thyroid disease Flashcards
what is an excess of thyroid hormone?
hyperthyroidism
what is a deficiency of thyroid hormone?
hypothyroidism
which is more common, primary or secondary thyroid disease?
primary
secondary rare
what are the causes of hyperthyroisism?
graves disease -70-80% -auto antibodies stimulating the TSH receptor toxic multi-nodular goitre toxic adenoma pituitary tumour
what are the signs of hyperthyroidism?
warm moist skin tachycardia & atrial fibrillation increased bp and heart failure tremor & hyperreflexia eyelid retraction & lid lag
what are the symptoms of hyperthyroidism?
hot excess sweating weight loss diarrhoea palpitations muscle weakness irritable, manic, anxious
describe graves disease
organ specific autoimmune disease goitre at base of neck -enlarged thyroid gland family history opthalmopthy conjunctival oedema
what are the causes of primary hypothyroidism?
hashimoto's (90%) idiopathic atrophy raioiodine treatment/thyroidectomy iodine deficiency drugs -cabimazole -amiodarone -litium congenital
what is the cause of secondary hypothyroidism?
hypothalamic/pituitary disease
what are the signs of hypothyroidism?
dry coarse skin bradycardia, hyperlipidaemia psychiatric or confusion goitre (hashimoto's) delayed relflexes
what are the symptoms of hypothyroidism?
tired cold intolerance weight gain constipation hoarse voice, goitre, puffy face/extremities angina slow/poor memory hair loss
describe hashimoto’s thyroiditis
middle aged/elderly women
associations
-family history of autoimmune disease
describe idiopathic atrophy
increased incidence with age 10x more in females likely autoimmune cause -lymphocytes infiltrate -associates with organ specific autoimmune disease
how is thyroid disease investigated?
blood -TSH, T3, T4 imaging -ultrasound -radioisotope scans -show what areas of gland are producing/non-producing tissue -fine needle aspirate/biopsy
what are the hormone levels in pituitary caused hyperthyroidism?
raised TSH
raised T3
what are the hormone levels in graves/adenoma caused hyperthyroidism?
low TSH
raised T3
what are the hormone levels in pituitary caused hypothyroidism?
low TSH
low T4
what are the hormone levels in gland failure hypothyroidism?
high TSH
low T4
what are the treatment options for hyperthyroidism?
carbimazole -blocks and replace T4 beta-blockers radioiodone partial thyroidectomy
what thyroid issue cannot be fixed?
graves opthalamopathy
graves changes in eye related to autoantibody not hormone
what is the treatment for hypothyroidism?
T4 tablets-thyroxine
increase dose slowly
recheck using TSH as guide if gland failure
describe goitre
diffuse enlargement of thyroid gland
often iodine deficient
diffuse, nodular
describe solitary nodule enlargement
adenoma, carcinoma, cyst formation possible,
low cancer risk
sus in children/elderly
describe thyroid cancer
usually with thyroid swelling young/elderly cold nodules on radioisotope scans often TSH sensitive- T4 post surgery good prognosis in young 80% 10 year mortality in folicular
what are dental aspects of thyroid disease?
goitre detectable hyperthyroid -pain anxiety and psychiatric problems -caution for tx until controlled hypothyroid -avoid using sedatives if severe treated=normal
