used to treat thyrotoxicosis?

name their side effects?

A

carbimazole
propylthiouracil

(rash, itching, joint pain and AGRANULOCYTOSIS that causes leucopenia)

24
Q

explain the ‘block and titrate’ method of administering anti-thyroid agents…

A

dose is titrated down until the therapeutic level of thyroxine is released. Monitored by regular bloods

25
Q

explain the ‘block and replace’ method of anti-thyroid agents…

A

thyroid function completely destroyed and replaced with regular levothyroxine

26
Q

how often should a pt have thyroid function tests if taking levothyroxine?

A

3 monthly

27
Q

according to the BNF, what is the dose of daily thyroxine?

A

1.6mcg/kg rounded to nearest 25mcg

28
Q

what should a prescriber be aware of when prescribing levothyroxine?

A

start dose at 25mcg in those with cardiac disease

29
Q

what is hashimotos thyroiditis?

A

autoimmune destruction of thyroid gland caused by TPO autoantibodies

30
Q

what is the pathophysiology of hashimotos thyroiditis?

A

TPO autoantibodies bind TPO, an enzyme used to create T4, and label it for destruction. This causes hypothyroidism

31
Q

what are the symptoms of hypothyroidism?

A 
weight gain
lethargy
cold intolerant
cool, dry skin
brittle hair
constipation
menorhagia
32
Q

what would you expect to see in a FBC of a young female with hypothyroidism?

A

anaemia (caused by menorhagia)

33
Q

what is the average daily dose of levothyroxine?

A

100-125mcg

34
Q

what is sub-clinical hypothyroidism?

A

normal T4
high TSH

thyroid is becoming resistant to action of TSH, normally develops into hypothyroidism within years

35
Q

when should you treat subclinical hypothyroidism?

A

if T4 is within normal ranges but TSH is greater than 10

36
Q

what is post-partum thyroiditis? What is it caused by?

A

thyrotoxicosis followed by hypothyroidism in the year following birth.

caused by post-partum autoantibodies raised against TPO

37
Q

what is the pathophysiology of PPT?

A

autoantibody destruction of TPO causes spike in T4 as stores are mobilised from dying cells.

once stores are depleted, hypothyroidism ensues

38
Q

what is sheehan’s syndrome?

A

affects mothers who are hypoxic due to childbirth

hypoxia causes pituitary gland necrosis and hence low TSH.

n.b TSH, LH/FSH, ACTH and GH will all be low

Y3 TCD CASES (15 decks)

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