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2a Endocrinology > Thyroid Diseases > Flashcards

Thyroid Diseases Flashcards

1
Q

Give examples of autoimmune hypothyroidism conditions

A

Hashimoto’s thyroiditis
Atrophic thyroiditis

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2
Q

What is Graves’ disease?

A

Overproduction of thyroid hormones giving hyperthyroidism symptoms and sometimes Graves’ ophthalmopathy (gritty, irritated, swollen, sensitive eyes) or Grave’s dermopathy (red, thick and rough, commonly on shins)

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3
Q

___ antibodies may be checked in patients with a high TSH, to help establish the underlying cause. If the ___ antibodies are positive, it means the cause of hypothyroidism is an autoimmune disease (e.g. Hashimoto’s thyroiditis)

A

TPO (thyroid peroxidase)

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4
Q

________ (Tg) is produced by thyroid cells: both benign and malignant cells, helps body create, store and release thyroid hormones. After successful cancer treatment, ______ should not be detectable in blood. Detectable presence, particularly rising ______ level, may give early warning of recurrence of cancer.

A

thyroglobulin

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5
Q

P_____ t_____ happens when a woman’s thyroid becomes inflamed after having a baby. It may first cause the thyroid to be overactive. But in time it can lead to an underactive thyroid.

A

Postpartum thyroiditis

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6
Q

What % of women will get Graves’ disease autoimmune hypothyroidism?

A

2%

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7
Q

What % of women will get postpartum thyroiditis?

A

5%

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8
Q

Which 2 autoantibodies are found in almost all patients with autoimmune hypothyroidism?

A

Thyroglobulin and thyroid peroxidase (TPO)

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9
Q

Mechanism of thyroid cell destruction

A

Cytotoxic T cell-mediated
Thyroglobulin and TPO antibodies may cause secondary damage

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10
Q

What antibody causes Grave’ disease

A

Many thyroid stimulating antibodies (TSH receptor antibodies) leading to hyperthyroidism

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11
Q

What happens in Myxoedema (hypothyroidism)? :

A

TSBAb (blocking antibodies) bind to receptor and block TSH causing hypothyroidism

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12
Q

Risk factors to thyroid autoimmunity

A

Female
Postpartum
Genetics (HLA-DR3 genes)
Environmental factors (stress, high iodine intake, smoking)

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13
Q

Name some autoimmune disease associated with thyroid autoimmunity

A

Type 1 diabetes mellitus
Addison’s disease
Chronic active hepatitis
Rheumatoid arthritis
Graves’ disease
Pernicious anaemia
Vitiligo

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14
Q

What is thyroid associated ophthalmopathy?

A

Present in most Grave’s disease patients, swelling in extraocular muscles, likely due to autoantigen that is similar shape to thyroid autoantigen

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15
Q

Grave’s disease is caused by thyroid stimulating antibodies that may cross the p___

A

placenta

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16
Q

What is goitre?

A

Palpable and visible thyroid enlargement

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17
Q

True of false: goitre is endemic in iodine deficient areas?

A

True

18
Q

What is the most common endocrine disorder?

A

Sporadic non-toxic goitre (8.6% prevalance), normal thyroid function.

19
Q

Definition of hyperthroidism

A

Excess of thyroid hormone in blood due to:

1) overproduction of thyroid hormone

2) leakage of preformed thyroid hormone from thyroid

3) ingestion of excess thyroid hormone

20
Q

Toxic m______ goitre and toxic adenoma can also cause hyperthyroidism

A

multinodular

21
Q

Drug iinduced hyperthyroidism

A

Iodine
Amiodarone
Lithium
Radiocontrast agents (contains iodine)

22
Q

Clinical features of hyperthyroidism

A

Weight loss
Anxiety
Tremor
Hyperphagia
Tachycardia
Heat intolerance
Sweating
Diarrhoea
Lid lag and stare
Menstrual disturbance

23
Q

Specific clinical signs of Graves’

A

Thyroid eye disease
Pretibial myxoedema (accumulation of excess glycosaminoglycans in the dermis and subcutis of the skin)
Acropachy (digital clubbing, soft tissue swelling of the hands and feet, and periosteal new bone formation)

24
Q

Adenoma specific clinical signs

A

Solitary nodule

25
Q

Investigation of hyperthyroidism

A

Thyroid function test
Supporting investigation: isotope uptake scan, thryoid antibodies: TPO, Tg, TRAb

26
Q

In primary hyperthyroidism, thyroid function tests would show…

A

increased free T4, increased free T3, suppressed TSH

27
Q

In secondary hyperthyroidism, thyroid function tests would show…

A

Increased free T4, increased T3, inappropriately high TSH

28
Q

Treatment for hyperthyroidism

A

Antithyroid drug (eg thionamides)
Radioiodine 131I
Surgery

29
Q

Name some thionamides (antithyroid drug)

A

Carbimazole (most common)
Propylthiouracil (PTU)
Methimazole

30
Q

How do thionamides work?

A

Decrease synthesis of new thyroid hormone

31
Q

Alongside decreasing synthesis of new thyroid hormone, what does PTU also do?

A

Inhibit conversion of T4 to T3

32
Q

Side effects of thionamides

A

Rash
Agranulocytes
Less common: arthralgia, hepatitis, neuritis, thrombocytopenia, vasculitis

33
Q

What is the most serious side effect of thionamides?

A

Agranulocytosis (deficiency of granulocytes in the blood, causing increased vulnerability to infection)
Signs = sore throat, fever, mouth ulcers
Stop thionamides if symptoms develop

34
Q

Slides 58-65

A
35
Q

Hypothyroidism

A

Thyroid hormones abnormally low (3 types)

Primary (>99%) absence/dysfunction thyroid gland, mostly due to Hashimoto’s thyroiditis

Secondary/tertiary
Pituitary/ hypothalamic dysfunction

36
Q

Causes of primary hypothyroidism

A

Hashimoto’s thyroiditis
131I therapy
Thyroidectomy
Postpartum thyroiditis
Drugs
Thyroiditides
Iodine deficiency
Thyroid hormone resistance

37
Q

Causes of secondary/tertiary hypothyroidism

A

Pituitary disease

Hypothalamic disease

38
Q

Clinical features of hypothyroidism

A

Fatigue
Weight gain
Cold intolerance
Constipation
Menstrual disturbance
Muscle cramps
Slow cerebration
Dry, rough skin
Periorbital oedema
Delayed muscle reflexes
Carotenaemia
oedema

39
Q

Investigation of hypothyroidism

A

Primary hypothyroidism:
Increased TSH, usually decreased T3 and T4

Secondary/ tertiary hypothyroidism:
TSH inappropriately low for reduced T3/4 levels

40
Q

Treatment for hypothyroidism

A

Synthetic L-thyroxine (T4)

41
Q
A

2a Endocrinology (13 decks)

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