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Endocrine Diseases > Thyroid Disease > Flashcards

Thyroid Disease Flashcards

1
Q

Describe excess thyroid dysfunction

A

Hyperthyroidism
Primary - common
Secondary - rare
Thyrotoxicosis without hyperthyroidism

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2
Q

Describe deficiency thyroid dysfunction

A

Hypothyroidism (myxoedema)
Primary - common
Secondary - less common

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3
Q

What is thyrotoxicosis

A

Excess thyroid hormone in circulation regardless of the source
Could be hyperthyroidism or sometimes patients take excess thyroid replacement hormone as the effects promote weight loss

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4
Q

What are the causes of hyperthyroidism

A

Graves’ disease - 70-80% of cases
Toxic multi-modular goitre
Toxic adenoma
Pituitary tumour - rare

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5
Q

What is Graves’ disease

A

Autoimmune disease where body produces antibody similar to TSH so antibody binds to TSH receptor on thyroid gland stimulating the gland to make more hormone

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6
Q

What are the signs of hyperthyroidism

A 
Warm moist skin
Tachycardia and atrial fibrillation
Increased blood pressure and heart failure
Tremor and hyperreflexia
Eyelid retraction and lid lag
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7
Q

What are the symptoms of hyperthyroidism

A 
Hot and excess sweating
Weight loss
Diarrhoea
Palpitations
Muscle weakness
Irritable, manic and anxious
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8
Q

What are the causes of primary hypothyroidism

A

Autoimmune (Hashimoto’s) thyroiditis - 90% of cases
Idiopathic atrophy
Radioiodine treatment/thyroidectomy surgery
Iodine deficiency
Drugs
Congenital

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9
Q

What are the causes of secondary hypothyroidism

A

Hypothalamic/pituitary disease

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10
Q

What are the signs of hypothyroidism

A 
Dry coarse skin
Bradycardia
Hyperlipidaemia
Psychiatric or confusion
Goitre (Hashimoto’s)
Delayed reflexes
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11
Q

What are the symptoms of hypothyroidism

A 
Tired
Cold intolerant
Weight gain
Constipation
Hoarse voice
Puffed face
Angina
Poor memory
Hair loss
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12
Q

Describe hypothyroidism caused by Hashimoto’s thyroiditis

A

Mostly affects middle aged and elderly women
Will present with goitre
Associated with a family history of autoimmune disease

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13
Q

Describe hypothyroidism caused by idiopathic atrophy

A

Increased incidence with age
10x more likely in females
Likely autoimmune cause

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14
Q

What investigations are carried out in patients with thyroid disease

A

Blood tests - TSH, T3 and T4
Imaging - ultrasound scan for cysts and radioisotope scans for gland uptake
Fine needle aspirate/biopsy (FNA and FNB)

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15
Q

Describe TSH and T3 levels in hyperthyroidism caused by the pituitary gland

A

Raised T3 because the gland is being asked to make more thyroid hormone
TSH released from the pituitary is higher than it should be and therefore the gland is making more T3 than it should

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16
Q

Describe TSH and T3 levels in hyperthyroidism caused by Graves’ or an adenoma

A

Raised T3 but the pituitary recognising there is too much thyroid hormone is trying to reduce gland stimulation by stopping production of TSH

17
Q

Describe the TSH and T4 levels in hypothyroidism caused by the pituitary gland

A

Low T4 paired with a low TSH as the pituitary is not asking the thyroid to make thyroxin

18
Q

Describe the TSH and T4 levels in hypothyroidism caused by gland failure

A

Problem with the gland which can’t respond when asked to make thyroid hormone by the pituitary so the pituitary level of TSH is increased but there is still a low T4

19
Q

What drugs can be used to treat hyperthyroidism

A

Carbimazole - will block and replace T4 as required

Beta blockers to reduce side effects of anxiety, tremor and palpitations

20
Q

What are the other treatments for hyperthyroidism

A

Radioiodine
Surgery - partial thyroidectomy
Graves’ ophthalmopathy has no treatment

21
Q

What are the treatments for hypothyroidism

A 
T4 tablets (thyroxine)
Increase dose slowly and the TSH levels will fall
As TSH levels return to normal you know the thyroid level is at the right value
22
Q

What are the causes of goitre

A

Diffuse enlargement of the thyroid gland
Often iodine deficiency
Modular
Drug related

23
Q

What are the causes of solitary nodule enlargement and what should be done

A

Adenoma
Carcinoma
Cyst formation
Must be investigated by ultrasound or biopsy

24
Q

Describe thyroid cancer and who it usually affects

A

Usually with a thyroid swelling
Affects all age ranges but older patients do less well
Cold nodules on radioisotope scans

25
Q

What are the dental aspects of thyroid disease

A

Feeling entire neck should be part of the normal examination - detect goitre
Hyperthyroid may cause pain, anxiety and psychiatric problems - caution for treatment until controlled
Hypothyroid - avoid the use of sedatives if severe
Both conditions are completely reversed with treatment

Endocrine Diseases (5 decks)

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