Thyroid Disease Tutorial Flashcards
of all thyroid complaints, how many are cancer?
<5%
what enzyme activates iodine to deiodinate?
peroxidase
causes of goitre?
iodine deficiency multinodular goitre graves thyroiditis tumour cysts inherited
what types of thyroiditis are subacute?
de quervains
viral
what types of thyroiditis are acute?
bacterial
causes of drug induced thyroiditis?
lithium
amiodarone
would a FHx of autoimmune disorders make you think benign or malignant?
benign
what autoantibodies are looked at in thyroid disease?
TPO
anti-thyroglobulin
TSH receptor antibody
causes of hyperthyroidism?
autoimmune eg graves multinodular goitre toxic solitary nodule thyroiditis exogenous thyroid hormones thyroid cancer TSH secreting pituitary tumour
how is thyroid storm managed?
high dose carbimazole b blockers hydrocortisone potassium iodide iv fluids inotropes
what is thyroid acropachy and what disease is it present in?
soft tissue swelling and periostial bone changes in graves disease
what eye symptoms other than proptosis and eyelid retraction is present in graves patients
gritty, watery eyes
visual blurring
painful eye movements
iatrogenic causes of hypothyroidism?
radioiodine
post surgery
what dose of thyroxine should you start at?
50-100mcg
maintenance dose of thyroxine
100-150mcg
1st, 2nd and 3rd line tests for a new thyroid lump?
- TFTs
- USS
- FNA
risk factors for malignant thyroid tumour?
acute onset previous radiation thyroid FH pain voice change swallowing problems smoker
what would a grade 1 result on FNA mean?
inappropriate sample
what would a grade 2 result on FNA mean?
benign
how long before radioiodine do you need to stop thyroid medication
2 weeks
where do papillary and follicular tumours of the thyroid arise from?
epithelial cells
where do medullary tumours arise from?
calcitonin secreting cells
most severe form of thyroid tumour?
anaplastic
how long can you not have close contact with people if youre taking radioiodine?
6-8wks
best treatment for toxic multinodular goitre?
radioiodine
is it safer to be hypo or hyperthyroid and why?
hypo because it can be controlled with HRT
how can you examine for exopthalamus?
look at white of sclera
how can you examine for proptosis?
look from above to see if the eyes protrude
tests for graves?
TFTs
TSH antibody
what warning should be given before taking antithyroid medication and why?
come and see you if they get: sore throat mouth ulcers high temp incase of agranulocytosis
how should you treat mild graves?
antithyroid drugs
how should you treat severe graves?
radioiodine
what should you warn a young patient about before taking radioiodine?
dont conceive for 6-8 months after
who is most likely to get graves?
young/middle aged women
how long should you try carbimazole in graves to see if it works?
12-18 months
