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BDS2: Endocrine Diseases > Thyroid Disease > Flashcards

Thyroid Disease Flashcards

1
Q

Describe thyroid dysfunction caused by excess in thyroid hormone

A
  1. Excess thyroid hormone - hyperthyroidism
    - primary: common
    - secondary: rare
    - thyrotoxicosis can occur without hyperthyroidism
    - usually due to weight loss attempts using excess thyroid replacing hormone
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2
Q

Describe thyroid dysfunction caused by a deficiency in thyroid hormone

A
  1. Deficiency - hypothyroidism
    - primary: common
    - secondary: less common
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3
Q

What are causes of hyperthyroidism?

A
  1. Graves’ disease - 70-80% of cases
    - autoantibodies stimulating TSH receptor: results in excess hormone release
  2. Toxic multi-nodular goitre
  3. Toxic adenoma
    - tumour within the thyroid gland which stimulates unregulated release of thyroid hormone resulting in hyperthyroidism
  4. Pituitary tumour (rare)
    - produces excess TSH which makes the thyroid gland produce too much hormone
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4
Q

What are signs of hyperthyroidism?

A
  1. Signs
    •warm moist skin
    - increased metabolism results in more heat generation
    •tachycardia and atrial fibrillation
    •increased blood pressure and heart failure
    •tremor and hyperreflexia
    • eyelid retraction and lid lag
    - in lid lag the eyeball moves down and exposes white sclera of the eye before the eyelid can catch up
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5
Q

What are symptoms of hyperthyroidism?

A
  1. Hot and excess sweating, weight loss, diarrhoea
  2. Palpitations, muscle weakness
  3. Irritable, manic, anxious
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6
Q

List some diseases which are often found in the family history of patients with Graves’ disease

A
  1. Vitiligo
  2. Pernicious anaemia
  3. Type 1 diabetes mellitus
  4. Coeliac disease
  5. Myaesthenia gravis
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7
Q

What other clinical features are associated with Graves’ disease?

A
  1. Diffuse goitre (enlarged thyroid gland)
  2. Opthalmopthy
    - sceral injection
    - proptosis
    - periorbital oedema
  3. Conjunctival oedema
    - chemosis
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8
Q

Describe primary hypothyroidism

A
  1. Autoimmune (hashimoto’s) thyroiditis (90% of cases)
  2. Idiopathic atrophy
  3. Radioiodine treatment/thyroidectomy surgery
    - excessive thyroid tissue removed results in hypothyroidism
    - radioiodine treatments reduce thyroid secretion which can lead to atrophy of the thyroid gland
  4. Iodine deficiency
  5. Drugs
    - carbimazole, amiodarone, lithium
  6. Congenital
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9
Q

Describe Hashimoto’s thyroiditis

A
  1. Autoimmune
    - antibodies attack the thyroid gland resulting in inflammation which causes gradual fibrosis and destruction of specialised thyroid tissue
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10
Q

Describe secondary hypothyroidism

A
  1. Caused by hypothalamic/pituitary disease
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11
Q

What are signs of hypothyroidism?

A
  1. Dry coarse skin
  2. Bradycardia, hyperlipidaemia
  3. Psychiatric or confusion
  4. Goitre (hashimoto’s)
  5. Delayed reflexes
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12
Q

What are symptoms of hypothyroidism?

A
  1. Tired
  2. Cold intolerance, weight gain, constipation
  3. Hoarse voice, goitre, puffed face and extremities
  4. Angina
  5. ‘Slow’, poor memory
  6. Hair loss
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13
Q

What are causes of hypothyroidism?

A

1.Hashimoto’s thyroiditis
2. Idiopathic atrophy
3. Iodine deficiency
4.

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14
Q

What group is most susceptible to Hashimoto’s thyroiditis and how does it present + what is it associated with?

A
  1. Middle Aged and elderly woman
  2. Presenting features
    - goitre
    - hypothyroid features
  3. Associations
    - often a family history of autoimmune disease
    (Vitiligo, PA, type 1 DM, Addison’s disease)
    - Down’s syndrome
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15
Q

Describe the epidemiology of idiopathic atrophy

A
  1. Increased incidence with age
  2. 10x more in females
  3. Likely autoimmune cause
    - lymphocyte infiltrate
    - associated with organ specific autoimmune disease
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16
Q

What are the 3 main investigations methods for thyroid disease?

A
  1. Blood
    - TSH, T3 and T4
  2. Imaging
    - ultrasound scan (cysts)
    - radioisotope scans - gland uptake
  3. Tissue
    - fine needle aspirate/biopsy (FNA and FNB)
17
Q

Describe the hormone levels in pituitary and graves or adenoma hyperthyroidism

A
  1. Pituitary cause
    - raised TSH
    - raised T3
  2. Graves or adenoma
    - low TSH
    - raised T3
    (Due to fact that pituitary is still functional so reduces TSH secretion)
18
Q

Describe hormone levels with a pituitary caused and gland failure caused hypothyroidism

A
  1. Pituitary cause
    - low TSH
    - low T4
  2. Gland failure
    - high TSH
    - low T4
19
Q

What are drug treatments for hyperthyroidism?

A
  1. Carbimazole
    - titration
    - block and replace - T4 as required
  2. Beta-blockers
  3. Radioiodine- 131I
    - hypothyroid risk with time - review
20
Q

What other treatments are available for hyperthyroidism?

A
  1. Surgery - partial thyroidectomy
    - usually follows drug therapy to stabilise
  2. Graves’ opthalmopathy - none/simple measures
21
Q

What are treatments for hypothyroidism?

A
  1. Give T4 tablets (thyroxine)
    - slow response - weeks
    • increase dose slowly
    - IHD
    • recheck using TSH as a guide of gland failed
22
Q

Describe goitre

A
  1. Diffuse enlargement of the thyroid gland
    - often iodine deficient (mountainous are as of developing countries
    - diffuse, nodular
    - potentially drug related
23
Q

What other change apart from goitre can occur in the thyroid?

A
  1. Solitary nodule enlargement
    - adenoma, carcinoma, cyst formation possible
    - low cancer risk, however it is suspicious in children or elderly
24
Q

What feature is often present in thyroid cancer?

A

Thyroid swelling

25
Q

What types of thyroid cancer are associated with young and elderly people?

A
  1. Papillary (80%) or folicular in younger

2. Undifferentiated in elderly

26
Q

Describe thyroid cancer

A
  1. ‘Cold’ nodules on radioisotope scans
  2. Often TSH sensitive - give T4 post surgery
  3. Generally a good prognosis in young people
    - 5% 10 year mortality in papillary
    But
    - 80% 10 year mortality in folicular
27
Q

What are dental aspects of thyroid disease?

A
  1. Goitre detectable to the dentist
    •hyperthyroid
    - pain, anxiety and psychiatric problems
    - caution for treatment until controlled

• hypothyroid
- avoid use of sedatives if severe

Treated patients are normal

BDS2: Endocrine Diseases (5 decks)

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