THYROID DISEASE Flashcards
Which type of thyroid dysfunction would produce the TFT pattern below?
LOW T4
HIGH TSH
primary HYPOthyroidism
Which type of thyroid dysfunction would produce the TFT pattern below?
LOW T4
NORMAL / LOW TSH
secondary HYPOthyroidism
Which type of thyroid dysfunction would produce the TFT pattern below?
HIGH T4
LOW TSH
primary HYPERthyroidism
Which type of thyroid dysfunction would produce the TFT pattern below?
HIGH T4
HIGH TSH
secondary HYPERthyroidism
name some common causes of primary hypothyroidism…
drugs e.g. amiodarone
thyroidectomy
autoimmune thyroiditis (hashimotos)
iodine derangement
name some common causes of hyperthyroidism (aka thyrotoxicosis)…
graves disease
toxic multinodular goitre
toxic adenoma
what are the symptoms of thyrotoxicosis?
INCREASED BASAL METABOLIC RATE
increased appetite decreased weight restless anxious heat intolerant mood changes - irritable frequent bowel actions
what are the signs of thyrotoxicosis?
tachycardia AF warm/moist skin tremor goitre visible hypertension pretibial myxoedema diplopia decreased visual acuity
what signs of thyrotoxicosis can be seen in the eye?
lid lag / retraction (perceived stare)
exopthalmos / proctopsis (SPECIFIC TO GRAVES)
conjunctival oedema
as a clinician, what is the main worry if a patient has longstanding thyrotoxicosis?
huge increase in cardiovascular mortality
how can different eye signs help differentiate the cause of thyrotoxicosis?
exopthalmus + proctopsis = graves (graves IgG react with orbital autoantigens)
lid lag + lid retraction = increase in basal sympathetic tone
how does graves disease present in 25% of cases?
EYES!!!
think discomfort, grittiness, tear production, diplopia, decreased visual acuity
(i.e. mum!)
what is graves disease?
hyperthyroidism whereby IgG antibodies mistakenly active the thyrotrophin receptor in a molecular mimicry type reaction. This causes smooth thyroid enlargement and increased thyroid production
what is a toxic multinodular goitre? (plummers disease)
many autonomous nodules of the thyroid gland that abhorrently secrete T4, irrespective of TSH status
a smooth goitre could would make a clinician suspicious of which pathologies?
graves disease
hashimotos thyroiditis
sub-acute thyroiditis
a nodular goitre could would make a clinician suspicious of which pathologies?
solitary toxic adenoma (rare cause of hyperthyroidism)
a multinodular goitre would make a clinician suspicious of which pathologies?
toxic multinodular goitre
which drugs can cause hyperthyroidism?
amiodarone
interferon
most thyroid nodules are benign, but a small amount are malignant. What is the most common type of thyroid cancer?
Papillary carcinoma
which diagnostic test would provide confirmation of suspected thyroid cancer?
fine needle aspiration
what are the red flags for thyroid cancer?
dysphagia neck pain hoarseness of voice radiation to neck FH of thyroid Ca
what drug is aimed at symptomatic relief for thyrotoxicosis?
propanolol
non selective beta blocker that reduces HR and helps with anxiety
what are the two drugs used to treat thyrotoxicosis?
name their side effects?
carbimazole
propylthiouracil
(rash, itching, joint pain and AGRANULOCYTOSIS that causes leucopenia)
explain the ‘block and titrate’ method of administering anti-thyroid agents…
dose is titrated down until the therapeutic level of thyroxine is released. Monitored by regular bloods
